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Sample records for basilar artery occlusion

  1. Primary stenting as emergency therapy in acute basilar artery occlusion

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    Spreer, Joachim; Arnold, Sebastian; Klisch, Joachim; Schumacher, Martin [Section of Neuroradiology, University Hospital Freiburg, Breisacher Strasse 64, 79106 Freiburg (Germany); Els, Thomas; Hetzel, Andreas; Huppertz, Hans-Juergen; Oehm, Eckhardt [Department of Neurology, University Hospital Freiburg, Freiburg (Germany)

    2002-09-01

    In three patients with acute occlusion of the basilar artery intra-arterial fibrinolysis resulted in only partial recanalization and revealed severe stenosis as the underlying cause. Application of micro-stents without previous dilatation resulted in vessel re-opening. Two patients had an excellent clinical outcome. One patient died 10 days after the stroke due to brainstem infarction. Emergency primary stent application may improve the outcome in acute basilar artery occlusion, if intra-arterial thrombolysis fails to re-establish a sufficient flow. (orig.)

  2. Stent-based mechanical thrombectomy in acute basilar artery occlusion.

    Science.gov (United States)

    Cohen, José E; Leker, Ronen R; Moscovici, Samuel; Attia, Moshe; Itshayek, Eyal

    2011-12-01

    Stent-based mechanical thrombectomy was recently proposed as an effective alternative to other mechanical techniques to achieve recanalization of large-vessel embolic occlusions in the anterior circulation. To our knowledge, there are no reports of the use of this technique in acute basilar artery occlusion (ABAO). We present a patient with complete endovascular recanalization of ABAO using a stent-based thrombectomy technique. Advantages and limitations of this technique in the management of ABAO are discussed. The stent-thrombectomy technique is promising, and will need further evaluation in posterior circulation stroke.

  3. Basilar artery occlusion: Prognostic signs of severity on computed tomography

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    Poletti, Pierre-Alexandre, E-mail: pierre-alexandre.poletti@hcuge.ch [Service of Radiology, University Hospital of Geneva (Switzerland); Pereira, Vitor Mendes [Service of Neuroradiology, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva (Switzerland); Department of Medical Imaging, University of Toronto (Canada); Department of Surgery, University of Toronto (Canada); Lovblad, Karl-Olof [Service of Neuroradiology, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva (Switzerland); Canel, Lucie [Service of Radiology, University Hospital of Geneva (Switzerland); Sztajzel, Roman [Service of Neurology, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva (Switzerland); Becker, Minerva [Service of Radiology, University Hospital of Geneva (Switzerland); Perneger, Thomas [Division of Clinical Epidemiology, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1211 Geneva (Switzerland); Platon, Alexandra [Service of Radiology, University Hospital of Geneva (Switzerland)

    2015-07-15

    Highlights: • The main CT signs associated with basilar artery occlusion were analyzed. • CT sign of acute ischemic lesion is significantly associated with a bad outcome. • The site of the basilar artery occlusion is not associated to the patients’ outcome. - Abstract: Purpose: To determine the computed tomography (CT) signs that are predictive of the clinical outcome of basilar artery occlusion (BAO). Materials and methods: The study population consisted in 37 patients (14 women, 23 men, mean age: 63 years), admitted with onset of neurological deficit, starting 1–72 h prior to admission, who were diagnosed with BAO on the basis of a CT examination with intravenous contrast agent. The following signs were collected on CT scans performed on admission: clot density on noncontrast images, clot length, and clot location, as well as the presence of acute ischemic lesions. The results were compared against the modified Rankin Scale (mRS) score of patients at 3 months, favorable clinical outcome being defined as a mRS score ≤3. Results: The clinical outcome was favorable in 13 (35%) of the 37 patients and unfavorable in 24 (65%). Signs of acute ischemia were visible in 13 of the 24 patients with unfavorable outcome but in none of the 13 patients with favorable outcome (p < 0.001). None of the other CT signs analyzed were significantly correlated with clinical prognosis. Conclusion: Of all the CT signs analyzed, only the presence of signs of acute ischemia on the admission CT of patients with BAO was associated with poor prognosis.

  4. Acute stenting and thromboaspiration in basilar artery occlusions due to embolism from the dominating vertebral artery

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    Nedeltchev, K.; Remonda, L.; Brekenfeld, C.; Ozdoba, C.; Schroth, G. [Institute of Diagnostic and Interventional Neuroradiology, University of Bern, Inselspital, Freiburgstrasse 4, 3010, Bern (Switzerland); Do, D.D. [Institute of Angiology, University of Bern, Inselspital, Bern (Switzerland); Arnold, M.; Mattle, H.P. [Department of Neurology, University of Bern, Inselspital, Bern (Switzerland)

    2004-08-01

    Intra-arterial thrombolysis (IAT) is the only treatment that has demonstrated benefit in patients with acute basilar artery occlusions (ABAO). IAT may be difficult to perform when access to the occluded basilar artery (BA) is prevented by pathology of the vertebral arteries (VA). We report on two patients with ABAO due to embolism from the dominating VA. Catheter navigation through the occluded VA and thromboaspiration enabled access to the BA. Thromboaspiration alone or in addition to IAT resulted in a complete recanalization of the BA and a favorable clinical outcome. A stent was deployed at the site of the stenosis in the VA either prior to or immediately after BA recanalization. (orig.)

  5. A Vertebral Artery Dissection with Basilar Artery Occlusion in a Child

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    Katleen Devue

    2014-01-01

    Full Text Available This paper presents the case report of an 11-year-old boy with an acute dissection with thrombosis of the left vertebral artery and thrombosis of the basilar artery. The patient was treated with acute systemic thrombolysis, followed by intra-arterial thrombolysis, without any clinical improvement, showing left hemiplegia, bilateral clonus, hyperreflexia, and impaired consciousness. MRI indicated persistent thrombosis of the arteria basilaris with edema and ischemia of the right brainstem. Heparinization for 72 hours, followed by a two-week LMWH treatment and subsequent oral warfarin therapy, resulted in a lasting improvement of the symptoms. Vertebral artery dissection after minor trauma is rare in children. While acute basilar artery occlusion as a complication is even more infrequent, it is potentially fatal, which means that prompt diagnosis and treatment are imperative. The lack of class I recommendation guidelines for children regarding treatment of vertebral artery dissection and basilar artery occlusion means that initial and follow-up management both require a multidisciplinary approach to coordinate emergency, critical care, interventional radiology, and child neurology services.

  6. Local lysis in acute basilar artery occlusions: a case report

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    Karnik, R.; Perneczky, G.; Ammerer, H.P.; Brenner, H.; Slany, J. (Krankenanstalt der Stadt Wien Rudolfstiftung (Austria))

    1984-01-01

    Thrombosis of the basilar artery is not a rare disease, and the mortality is reported to be 60 to 80%. Present standard therapy with heparin infusions yields poor results. The high risk of intracerebral haemorrhage prohibits systemic fibrinolytic therapy. Due to these facts and good experience in our department with the use of local intracoronary lysis in acute myocardial infarction, the method of local thrombolysis was applied in a case of acute basiliar artery thrombosis. Fibrinolytic therapy was started via an angiography catheter placed in the vertebral artery in a 28 year-old woman with hemiplegia and severe brain stem symptoms. The patient received 200,000 IU streptokinase within 2 hours and subsequently 300,000 IU urokinase within 10 hours. The vessel re-opened completely. The neurological symptoms decreased during the following weeks. Based on this experience and according to rare reports in the literature we believe local low-dose thrombolysis to be a causal therapy promising success for acute thrombosis of the basilar artery. This therapy can be carried out in every medical centre able to perform selective angiography and experienced in the administration of fibrinolytic drugs.

  7. Different Imaging Strategies in Patients with Possible Basilar Artery Occlusion: Cost-Effectiveness Analysis

    NARCIS (Netherlands)

    S.E. Beyer (Sebastian E.); M.G.M. Hunink (Myriam); F. Schöberl (Florian); L. von Baumgarten; S.E. Petersen (Steffen); C. Kubisch (Christian); H. Janssen (Hendrik); B. Ertl-Wagner (Birgit); M.F. Reiser (Maximilian F.); W.H. Sommer (Wieland H.)

    2015-01-01

    textabstractBackground and Purpose-This study evaluated the cost-effectiveness of different noninvasive imaging strategies in patients with possible basilar artery occlusion. Methods-A Markov decision analytic model was used to evaluate long-term outcomes resulting from strategies using computed tom

  8. The efficiency analysis of thrombolytic rt-PA combined with intravascular interventional therapy in patients with acute basilar artery occlusion

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    Xianxian, Zhao; Chengsong, Yue; Qiang, Mei; Fei, Wei; Lin, Shen; Huiyan, Ding; Zili, Gong

    2017-01-01

    In order to further optimize the treatment strategy for the patients with acute basilar artery occlusion, we were dedicated to study the therapeutic effects and influential factors in the process of treated basilar artery occlusion with thrombolytic combined vascular interventional therapy. 75 patients with acute basilar artery occlusion treated with arterial thrombolytic therapy were analyzed retrospectively. In accordance with the discharge records of patients, their short-term curative effect with 24-hour treatment and 14-days treatment were evaluated. Our data showed that the survival condition of the patients with acute acute basilar artery occlusion were visibly improved by combination thrombolytic and interventional therapy. Moreover, their BI scores were remarkably improved, while NIHSS and mRS scores were evidently reduced. These data proved that our treatment strategy was able to improve the survival condition of patients with acute basilar artery occlusion. Furthermore, our data showed that coagulation related factors remarkably improved in the patients, when they treated by combination thrombolytic therapy with interventional therapy. In addition, our results suggested that the patients' bilateral Babinski(+), revascularization and coma symptom were closely related to their prognosis after treated the patients with combination thrombolytic and vascular interventional therapy, and the difference was statistically significant (pBabinski(+), and revascularization in the patients with acute basilar artery occlusion have an appreciable impact on the patients' prognosis. PMID:28123346

  9. The challenge of basilar artery occlusion wake-up stroke: too late for intravenous thrombolysis?

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    Caliandro, Pietro; Reale, Giuseppe; Tartaglione, Tommaso; Rossini, Paolo Maria

    2016-07-01

    We describe the case of a patient carried to our emergency department, with the wake-up finding of dysarthria, right hemiplegia and worsening consciousness impairment (NIHSS 12). After performing a CT angiography, which showed complete basilar occlusion, we determined the MR DWI-FLAIR mismatch to estimate the stroke onset time. Because of the favorable mismatch (DWI hyperintensity in the left pons, no FLAIR hyperintensity in the same region), the patient underwent thrombolysis with sudden neurological improvement. In addition, the DWI hyperintensity first observed in the left pons totally regressed after thrombolysis. Wake-up stroke constitutes about 14 % of all strokes, while the percentage of basilar artery occlusion wake-up strokes is still unknown. Although thrombolysis in patients with unknown-onset time is still an off-label therapy, basilar artery occlusion is a potentially fatal event. In our case we used RM DWI-FLAIR mismatch to rapidly estimate the stroke onset time and to treat the patient with an off-label but potentially effective and safe therapy.

  10. Transient basilar artery occlusion monitored by transcranial color Doppler presenting with a spectacular shrinking deficit: a case report

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    Del Sette Massimo

    2010-01-01

    Full Text Available Abstract Introduction We describe the case of a 79-year-old Caucasian Italian woman with a transient basilar occlusion monitored by transcranial Doppler, with subsequent recanalization and clinical shrinking deficit. This is the first case of transient basilar occlusive disease diagnosed and monitored by transcranial Doppler. This case is important and needs to be reported because transient basilar occlusion may be easily diagnosed if transcranial Doppler is performed. Case presentation A 79-year-old woman affected by chronic atrial fibrillation and not treated with oral anticoagulants, cardioverted to sinus rhythm during a gastric endoscopy. She then showed a sudden-onset loss of consciousness, horizontal and vertical gaze palsy, tetraparesis and bilateral miosis and coma. Two hours later, the symptoms resolved quickly, leaving no residual neurologic deficits. Transcranial Doppler examination showed a dampened flow in the basilar artery in the emergency examination and a restored flow when the symptoms resolved. Conclusion This is the first case of transient basilar occlusive disease diagnosed and monitored by transcranial Doppler. We believe that transcranial Doppler should be performed in all cases of unexplained acute loss of consciousness, in particular, if associated with signs of brainstem dysfunctions.

  11. Prodromal Transient Ischemic Attack or Minor Stroke and Outcome in Basilar Artery Occlusion

    NARCIS (Netherlands)

    Conforto, Adriana B.; De Freitas, Gabriel R.; Schonewille, Wouter J.; Kappelle, L. Jaap; Algra, Ale

    2015-01-01

    Background The presence of prodromal transient ischemic attacks (TIAs) has been associated with a favorable outcome in anterior circulation stroke. We aimed to determine the association between prodromal TIAs or minor stroke and outcomes at 1 month, in the Basilar Artery International Cooperation St

  12. Prodromal Transient Ischemic Attack or Minor Stroke and Outcome in Basilar Artery Occlusion

    NARCIS (Netherlands)

    Conforto, A.B.; Freitas, G.R. de; Schonewille, W.J.; Kappelle, L.J.; Algra, A.; Leeuw, F.E. de

    2015-01-01

    BACKGROUND: The presence of prodromal transient ischemic attacks (TIAs) has been associated with a favorable outcome in anterior circulation stroke. We aimed to determine the association between prodromal TIAs or minor stroke and outcomes at 1 month, in the Basilar Artery International Cooperation S

  13. Ruptured aneurysm at the cortical segment of the distal posterior inferior cerebellar artery associated with hemodynamic stress after basilar artery occlusion

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    Akiko Marutani

    2016-01-01

    Conclusion: This report describes a case of de novo development of a saccular distal PICA aneurysm after atherosclerotic basilar artery occlusion. We believe that increased hemodynamic stress at the PICA might have contributed to the occurrence and rupture of the aneurysm. STA-SCA bypass, introduced in the territory of the cerebellar hemisphere, reduces hemodynamic stress, which would prevent the occurrence of de novo aneurysm and recurrent bleeding.

  14. Sequential combination of two intravenous thrombolytics (recombinant tissue plasminogen activator/tenecteplase) in a patient with stroke and cardioembolic basilar artery occlusion.

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    Smadja, Didier; Olindo, Stéphane; Saint-Vil, Martine; Chausson, Nicolas

    2009-01-01

    Stroke caused by acute occlusion of basilar artery (AOBA) produces high risk of death. In eligible patients, thrombolysis significantly reduces mortality and disability rate. In most hospitals, thrombolysis is limited to intravenous (IV) route of recombinant tissue plasminogen activator, without any therapeutic alternative in cases of treatment failure. We report a case of cardioembolic AOBA, not responsive to a conventional regimen of IV recombinant tissue plasminogen activator. A sequential combination of IV tenecteplase (0.4 mg/kg) led to a complete recanalization of basilar artery, with a very good clinical outcome. The potential for a combination of two successive IV regimens should be evaluated in AOBA.

  15. Mechanical thrombectomy in basilar artery thrombosis

    DEFF Research Database (Denmark)

    Fesl, Gunther; Holtmannspoetter, Markus; Patzig, Maximilian;

    2014-01-01

    PURPOSE: Multiple endovascular devices have been used for mechanical thrombectomy (MT) in basilar artery occlusion (BAO) for >10 years. Based on a single-center experience during the course of one decade, we present data on safety and efficacy of previous MT devices compared with modern stent ret...

  16. Vertebral artery stenosis in the Basilar Artery International Cooperation Study (BASICS): prevalence and outcome

    NARCIS (Netherlands)

    Compter, A.; Hoeven, E.J. van der; Worp, H.B. van der; Vos, J.A.; Weimar, C.; Rueckert, C.M.; Kappelle, L.J.; Algra, A.; Schonewille, W.J.; Leeuw, F.E. de

    2015-01-01

    We assessed the prevalence of vertebral artery (VA) stenosis or occlusion and its influence on outcome in patients with acute basilar artery occlusion (BAO). We studied 141 patients with acute BAO enrolled in the Basilar Artery International Cooperation Study (BASICS) registry of whom baseline CT an

  17. Vertebral artery stenosis in the Basilar Artery International Cooperation Study (BASICS) : prevalence and outcome

    NARCIS (Netherlands)

    Compter, Annette; van der Hoeven, Erik J R J; van der Worp, H. Bart; Vos, Jan Albert; Weimar, Christian; Rueckert, Christina M.; Kappelle, L. Jaap; Algra, Ale; Schonewille, Wouter J.; Vergouwen, MD

    2015-01-01

    We assessed the prevalence of vertebral artery (VA) stenosis or occlusion and its influence on outcome in patients with acute basilar artery occlusion (BAO). We studied 141 patients with acute BAO enrolled in the Basilar Artery International Cooperation Study (BASICS) registry of whom baseline CT an

  18. Acute arterial occlusion - kidney

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    Acute renal arterial thrombosis; Renal artery embolism; Acute renal artery occlusion; Embolism - renal artery ... kidney can often result in permanent kidney failure. Acute arterial occlusion of the renal artery can occur after injury or trauma to ...

  19. Electroencephalograms in basilar artery migraine.

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    Parain, D; Samson-Dollfus, D

    1984-11-01

    Nine cases of 'basilar artery migraine' (BAM) have been recorded. In 8 cases, excess of beta activity was observed during the attacks and disappeared in less than 3 days. The inter-ictal EEGs were normal. Drug ingestion was excluded each time. These EEG patterns are different from those which have been reported in the literature, i.e., transitory posterior abnormal slow waves. However, case no.1 is in agreement with the literature. The expression 'BAM' probably covers different syndromes which are further discussed.

  20. Acute occlusion of the left subclavian artery with artery dissection

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ Subclavian steal syndrome is cerebral or brain stem ischemia resulting from diversion of blood flow from the basilar artery to the subclavian artery, which is caused by occlusive disease of either the subclavian artery or the innominate artery before they branch off at the vertebral artery. In the patients with subclavian steal syndrome the subclavian artery is fed by retrograde flow from the vertebral artery via the carotids and the circle of Willis.

  1. Basilar artery migraine and reversible imaging abnormalities.

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    Maytal, J; Libman, R B; Lustrin, E S

    1998-01-01

    We report a case of a basilar artery migraine in a 17-year-old boy with transient CT and MR abnormalities after each of two migraine episodes. A repeat MR study 6 months after the last event showed complete resolution of the lesion. Transient abnormalities on brain images similar to those shown in our case have been reported in patients with migraine and other neurologic conditions and are most likely related to cerebral vasogenic edema.

  2. Middle meningeal artery arising from the basilar artery.

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    Salem, Mohamed M; Fusco, Matthew R; Dolati, Parviz; Reddy, Arra S; Gross, Bradley A; Ogilvy, Christopher S; Thomas, Ajith J

    2014-12-01

    Various anomalies for the origin of the middle meningeal artery (MMA) have been described in the literature. However, origin of the MMA from the basilar trunk is an extremely rare variant. We report on a 54-year-old female who presented with frequent headaches; magnetic resonance imaging showed a right parietal meningioma. The abnormal origin of the middle meningeal artery from the basilar artery was diagnosed by angiography performed for preoperative embolization of the tumor. We report on the case with a review of the embryologic basis, possible explanations for this aberrant origin, and its clinical implications.

  3. Basilar artery of the capybara (Hydrochaeris hydrochaeris): an ultrastructural study.

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    Islam, S; Ribeiro, A A C M; Loesch, A

    2004-04-01

    The present study investigated the ultrastructural features of the basilar artery of the largest rodent species, the capybara. The study suggests that the general ultrastructural morphological organization of the basilar artery of the capybara is similar to that of small rodents. However, there are some exceptions. The basilar artery of the capybara contains a subpopulation of 'granular' vascular smooth muscle cells resembling monocytes and/or macrophages. The possibility cannot be excluded that the presence of these cells reflects the remodelling processes of the artery due to animal maturation and the regression of the internal carotid artery. To clarify this issue, more systemic studies are required involving capybaras of various ages.

  4. Cross-sectional imaging for diagnosis and clinical outcome prediction of acute basilar artery thrombosis

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    Mortimer, A.M., E-mail: alex_mortimer@hotmail.co [Severn School of Radiology, Bristol (United Kingdom); Department of Radiology, Great Western Hospital, Swindon (United Kingdom); Saunders, T.; Cook, J.-L. [Department of Radiology, Great Western Hospital, Swindon (United Kingdom)

    2011-06-15

    Basilar artery occlusion is a potentially fatal condition and imaging findings can be subtle. Prompt diagnosis is vital, as recognition may lead to therapeutic recanalization that may improve functional outcome and survival. Furthermore, cross-sectional imaging signs may help predict eventual outcome and, therefore, guide which patients should be subjected to aggressive treatment. Computed tomography (CT) signs include a hyperdense basilar artery that has a high specificity, accuracy, positive and negative predictive value. Evidence regarding the prognostic significance of the hyperdense basilar artery sign is conflicting. Early magnetic resonance imaging (MRI) features include loss of flow void, seen as increased signal intensity within the basilar artery on T2-weigted images and identification of acute thrombus, seen as intermediate signal on T1-weighted images. MRI sequences are more sensitive for early detection of acute ischaemia or infarction, ideally with diffusion-weighted imaging (DWI). Both CT and MR angiography are sensitive for detection of acute thrombus, seen as a filling defect or occlusion. These are the non-invasive imaging techniques of choice to confirm diagnosis, with perhaps the speed and accessibility of CT angiography resulting in this technique being valuable in the acute setting. Several new scoring systems based on arterial segmentation rather than global volume assessment using CT angiography source images and DWI have shown early promise in the prediction of eventual clinical outcome in order to isolate those patients who may benefit from therapeutic recanalization.

  5. Rapid ventricular pacing for a basilar artery pseudoaneurysm in a pediatric patient: case report.

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    Nimjee, Shahid M; Smith, Tony P; Kanter, Ronald J; Ames, Warwick; Machovec, Kelly A; Grant, Gerald A; Zomorodi, Ali R

    2015-06-01

    Large cerebral aneurysms of the basilar apex are difficult to treat. Recently, endovascular treatment has mitigated much of the morbidity associated with treating these lesions. However, the morphology of aneurysms of the vertebrobasilar system can preclude endovascular treatment. Rapid ventricular pacing (RVP) facilitates open surgical treatment of cerebral aneurysms. It can assist in reducing the pressure of the neck of the aneurysm, allowing safe application of a clip. The authors present a case of a pediatric patient who developed a basilar artery pseudoaneurysm that required surgery. Given the large size of the aneurysm, RVP was performed, allowing the surgeons to dissect the dome of the aneurysm from the surrounding tissue and pontine perforating branches away from the lesion to safely clip the lesion. The patient had an uneventful recovery. To the authors' knowledge, this represents the first known case of RVP to aid in basilar artery clip occlusion in a pediatric patient.

  6. Intraorbital ophthalmic artery aneurysm associated with basilar tip saccular aneurysm

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    Dehdashti, A.R.; Tribolet, N. de [Department of Neurosurgery, HUG, Geneva (Switzerland); Safran, A.B. [Department of Ophthalmology, HUG, Geneva (Switzerland); Martin, J.B.; Ruefenacht, D.A. [Division of Neuroradiology, HUG, Geneva (Switzerland)

    2002-07-01

    We present a rare case of intraorbital ophthalmic artery aneurysm found incidentally, together with a ruptured aneurysm of the tip of the basilar artery. The intraorbital aneurysm was asymptomatic, and no treatment was offered. Angiographic control was recommended to detect any progression. Treatment may be indicated for documented enlargement or significant mass effect of the aneurysm. (orig.)

  7. Basilar artery thrombosis in the setting of antiphospholipid syndrome.

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    Saad, Amin F; Nickell, Larry T; Heithaus, R Evans; Shamim, Sadat A; Opatowsky, Michael J; Layton, Kennith F

    2014-07-01

    Antiphospholipid syndrome is an autoimmune disorder characterized by arterial or venous thrombosis, recurrent first-trimester pregnancy loss, and multiple additional clinical manifestations. We describe a man with severe atherosclerotic basilar artery stenosis and superimposed in situ thrombus who was found to have antiphospholipid syndrome.

  8. Basilar artery aneurysm case presented with neck pain

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    Uygar Utku

    2013-04-01

    Full Text Available Neck pain related with disorders of the brain and neck vascular structures is not rare but importance was attached to a condition that is often overlooked. Tension as a sudden onset, radiating to the nape, the neck pain becomes unbearable and within seconds the raging 51-year-old female patient with aneurysm at the distal end of basilar artery was found. Case, the only sign of neck pain with unruptured basilar artery aneurysm is presented in terms of raising awareness on the subject.

  9. Relaxation effect of abacavir on rat basilar arteries.

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    Rachel Wai Sum Li

    Full Text Available The use of abacavir has been linked with increased cardiovascular risk in patients with human immunodeficiency virus infection; however, the mechanism involved remains unclear. We hypothesize that abacavir may impair endothelial function. In addition, based on the structural similarity between abacavir and adenosine, we propose that abacavir may affect vascular contractility through endogenous adenosine release or adenosine receptors in blood vessels.The relaxation effect of abacavir on rat basilar arteries was studied using the myograph technique. Cyclic GMP and AMP levels were measured by immunoassay. The effects of abacavir on nucleoside transporters were studied using radiolabeled nucleoside uptake experiments. Ecto-5' nucleotidase activity was determined by measuring the generation of inorganic phosphate using adenosine monophosphate as the substrate.Abacavir induced the relaxation of rat basilar arteries in a concentration-dependent manner. This relaxation was abolished when endothelium was removed. In addition, the relaxation was diminished by the nitric oxide synthase inhibitor, L-NAME, the guanylyl cyclase inhibitor, ODQ, and the protein kinase G inhibitor, KT5820. Abacavir also increased the cGMP level in rat basilar arteries. Abacavir-induced relaxation was also abolished by adenosine A2 receptor blockers. However, abacavir had no effect on ecto-5' nucleotidase and nucleoside transporters. Short-term and long-term treatment of abacavir did not affect acetylcholine-induced relaxation in rat basilar arteries.Abacavir induces acute endothelium-dependent relaxation of rat basilar arteries, probably through the activation of adenosine A2 receptors in endothelial cells, which subsequently leads to the release of nitric oxide, resulting in activation of the cyclic guanosine monophosphate/protein kinase G-dependent pathway in vascular smooth muscle cells. It is speculated that abacavir-induced cardiovascular risk may not be related to

  10. Sensitivity of Hyperdense Basilar Artery Sign on Non-Enhanced Computed Tomography.

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    Marielle Ernst

    Full Text Available The hyperdense basilar artery sign (HBAS is an indicator of vessel occlusion on non contrast-enhanced computer tomography (NECT in acute stroke patients. Since basilar artery occlusion (BAO is associated with a high mortality and morbidity, its early detection is of great clinical value. We sought to analyze the influence of density measurement as well as a normalized ratio of Hounsfield unit/hematocrit (HU/Hct ratio on the detection of BAO on NECT in patients with suspected BAO.102 patients with clinically suspected BAO were examined with NECT followed immediately by Multidetector computed tomography Angiography. Two observers independently analyzed the images regarding the presence or absence of HBAS on NECT and performed HU measurements in the basilar artery. Receiver operating characteristic curve analysis was performed to determine the optimal density threshold for BAO using attenuation measurements or HU/Hct ratio.Sensitivity of visual detection of the HBAS on NECT was relatively low 81% (95%-CI, 54-95% while specificity was high 91% (95%-CI, 82-96%. The highest sensitivity was achieved by the combination of visual assessment and additional quantitative attenuation measurements applying a cut-off value of 46.5 HU with 94% sensitivity and 81% specificity for BAO. A HU/Hct ratio >1.32 revealed sensitivity of 88% (95%-CI, 60-98% and specificity of 84% (95%-CI, 74-90%.In patients with clinically suspected acute BAO the combination of visual assessment and additional attenuation measurement with a cut-off value of 46.5 HU is a reliable approach with high sensitivity in the detection of BAO on NECT.

  11. SolitaireTM支架取栓治疗急性基底动脉闭塞研究%Mechanical Thrombectomy with the SolitaireTM Device in Acute Basilar Artery Occlusion

    Institute of Scientific and Technical Information of China (English)

    高峰; 孙瑄; 莫大鹏; 马宁; 刘恋; 霍晓川; 缪中荣

    2015-01-01

    Objective To evaluate the efifcacy and safety of mechanical thrombectomy with the SolitaireTM device in revascularization of patients with acute basilar artery occlusion (ABAO) and to identify its predictive factors for clinical outcome. Methods Thirty patients with acute ischemic stroke attributable to ABAO treated with the SolitaireTM device in our center were retrospectively studied. Recanalization rates after stent Retrieval were determined and the clinical outcome and mortality rate were assessed 90 days after treatment. Predictive factors for clinical outcome were analyzed. Results The mean age of the patients was (58.6±8.4) years, the median prethrombectomy National Institutes of Health Stroke Scale score was 25.5 (21.3, 29.5), the median Glasgow Coma Scale (GCS) score was 8 (6.0, 9.8) and the mean modiifed Rankin Scale (mRS) score was 5 (5.0, 5.0). Successful recanalization (Thrombolysis in Cerebral Ischemia Scale, TICI 3 or 2b) was achieved in 28 patients (93.3%). Six symptomatic intracranial hemorrhages occurred after procedure. A favorable outcome, defined as a mRS of 0~2, was observed in 30.0% of patients (9/30). Overall mortality rate was 30.0% (9/30). In the univariate analysis, patients with coma (P=0.014) and a higher mRS (mRS>2, P=0.020) on admission was signiifcantly associated with a poor outcome. Conclusion Mechanical thrombectomy with the SolitaireTM device can rapidly and effectively contribute to a high rate of recanalization and improve functional outcome in patients with ABAO.%目的:评估急性基底动脉闭塞患者使用SolitaireTM支架机械取栓的有效性和安全性,分析其临床预后的影响因素。方法回顾性分析本中心连续入组的30例急性基底动脉闭塞患者,均使用SolitaireTM支架设备进行机械取栓治疗分析支架,分析取栓治疗的再通率及并发症,评估治疗90 d临床预后,分析影响临床预后的因素。结果30例患者均顺利完成机械取栓手

  12. Segmental myoclonus and basilar artery giant aneurysm case report

    Directory of Open Access Journals (Sweden)

    J. Pitágoras de Mattos

    1992-12-01

    Full Text Available A 70 years-old man was admitted at our hospital because of unstable angina pectoris. He had essential hypertension and right hemiplegia from a ischemic stroke two years before admission. On neurologic examination, it was found mental disorientation, unstable emotionality, right spastic hemiparesis with right Babinski sign, and segmental myoclonus affecting the superior lip and the palate (palatal nystagmus on the right side. On the CT scan, a giant aneurysm of the basilar artery was detected. We conclude that the segmental myoclonus could be explained by ischemic lesions in the Guillain - Mollaret triangle.

  13. Bilateral hypoplasia of the internal carotid arteries with basilar aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Briganti, F.; Tortora, F.; Elefante, A. [Universita di Napoli Federico II, Dipartimento di Scienze Neurologiche, Cattedra di Neuroradiologia, 80131, Napoli (Italy); Maiuri, F. [Universita di Napoli Federico II, Department of Neurological Sciences, Neurosurgery Service, Napoli (Italy)

    2004-10-01

    We report a rare case of bilateral hypoplasia of the internal carotid arteries with an associated aneurysm of the basilar tip, studied by CT angiography, MR angiography and digital angiography. The patient became symptomatic with an episode of loss of consciousness, likely due to reduced blood perfusion. The other 20 reported cases of bilateral carotid hypoplasia (only four of which with an associated aneurysm) are reviewed. The findings of noninvasive procedures (including narrowing of the carotid canals on CT) may lead to a correct diagnosis before angiography is performed; they may also help to differentiate angiographic narrowing of the hypoplastic internal carotids from the string sign often observed in some acquired conditions. (orig.)

  14. Hemifacial spasm in a patient with basilar artery dolichoectasia caused by uncontrolled hypertension

    Directory of Open Access Journals (Sweden)

    Gordon S. Crabtree

    2016-10-01

    Full Text Available A 47-year-old male presented with a 2-year history of hemifacial spasm. Magnetic resonance imaging performed showed his tortuous basilar artery with nerve compression, and the patient was treated conservatively with botulinum toxin injections with complete resolution of symptoms. This rare disease was caused by his long history of hypertension, which led to his major basilar artery dolichoectasia.

  15. A cadaveric study of the endoscopic endonasal transclival approach to the basilar artery.

    Science.gov (United States)

    Lai, Leon T; Morgan, Michael K; Chin, David C W; Snidvongs, Kornkiat; Huang, June X Z; Malek, Joanne; Lam, Matthew; McLachlan, Rohan; Harvey, Richard J

    2013-04-01

    The anterior transclival route to basilar artery aneurysms is not widely performed. The objective of this study was to carry out a feasibility assessment of the transclival approach to basilar aneurysms with advanced endonasal techniques on 11 cadaver heads. Clival dura was exposed from the sella to the foramen magnum between the paraclival segments of the internal carotid arteries (ICA) laterally. An inverted dural "U" flap was reflected inferiorly to expose the basilar artery. The maximal dimensions from operative measurements were recorded. Surgical manoeuvrability of multiple instruments and the proficiency to place proximal and distal vascular clips were evaluated. The mean operative depth (± standard deviation), measured from the anterior choanae to the basilar artery, was 110±6mm. The lateral corridors were limited distally by the medial pterygoids (mean width 21±2mm) and paraclival ICA (mean width 20±2mm). The mean transclival craniectomy dimensions were 19±2mm (width) and 23±4mm (height). Exposure of the basilar-anterior inferior cerebellar artery junction, superior cerebellar artery, and the basilar caput were possible in 100%, 91%, and 64% of instances, respectively. Placements of proximal and distal aneurysm clips were achieved in all instances. Based on our findings, the transclival endoscopic endonasal surgery approach provides excellent visualisation of the basilar artery. Clip application and manoeuvrability of instruments was considered adequate for basilar aneurysm surgery. Surgical skills and instrumentation to control significant haemorrhage can potentially limit the clinical applicability of this technique.

  16. The ELANA technique : Constructing a high flow bypass using a non-occlusive anastomosis on the ICA and a conventional anastomosis on the SCA in the treatment of a fusiform giant basilar trunk aneurysm

    NARCIS (Netherlands)

    Streefkerk, HJN; Wolfs, JFC; Sorteberg, W; Sorteberg, AG; Tulleken, CAF

    2004-01-01

    A patient with a partially thrombosed fusiform giant basilar trunk aneurysm presented with devastating headache and symptoms of progressive brain stem compression. Having an aneurysm inaccessible for endovascular treatment, and after failing a vertebral artery balloon occlusion test, he was offered

  17. Retinal artery occlusions in children.

    Science.gov (United States)

    Dharmasena, Aruna; Wallis, Simon

    2014-01-01

    The purpose of this study is to present a case of RAO in a 13 year old girl with a preceding history of hyperextension of the neck at her hairdressers for a long duration and use of her mobile phone handset resting it against the side of her neck presumably exerting some pressure on carotids during the same time. Materials and methods of this study was reported as case report and review of literature. A 13 year-old girl presented with the left supero-nasal scotoma due to an inferior temporal branch retinal artery occlusion (BRAO). She underwent extensive investigations and no underlying cause was discovered. She gave a history of cervical extension over a long period of time while having the hair coloured twice in the preceding week. She also mentioned that she was using her mobile phone more or less continuously during both these occasions keeping it against her neck. Given the above history it is possible that the pressure on the ipsilateral carotid arteries or the prolong neck extension may have been responsible for the formation of a platelet embolus resulting in the BRAO. In conclusion, although cerebro-vascular accidents due to 'beauty parlor stroke syndrome' (JAMA 269:2085-2086, 1993) have been reported previously it has not been reported in children to our knowledge. On the other hand, 'beauty parlor stroke syndrome' occurs due to a dissection of the vertebral arteries or due to mechanical compression of the vertebral arteries during the prolonged hyperextension of the neck. The central retinal artery originates from the internal carotid circulation and it is highly unlikely for an embolus to enter the retinal circulation from the vertebral arteries. Therefore, the authors favour the possibility that the compulsive use of a mobile phone exerting pressure on the carotid arteries for a long time may have led to the formation of an embolus and subsequent RAO in this case.

  18. Atherosclerotic Aneurysm of the Basilar Artery and Hydrocephalus. A Case Report

    Directory of Open Access Journals (Sweden)

    Ania Alvarado Borges

    2014-08-01

    Full Text Available Intracranial aneurysms are fairly common. Many of them produce no symptoms, often remaining undiagnosed during life. At autopsy, aneurysms of the basilar artery appear in 2 to 5% of the cases; among them, saccular and congenital aneurysms are more common than atherosclerotic and fusiform aneurysms. A case of atherosclerotic aneurysm of the basilar artery diagnosed at autopsy in an 88-year-old man is presented. This patient had been admitted with a diagnosis of ischemic stroke, intracranial hypertension and hydrocephalus, which led physicians to consider a posterior fossa tumor. This paper aims at presenting the autopsy findings that showed the presence of an atherosclerotic aneurysm of the basilar artery.

  19. Bilateral internal carotid artery occlusion. Comparison among MRI, hemodynamics and clinical feature

    Energy Technology Data Exchange (ETDEWEB)

    Yamamoto, Yasumasa; Tsuda, Harumi; Nabatame, Hidehiko; Akiguchi, Ichiro; Kameyama, Masakuni

    1987-10-01

    Four cases of bilateral internal carotid occlusion are reported with respect to clinical features, hemodynamics and various image diagnosis. MRI is applied to three cases. The patients comprised 2.08 % of all cerebral occlusive diseases treated during the past five years at our clinic. One case is of abrupt onset and three cases are progressing profiles. In one of these cases, collateral circulation is supplied mainly by leptomeningeal anastomosis of the posterior cerebral artery and posterior pericallosal artery branching from the basilar artery. In two of them, they are supplied through the circle of Willis. Middle cerebral artery occlusion, occlusion supra occlusionem, however, causes decisive ischemic lesion in its teritory. Applying MRI, complicated ischemic lesions, such as lacunar infarction, paraventricular lesion, deep white matter lesion and border zone infarction can clearly be identified. In the case of total aphasia, the lesions responsible are demonstrated clearly by MRI, but only vaguely by X-ray CT.

  20. Idiopathic pediatric retinal artery occlusion

    Directory of Open Access Journals (Sweden)

    Manayath George

    2010-01-01

    Full Text Available We report a case of branch retinal artery occlusion (BRAO in a healthy young girl. An eight-year-old girl presented with sudden loss of vision in her left eye. She had a pale retina with macular edema consistent with extensive BRAO. A thorough workup was performed to determine any etiologic factor. All test results were within normal limits. Her visual acuity improved from finger counting to 20/40 over two weeks, on immediate treatment with intravenous steroids (methyl prednisolone. This case suggests that BRAO can occur in healthy children without any detectable systemic or ocular disorders and a dramatic improvement may be achieved with prompt treatment with intravenous steroids.

  1. The role of Na(+), K(+)-ATPase in the hypoxic vasoconstriction in isolated rat basilar artery.

    Science.gov (United States)

    Shen, Haitao; Liang, Peng; Qiu, Suhua; Zhang, Bo; Wang, Yongli; Lv, Ping

    2016-06-01

    Hypoxia-induced cerebrovascular dysfunction is a key factor in the occurrence and the development of cerebral ischemia. Na(+), K(+)-ATPase affects the regulation of intracellular Ca(2+) concentration and plays an important role in vascular smooth muscle function. However, the potential role of Na(+), K(+)-ATPase in hypoxia-induced cerebrovascular dysfunction is unknown. In this study, we found that the KCl-induced contraction under hypoxia in rat endothelium-intact basilar arteries is similar to that of denuded arteries, suggesting that hypoxia may cause smooth muscle cell (SMC)-dependent vasoconstriction in the basilar artery. The Na(+), K(+)-ATPase activity of the isolated basilar artery with or without endothelium significantly reduced with prolonged hypoxia. Blocking the Na(+)-Ca(2+) exchanger with Ni(2+) (10(-3)M) or the L-type Ca(2+) channel with nimodipine (10(-8)M) dramatically attenuated KCl-induced contraction under hypoxia. Furthermore, prolonged hypoxia significantly reduced Na(+), K(+)-ATPase activity and increased [Ca(2+)]i in cultured rat basilar artery SMCs. Hypoxia reduced the protein and mRNA expression of the α2 isoform of Na(+), K(+)-ATPase in SMCs in vitro. We used a low concentration of the Na(+), K(+)-ATPase inhibitor ouabain, which possesses a high affinity for the α2 isoform. The contractile response in the rat basilar artery under hypoxia was partly inhibited by ouabain pretreatment. The decreased Na(+), K(+)-ATPase activity in isolated basilar artery and the increased [Ca(2+)]i in SMCs induced by hypoxia were partly inhibited by pretreatment with a low concentration of ouabain. These results suggest that hypoxia may educe Na(+), K(+)-ATPase activity in SMCs through the α2 isoform contributing to vasoconstriction in the rat basilar artery.

  2. Pharmacological and molecular comparison of K(ATP) channels in rat basilar and middle cerebral arteries

    DEFF Research Database (Denmark)

    Ploug, Kenneth Beri; Edvinsson, Lars; Olesen, Jes;

    2006-01-01

    ATP-sensitive potassium (K(ATP)) channels play an important role in the regulation of cerebral vascular tone. In vitro studies using synthetic K(ATP) channel openers suggest that the pharmacological profiles differ between rat basilar arteries and rat middle cerebral arteries. To address this issue....... Densitometric measurements of the Western blot signals further showed higher expression levels of Kir6.1 and SUR2B proteins in rat middle cerebral arteries than was found in rat basilar arteries. In conclusion, our in vitro pharmacological studies showed no evidence for functional endothelial K(ATP) channels...

  3. Branch retinal artery occlusion in Susac's syndrome

    Directory of Open Access Journals (Sweden)

    Ricardo Evangelista Marrocos de Aragão

    2015-02-01

    Full Text Available Susac's syndrome is a rare disease attribuited to a microangiopathy involving the arterioles of the cochlea, retina and brain. Encefalopathy, hearing loss, and visual deficits are the hallmarks of the disease. Visual loss is due to multiple, recurrent branch arterial retinal occlusions. We report a case of a 20-year-old women with Susac syndrome presented with peripheral vestibular syndrome, hearing loss, ataxia, vertigo, and vision loss due occlusion of the retinal branch artery.

  4. Chronic basilar artery dissection with an associated symptomatic aneurysm presenting with massive subarachnoid hemorrhage.

    Science.gov (United States)

    Cohen, José E; Moscovici, Samuel; Rajz, Gustavo; Vargas, Andres; Itshayek, Eyal

    2016-08-01

    Basilar artery dissection (BAD) is a rare condition with a worse prognosis than a dissection limited to the vertebral artery. We report a rare case of chronic BAD with an associated symptomatic aneurysm presenting with massive subarachnoid hemorrhage (SAH) in a 54-year-old woman. The diagnosis of acute BAD could only be made retrospectively, based on clinical and neuroradiological studies from a hospital admission 10months earlier. Angiography performed after her SAH showed unequivocal signs of imperfect healing; she was either post-recanalization of a complete occlusion or post-dissection. Residual multi-channel intraluminal defects led to the development of a small aneurysm, which was responsible for the massive hemorrhage. The occurrence of an associated aneurysm, and wall disease, but not an intraluminal process, reinforces the diagnosis of dissection. The patient was fully recovered at 90day follow-up. This case reinforces the need for long-term neuroradiological surveillance after non-hemorrhagic intracranial dissections to detect the development of de novo aneurysms.

  5. [Thrombolysis of the basilar artery: 5-year results from the Saarland stroke registry].

    Science.gov (United States)

    Grunwald, I Q; Struffert, T; Roth, C; Papanagiotou, P; Scheuermann, J; Voges, M; Reith, W

    2005-05-01

    Acute thrombosis of the basilar artery has a fatal outcome if left untreated. The relatively good prognosis with intra-arterial thrombolysis makes it the therapy of choice for acute basilar thrombosis. In the Saarland stroke registry, we analyzed 47 patients with angiographically proven basilar artery thrombosis within the last 5 years. We observed a better outcome in patients with good income, with recanalization, and a short time between onset of symptoms and start of thrombolysis. The complications, such as intracerebral bleedings, occurred only in the group treated with rt-PA. Intra-arterial thrombolysis with urokinase or rt-PA is a relatively safe therapy, but should be performed in neuroradiological centers. With progressing symptoms the therapeutic window can be stretched up to 12 h, but coma lasting for more than 4 h is related to a bad outcome.

  6. Pharmacological and molecular comparison of K(ATP) channels in rat basilar and middle cerebral arteries

    DEFF Research Database (Denmark)

    Ploug, Kenneth Beri; Edvinsson, Lars; Olesen, Jes;

    2006-01-01

    ATP-sensitive potassium (K(ATP)) channels play an important role in the regulation of cerebral vascular tone. In vitro studies using synthetic K(ATP) channel openers suggest that the pharmacological profiles differ between rat basilar arteries and rat middle cerebral arteries. To address this issue...

  7. Unusual origin of the left ophthalmic artery from the basilar trunk.

    Science.gov (United States)

    Rivera, Rodrigo; Choi, In Sup; Sordo, Juan Gabriel; Giacaman, Pablo; Badilla, Lautaro; Bravo, Eduardo; Echeverria, Daniel

    2015-05-01

    The formation of the ophthalmic artery (OA) is a complex process with two different proposed embryological steps for its development. Several anatomical variants have been described. We present a very unusual origin of the ophthalmic artery from the basilar trunk, in a 45-year-old male with a history of pontine hemorrhagic stroke. MRI and CTA showed evidence of previous hemorrhage in the pons and several intracranial arterial dysplastic dilatations. DSA confirmed several fusiform dilatations of the basilar trunk. In the left ICA, no ophthalmic artery was seen arising from the carotid siphon. The left ophthalmic artery arises from the basilar trunk and runs lateral to the cavernous sinus through the middle cranial fossa, entering the left orbit at the superior orbital fissure. The patient was treated conservatively. Two main theories for this anomaly are known, one from Lasjaunias and the other from Paget. To our knowledge, this basilar origin of the OA has only been described three times in the literature. For its origin, we propose a partial persistence of the trigeminal artery together with a dominance of the dorsal ophthalmic artery.

  8. Characterization of CGRP(1) receptors in the guinea pig basilar artery

    DEFF Research Database (Denmark)

    Jansen-Olesen, I; Kaarill, L; Edvinsson, L

    2001-01-01

    The purpose of the present study was to characterise receptors mediating calcitonin gene-related peptide (CGRP)-induced relaxation of guinea pig basilar artery. This was done by investigating vasomotor responses in vitro and performing autoradiographic binding studies. We also intended to study...... the importance of an intact endothelium. Agonist studies showed that peptides of the CGRP family induced relaxation of the guinea pig basilar artery with the following order of potency: human beta-CGRP=human alpha-CGRP>adrenomedullin=[acetamidomethyl-Cys(2,7)]alpha-human CGRP ([Cys(ACM)(2,7)]CGRP...... in the absence of human CGRP-(8-37). The study shows the presence of a relaxant CGRP(1) receptor on the smooth muscle cells of guinea pig basilar artery. Various endothelial factors did not influence relaxant responses....

  9. Complex neurological symptoms in bilateral thalamic stroke due to Percheron artery occlusion

    Science.gov (United States)

    Caruso, Paola; Manganotti, Paolo; Moretti, Rita

    2017-01-01

    The artery of Percheron is a rare anatomical variant where a single thalamic perforating artery arises from the proximal posterior cerebral artery (P1 segment) between the basilar artery and the posterior communicating artery and supplies the rostral mesencephalon and both paramedian territories of the thalami. Almost one-third of human brains present this variant. Occlusion of the artery of Percheron mostly results in a bilateral medial thalamic infarction, which usually manifests with altered consciousness (including coma), vertical gaze paresis, and cognitive disturbance. The presentation is similar to the “top of the basilar syndrome”, and early recognition should be prompted. We describe the case of a young female with this vessel variant who experienced a bilateral thalamic stroke. Magnetic resonance angiography demonstrated bilateral thalamic infarcts and a truncated artery of Percheron. Occlusion of the vessel was presumably due to embolism from a patent foramen ovale. Thrombolysis was performed, with incomplete symptom remission, cognitive impairment, and persistence of speech disorders. Early recognition and treatment of posterior circulation strokes is mandatory, and further investigation for underlying stroke etiologies is needed. PMID:28053539

  10. Endovascular Treatment of the Huge Dissecting Aneurysms Involving the Basilar Artery by the Internal Trapping Technique: Technical Note

    Institute of Scientific and Technical Information of China (English)

    Shi-Qing Mu; Xin-Jian Yang; You-Xiang Li; Chu-Han Jiang; Zhong-Xue Wu

    2015-01-01

    Background:The endovascular strategy of the huge dissecting aneurysms involving the basilar artery (BA) is controversial and challenging.This study was to investigate the clinical and angiographic outcomes of the treatment of the huge dissecting aneurysms involving the BA by the internal trapping (IT) technique.Methods:We retrospectively studied 15 patients with the huge dissecting aneurysms involving the BA treated by the IT technique between September 2005 and September 2014 in Department of lnterventional Neuroradiology of Beijing Tiantan Hospital.Clinical and angiographic data were reviewed and evaluated.Results:All patients were treated by the IT technique.That meant the dissecting artery and aneurysm segments were completed occlusion.After the procedure,the angiography demonstrated that all the dissecting artery and aneurysm segments were completed occlusion.Follow-up angiography was performed at 3-6 months or 12-18 months after the endovascular treatment (median 8 months),14 patients had a good recovery.Re-canalization occurred in one patient whose aneurysm involved in bilateral vertebral arteries and the two third of the middle-lower BA.After the second treatment,the patient died by the ventricular tachycardia.Conclusions:The IT technique is a technically feasible and safe alternative for the treatment of BA dissecting aneurysms,but it is not necessarily the safest or most definitive treatment modality.The ideal treatment of the huge dissecting aneurysms involving the BA remains debatable and must be investigated on a case-by-case basis.

  11. Endovascular Treatment of the Huge Dissecting Aneurysms Involving the Basilar Artery by the Internal Trapping Technique: Technical Note

    Directory of Open Access Journals (Sweden)

    Shi-Qing Mu

    2015-01-01

    Full Text Available Background: The endovascular strategy of the huge dissecting aneurysms involving the basilar artery (BA is controversial and challenging. This study was to investigate the clinical and angiographic outcomes of the treatment of the huge dissecting aneurysms involving the BA by the internal trapping (IT technique. Methods: We retrospectively studied 15 patients with the huge dissecting aneurysms involving the BA treated by the IT technique between September 2005 and September 2014 in Department of Interventional Neuroradiology of Beijing Tiantan Hospital. Clinical and angiographic data were reviewed and evaluated. Results: All patients were treated by the IT technique. That meant the dissecting artery and aneurysm segments were completed occlusion. After the procedure, the angiography demonstrated that all the dissecting artery and aneurysm segments were completed occlusion. Follow-up angiography was performed at 3-6 months or 12-18 months after the endovascular treatment (median 8 months, 14 patients had a good recovery. Re-canalization occurred in one patient whose aneurysm involved in bilateral vertebral arteries and the two third of the middle-lower BA. After the second treatment, the patient died by the ventricular tachycardia. Conclusions: The IT technique is a technically feasible and safe alternative for the treatment of BA dissecting aneurysms, but it is not necessarily the safest or most definitive treatment modality. The ideal treatment of the huge dissecting aneurysms involving the BA remains debatable and must be investigated on a case-by-case basis.

  12. EFFECT OF ACUPUNCTURE ON BLOOD FLOW OF VERTEBRAL AND BASILAR ARTERIES IN STROKE PATIENTS

    Institute of Scientific and Technical Information of China (English)

    吕建明; 王伟志

    2004-01-01

    Objective: To observe the short-term effect and long-term effect of acupuncture on blood flow of vertebral and basilar arteries in stroke patients.Methods: A total of 58 stroke patients (34 males and 24 females) were agreed to participate in this study, and changes of blood flow of the vertebral and basilar arteries were detected after one week's and 45 days' continuous acupuncture treatment by using a Doppler's ultrasonic diagnosis apparatus.Bilateral Fengchi (GB 20), Wangu (GB 12), Tianzhu (BL 10), etc.were punctured and stimulated with small amplitude, high frequency and twirling-reinforcing method for 3 min.The treatment was conducted once daily.Results: Following one week's and 45 days' acupuncture treatment, diastolic velocity (DV), systolic velocity (SV) and mean velocity (MV) of the basilar artery increased significantly in comparison with pre-treatment (P0.05).Results indicated that acupuncture treatment could effectively improve blood supply of the basilar artery and regulate the uneven blood flow of the bilateral vertebral arteries.Conclusion: Acupuncture treatment can raise blood flow of the brain in stroke patients.

  13. Comparison of P2X receptors in rat mesenteric, basilar and septal (coronary) arteries.

    Science.gov (United States)

    Lewis, C J; Evans, R J

    2000-07-01

    alpha beta meATP-evoked concentration-dependent, PPADS-sensitive, desensitising, P2X receptor-mediated, constrictions of mesenteric, basilar and septal artery rings with EC(50) values of 1, 1 and 30 microM, respectively. In patch clamp studies on acutely dissociated artery smooth cells alpha beta meATP-evoked transient inward currents (tau approximately 100 ms) with mean current densities of approximately 340, 175 and 120 pA/pF, respectively. P2X(1) receptor immunoreactivity was expressed in mesenteric and basilar arteries and this receptor subunit appears to dominate the P2X receptor phenotype in these vessels. In contrast P2X(1) receptor immunoreactivity was not detected in septal arteries and the alpha beta meATP sensitivity of constriction was not consistent with the involvement of P2X(1) receptors. These results suggest that not all arteries share a common P2X receptor phenotype.

  14. Contractile responses to rat urotensin II in resting and depolarized basilar arteries.

    Science.gov (United States)

    Porras-González, Cristina; Ureña, Juan; Egea-Guerrero, Juan José; Gordillo-Escobar, Elena; Murillo-Cabezas, Francisco; González-Montelongo, María del Carmen; Muñoz-Sánchez, María Angeles

    2014-03-01

    The effects of human urotensin II (hUII) on the vascular tone of different animal species has been studied extensively. However, little has been reported on the vasoactive effects of rat urotensin (rUII) in murine models. The aim of the present study was to investigate the effects of rUII on vasoreactivity in rat basilar arteries. Basilar arteries from adult male Wistar rats (300-350 g) were isolated, cut in rings, and mounted on a small vessel myograph to measure isometric tension. rUII concentrations were studied in both resting and depolarized state. To remove endothelial nitric oxide effects from the rUII response, we treated selected arterial rings with Nω-nitro-L-arginine methyl ester (L-NAME). 10 μM rUII produced a potent vasoconstrictor response in rat basilar arteries with intact endothelium, while isometric forces remained unaffected in arterial rings treated with lower rUII concentrations. Although L-NAME did not have a significant effect on 10 μM rUII-evoked contraction, it slightly increased arterial ring contraction elicited by 1 μM rUII. In depolarized arteries, dose-dependent rUII increased depolarization-induced contractions. This effect was suppressed by L-NAME. Our results show that the rat basilar artery has a vasoconstrictor response to rUII. The most potent vasoconstrictor effect was produced by lower doses of rUII (0.1 and 1 μM) in depolarized arteries with intact endothelium. This effect could facilitate arterial vasospasm in vascular pathophysiological processes such as subarachnoid hemorrhage and hypertension, when sustained depolarization and L-type Ca(2+) channel activation are present.

  15. Arterial occlusion precipitated by cisplatinbased chemotherapy

    OpenAIRE

    2010-01-01

    Cisplatin-based therapy is curative in testicular cancer. Adverse effects of cisplatin-based chemotherapy include dose-dependent myelosuppression, nephrotoxicity, neurotoxicity, and ototoxicity. By contrast, chemotherapy-associated vascular complications are unpredictable. Few incidents of digital gangrene with cisplatin have been reported. Here, we present a patient who developed arterial occlusion leading to gangrene of the toe after cisplatinbased chemotherapy.

  16. Cilioretinal artery occlusion following intranasal cocaine insufflations

    Directory of Open Access Journals (Sweden)

    Balaji Kannan

    2011-01-01

    Full Text Available Cocaine is used to produce a euphoric effect by abusers, who may be unaware of the devastating systemic and ocular side effects of this drug. We describe the first known case of cilioretinal artery occlusion after intranasal cocaine abuse.

  17. Arterial gas occlusions in operating heat pipes

    Science.gov (United States)

    Saaski, E. W.

    1975-01-01

    The effect of noncondensable gases on high performance arterial heat pipes has been investigated both analytically and experimentally. Models have been generated which characterize the dissolution of gases in condensate and the diffusional loss of dissolved gases from condensate in arterial flow. These processes, and others, have been used to postulate stability criteria for arterial heat pipes. Experimental observations of gas occlusions were made using a stainless steel heat pipe equipped with viewing ports, and the working fluids methanol and ammonia with the gas additives helium, argon, and xenon. Observations were related to gas transport models.

  18. Intracranial Large Artery Occlusive Disease

    Institute of Scientific and Technical Information of China (English)

    Wong KS; Li H; Kay R

    2000-01-01

    @@Intracranial large artery stenosis is the most commonly found vascular lesion in stroke patient of Chinese, Hispanic and African ancestry. There .have been few studies on the epidemiology, pathophysiology, treatment and prognosis of this important disease. Recent advances in technology provide safe and reliable investigation for studying large number of patients. Transcranial Doppler is an easily accessible, cheap and reliable method to diagnose intracranial stenosis. It is suitable for screening for and monitoring the progress of intracranial stenosis. Magnetic resonance angiography and CT angiography provide the morphology of lumenal stenosis but are less accessible.

  19. Megadolicho basilar artery as a cause of asymmetrical sensorineural hearing loss - case report

    Directory of Open Access Journals (Sweden)

    Melo, Antonio Antunes

    2011-07-01

    Full Text Available Introduction: At the differentiated diagnosis of asymmetrical sensorineural hearing losses, vascular disorders are present, one of which is megadolicho basilar artery. This disease is generally asymptomatic, and when symptoms are found, they can be caused by a compression or ischemia. Clinically, sensorineural hearing loss, tinnitus, headache, facial hypoesthesia, trigeminal neuralgia, vertigo, diplopia and facial palsy, among others, are likely to occur. The image examination of choice for its diagnosis is nuclear magnetic resonance. The megadolicho basilar artery therapy can be surgical or conservative, according to the associated findings. A multidisciplinary approach, including a neurologist, neurosurgeon and an otorhinolaryngologist is recommended for a proper administration of the case. Objective: Report the case of a patient with asymmetrical sensorineural hearing loss, diagnosed of megadolicho basilar artery. Case report: JBS, 57-year-old white male with a history of asymmetrical sensorineural hearing loss and bilateral whistle-like tinnitus for several years. The otorhinolaryngologic evaluation, including otoscopy, anterior rhinoscopy and oral pharynx, was normal. Final Comments: The treatment consisted in following up with the patient, controlling the tinnitus by drugs and using an individual sound amplification apparatus on the left ear.

  20. 临床症状与弥散加权成像不匹配的基底动脉急性闭塞患者的血管内再通治疗%Endovascular recanalization therapy of basilar artery occlusion based on clinical-diffusion mismatch

    Institute of Scientific and Technical Information of China (English)

    张海峰; 许德兵; 练学淦; 葛树勇; 刘玲; 刘新峰; 张仁良

    2011-01-01

    Objective To investigate the feasibility of performing endovascular recanalization therapy (ERT) in patients with acute basilar artery occlusion (BAO) of broadened time window ( 5^24 hours) based on clinical-diffusion mismatch (CDM). Methods A total of 11 CDM patients whose Glasgow Coma Scale (GCS) score <8 at admission were recruited and the diffusion-weighted imaging (DWI) did not find their brainstem reticular formation and bilateral damage to hypothalamus. Intra-arterial thrombolysis (1AT) with rt-PA alone or in combination with IAT, percutaneous transluminal angioplasty (PTA) and stenting were used. At the same time, the degree of recanalization was evaluated according to the thrombolysis in myocardial infarction (TIMI) criteria and the complications were observed. The modified Rankin scale ( mRS) was used to assess after 3 months. Results CDThe mean onset time and duration of coma of the 11 patients were 42 hours (range 25 to 73 hours) and 11 hours { range 2 to 24 hours) , respectively. The mean GCS score at admission was 6 ( range 3 to 7) and that was 14 (range 3 to 15 ) at discharge. (2)Nine patients performed ERT successfully (n =2, TIMI grade 2, n =7, TIMI grade 3) and 2 failed (TIMI 0). There were no complications such as bleeding. The patients regained consciousness within 9 to 27 hours. (S)The patients were followed up after 3 months, 7 had good outcome ( mRS, 0 to 2) and 2 had poor outcome( mRS, 3). ERT failed in 2 patients and they died at day 5 and day 21 after the procedures. Conclusion The patients with broadened time window on CDM who performed ERT may have a higher recanalization rate and relatively good clinical outcome. The patients with collateral circulation has good outcome.%目的 探讨临床症状与弥散加权成像不匹配(CDM),且起病时间≥24h的基底动脉急性闭塞(BAO)患者行血管内再通治疗(ERT)的可行性. 方法 共纳入11例起病时间≥24h入院时格拉斯哥昏迷量表(GCS)评分<8

  1. Metabolic syndrome and central retinal artery occlusion

    Directory of Open Access Journals (Sweden)

    Kosanović-Jaković Natalija

    2005-01-01

    Full Text Available Background. The accumulation of risk factors for central retinal artery occlusion can be seen in a single person and might be explained by the metabolic syndrome. Case report. We presented the case of a 52-year-old man with no light perception in his right eye. The visual loss was monocular and painless, fundoscopy showed central retinal artery occlusion and the laboratory investigation showed the raised erythrocyte sedimentation rate of 105 mm/h and the raised C-reactive protein of 22 mg/l. Specific laboratory investigations and fluorescein angiography excluded the presence of vasculitis, collagen vascular diseases, hypercoagulable state and antiphospholipid syndrome. Conclusion. The patient met all the five of the National Cholesterol Education Program (NCEP criteria for the metabolic syndrome: hypertension, abnormal lipid profile, abnormal glucose metabolism, obesity and hyperuricemia. Measurement of C-reactive protein is useful for the assessment of therapeutic systemic effect on any abnormality in the metabolic syndrome. Individual therapy for all risk factors in the metabolic syndrome is necessary to prevent complications such as cardiovascular, retinal vascular diseases and stroke.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2000-11-01

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

  3. Celiac artery stenosis/occlusion treated by interventional radiology

    Energy Technology Data Exchange (ETDEWEB)

    Ikeda, Osamu [Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, 1-1-1, Honjo Kumamoto 860-8505 (Japan)], E-mail: osamu-3643ik@do9.enjoy.ne.jp; Tamura, Yoshitaka; Nakasone, Yutaka; Yamashita, Yasuyuki [Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, 1-1-1, Honjo Kumamoto 860-8505 (Japan)

    2009-08-15

    Severe stenosis/occlusion of the proximal celiac trunk due to median arcuate ligament compression (MALC), arteriosclerosis, pancreatitis, tumor invasion, and celiac axis agenesis has been reported. However, clinically significant ischemic bowel disease attributable to celiac axis stenosis/occlusion appears to be rare because the superior mesenteric artery (SMA) provides for rich collateral circulation. In patients with celiac axis stenosis/occlusion, the most important and frequently encountered collateral vessels from the SMA are the pancreaticoduodenal arcades. Patients with celiac artery stenosis/occlusion are treated by interventional radiology (IR) via dilation of the pancreaticoduodenal arcade. In patients with dilation of the pancreaticoduodenal arcade on SMA angiograms, IR through this artery may be successful. Here we provide several tips on surmounting these difficulties in IR including transcatheter arterial chemoembolization for hepatocellular carcinoma, an implantable port system for hepatic arterial infusion chemotherapy to treat metastatic liver tumors, coil embolization of pancreaticoduodenal artery aneurysms, and arterial stimulation test with venous sampling for insulinomas.

  4. Elongation and dilatation of the basilar artery in CT imaging; Wydluzenie i poszerzenie tetnicy podstawowej w obrazie KT

    Energy Technology Data Exchange (ETDEWEB)

    Lasek, W.; Burzynska-Makuch, M.; Pilecki, S.; Grzegorzewski, M.; Boron, Z. [Akademia Medyczna, Bydgoszcz (Poland)

    1994-12-31

    During two years 5 rare cases of elongation and dilatation of basilar artery were recognized in CT examination. In patients with cranial nerve deficits, cerebellar, brainstem and ponto-cerebellar angle signs artery megadolichobasilaris should be taken into account. CT examination is the sufficient method to see the diagnosis. (author). 15 refs, 3 tabs, 4 figs.

  5. Thrombophilic screening in retinal artery occlusion patients

    Directory of Open Access Journals (Sweden)

    Valeria Nagy

    2008-10-01

    Full Text Available Valeria Nagy1, Lili Takacs1, Zita Steiber1, György Pfliegler2, Andras Berta11Department of Ophthalmology, 2Division of Rare Diseases, University of Debrecen Medical and Health Science Center, Debrecen, HungaryBackground: Retinal artery occlusion (RAO is an ischemic vascular damage of the retina, which frequently leads to sudden, mostly irreversible loss of vision. In this study, blood thrombophilic factors as well as cardiovascular risk factors were investigated for their relevance to this pathology. Thrombophilic risk factors so far not evaluated were included in the study.Patients and methods: 28 RAO patients and 81 matched control subjects were examined. From blood samples, protein C, protein S, antithrombinopathy, and factor V (Leiden mutation (FV, factor II gene polymorphism, factor VIII C level, plasminogen activity, lipoprotein(a and fibrinogen levels, hyperhomocysteinemia and presence of anticardiolipin – antiphospholipid antibodies were investigated. Possibly relevant pathologies such as diabetes mellitus, hypertension, and ischemic heart disease were also registered. Statistical analysis by logistic regression was performed with 95% confidence intervals.Results: In the group of patients with RAO only the incidence of hypertension (OR: 3.33, 95% CI: 1.30–9.70, p = 0.014 as an average risk factor showed significant difference, but thrombophilic factors such as hyperfibrinogenemia (OR: 2.9, 95% CI: 1.29–6.57, p = 0.010 and the presence of FV (Leiden mutation (OR: 3.9, 95% CI: 1.43–10.96, p = 0.008 increased the chances of developing this disease.Conclusions: Our results support the assumption that thrombophilia may contribute to the development of RAO besides vascular damage due to the presence of cardiovascular risk factors. Further studies are needed, however, to justify the possible use of secondary prophylaxis in form of anticoagulant/antiplatelet therapy.Keywords: retinal arterial occlusion, risk factors, thrombophilia

  6. Endothelin-1 and endothelin receptors in the basilar artery of the capybara.

    Science.gov (United States)

    Loesch, Andrzej; Gajkowska, Barbara; Dashwood, Michael R; Fioretto, Emerson T; Gagliardo, Karina M; Lima, Ana R De; Ribeiro, Antonio A C M

    2005-02-01

    Little is known about cerebral vasculature of capybara, which seems may serve as a natural model of studying changes in cerebral circulation due to internal carotid artery atrophy at animal sexual maturation. This is the first study of the light- and electron-immunocytochemical localisation of endothelin-1 (ET-1) and ETA and ETB endothelin receptors in the basilar artery of capybaras (6 to 12-month-old females and males) using an ExtrAvidin detection method. All animals examined showed similar patterns of immunoreactivity. Immunoreactivity for ET-1 was detected in the endothelium and adventitial fibroblasts, whilst immunoreactivity for ETA and ETB receptors was present in the endothelium, vascular smooth muscle, perivascular nerves and fibroblasts. In endothelial cells immunoreactivity to ET-1 was pronounced in the cytoplasm or on the granular endoplasmic reticulum. Similar patterns of immunolabelling were observed for ETA and ETB receptors, though cytoplasmic location of clusters of immunoprecipitate seems dominant. These results suggest that the endothelin system is present throughout the wall of the basilar artery of capybara.

  7. Isolated supraclinoid occlusive disease of the internal carotid artery.

    Science.gov (United States)

    Lagrèze, H L; Hartmann, A; Ries, F; Wappenschmidt, J; Hanisch, E

    1987-01-01

    Isolated supraclinoid occlusive disease of the internal carotid artery is a rare cause of cerebral ischemia. The authors of the only review of this subject concluded that it is caused predominantly by factors other than atherosclerosis. We examined 6 patients with isolated supraclinoid occlusive lesions. Five of them had one or more risk factors for atherosclerosis. Thus, the isolated stenosis of that part of the internal carotid artery does not seem to represent a particular pathologic entity.

  8. Digital Artery Occlusion Secondary to Plastic Shopping Bag Trauma

    Science.gov (United States)

    Joy, R; Isaacs, JL; McCarthy, RJ

    2007-01-01

    Upper limb digital arterial occlusion is uncommon. We present the case of a 47-year-old man with an ischaemic right middle finger (dominant hand) due to trauma from carrying a heavy plastic shopping bag. Duplex scanning revealed no proximal source of emboli. An angiogram demonstrated occlusions in the medial and lateral digital arteries of the middle digit at the level of the proximal phalanx. Treatment with heparin and warfarin resulted in complete resolution of symptoms. PMID:18201465

  9. Successful coil embolization of a ruptured basilar artery aneurysm in a child with leukemia: a case report.

    Science.gov (United States)

    Hayashi, Shihori; Maehara, Taketoshi; Mukawa, Maki; Aoyagi, Masaru; Yoshino, Yoshikazu; Nemoto, Shigeru; Ono, Toshiaki; Ohno, Kikuo

    2014-01-01

    Ruptured intracranial aneurysms are rare in the pediatric population compared to adults. This has incited considerable discussion on how to treat children with this condition. Here, we report a child with a ruptured saccular basilar artery aneurysm that was successfully treated with coil embolization. A 12-year-old boy with acute lymphoblastic leukemia and accompanying abdominal candidiasis after chemotherapy suddenly complained of a severe headache and suffered consciousness disturbance moments later. Computed tomography scans and cerebral angiography demonstrated acute hydrocephalus and subarachnoid hemorrhage caused by saccular basilar artery aneurysm rupture. External ventricular drainage was performed immediately. Because the patient was in severe condition and did not show remarkable signs of central nervous system infection in cerebrospinal fluid studies, we applied endovascular treatment for the ruptured saccular basilar artery aneurysm, which was successfully occluded with coils. The patient recovered without new neurological deficits after ventriculoperitoneal shunting. Recent reports indicate that both endovascular and microsurgical techniques can be used to effectively treat ruptured cerebral aneurysms in pediatric patients. A minimally invasive endovascular treatment was effective in the present case, but long-term follow-up will be necessary to confirm the efficiency of endovascular treatment for children with ruptured saccular basilar artery aneurysms.

  10. Occlusion of Internal Carotid Artery in Kimura's Disease

    Directory of Open Access Journals (Sweden)

    Tomonori Tamaki

    2010-01-01

    Full Text Available We describe a unique case of Kimura's disease in which cerebral infarction was caused by occlusion of the right internal carotid artery. A 25-year-old man with Kimura's disease was admitted to our hospital because of left hemiparesis. Computed tomography and magnetic resonance imaging of the head showed infarction in the right frontal and temporal lobes. Cerebral angiography demonstrated right internal carotid artery occlusion affecting the C1 segment, with moyamoya-like collateral vessels arising from the right opthalamic artery. Kimura's disease is a chronic disease characterized by the clinical triad of slowly enlarging subcutaneous masses with lymphoid hyperplasia in the head and neck. It often occurs in young Asian men. In our patient, the pathogenesis of internal carotid artery occlusion was unknown. There have only been a few case reports in which occlusion of the internal carotid artery was associated with autoimmune disease, and no previous cases of internal carotid occlusion associated with Kimura's disease have been reported. We suspected that occlusion of this patient's internal carotid artery may be caused by the autoimmune mechanism that underlies Kimura's disease.

  11. Central retinal artery occlusion (reversible in sickle trait with glaucoma.

    Science.gov (United States)

    Radius, R L; Finkelstein, D

    1976-01-01

    We report a case of central retinal artery occlusion in an 18-year-old black woman with sickle-trait haemoglobinopathy and acute glaucoma after hyphaema. The central retinal artery occlusion occurred immediately after treatment of the glaucoma with osmotic agents, raising the possibility that they played a precipitating role. We suggest that osmotic agents be used with extreme caution in sickle patients with glaucoma. The occlusion was treated by anterior chamber paracentesis with eventual return of good vision. The reversibility of retinal and optic nerve function after total ischaemia is discussed. PMID:952815

  12. Distal arterial occlusive disease in diabetes is related to medial arterial calcification.

    Science.gov (United States)

    Chantelau, E; Lee, K M; Jungblut, R

    1997-01-01

    In diabetes mellitus, peripheral arterial occlusive disease predominantly affects the lower leg (tibial and peroneal vessel disease). Our study suggests that this feature is related to the presence of forefoot medial arterial calcification.

  13. Leptospirosis and Peripheral Artery Occlusive Disease

    Science.gov (United States)

    Chiu, Chun-Hsiang; Lin, Cheng-Li; Lee, Feng-You; Wang, Ying-Chuan; Kao, Chia-Hung

    2016-01-01

    Abstract Data on the association between peripheral artery occlusive disease (PAOD) and leptospirosis are limited. We conducted a retrospective cohort study for determining whether leptospirosis is one of the possible risk factors for PAOD. Patients diagnosed with leptospirosis by using 2000 to 2010 data from the Taiwan National Health Insurance Research Database. Patients with leptospirosis without a history of PAOD were selected. For each leptospirosis patient, 4 controls without a history of leptospirosis and PAOD were randomly selected and frequency-matched for sex, age, the year of the index date, and comorbidity diseases. The follow-up period was from the time of the initial diagnosis of leptospirosis to the diagnosis date of PAOD, or December 31, 2011. The Cox proportional hazard regression models were used for analyzing the risk of PAOD. During the follow-up period, the cumulative incidence of PAOD was higher among the patients from the leptospirosis cohort than among the nonleptospirosis cohort (log-rank test, P < 0.001). In total, 29 patients with PAOD from the leptospirosis cohort and 81 from the nonleptospirosis cohort were observed with the incidence rates of 2.1 and 1.3 per 1000 person-years, respectively, yielding a crude hazards ratio (HR) of 1.62 (95% confidence interval [CI] = 1.44–1.81) and adjusted HR (aHR) of 1.75 (95% CI = 1.58–1.95). The risk of PAOD was 1.75-fold higher in the patients with leptospirosis than in the general population. PMID:26986166

  14. Cardioembolic occlusion of the internal carotid artery presented with infarction in the posterior cerebral artery territory

    Institute of Scientific and Technical Information of China (English)

    XUE Su-fang; JIA Jian-ping

    2010-01-01

    @@ Posterior circulation stroke may rarely be associated with occlusive disease in the anterior circulation, such as in the context of a direct (fetal) origin of the posterior cerebral artery (PCA) from the internal carotid artery (ICA), or in the presence of a persistent trigeminal artery (PTA) or persistent hypoglossal artery (PHA).1,2

  15. Radiological evaluation of multiple progressive intracranial arterial occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Park, Byung Whan; Choi, Byung Ihn; Ha, Sung Whan [Capital Armed Forces General Hospital, Seoul (Korea, Republic of)

    1980-12-15

    Multiple Progressive intracranial Arterial Occlusion (MPIAO) is a rare cerebrovascular disease and its clinical diagnosis is nearly impossible and diagnosis depends upon neuroradiological studies. Among neuroradiological studies, cerebral angiography is mandatory in diagnosis and in localization of stenotic or occlusive vascular lesion, visualization of collateral channels and aid the surgical management. Five cases MPIAO which were proved by cerebral angiography at Capital Armed Forces General Hospital during last 5 years are presented, with analysis of radiological findings as well as clinical assessment. The results are as follows; 1. Age distribution ranges from 23 to 46. For cases are male and one female. 2. Cardinal clinical symptoms are headache and vomiting, and neurological manifestations are hemiplegia and speech disturbance. 3. All cases show the characteristic angiographic findings of MPIAO which are occlusion or stenosis at the distal internal carotid artery, proximal part of anterior and middle cerebral arteries with fine collateral network in basal ganglia area, leptomeningeal anastomosis and transdural external-internal carotid anastomoses. The major region of occlusion or stenosis is first portion of anterior and middle cerebral arteries. In one case, the lesion is seen in cervical portion of internal carotid artery. There is no evidence of occlusion or stenosis in vertebral angiogram. 4. In 2 cases, computed tomography was done. One case shows the findings of cerebral infarction and the other intracerebral hematoma.

  16. Choice PTTM guidewire for recanalization of total occlusive coronary arteries

    Institute of Scientific and Technical Information of China (English)

    OUYANG Ping; HE Shi-hua; CHEN Wei-Kang; WOO Carrie

    2002-01-01

    Objective: To evaluate the therapeutic effects of 0. 014″Choice PTTM wire in chronic total occlusion angioplasty. Methods: Balloon angioplasty was attempted in 25 arteries with chronic total occlusion,with the mean time of occlusion of 17±13 months (ranging from 2 to 84 months) and mean length of 14±6mm (ranging from 5 to 25 mm). The morphology of the lesions included bridging collaterals (4 cases), calcification (3 cases) and major side branch at the lesion (4 cases) . Choice PTTM wire was used electively in all the cases. Results: Lesion was crossed successfully in 92% (23/25) cases, without incidences of dissection of the coronary artery with subintimal entry. Balloon angioplasy and stenting (n=21) were performed with good immediate angiograghic results. Acute myocardial infarction or death occurred in none of the patients.Conclusion Successful recanalization of chronic coronary total occlusions using Choice PTTM wire can be achieved with good safety.

  17. Spontaneous regression of a giant basilar artery aneurysm in a young adult after surgical injury:case report and literature review

    Institute of Scientific and Technical Information of China (English)

    ZHANG He; LI Ming-hua; WANG Chun; LI Yong-dong; XU Tao

    2007-01-01

    A giant basilar artery aneurysm of young woman with endocrine disturbance was misdiagnosed as a large pituitary adenoma and treated surgically via a trans-sphenoidal approach was planned.But the neurosurgery was finally aborted because of massive bleeding during the procedure. One year later, a cerebral angiography confirmed this basilar artery aneurysm was obviously regressed and then endovascular coiling was successfully performed. No neurological complication occurred post-procedure and the endocrine dysfunction symptom was obviously improved.

  18. Progression from stenosis to occlusion in the proximal native coronary artery after coronary artery bypass grafting.

    Science.gov (United States)

    Tanaka, Akihito; Ishii, Hideki; Oshima, Hideki; Shibata, Yohei; Tatami, Yosuke; Osugi, Naohiro; Ota, Tomoyuki; Kawamura, Yoshihiro; Suzuki, Susumu; Usui, Akihiko; Murohara, Toyoaki

    2016-07-01

    Coronary artery bypass grafting (CABG) is an established treatment for multivessel coronary artery disease. However, problematic situations are occasionally encountered after CABG, such as disease progression in the native coronary artery with graft occlusion, which causes difficulty in revascularization. The purpose of this study was to evaluate changes in the native coronary artery after CABG. Between 2009 and 2012 in our institution, 351 patients underwent CABG, and 768 bypass grafts were anastomosed to non-occluded coronary arteries. Of these, 489 bypass grafts had available early postoperative angiographic results (≤6 months) suitable for assessment in this study. We defined malignant graft failure after CABG to be bypass graft occlusion and de novo complete occlusion of the target native coronary artery proximal to the graft anastomosis site. In the early angiographic results, 17 grafts were occluded (17/489; 3.5 %). Two of the grafts displayed malignant graft failure (a saphenous vein graft to the right coronary artery and a saphenous vein graft to the diagonal branch) (2 of 17 occluded grafts, and 2 of 489 studied grafts). Of the patent bypass grafts, 24 involved progression to occlusion in the proximal native coronary artery (19 saphenous vein grafts, 4 left internal thoracic artery grafts, and 1 right internal thoracic artery graft). Malignant graft failure was uncommon during short-term follow-up after CABG. At the same time, disease progression in the proximal native coronary artery from stenosis to occlusion following patent bypass grafting was relatively common, especially for vein grafts.

  19. A Case of Branch Retinal Artery Occlusion following Uneventful Phacoemulsification

    Directory of Open Access Journals (Sweden)

    Daniel Dragnev

    2013-03-01

    Full Text Available We would like to present a case of branch retinal artery occlusion following uneventful phacoemulsification, possibly caused by sub-Tenon's anaesthesia. There were no predisposing general health problems. There are two possible mechanisms: (1 mechanical effect of the bolus anaesthetic; (2 pharmacologically mediated changes in the vascular calibre. The latter mechanism is much more probable, because of the vasoconstrictive properties of both medications used. This is the first reported case of branch retinal artery occlusion after sub-Tenon's anaesthesia with preservative-free medications.

  20. Clinical characteristics of basilar artery syndrome%基底动脉尖综合征的临床特点

    Institute of Scientific and Technical Information of China (English)

    成亚琴

    2013-01-01

    Objective To investigate the clinical manifestations and imaging characteristics of the basilar artery syndrome. Methods A retrospective analysis of 32 cases with acute basilar artery syndrome was made. Results The patients were all acute onset with dizziness and vomiting in 12 cases,blurred vision in 3 cases, slurred speech in 14 cases, disturbance of consciousness in 16 cases, lmb paralysis in 14 case, unsteady gait in 5 cases, and headache and vomiting in 1 case. Multiple lesions were seen on the cerebral imagings in all patients. Conclusion The clinical manifestations of the basilar artery syndrome are veriable and complex with mild paralysis. MRI is helpful in the early diagnosis of the basilar artery syndrome.%目的 探讨基底动脉尖综合征的临床表现及影像学特点.方法 回顾性分析32例急性基底动脉尖综合征患者的临床资料.结果 32例患者均为急性起病,临床表现为眩晕、呕吐12例,视物不清3例,言语不清14例,意识障碍16例,肢体瘫痪14例,行走不稳5例,起病时仅感头痛、呕吐1例.所有患者头颅影像学检查均发现多发性病灶.结论 基底动脉尖综合征临床表现复杂多样,瘫痪程度较轻,MRI成像有助于早期确诊.

  1. Retinal arterial occlusion in Takayasu′s arteritis

    Directory of Open Access Journals (Sweden)

    Kaushik Sushmita

    2005-01-01

    Full Text Available Takayasu′s arteritis is an auto-immune disorder of the large and medium-sized arteries, commonly involving the heart and its main vessels. It is now recognised that the inflammatory process of the large arteries affects regions of the walls supplied by the vasa vasorum, suggesting that primary small vessel involvement may contribute to the development of the clinico-pathological features of Takayasu aorto-arteritis. Classical ophthalmic features of the disease result from reduced ocular perfusion, which manifests as hypoxic retinal changes such as microaneurysms, arterio-venous anastomosis and non-perfused areas. Branch retinal artery occlusion has not been previously described in this condition. This case illustrates retinal arterial occlusion as the presenting feature of Takayasu′s arteritis.

  2. Level selection in leg amputation for arterial occlusive disease

    DEFF Research Database (Denmark)

    Holstein, P

    1982-01-01

    In 102 leg amputations for arterial occlusion including 84 below-knee (BK), 16 above-knee (AD) and 2 through-knee (TK) amputations, the amputation level was determined by means of clinical criteria. The healing results and the selection of levels were then compared with sealed preoperative measur...

  3. Fundus artery occlusion caused by cosmetic facial injections

    Institute of Scientific and Technical Information of China (English)

    Chen Yanyun; Wang Wenying; Li Jipeng; Yu Yajie; Li Lin; Lu Ning

    2014-01-01

    Background With the increasing popularity of cosmetic facial filler injections in recent years,more and more associated complications have been reported.However,the causative surgical procedures and preventative measures have not been studied well up to now.The aim of this stady was to investigate the clinical characteristics and visual prognosis of fundus artery occlusion resulting from cosmetic facial filler injections.Methods Thirteen consecutive patients with fundus artery occlusion caused by facial filler injections were included.Main outcome measures were filler materials,injection sites,best-corrected visual acuity (BCVA),fundus fluorescein angiography,and associated ocular and systemic manifestations.Results Eleven patients had ophthalmic artery occlusion (OAO) and one patient each had central retinal artery occlusion (CRAO) and anterior ischemic optic neuropathy (AION).Injected materials included autologous fat (seven cases),hyaluronic acid (five cases),and bone collagen (one case).Injection sites were the frontal area (five cases),periocular area (two cases),temple area (two cases),and nose area and nasal area (4 cases).Injected autologous fat was associated with worse final BCVA than hyaluronic acid.The BCVA of seven patients with autologous fat injection in frontal area and temple area was no light perception.Most of the patients with OAO had ocular pain,headache,ptosis,ophthalmoplegia,and no improvement in final BCVA.Conclusions Cosmetic facial injections can cause fundus artery occlusion.Autologous fat injection tends to be associated with painful blindness,ptosis,ophthalmoplegia,and poor visual outcomes.The prognosis is much worse with autologous fat injection than hyaluronic acid injection.

  4. Hyperdense basilar artery sign diagnoses acute posterior circulation stroke and predicts short-term outcome

    Energy Technology Data Exchange (ETDEWEB)

    Tan, Xiaoping [Affiliated Hospital of China Medical University at Shenyang, Department of Neurology, Shengjing Hospital, Shenyang (China); Guo, Yang [Shengjing Hospital, Department of Neurology, Shenyang (China)

    2010-12-15

    It is well established that the hyperdense middle cerebral artery sign is a specific marker for early ischemia in anterior circulation. However, little is known about the hyperdense basilar artery sign (HDBA) in posterior circulation. Our aim was to determine whether the HDBA sign has utility in early diagnosis of acute posterior circulation stroke and prediction of short-term outcome. Three-blinded readers examined unenhanced computed tomography scans for the HDBA sign, and materials were classified into two groups according to this sign. Vascular risk factors, admission and discharge National Institute of Health Stroke Scale (NIHSS) scores, short-term outcome, and radiological findings between the two groups were compared. One hundred and twenty-six cases of acute posterior circulation stroke (PCS) were included in the study. No statistically significant differences were found in risk factors of ischemic stroke, except atrial fibrillation (P = 0.025). Admission and discharge NIHSS scores for the positive HDBA group were significantly higher than scores for the negative HDBA group (P = 0.001, 0.002, respectively). The infarction territory for the positive HDBA group was mainly multi-region in nature (51.6%, P < 0.001), while the negative HDBA group showed mainly middle territory infarction. Significant independent predictors of short-term outcome included the HDBA sign (P < 0.001) and admission NIHSS scores (P < 0.001). Approximately half of the HDBA patients showed multi-region infarction and a serious neurological symptom. Based on our results, this sign might not only be helpful in early diagnosis of acute PCS but also be able to correlate with a poor short-term outcome. (orig.)

  5. CABG surgery in a patient with left iliac artery occlusion

    Directory of Open Access Journals (Sweden)

    Oscar F. De La Peña Brush

    2015-09-01

    Full Text Available We present the case of an 82 years old male with Congestive Heart Failure (Left Ventricle Ejection Fraction: 20% and Acute Pulmonary Edema secondary to Acute Myocardial Infarction that required Coronary Artery Bypass Graft (CABG surgery. Past Medical History included Aortoiliac Occlusive Ddisease with total occlusion of the Left Iliac Artery and collateral circulation to the left inferior limb through the Left Internal Mammary Artery (LIMA. CABG was perfomed without harvesting the LIMA due to high risk of leg ischemia. An attempt to revascularize the left limb previous to the cardiac surgery in other to do so. Would have been too risky in this case. After 2 months follow up, patient showed good clinical outcomes.

  6. 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.

  7. Suppression of ischemia in arterial occlusive disease by JNK-promoted native collateral artery development.

    Science.gov (United States)

    Ramo, Kasmir; Sugamura, Koichi; Craige, Siobhan; Keaney, John F; Davis, Roger J

    2016-08-09

    Arterial occlusive diseases are major causes of morbidity and mortality. Blood flow to the affected tissue must be restored quickly if viability and function are to be preserved. We report that disruption of the mixed-lineage protein kinase (MLK) - cJun NH2-terminal kinase (JNK) signaling pathway in endothelial cells causes severe blockade of blood flow and failure to recover in the murine femoral artery ligation model of hindlimb ischemia. We show that the MLK-JNK pathway is required for the formation of native collateral arteries that can restore circulation following arterial occlusion. Disruption of the MLK-JNK pathway causes decreased Dll4/Notch signaling, excessive sprouting angiogenesis, and defects in developmental vascular morphogenesis. Our analysis demonstrates that the MLK-JNK signaling pathway is a key regulatory mechanism that protects against ischemia in arterial occlusive disease.

  8. Complications of transcatheteral occlusion of abdominal arteries

    Energy Technology Data Exchange (ETDEWEB)

    Vogel, H.; Belz, Buecheler, E.

    1981-09-01

    The number of transcatheteral occulsion of abdominal arteries reported so far enables us to differentiate between complications, which are specific for the methods used, or which are organ-specific and material-specific. Among the complications specific for the methods concerned are: complications occuring in angiography; tumour embolism in the lung; transport of embolic material into the lung; transport of embolic material into the arteries of the lower half of the body; renal insufficiency; necrosis; and, finally, abscess formation. Among the organ-specific complications are: necrosis (especially of the spleen and in the operated upper gastro-intestinal tract); abscess formation (spleen, kidneys, liver); retroperitoneal phlegmones (kidney); relapsing haemorrhages (gastro-intestinal tract, kidneys); renal insufficiency (in case of pre-existing renal damage); hypertension (described so far as transient blood pressure increase only); hypertensive crisis (after renal artery occulsion for malignant hypertension); hepatic insufficiency and gallbladder infarction (in embolisation of the liver); transport of embolic material into adjacent arteris (in case of embolisation, into the vessels of the truncus coeliacus); and, finally, hypoglycaemia (in embolisation of the liver). Among the material-specific complications are: adhesion of the catheter tip to the vascular wall (Bucrylate); dislocation of Gianturco's spiral; allergic (anaphylactic) reaction to the embolic material (not described so far); recanalisation (in case of absorbable substances such as Fibrospum and Gelfoam); substitutive blood supply via the formation or extension of collaterals; necrosis in peripherally (capillary) occluding substances such as Bucrylate and Ethibloc; and, finally, abscess formation (in case of non-sterile embolic material). Some of these complications can be classified under more than one category.

  9. Popliteal artery occlusion in a young baseball athlete.

    Science.gov (United States)

    Guo, Mindy Ming-Huey; Chuech, Leonard Shun-Jen; Yang, Cheng-Hsu; Wu, Chiung-Jen; Guo, Gary Bih-Fang

    2007-02-01

    Popliteal artery occlusion is a rare vascular complication in athletes and has not been previously documented in baseball players. A 21-year-old male baseball player presented with a 10-month history of progressive claudication because of repeated trauma-induced popliteal artery occlusion from frequently practicing stealing bases by sliding down onto his right leg. He was found to have a transient deficiency in both protein C and protein S. The patient underwent percutaneous transluminal recanalization angioplasty followed by anticoagulation therapy, with good results. This case illustrates the importance of awareness of this potential complication in baseball athletes, work-up for a hypercoagulable state and the feasibility of angioplasty therapy in the management of ischemic limbs after trauma.

  10. Ocular neovascularization in eyes with a central retinal artery occlusion or a branch retinal artery occlusion

    Directory of Open Access Journals (Sweden)

    Mason lll JO

    2015-06-01

    Full Text Available John O Mason III,1,2 Shyam A Patel,1 Richard M Feist,1,2 Michael A Albert Jr,1,2 Carrie Huisingh,1 Gerald McGwin Jr,1,3 Martin L Thomley1,2 1Department of Ophthalmology, University of Alabama School of Medicine, Birmingham, AL, USA; 2Retina Consultants of Alabama, Callahan Eye Foundation Hospital, Birmingham, AL, USA; 3Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA Purpose: To investigate the ocular neovascularization (ONV rate in eyes with a branch retinal artery occlusion (BRAO or a central retinal artery occlusion (CRAO, and to study factors that may influence the ONV rate secondary to CRAO.Methods: This was a retrospective case series of consecutive patients (286 total eyes: 83 CRAOs and 203 BRAOs who were diagnosed with a retinal artery occlusion from 1998 to 2013 at the Retina Consultants of Alabama and University of Alabama at Birmingham, Birmingham, AL, USA. Generalized estimating equations were used to evaluate the association between hypothesized risk factors and ONV development.Results: Twelve (14.5% of the 83 eyes with a CRAO developed ONV. Eleven of 12 eyes (91.7% had iris neovascularization, ten of 12 eyes (83.3% had neovascular glaucoma, and two of 12 eyes (16.7% had neovascularization of the optic disc. The average time for ONV development secondary to CRAO was 30.7 days, ranging from the date of presentation to 137 days. Only two (<1.0% of the 203 eyes with a BRAO developed iris neovascularization. Diabetes mellitus type 2 was a risk factor for ONV development following a CRAO with an adjusted odds ratio of 5.2 (95% confidence interval: 1.4–19.8 (P=0.02.Conclusion: ONV is an important complication of CRAO and is a less-frequent complication of BRAO. Patients with a CRAO, especially those with diabetes mellitus type 2, should be closely monitored for the first 6 months for ONV. Keywords: neovascularization, neovascular glaucoma, retinal artery occlusion, central

  11. Schizencephaly with occlusion or absence of middle cerebral artery

    Energy Technology Data Exchange (ETDEWEB)

    Fernandez-Bouzas, A.; Harmony, T.; Santiago-Rodriguez, E.; Ricardo-Garcell, J.; Fernandez, T.; Avila-Acosta, D. [Instituto de Neurobiologia de la Universidad Nacional Autonoma de Mexico (UNAM) Campus Juriquilla, Juriquilla, QRO (Mexico)

    2006-03-15

    In a study of 160 infants with prenatal and/or perinatal risk factors for brain damage, we observed three cases of schizencephaly. All cases were unilateral, and the clefts had open lips. In two cases, magnetic resonance angiography showed occlusion or absence of the middle cerebral artery (MCA) on the affected side. Two of the patients, including one with absent flow in the MCA of the affected side, had ipsilateral cerebellar atrophy. (orig.)

  12. Total occlusion of left main coronary artery without angina pectoris.

    Science.gov (United States)

    DePace, N L; Kimbiris, D; Iskandrian, A S; Bemis, C E; Segal, B L

    1983-05-01

    A patient had total occlusion of the left main coronary artery that was proved by coronary arteriography. The patient was initially seen with clinical signs of congestive heart failure but without symptoms of angina pectoris or ECG evidence of myocardial infarction. The patient's extensive right-to-left coronary artery collaterals may have contributed to the absence of chest pain. Because of the severe left ventricular dysfunction and the absence of chest pain, the patient was treated with medical therapy. Six months after the cardiac catheterization, he was alive and well under New York Heart Association functional classification II.

  13. Basilar Artery Territory Stroke Secondary to Invasive Fungal Sphenoid Sinusitis: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Katherine A. Fu

    2015-03-01

    Full Text Available Background: Mucormycosis is a fungal infection with the following 5 classic forms: cutaneous, pulmonary, gastrointestinal, disseminated, and rhinocerebral. The rhinocerebral form can be rapidly progressive and invasive with a high mortality rate. We present a case of a 38-year-old man with invasive mucormycosis that led to a basilar artery territory stroke. Rhinocerebral mucormycosis is an unusual cause of stroke. Case Report: A 38-year-old man with a past medical history of diabetes mellitus presented with altered mental status. A lumbar puncture revealed eosinophilic pleocytosis with a mildly elevated total protein and borderline low glucose level. CT revealed a left medullary and cerebellar infarct confirmed by MRI. MRI also displayed a diffuse marrow signal abnormality in the clivus with contiguous sinus disease. Endoscopic sinus surgery confirmed that the fungal sinusitis was mucormycosis of the Rhizopus genus, which had affected the left sphenoid sinus, invaded through the skull base, and involved the basilar artery. He was given liposomal amphotericin (500 mg i.v. with posaconazole (400 mg i.v. twice daily. Due to the severity of the invasion and poor prognosis, the patient was discharged with comfort care measures. Discussion: Clinicians should be aware of invasive sinusitis as a rare cause of stroke in diabetics. Once the subarachnoid space and basal arteries of the brain have been invaded, the prognosis is very poor. The key to improvement of outcomes is early recognition and treatment, and examination of the sinuses on neuroimaging in all cases of stroke is vital.

  14. A novel method to determine perineal artery occlusion among male bicyclists

    OpenAIRE

    Sujeeth Parthiban; Hotaling, James M.; Martin Kathrins; Amit P. Baftiri; Sally Freels; Craig S. Niederberger

    2015-01-01

    Background. Perineal pressure due to bicycle riding has been associated with erectile dysfunction. We developed a novel method to measure the occlusive force exerted over the perineal arteries and determined perineal artery occlusion by a variety of seat designs. Methods. Doppler ultrasonography facilitated perineal artery localization and determination of the force required for perineal artery occlusion in 20 healthy men. Flexiforce® sensors were affixed over the proximal and distal aspects ...

  15. Carotid artery occlusion by rhinoorbitocerebral mucormycosis.

    Science.gov (United States)

    Al-Otaibi, Faisal; Albloushi, Monirah; Alhindi, Hindi; Timms, Michael S

    2012-01-01

    Mucormycosis is the third most common invasive fungal infection that particularly occurs in immunocompromised patients. Intracranial and extracranial arteriovenous vasculopathy is a complication that makes this disease more complex and difficult to treat. We describe a 23-year-old female, who presented to her local hospital with acute blindness and diabetic ketoacidosis-induced coma requiring intensive care treatment. She was found to have lesions in the nasal sinuses, orbit, and frontal base. The left carotid artery was occluded from its origin in the neck to the supraclinoid segment and left cavernous sinus involvement. No cerebral infarction was noted. Biopsies obtained by endonasal debridement confirmed mucormycosis. In addition to antimicrobial therapy, she underwent several multidisciplinary approaches to treat her disease. Multiple endonasal, and cranial procedures were done including bilateral orbital exenteration. After prolonged treatment on the intensive care unit she made a remarkable recovery to the point where she was communicating verbally and had normal limb movements and later discharged home. She remained alive and well for two months, but later succumbed to a recurrence of her disease. In conclusion, mucormycosis-induced vasculopathy is a complex problem, which merits aggressive treatment of this invasive disease. It is normally regarded as an indicator of grave prognosis.

  16. Carotid Artery Occlusion by Rhinoorbitocerebral Mucormycosis

    Directory of Open Access Journals (Sweden)

    Faisal Al-Otaibi

    2012-01-01

    Full Text Available Mucormycosis is the third most common invasive fungal infection that particularly occurs in immunocompromised patients. Intracranial and extracranial arteriovenous vasculopathy is a complication that makes this disease more complex and difficult to treat. We describe a 23-year-old female, who presented to her local hospital with acute blindness and diabetic ketoacidosis-induced coma requiring intensive care treatment. She was found to have lesions in the nasal sinuses, orbit, and frontal base. The left carotid artery was occluded from its origin in the neck to the supraclinoid segment and left cavernous sinus involvement. No cerebral infarction was noted. Biopsies obtained by endonasal debridement confirmed mucormycosis. In addition to antimicrobial therapy, she underwent several multidisciplinary approaches to treat her disease. Multiple endonasal, and cranial procedures were done including bilateral orbital exenteration. After prolonged treatment on the intensive care unit she made a remarkable recovery to the point where she was communicating verbally and had normal limb movements and later discharged home. She remained alive and well for two months, but later succumbed to a recurrence of her disease. In conclusion, mucormycosis-induced vasculopathy is a complex problem, which merits aggressive treatment of this invasive disease. It is normally regarded as an indicator of grave prognosis.

  17. Neurofibromatosis, stroke and basilar impression: case report

    Directory of Open Access Journals (Sweden)

    PIOVESAN ELCIO JULIATO

    1999-01-01

    Full Text Available Neurofibromatosis type 1 (NF1 can virtually affect any organ, presenting most frequently with "cafe au lait" spots and neurofibromas. Vasculopathy is a known complication of NF1, but cerebrovascular disease is rare. We report the case of a 51-year-old man admitted to the hospital with a history of stroke four months before admission. On physical examination, he presented various "cafe au lait" spots and cutaneous neurofibromas. Neurologic examination demonstrated right-sided facial paralysis, right-sided hemiplegia, and aphasia. Computed tomography scan of head showed hypodense areas in the basal ganglia and centrum semiovale. Radiographs of cranium and cervical spine showed basilar impression. Angiography revealed complete occlusion of both vertebral and left internal carotid arteries, and partial stenosis of the right internal carotid artery. A large network of collateral vessels was present (moyamoya syndrome. It is an uncommon case of occlusive cerebrovascular disease associated with NF1, since most cases described in the literature are in young people, and tend to spare the posterior cerebral circulation. Basilar impression associated with this case may be considered a pure coincidence, but rare cases of basilar impression and NF1 have been described.

  18. The experience for stent assisted therapy application on complicated basilar artery apex aneurysm%支架辅助技术介入治疗复杂基底动脉顶端动脉瘤的临床应用

    Institute of Scientific and Technical Information of China (English)

    张金峰; 张向艳; 左书浩; 王东; 李建华; 屈浙; 田军; 胡昱红

    2015-01-01

    目的:总结采用支架辅助技术结合弹簧圈介入治疗复杂基底动脉顶端动脉瘤中的经验,并评估其安全性。方法回顾分析27例复杂基底动脉顶端动脉瘤,采用支架技术结合弹簧圈栓塞基底动脉顶端动脉瘤的临床资料。结果27例手术完成,影像学示完全填塞19例,近全填塞7例,疏松填塞1例。手术并发症3例:1例出血,1例载瘤动脉闭塞,1例弹簧圈脱落。死亡2例:1例V级,1例术前2次出血。结论支架辅助技术结合弹簧圈介入治疗复杂基底动脉顶端动脉瘤是一种可选择的、安全的、有效的方法。%Objective To evaluate the security of application with stent assisted therapy combined with axiom detach-able coil on complicated basilar artery apex aneurysm. Method To review and analyze 27 complicated basilar artery apex aneurysm surgery cases, using the application of stent assisted therapy combined with detachable coil deal with the basilar artery apex aneurysm. Result The image of the 27 surgery cases showed that 19 cases were completed tamponed, and 7 cased were nearly completed tamponed, 1 loose tamponed. It also had three operation complica-tions:one hemorrhaged, one parent artery occlusion, one coil detached. 2 death cases: one was V-level, another had secondary hemorrhaged before surgery. Conclusion The application with stent assisted therapy on complicated basilar artery apex aneurysm is selectable, safe and effective.

  19. Peripheral Arterial Occlusive Disease - an Interdisciplinary Approach

    Directory of Open Access Journals (Sweden)

    Groechenig E

    2003-01-01

    Full Text Available Vascular diseases are the most common diseases and the most common causes of death in developed countries. Many medical disciplines deal with vascular diseases and there is no strict and clear concept in education and training of these physicians. In German-speaking countries "angiology" was established several years ago. The angiologist is a highly qualified physician, who, in most cases, comes from internal medicine (a minority from dermatology. Although peripheral arterial disease (PAD is the most frequent disease angiology deals with, the angiologist has to have a broad knowledge of general vascular medicine and has to be qualified in all diagnostic and therapeutic procedures. PAD is just like the tip of an iceberg and has to be mentioned as a severe disease with a bad overall prognosis similar to that of Duke-B colon carcinoma. So, global access with staging and grading of atherosclerosis, evaluation of concomitant diseases, control of risk factors and adequate treatment of PAD is the gold standard. Therefore, several medical specialities are involved with the angiologist functioning as the integrative "general manager" between the disciplines for the welfare of the patient. Periphere arterielle Verschlußkrankheit - ein interdisziplinärer Ansatz. Gefäßkrankheiten sind die häufigsten Erkrankungs- und Todesursachen in den industrialisierten Ländern. Gefäßerkrankungen können sich an verschiedensten Organen manifestieren und dazu führen, daß unterschiedliche medizinische Disziplinen damit beschäftigt werden, ohne daß häufig eine gefäßspezifische Ausbildung vorhanden ist. Um diesem Umstand Rechnung zu tragen, wurde in den deutschsprachigen Ländern vor einigen Jahren der Additivfacharzt für Angiologie eingeführt. Der Angiologe ist ein hochqualifizierter Spezialist mit einer internistischen (seltener dermatologischen Basisausbildung. Der Angiologe hat einerseits ein breites Wissen über die allgemeine Gefäßpathologie und

  20. Branch Retinal Artery Occlusion Caused by Toxoplasmosis in an Adolescent

    Directory of Open Access Journals (Sweden)

    Elizabeth Chiang

    2012-10-01

    Full Text Available Purpose: Branch retinal artery occlusion (BRAO, while not uncommon in elderly patient populations, is rare in children and adolescents. We report a case of a BRAO secondary to toxoplasmosis in this demographic. Case: A previously healthy 17-year-old male developed a unilateral BRAO in conjunction with inflammation and increased intraocular pressure. Family history was positive for cerebrovascular accidents in multiple family members at relatively young ages. The patient had a hypercoagulable workup as well as a cardiovascular workup which were both normal. A rheumatologic workup was unremarkable. By 3 weeks, a patch of retinitis was more easily distinguished from the BRAO and the diagnosis of ocular toxoplasmosis was made. Treatment was started with prednisone and azithromycin with subsequent improvement in vision. Toxoplasma antibody levels were elevated for IgG and negative for IgM, IgA, and IgE. The etiology of the BRAO was attributed to ocular toxoplasmosis. Conclusions: Vascular occlusions are rare in toxoplasmosis. This is the third case report of a BRAO in a patient in the pediatric population. The diagnosis of ocular toxoplasmosis should be considered in young patients with retinal artery occlusions associated with inflammation.

  1. Acute arterial occlusion in the midpiece of femoral artery following total knee arthroplasty: Report of one case

    Institute of Scientific and Technical Information of China (English)

    Rui He; Liu Yang

    2016-01-01

    Acute arterial occlusion is a rare complication following total knee arthroplasty (TKA).The incidence as reported previously is from 0.03% to 0.17%;however,the sequelae can be disastrous because of its potential threat to limb loss.We report a case of acute arterial occlusion in the midpiece of femoral artery following TKA occurred 40 min postoperatively.The occlusion site existed at the midpiece of femoral artery is uncommon.Arterial circulation of the lower limb could not be restored by the thrombolysis and thrombectomy treatments performed within 11 h after TKA.In the end,amputation had to be carried out.In the treatment of acute arterial occlusion following TKA with a tourniquet,it is important to fully consider that arteriosclerosis may induce atheromatous plaque disruption,which might be the reason for acute arterial occlusion.

  2. Sinus bradycardia as a predictor of right coronary artery occlusion in patients with inferior myocardial infarction.

    Science.gov (United States)

    Serrano, C V; Bortolotto, L A; César, L A; Solimene, M C; Mansur, A P; Nicolau, J C; Ramires, J A

    1999-01-01

    Differentiation of right coronary artery (RCA) from left circumflex artery (LCxA) occlusion may be difficult since both can present an electrocardiographic pattern of inferior myocardial infarction (IMI). We studied 133 patients with IMI, 92 patients with RCA occlusion and 41 patients with LCxA occlusion. Risk factors such as previous MI, arterial hypertension, diabetes, smoking, and dislipemia, were similar for RCA and LCxA occlusions. Patients with RCA occlusion had a higher incidence of isolated IMI than patients with LCxA occlusion, 50% vs. 17%, respectively (P<0.001). Arterial hypotension was more prevalent (P<0.05) among patients with RCA (18%) rather than those with LCxA occlusion (2%). RCA occlusion presented an association with sinus bradycardia, an association not observed with LCxA occlusion (15% vs. 0%, respectively; P<0.01). Total atrioventricular block was only present among patients with RCA (18%). Proximal occlusions of the RCA presented lower heart rates (sinus bradycardia) than medial and distal occlusions (13% vs. 1% and 1%, respectively; P<0.0001 and P<0.001). Therefore, regarding patients with IMI: (1) sinus bradycardia is more frequent when the infarct-related artery is the RCA; (2) proximal occlusions of the right coronary predispose low heart rates; and (3) occlusion of the LCxA rarely induces sinus bradycardia.

  3. Endovascular treatment strategies for supra-aortic arterial occlusive disease.

    Science.gov (United States)

    Peeters, P; Verbist, J; Deloose, K; Bosiers, M

    2005-06-01

    Because of the focal nature of stenoses or occlusions in the supra-aortic vasculature, the high blood-pressures in this area and the very low morbidity rates related to percutaneous therapy have largely replaced surgical revascularization as the initial treatment of choice for patients with supra-aortic arterial occlusive disease. The initial technical success and durability of percutaneous angioplasty (PTA) and stenting in these lesions is excellent. Nevertheless several factors can make PTA and stenting a complex procedure that requires advanced endovascular skills for a successful outcome. Profound knowledge of surgical reconstruction techniques or extra-anatomic bypasses remains mandatory, as it is occasionally required for failure of endovascular techniques or if contraindications exist.

  4. Vanillin and vanillin analogs relax porcine coronary and basilar arteries by inhibiting L-type Ca2+ channels.

    Science.gov (United States)

    Raffai, Gábor; Khang, Gilson; Vanhoutte, Paul M

    2015-01-01

    Vanillin (VA) and vanillyl alcohol (VAA), components of natural vanilla, and ethyl vanillin (EtVA; synthetic analog) are used as flavoring agents and/or as additives by the food, cosmetic, or pharmaceutic industries. VA, VAA, and EtVA possess antioxidant and anti-inflammatory properties, but their vascular effects have not been determined. Therefore, we compared in isolated porcine coronary and basilar arteries the changes in isometric tension caused by VA, VAA, and EtVA. VA and its analogs caused concentration-dependent relaxations of both preparations during contractions from U46619 (9,11-dideoxy-11α,9α-epoxymethanoprostaglandin F2α, a thromboxane A2 receptor agonist), and of coronary arteries contracted with KCl or endothelin-1. The order of potency was VAA vanillin additives.

  5. Alterations of voltage-dependent calcium channel currents in basilar artery smooth muscle cells at early stage of subarachnoid hemorrhage in a rabbit model.

    Directory of Open Access Journals (Sweden)

    Xianqing Shi

    Full Text Available OBJECTIVE: To investigate the changes in the currents of voltage-dependent calcium channels (VDCCs in smooth muscle cells of basilar artery in a rabbit model of subarachnoid hemorrhage (SAH. METHODS: New Zealand white rabbits were randomly divided into five groups: sham (C, normal (N, 24 hours (S1, 48 hours (S2 and 72 hours (S3 after SAH. Non-heparinized autologous arterial blood (1 ml/kg was injected into the cisterna magna to create SAH after intravenous anesthesia, and 1 ml/kg of saline was injected into cisterna magna in the sham group. Rabbits in group N received no injections. Basilar artery in S1, S2, S3 group were isolated at 24, 48, 72 hours after SAH. Basilar artery in group C was isolated at 72 hours after physiological saline injection. Basilar artery smooth muscle cells were isolated for all groups. Whole-cell patch-clamp technique was utilized to record cell membrane capacitance and VDCCs currents. The VDCCs antagonist nifedipine was added to the bath solution to block the Ca(++ channels currents. RESULTS: There were no significant differences in the number of cells isolated, the cell size and membrane capacitance among all the five groups. VDCC currents in the S1-S3 groups had higher amplitudes than those in control and sham groups. The significant change of current amplitude was observed at 72 hours after SAH, which was higher than those of 24 and 48 hours. The VDCCs were shown to expression in human artery smooth muscle cells. CONCLUSIONS: The changes of activation characteristics and voltage-current relationship at 72 hours after SAH might be an important event which leads to a series of molecular events in the microenvironment of the basilar artery smooth muscle cells. This may be the key time point for potential therapeutic intervention against subarachnoid hemorrhage.

  6. The history of surgical treatment for occlusive carotid artery diseases

    Directory of Open Access Journals (Sweden)

    Ding-biao ZHOU

    2014-01-01

    Full Text Available In this article, the history of surgical treatment for occlusive carotid artery diseases is briefly reviewed. It is emphasized that, after the results of large cohort, multicenter, randomized clinical trials, including North American Symptomatic Carotid Endarterectomy Trial (NASCET and European Carotid Surgery Trial (ECST, were reported in 1991, the important role of carotid endarterectomy (CEA for the surgical treatment of carotid atherosclerosis had already been confirmed. Although it has a late start in China, CEA has a bright and promising future.

  7. Bilateral Central Retinal Vein Occlusions Combined with Artery Occlusions in A Patient with Acquired Immune Deficiency Syndrome

    Institute of Scientific and Technical Information of China (English)

    Feng Wen; Xuemei Chen; Haitai Li; Ruiduan Liao; Dezheng Wu

    2002-01-01

    Purpose: This is the first report of a bilateral nonischemic central retinal vein occlusionscombined with artery occlusions in a patient with acquired immune deficiency syndrome(AIDS). Methods: Case report. Results: A 22-year-old Chinese(male) with a positive human immunodeficiency virus(HIV) infection developed bilateral nonischemic central retinal vein occlusions combinedwith artery occlusions and severe vision loss. The manifestations of the fundus andfluorescein angiography were similar in both eyes.Conclusion: This case report provides the evidences that central retinal vein and arteryocclusions are probably part of the spectrum of AIDS vascular diseases.

  8. [Cyclothymia and the brain stem. The question of symptomatic cyclothymia on the basis of observations in insufficiency of the basilar arterial system].

    Science.gov (United States)

    Marneros, A; Philipp, M

    1978-01-01

    Seven patients with an insufficiency in the basilar arterial system showed a typical endogenous depression. We assumed that the temporal coincidence of neurological and psychial syndromes was not accidental but both were caused by a circulation disturbance in the cerebral stem structures.

  9. Hypercapnic vasodilatation in isolated rat basilar arteries is exerted via low pH and does not involve nitric oxide synthase stimulation or cyclic GMP production

    DEFF Research Database (Denmark)

    You, J P; Wang, Qian; Zhang, W;

    1994-01-01

    The relaxant effect of hypercapnia (15% CO2) was studied in isolated circular segments of rat basilar arteries with intact endothelium. The nitric oxide synthase inhibitor nitro-L-arginine (L-NOARG) and the cytosolic guanylate cyclase inhibitor methylene blue (MB), significantly reduced...

  10. Catastrophic Antiphospholipid Syndrome Presenting as Bilateral Central Retinal Artery Occlusions

    Directory of Open Access Journals (Sweden)

    Steven S. Saraf

    2015-01-01

    Full Text Available A previously healthy 22-year-old African American woman presented with bilateral vision loss associated with headache. Her ocular examination was significant for bilateral retinal arterial “boxcarring,” retinal whitening, retinal hemorrhages, and cherry red spots. She was diagnosed with bilateral central retinal artery occlusions and was hospitalized due to concomitant diagnosis of stroke and hypercoagulable state. She was also found to be in heart failure and kidney failure. Rheumatology was consulted and she was diagnosed with catastrophic antiphospholipid syndrome in association with systemic lupus erythematosus. Approximately 7 months after presentation, the patient’s vision improved and remained stable at 20/200 and 20/80.

  11. Central retinal artery occlusion resembling Purtscher-like retinopathy

    Directory of Open Access Journals (Sweden)

    Etomi T

    2011-08-01

    Full Text Available Takuji Kurimoto1, Norio Okamoto2, Hidehiro Oku1, Yuko Kanbara1, Tomohiko Etomi1, Masahiro Tonari1, Tsunehiko Ikeda11Department of Ophthalmology, Osaka Medical College, Takatsuki, Japan; 2Okamoto Eye Clinic, Suita, Osaka, JapanAbstract: This paper reports three cases of central retinal artery occlusion (CRAO with Purtscher-like retinopathy and good recovery of visual function. The three cases of CRAO had similar fundus changes, ie, cotton wool patches surrounding the optic disc and whitening of the retina surrounding the fovea with a cherry red spot. Fluorescein angiography showed a delay of arm-to-retina circulation time and a partial defect of choroid circulation. Although the three cases were treated by different regimens of steroid pulse therapy and antiplatelet therapy, visual function recovered well and all disturbances of the retinal and choroid circulations resolved. Although eyes with a CRAO normally have a poor visual prognosis, our three cases responded well to the treatments and recovered good visual function. Thus, cases showing fundus changes similar to our three cases may have a pathogenesis different from that of a complete CRAO.Keywords: central retinal artery occlusion, cotton wool patches, Purtscher retinopathy, steroid therapy

  12. Evaluation of the Effects of Sildenafil Citrate (Viagra) on Vertebral Artery Blood Flow in Patients with Vertebro-Basilar Insufficiency

    Energy Technology Data Exchange (ETDEWEB)

    Bozgeyik, Zulkif; Berilgen, Sait; Ozdemir, Huseyin; Ogur, Erkin [Firat University School of Medicine, Elazig(Turkmenistan); Tekatas, Aslan [Elazig Government Hospital, Elazig (Turkmenistan)

    2008-12-15

    To investigate the effects of sildenafil citrate (Viagra) on the vertebral artery blood flow of patients with vertebro-basilar insufficiency (VBI) using color duplex sonography (CDS). The study included 21 patients with VBI (aged 31-76; mean 61.0 +- 10.5 yrs). We administered a 50 mg oral dose of sildenafil citrate to all patients. Next, we measured the peak systolic velocity (Vmax), end diastolic velocity (Vmin), resistive index (RI), pulsatility index (PI), diameter, area, and flow volume (FV) of vertebral arteries using CDS before the administration of sildenafil citrate; 45 minutes after, and 75 minutes after administration. Statistical testing was performed using SPSS for windows version 11.0. The statistical test used to determine the outcome of the analysis was the repeated measures analysis of variance (ANOVA) test. Compared to the baseline values, the vertebral artery diameter, area, and FV increased significantly following the administration of sildenafil citrate. The diameter, area and FV increased from 3.39 mm at 45 minutes to 3.64 mm at 75 minutes, 9.43 cm{sup 2} to 10.80 cm{sup 2} at 45 minutes and 10.81 cm{sup 2} at 75 minutes, as well as from 0.07 L/min at baseline to 0.09 L/min at 45 minutes and unchanged at 75 minutes, respectively. Sildenafil citrate elicited a significant effect on vertebral artery diameter, area and FVs

  13. Traumatic basilar pseudoaneurysm with a basilar-cavernous arteriovenous fistula

    Energy Technology Data Exchange (ETDEWEB)

    Connor, S.E.J.; Deasy, N.P.; Jeffree, M.A. [Dept. of Neuroradiology, King' s Coll. Hospital, London (United Kingdom); Martin, A.J.; Strong, A.J. [Dept. of Neurosurgery, King' s Coll. Hospital, London (United Kingdom)

    2001-03-01

    A traumatic pseudoaneurysm of the basilar artery with a basilar-cavernous sinus arteriovenous fistula was diagnosed in a 12-year-old girl using CT, MRI and angiography. It was successfully treated by coil embolisation. We speculate on the mode of formation of this rare traumatic lesion. (orig.)

  14. Dynamic contrast-enhanced ultrasound and transient arterial occlusion for quantification of arterial perfusion reserve in peripheral arterial disease

    Energy Technology Data Exchange (ETDEWEB)

    Amarteifio, E., E-mail: erick.amarteifio@med.uni-heidelberg.de [University Hospital of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Department of Radiology, German Cancer Research Center, Heidelberg (Germany); Wormsbecher, S. [University Hospital of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Department of Radiology, German Cancer Research Center, Heidelberg (Germany); Krix, M. [University Hospital of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Department of Radiology, German Cancer Research Center, Heidelberg (Germany); Bracco Imaging Germany, Konstanz (Germany); Demirel, S. [University Hospital of Heidelberg, Department of Vascular Surgery, Heidelberg (Germany); Braun, S. [Department of Biostatistics, German Cancer Research Center, Heidelberg (Germany); Delorme, S. [Department of Radiology, German Cancer Research Center, Heidelberg (Germany); Boeckler, D. [University Hospital of Heidelberg, Department of Vascular Surgery, Heidelberg (Germany); Kauczor, H.-U. [University Hospital of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Weber, M.-A. [University Hospital of Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Department of Radiology, German Cancer Research Center, Heidelberg (Germany)

    2012-11-15

    Objective: To quantify muscular micro-perfusion and arterial perfusion reserve in peripheral arterial disease (PAD) with dynamic contrast-enhanced ultrasound (CEUS) and transient arterial occlusion. Materials and methods: This study had local institutional review board approval and written informed consent was obtained from all subjects. We examined the dominant lower leg of 40 PAD Fontaine stage IIb patients (mean age, 65 years) and 40 healthy volunteers (mean age, 54 years) with CEUS (7 MHz; MI, 0.28) during continuous intravenous infusion of 4.8 mL microbubbles. Transient arterial occlusion at mid-thigh level simulated physical exercise. With time-CEUS-intensity curves obtained from regions of interest within calf muscles, we derived the maximum CEUS signal after occlusion (max) and its time (t{sub max}), slope to maximum (m), vascular response after occlusion (AUC{sub post}), and analysed accuracy, receiver operating characteristic (ROC) curves, and correlations with ankle-brachial index (ABI) and walking distance. Results: All parameters differed in PAD and volunteers (p < 0.014). In PAD, t{sub max} was delayed (31.2 {+-} 13.6 vs. 16.7 {+-} 8.5 s, p < 0.0001) and negatively correlated with ankle-brachial-index (r = -0.65). m was decreased in PAD (4.3 {+-} 4.6 mL/s vs. 13.1 {+-} 8.4 mL/s, p < 0.0001) and had highest diagnostic accuracy (sensitivity/specificity, 75%/93%) for detection of diminished muscular micro-perfusion in PAD (cut-off value, m < 5{approx}mL/s). Discriminant analysis and ROC curves revealed m, and AUC{sub post} as optimal parameter combination for diagnosing PAD and therefore impaired arterial perfusion reserve. Conclusions: Dynamic CEUS with transient arterial occlusion quantifies muscular micro-perfusion and arterial perfusion reserve. The technique is accurate to diagnose PAD.

  15. Lipid peroxidation following superior mesenteric artery occlusion in rat intestine

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    P. Pasbakhsh

    2006-07-01

    Full Text Available Background: The aim of this study was to determine the level of lipid peroxidation and tissue protein after superior mesenteric artery occlusion tissue damage. The effect of melatonin as anti oxidant and free radical scavenger in prevention of tissue damage, were also evaluated. Methods: Thity six young male Wisatr-Albino rats (weight: 80-120 gr, were divided equally in 6 group with different concentrations of melatonin (10,20,30 mg/kg treatment. Group 1was control, group 2 the sham that surgical process was applied until superior mesenteric artery dissection and received vehicle solution only in equally volume by intra muscular route. Group 3 was ischemia- reperfusion (I/R, group 4 was I/R plus melatonin 10 mg/kg, group 5 I/R plus melatonin 20 mg/kg and finally group 6 I/R plus melatonin 30 mg/kg. After laparatomy, a microvascular atraumatic clip was placed across the superior mesenteric artery under general anaesthesia and itbremoved after ischemia for 30 minutes. The first dose of melatonin was applied just beforereperfusion, second dose, after reperfusion and third dose on the second day .On third day rats were killed and their bowels were removed. The level of tissue melandialdehyde (MDA as index of lipid peroxidation and tissue protein was determined. Results: The level of tissue MDA were significantly lower in group 4, 5, 6 than group 3 (p0, 05. Conclusion: These results suggest that melatonin 10 mg/kg has antioxidant effect in prevention of inducing tissue damage during SMA occlusion in rat intestine.

  16. Bilateral Internal Carotid Artery Occlusion Associated with the Antiphospholipid Antibody Syndrome

    Directory of Open Access Journals (Sweden)

    Pria Anand

    2014-03-01

    Full Text Available A 39-year-old woman presented with a right-hemispheric stroke 1 year after she had suffered a left-hemispheric stroke. Her diagnostic workup was notable for bilateral occlusions of the internal carotid arteries at their origins and a positive lupus anticoagulant antibody test. There was no evidence of carotid dissection or another identifiable cause for her carotid occlusions. These findings suggest that the antiphospholipid antibody syndrome may be implicated in the pathological changes that resulted in occlusions of the extracranial internal carotid arteries. Young stroke patients who present with unexplained internal carotid artery occlusions may benefit from testing for the presence of antiphospholipid antibodies.

  17. Bilateral internal carotid artery occlusion associated with the antiphospholipid antibody syndrome.

    Science.gov (United States)

    Anand, Pria; Mann, Sharan K; Fischbein, Nancy J; Lansberg, Maarten G

    2014-01-01

    A 39-year-old woman presented with a right-hemispheric stroke 1 year after she had suffered a left-hemispheric stroke. Her diagnostic workup was notable for bilateral occlusions of the internal carotid arteries at their origins and a positive lupus anticoagulant antibody test. There was no evidence of carotid dissection or another identifiable cause for her carotid occlusions. These findings suggest that the antiphospholipid antibody syndrome may be implicated in the pathological changes that resulted in occlusions of the extracranial internal carotid arteries. Young stroke patients who present with unexplained internal carotid artery occlusions may benefit from testing for the presence of antiphospholipid antibodies.

  18. Acute Myocardial Infarction by Right Coronary Artery Occlusion Presenting as Precordial ST Elevation on Electrocardiography

    OpenAIRE

    Kim, Sung Eun; Lee, Jun-Hee; Park, Dae-Gyun; Han, Kyoo-Rok; Oh, Dong-Jin

    2010-01-01

    It is rare to observe ST-segment elevation in only the anterior leads and not the inferior leads during right coronary artery occlusion. We describe a case with acute myocardial infarction (MI) by right coronary artery occlusion who developed ST-segment elevation only in the precordial leads V1 to V3.

  19. 基底动脉发育不良影像学特征%Imaging characteristics of basilar artery hypoplasia

    Institute of Scientific and Technical Information of China (English)

    顾华; 钱晓军; 王双坤; 闵小红; 鲁万红; 胡文立

    2014-01-01

    目的 研究基底动脉发育不良(BAH)的影像学特征.方法 回顾2009年10月至2013年8月在首都医科大学附属北京朝阳医院进行MRA和MRI检查的连续病例.根据BAH诊断标准共检出210例BAH,测量(椎)基底动脉直径.根据诊断标准急性脑梗死分成前循环和后循环梗死.结果 10 193例MRA中检出210例BAH,女性多于男性.BAH伴有双侧胚胎型大脑后动脉175例(83.3%),单侧35例(16.7%).99.5% BAH患者伴有V4段椎动脉发育不良;颈段(V1 ~V3)椎动脉发育不良占56.0%(28/50).210例中74例合并急性脑梗死,男性多于女性(59.5%比40.5%,P=0.021).急性脑梗死中BAH的发病率是2.2%(74/3 294).结论 BAH是较少见的脑血管发育异常,伴有胚胎型大脑后动脉和V4段椎动脉发育不良.%Objective To determine the imaging characteristics of basilar artery hypoplasia (BAH).Methods From October 2009 to August 2013,10 193 magnetic resonance angiogram (MRA) and 31 716 magnetic resonance imaging (MRI) consecutive cases were retrospectively retrieved from our institutional Picture Archiving and Communication System (PACS) database.BAH was defined as a continuous diameter reduction all over artery and a basilar artery diameter ≤2 mm.The same cut-off value was applied for vertebral artery hypoplasia (VAH).We measured the diameters of basilar and vertebral arteries with PACS in all patients according to source imaging and IMP construction of MRA.The carotid arterial computed tomography angiogram (CTA) profiles were reviewed in 50 patients.The fetal-type posterior circle of Willis (FTP) was assessed.The diagnosis of acute cerebral infarction was based on clinical symptoms,signs and a high signal on diffusion-weighted imaging (DWI).Acute cerebral infarction was divided into anterior circulation stroke (ACS) and posterior circulation stroke (PCS).Results A total of 210 BAH were identified among 10 193 consecutive patients.BAH was more common in females (56.7%) than males

  20. 'Top of the basilar' syndrome: Clinico-radiological evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Sato, M.; Tanaka, S.; Kohama, A.

    1987-07-01

    Sixteen patients having infarction caused by circulatory disturbance at the top of the basilar artery, that is to say, the 'top of the basilar' syndrome, were studied, the diagnosis having been made by computerized tomography. Infarcts were widely distributed in each patient between the thalamus, midbrain, pons, cerebellum, and occipital lobe. Both thalami were involved in 7 cases. When the thalamus was involved bilaterally, the low density areas were symmetrical in size and localization. Angiography revealed that stenosis or occlusion by within a circle 2 cm in diameter surrounding the five-forked junction at the top of the basilar artery in 84.6%. Recanalization of the occluded artery occurred in 61.5%, suggesting that embolism played an important role in appearance of this syndrome.

  1. Selective thrombolysis performed through meningo-ophthalmic artery in central retinal artery occlusion.

    Science.gov (United States)

    Cohen, José E; Moscovici, Samuel; Halpert, Michael; Itshayek, Eyal

    2012-03-01

    The poor natural history of central retinal artery occlusion (CRAO) is usually not modified with conventional, conservative management techniques. Guidelines for selective intraarterial ophthalmic thrombolysis are still lacking. While many centers continue to perform this procedure with promising results, others are reluctant due to conflicting findings in recent studies. We present our experience in a 36-year-old male with CRAO. Based on the patient's clinical presentation, we planned to perform selective intraarterial ophthalmic thrombolysis via the ophthalmic artery. When angiography demonstrated that the retina was not supplied by the ophthalmic artery, but by a meningo-ophthalmic artery branching from the internal maxillary artery, we instead administered thrombolytic agents via the meningo-ophthalmic artery. The patient's vision recovered completely, with visual acuity and visual field examination at 30 day follow up comparable to his pre-treatment status. This case emphasizes the need for external carotid artery examination in cases of nonvisualization of the ophthalmic artery. In addition, it illustrates the successful use of the meningo-ophthalmic artery to perform selective intraarterial thrombolysis for CRAO.

  2. Balloon occlusion of the internal iliac arteries in the multidisciplinary management of placenta percreta

    DEFF Research Database (Denmark)

    Clausen, Caroline; Stensballe, Jakob; Albrechtsen, Charlotte K;

    2013-01-01

    Objective. To evaluate our experience with prophylactic balloon occlusion of the internal iliac arteries as a part of a multidisciplinary algorithm for the management of placenta percreta. Design. Consecutive case series. Setting. Rigshospitalet, Copenhagen University Hospital, Denmark. Sample....... Prophylactic balloon occlusion of the internal iliac arteries as part of a multidisciplinary algorithm allowed for a safe management of all cases in our consecutive series of 17 women with placenta percreta. However, intraoperative blood loss and transfusion requirements were significant. We have therefore...... decided to modify our multidisciplinary algorithm to include balloon occlusion of the common iliac arteries rather than the internal iliac arteries....

  3. Emergent revascularization of acute tandem vertebrobasilar occlusions: Endovascular approaches and technical considerations-Confirming the role of vertebral artery ostium stenosis as a cause of vertebrobasilar stroke.

    Science.gov (United States)

    Cohen, José E; Leker, Ronen R; Gomori, J Moshe; Eichel, Roni; Rajz, Gustavo; Moscovici, Samuel; Itshayek, Eyal

    2016-12-01

    Patients suffering from acute atherothrombotic occlusion of the proximal vertebral artery (VA) and concomitant basilar artery (BA) occlusion present a grim prognosis. We describe our experience in the endovascular recanalization of tandem vertebrobasilar occlusions using endovascular techniques. The BA was accessed through the normal VA (clean-road) or the occluded, thrombotic VA (dirty-road), and stentriever-based thrombectomy was performed using antegrade or reverse revascularization variants. Seven patients underwent successful stentriever-assisted mechanical thrombectomy of the BA and five sustained concomitant VA revascularization. Stroke onset to endovascular intervention initiation (time-to-treatment) ranged from 4.5-13hours (mean 8.6). In two of seven patients, the BA occlusion was approached with a 'clean-road' approach via the contralateral VA; in five of seven patients, a 'dirty-road' approach via the occluded VA was used. Mean time-to-recanalization was 66minutes (range 55-82). There were no perforations, iatrogenic vessel dissections, or other technical complications. Four patients presented mild-to-moderate disability (modified Rankin Scale [mRS] 0-3) at 3months, one remained with moderate-to-severe disability (mRS 4), and two patients died on days 9 and 23 after their strokes. Follow-up ranged from 6-45months (mean 24months). In selected patients with acute VA-BA occlusion, stentriever-based thrombectomy performed through either the patent or the occluded VA, may be feasible, effective, and safe. Clinical outcomes in these patients seem to equipoise the neurological outcome of patients with successful revascularization for isolated BA occlusion. This unique pair of occlusions confirms the role of VA ostium stenosis as a cause of vertebrobasilar stroke.

  4. Waveform patterns and peak reversed velocity in vertebral arteries predict severe subclavian artery stenosis and occlusion.

    Science.gov (United States)

    Chen, Shun-Ping; Hu, Yuan-Ping

    2015-05-01

    This study investigated the value of analyzing spectral Doppler waveform patterns and measuring the peak reversed velocity (PRV) of the vertebral artery (VA) in predicting proximal severe subclavian artery (SA) stenosis and occlusion. Fifty-one patients with proximal SA stenosis were studied retrospectively. Based on the depth of the mid-systolic notch, the Doppler waveforms of the ipsilateral VA were divided into five subtypes (type I, n = 8; type II, n = 8; type III, n = 6; type IV, n = 13; and type V, n = 16). PRV was also measured. PRV receiver operating characteristic curves were constructed to obtain the best cutoff value for predicting severe SA stenosis or complete SA occlusion. The results indicated that both VA Doppler waveform and PRV were associated with the degree of SA stenosis (p waveform in the VA had similar accuracy in predicting SA occlusion (84.3%, 43/51). PRV was more accurate than VA waveforms in predicting severe SA stenosis (98%, 50/51 vs. 94.1%, 48/51). However, no significant differences between the two methods in predicting severe SA stenosis were observed (p = 0.84). Thus, with severe obstruction of the SA, typical Doppler waveform patterns of the VA could be observed. PRV is a helpful criterion in predicting severe stenosis and occlusion of the SA.

  5. MRI evaluation of leptomeningeal anastomosis in middle cerebral artery occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Katsumata, Yasushi [Yokohama City Univ. (Japan). School of Medicine

    2001-05-01

    In steno-occlusive disease of the middle cerebral artery (MCA), there may be some discrepancy between the MRA and MRI findings, because the collateral flow via leptomeningeal anastomosis (LMA) from the anterior cerebral artery (ACA) to the MCA cannot be demonstrated in MRA. There is no simple method to evaluate the LMA non-invasively. We hypothesized that LMA could be identified as signal loss by flow void, so that the more LMA develops, the more the signal loss increases. We studied 18 patients with occlusive or markedly stenotic disease of the MCA, diagnosed by MRA. Although no collateral flow was demonstrated in MRA, several low signal spots suggesting flow void were noted in various degrees on the surface of the middle frontal gyrus, the border zone between the ACA and the MCA. These low signal spots were suspected to be LMA, and this was confirmed by angiography in 3 cases. Compared with the contralateral hemisphere, the spots were graded as ''-1'' (fewer), ''0'' (equal), ''+1'' (more), ''+2'' (markedly more). The number of Grades -1, 0, +1 and +2 was 0, 6, 5 and 7, respectively. MRI revealed infarct in the perforator territory in 16/18 cases. Cortical infarct was seen in 5/6 cases of Grade 0, 1/5 cases of Grade +1, and 0/7 cases of Grade +2. In Grade +1 and +2 cases, the cortex was spared by collateral flow via LMA, presumably. This result suggests that the flow void in the vicinity of the middle frontal gyrus may predict the development of LMA and the size of the infarct. (author)

  6. A Case Report: Balloon Occlusion Of Vertebral Artery In A Giant Vertebral Artery Aneurysm

    Directory of Open Access Journals (Sweden)

    K. Edraki

    2005-08-01

    Full Text Available Introduction & Background: True aneurysms of extra cranial vertebral arteries are rare. The usual pathogenesis of aneurysms in this location is either penetrating or blunt trauma with resultant pseudo- aneurysm formation. We report a patient with a presumed pseudo-aneurysm of the extra- cranial vertebral artery presenting with painful neck mass, without obvious history of trauma. Case description: A 59-year old man presented with painful left lateral neck mass from 3 month ago with a bruit over it on physical examination. Patient had a history of long term anticoagulant therapy because of chronic lower extremity DVT. Patient was referred to our DSA (Department for angiography. After color Doppler US, CT scan and MR-angiography were performed and a giant aneurysm in left vertebral artery was detected. The lesion was successfully treated by an endovascular technique of balloon occlusion of the verte-bral artery.

  7. Glue embolization of ruptured anterior thalamoperforating artery aneurysm in patient with both internal carotid arteries occlusion.

    Science.gov (United States)

    Lee, Jae Il; Choi, Chang Hwa; Ko, Jun Kyeung; Lee, Tae Hong

    2011-05-01

    Thalamoperforating artery aneurysms are rarely reported in the literature. We report an extremely rare case of ruptured distal anterior thalamoperforating artery aneurysm which was treated by endovascular obliteration in a patient with occlusion of both the internal carotid arteries (ICAs) : A 72-year-old woman presented with severe headache and loss of consciousness. Initial level of consciousness at the time of admission was drowsy and the Glasgow Coma Scale score was 14. Brain computed tomography (CT) scan was performed which revealed intracerebral hemorrhage in right basal ganglia, subarachnoid hemorrhage, and intraventricular hemorrhage. The location of the aneurysm was identified as within the globus pallidus on CT angiogram. Conventional cerebral angiogram demonstrated occlusion of both the ICAs just distal to the fetal type of posterior communicating artery and the aneurysm was arising from right anterior thalamoperforating artery (ATPA). A microcatheter was navigated into ATPA and the ATPA proximal to aneurysm was embolized with 20% glue. Post-procedural ICA angiogram demonstrated no contrast filling of the aneurysm sac. The patient was discharged without any neurologic deficit. Endovascular treatment of ATPA aneurysm is probably a more feasible and safe treatment modality than surgical clipping because of the deep seated location of aneurysm and the possibility of brain retraction injury during surgical operation.

  8. Central retinal artery occlusion in association with fibromuscular dysplasia

    Directory of Open Access Journals (Sweden)

    Altun A

    2013-11-01

    Full Text Available Ahmet Altun,1 Gulengul Altun,2 Osman Okan Olcaysu,3 Sevda Aydin Kurna,1 Suat Fazil Aki11Clinic of Ophthalmology, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey; 2Department of Pediatrics, Yeditepe University, Istanbul, Turkey; 3Clinic of Ophthalmology, Erzurum Region Education and Research Hospital, Erzurum, TurkeyAbstract: A 14 year-old female, whose chief complaint was severe vision loss in the right eye for 2 days, presented to the Clinic of Ophthalmology of Fatih Sultan Mehmet Education and Research Hospital. The patient had been attending follow-up visits for 4 years, following a diagnosis of fibromuscular dysplasia by the Clinic of Pediatrics. The patient underwent a complete ophthalmologic, angiographic, hematologic, and systemic evaluation. Fundus fluorescein angiography was performed immediately, because of the cherry-red spot sign in the macula of the right eye. Fundus fluorescein angiography revealed evidence of marked stasis of the retinal arterial circulation in the right eye. Best corrected visual acuity was 20/400 in the right eye and 20/20 in the left eye.Keywords: retina, artery, occlusion, fibromuscular, dysplasia

  9. A novel method to determine perineal artery occlusion among male bicyclists

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    Sujeeth Parthiban

    2015-12-01

    Full Text Available Background. Perineal pressure due to bicycle riding has been associated with erectile dysfunction. We developed a novel method to measure the occlusive force exerted over the perineal arteries and determined perineal artery occlusion by a variety of seat designs.Methods. Doppler ultrasonography facilitated perineal artery localization and determination of the force required for perineal artery occlusion in 20 healthy men. Flexiforce® sensors were affixed over the proximal and distal aspects of the perineal arteries bilaterally. Individuals completed bicycle rides in the road- and stationary-settings with six distinct seat designs, including those with and without an anterior “nose.”Results. The occlusion time proportion of the total ride time was calculated for each trial. The overall occlusion time proportion was 0.59 (95% CI [0.45–0.73] across all seats and settings. The “no-nose” bicycle seat and the stationary-setting demonstrated significantly lower occlusion proportion times than the traditional nose bicycle seat and road-setting, respectively. However, all bicycle seats yielded an occlusion time proportion of 0.41 or greater.Discussion. Our method of real-time, non-invasive force measurement localized to the perineal arteries may be used to validate future bicycle seat design. It also underscores the significant risk of perineal artery insufficiency in men who are avid bicyclists. This risk may be minimized by using newer “no-nose” bicycle seats.

  10. A novel method to determine perineal artery occlusion among male bicyclists.

    Science.gov (United States)

    Parthiban, Sujeeth; Hotaling, James M; Kathrins, Martin; Baftiri, Amit P; Freels, Sally; Niederberger, Craig S

    2015-01-01

    Background. Perineal pressure due to bicycle riding has been associated with erectile dysfunction. We developed a novel method to measure the occlusive force exerted over the perineal arteries and determined perineal artery occlusion by a variety of seat designs. Methods. Doppler ultrasonography facilitated perineal artery localization and determination of the force required for perineal artery occlusion in 20 healthy men. Flexiforce(®) sensors were affixed over the proximal and distal aspects of the perineal arteries bilaterally. Individuals completed bicycle rides in the road- and stationary-settings with six distinct seat designs, including those with and without an anterior "nose." Results. The occlusion time proportion of the total ride time was calculated for each trial. The overall occlusion time proportion was 0.59 (95% CI [0.45-0.73]) across all seats and settings. The "no-nose" bicycle seat and the stationary-setting demonstrated significantly lower occlusion proportion times than the traditional nose bicycle seat and road-setting, respectively. However, all bicycle seats yielded an occlusion time proportion of 0.41 or greater. Discussion. Our method of real-time, non-invasive force measurement localized to the perineal arteries may be used to validate future bicycle seat design. It also underscores the significant risk of perineal artery insufficiency in men who are avid bicyclists. This risk may be minimized by using newer "no-nose" bicycle seats.

  11. Enhancing hippocampal blood flow after cerebral ischemia and vasodilating basilar arteries: in vivo and in vitro neuroprotective effect of antihypertensive DDPH

    Directory of Open Access Journals (Sweden)

    Li Sun

    2015-01-01

    Full Text Available 1-(2,6-Dimethylphenoxy-2-(3,4-dimethoxyphenylethylamino-propane hydrochloride (DDPH is a novel antihypertensive agent based on structural characteristics of mexiletine and verapamine. We investigated the effect of DDPH on vasodilatation and neuroprotection in a rat model of cerebral ischemia in vivo, and a rabbit model of isolated basilar arteries in vitro. Our results show that DDPH (10 mg/kg significantly increased hippocampal blood flow in vivo in cerebral ischemic rats, and exerted dose-dependent relaxation of isolated basilar arteries contracted by histamine or KCl in the in vitro rabbit model. DDPH (3 × 10 -5 M also inhibited histamine-stimulated extracellular calcium influx and intracellular calcium release. Our findings suggest that DDPH has a vasodilative effect both in vivo and in vitro, which mediates a neuroprotective effect on ischemic nerve tissue.

  12. Successful percutaneous coronary intervention for chronic total occlusion of right coronary artery in patient with dextrocardia.

    Science.gov (United States)

    Munawar, Muhammad; Hartono, Beny; Iskandarsyah, Kurniawan; Nguyen, Thach N

    2013-07-01

    Situs inversus with dextrocardia is rare congenital anomaly. Coronary artery disease in such patients is quite rare. We reported a 52-year-old man with dextrocardia and chronic total occlusion at the proximal right coronary artery just after conus branch and severe stenosis at the proximal left anterior descending artery. He underwent successful percutaneous coronary intervention with stenting of total occluded right coronary artery and simultaneously stenting of the proximal left anterior descending artery.

  13. Locked-in syndrome in a patient with acute obstructive hydrocephalus, caused by large unruptured aneurysm of the basilar artery (BA).

    Science.gov (United States)

    Kolić, Zlatko; Kukuljan, Melita; Vukas, Duje; Bonifačić, David; Vrbanec, Kristina; Franić, Ivana Karla

    2016-09-15

    We describe a case of acute obstructive hydrocephalus as a consequence of compression of the brainstem by a large aneurysm of the basilar artery (BA) in a 62-year-old male. After the insertion of the ventriculoperitoneal shunt (VPS), we encountered the "locked-in syndrome" clinical condition. "Locked-in syndrome" is a clinical state characterized by quadriplegia and anarthria with preserved consciousness, most commonly caused by ischemia in the ventral part of pons.

  14. Endovascular therapy of ruptured distal anterior choroidal artery aneurysm associated with moyamoya pattern collateralization secondary to middle cerebral artery occlusion

    Directory of Open Access Journals (Sweden)

    Hidenori Oishi

    2013-01-01

    Full Text Available We report a case of a ruptured distal anterior choroidal artery (AChoA aneurysm associated with moyamoya pattern collateralization secondary to the middle cerebral artery occlusion. Patient was successfully treated with the coil embolization of the distal AChoA. This case supports the feasibility and efficacy of the endovascular therapy for the distal AChoA aneurysms in patients with MCA occlusion with moyamoya pattern collateralization.

  15. Evaluation of Haemodynamic Changes of Proximal Arterial Occlusion in the Lower Extremities by Spectrum Doppler Ultrasonography

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    Z Wang

    2015-06-01

    Full Text Available Objective: The objective is to analyse the changes of haemodynamic and Doppler ultrasonography spectrum in the proximal arterial occlusion of lower extremities, and to explore the value of spectrum Doppler ultrasonography in the diagnosis of lower extremity arterial occlusive disease. Methods: Thirty-four patients (thirty-nine occlusion arteries were examined with two-dimensional ultrasound combined with colour Doppler flow imaging (CDFI, and the results were compared. Result: The waveform shape in the artery proximal to the occlusion shows that blood flow velocity becomes slower, and diastolic reverse wave slowly disappears even upward. Systolic waveform records a steep upstroke, a slow downstroke and a shoulder on the downstroke. The appearance of the shoulder on the downstroke is earlier than the diastolic upward wave. The differences of peak systolic velocity, acceleration time, deceleration time, systolic acceleration, deceleration, diastolic reverse flow velocity, systolic acceleration time/systolic duration and systolic deceleration time/systolic duration in the proximal occlusion segment compared with the control group are statistically significant (p < 0.05. Conclusion: Artery occlusion can lead to haemodynamic response and spectrum waveform change. Timely discovery of the changes of the spectrum can be of clinical significance in the diagnosis of lower extremity arterial occlusive disease.

  16. Combined central retinal artery and vein occlusion in Churg-Strauss syndrome

    DEFF Research Database (Denmark)

    Hamann, Steffen; Johansen, Sven; Hamann, Steffen Ellitsgaard

    2006-01-01

    PURPOSE: To describe a rare case of Churg-Strauss syndrome presenting with severe visual loss due to a combined central retinal vein and artery occlusion. METHODS: A 42-year old man with a medical history of asthma and blood hypereosinophilia developed a sudden loss of vision in his right eye. We...... describe the clinical features and evolution of the case after treatment. RESULTS: A combined occlusion of the central retinal artery and central retinal vein was diagnosed by the funduscopic appearance of retinal whitening, macular cherry-red spot, papilloedema, retinal haemorrhages in all four quadrants...... the vascular occlusion and experienced no visual improvement. CONCLUSION: Combined central retinal artery and vein occlusion can occur in Churg-Strauss syndrome. We suggest that regional vasculitis may be the pathological mechanism underlying the vascular occlusions observed in our case. The condition carries...

  17. Prognostic value of collateral circulation in patients with unilateral middle cerebral artery occlusion

    Institute of Scientific and Technical Information of China (English)

    梅雨晴

    2014-01-01

    Objective To investigate the characteristics of the collateral circulation in patients with acute cerebral infarction after the middle cerbral artery(MCA)occlusion,and to evaluate its prognostic value.Methods Consecutive series of 118 patients with first-ever stroke after MCA occlusions subjects were retrieved from our hospital and Nanjing Stroke Registry Program between April 2010 and

  18. Leptospirosis and Peripheral Artery Occlusive Disease: A Nationwide Cohort Analysis.

    Science.gov (United States)

    Chiu, Chun-Hsiang; Lin, Cheng-Li; Lee, Feng-You; Wang, Ying-Chuan; Kao, Chia-Hung

    2016-03-01

    Data on the association between peripheral artery occlusive disease (PAOD) and leptospirosis are limited. We conducted a retrospective cohort study for determining whether leptospirosis is one of the possible risk factors for PAOD. Patients diagnosed with leptospirosis by using 2000 to 2010 data from the Taiwan National Health Insurance Research Database. Patients with leptospirosis without a history of PAOD were selected. For each leptospirosis patient, 4 controls without a history of leptospirosis and PAOD were randomly selected and frequency-matched for sex, age, the year of the index date, and comorbidity diseases. The follow-up period was from the time of the initial diagnosis of leptospirosis to the diagnosis date of PAOD, or December 31, 2011. The Cox proportional hazard regression models were used for analyzing the risk of PAOD. During the follow-up period, the cumulative incidence of PAOD was higher among the patients from the leptospirosis cohort than among the nonleptospirosis cohort (log-rank test, P leptospirosis cohort and 81 from the nonleptospirosis cohort were observed with the incidence rates of 2.1 and 1.3 per 1000 person-years, respectively, yielding a crude hazards ratio (HR) of 1.62 (95% confidence interval [CI] = 1.44-1.81) and adjusted HR (aHR) of 1.75 (95% CI = 1.58-1.95).The risk of PAOD was 1.75-fold higher in the patients with leptospirosis than in the general population.

  19. The central retinal artery occlusion in the right eye followed by a branch retinal artery occlusion in the left eye four days later

    Directory of Open Access Journals (Sweden)

    Cagatay Caglar

    2013-01-01

    Full Text Available A 65-year-old woman was admitted to our clinic with complaints of sudden, painless, decrease in vision, and sectoral visual field defect in the left eye and later presented to our clinic again with a history of sudden loss of vision in her right eye. In this case study we reported that the patient had branch retinal artery occlusion (BRAO in the left eye and at the same time progressing central retinal artery occlusion (CRAO in the right eye.

  20. Retinal Arterial Occlusive Disease in a Young Patient with Cat Scratch Disease

    OpenAIRE

    Georgios Batsos; Kabanarou, Stamatina A.; Pantelis Fotiou; Alexandros Rouvas; Tina Xirou

    2013-01-01

    Purpose: To report an unusual case of a branch retinal arterial occlusion and bilateral multifocal retinitis in a young woman with cat scratch disease. Methods: A 23-year-old woman was referred to our clinic complaining of a sudden scotoma in the upper part of the visual field of her left eye. Fundoscopy revealed occlusion of an inferior temporal branch of the retinal artery in the left eye and bilateral multifocal retinitis, which was confirmed by fluorescein angiography. Subsequent indocyan...

  1. Subintimal stent placement in patients with long segment occlusion of the iliac artery

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Ho Jung; Kim, Young Hwan; Kim, Si Hyung; Ko, Sung Min; Choi, Jin Soo; Lee, Hyun Jin; Kim, Hyung Tae; Jo, Won Hyun [Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of); Kim, Yong Joo [Andong General Hospital, Andong (Korea, Republic of)

    2008-01-15

    We evaluated the technical feasibility and clinical efficacy of subintimal stent placement for long segment occlusion of the iliac artery. From March 2003 to February 2007, subintimal stent placement for long segment occlusion of the iliac artery of 24 limbs in 22 patients was analyzed retrospectively. Endovascular access was performed via the ipsilateral femoral artery in 7 cases, via the contralateral femoral artery in 6 cases, via both femoral arteries in 10 cases and via the brachial artery in one case. The SAFARI (subintimal arterial flossing with antegrade-retrograde intervention) technique using a microcatheter was performed to recannalize iliac artery occlusion in three cases. Medical records were reviewed for the collection of follow-up data. The stent patency rate was analyzed by use of the Kaplan-Meier method. Subintimal stent placement was technically successful in 23 of 24 procedures (95.8%). The mean ankle-brachial index (ABI) increased form 0.26 to 0.82. The Fontaine classification was improved after stent placement in all patients. Major complications occurred in four procedures: three distal embolizations and one arterial rupture. All of the complications were successfully treated by endovascular intervention. The primary stent patency rates at 6-months, 1-, 2-and 3-years were 95%, 88%, 88% and 88%, respectively. Subintimal stent placement is a safe and effective treatment for long segment occlusion of the iliac artery.

  2. Lower Extremity Arterial Occlusive Disease As a Rare Complication of Crohn's Disease

    Institute of Scientific and Technical Information of China (English)

    Wei-wei Wu; Xue-ying Jiang; Chang-wei Liu; Yong-jun Li; Rong Zeng

    2009-01-01

    Objective To investigate the dinical characteristics and treatment strategy of lower extremity arterial occlusive disease in patients with Crohn's disease(CD).Methods Clinical information of 9 cases suffering from lower extremity arterial occlusion and CD was investigated retrospectively.Results All the cases were less than 50 years old and the most were females(8/9).Arterial occlusions occurred in either active(5/9)or inactive(4/9)stage of CD.Besides the arteries of lower extremities,other arteries could also be involved such as aorta,iliac artery,renal artery or mesentery artery.Seven cases had atherosclerotic imaging findings(4 had aortic plaques and 6 had iliac artery stenoses).Embolectomy or thromboendarterectomy were mostly performed.Four(44.4% )cases had recurrent lower limb ischemia.Conclusions Arterial occlusive disease is a rare extraintestinal manifestation of CD.A thorough inspection of aorta is necessary.Embolectomy is mostly preferred.Anticoagulation treatment is highly recommended after the operation.

  3. Temporary balloon occlusion of internal carotid artery : a simple and reliable clinical test.

    Directory of Open Access Journals (Sweden)

    Sudhakar K

    2000-04-01

    Full Text Available Balloon test occlusion of internal carotid artery has been frequently used in preoperative evaluation of patients with carotid aneurysms, fistulas and skull based neoplasms in whom arterial sacrifice is planned or considered as a possible part of therapy. We present our experience of the test in 28 patients. The test was positive in four and negative in twenty four patients. The results are compared with cross-compression angiography and the outcome following internal carotid artery sacrifice. There were no complications related to the test and the results accurately predicted the tolerance to occlusion of artery. We found the test safe, simple to perform and reliable to preoperatively detect patients at risk of ischaemic stroke following surgical ligation or endovascular occlusion of internal carotid artery.

  4. enhancing hippocampal blood lfow after cerebral ischemia and vasodilating basilar arteries:in vivo andin vitro neuroprotective effect of antihypertensive DDPH

    Institute of Scientific and Technical Information of China (English)

    Li Sun; Qin Li; Wei-ting Wang; Yu-hua Chen; Lian-jun Guo

    2015-01-01

    1-(2,6-Dimethylphenoxy)-2-(3,4-dimethoxyphenylethylamino)-propane hydrochloride (DDPH) is a novel antihypertensive agent based on structural characteristics of mexiletine and verapamine. We investigated the effect of DDPH on vasodilatation and neuroprotection in a rat model of cerebral ischemiain vivo, and a rabbit model of isolated basilar arteriesin vitro. Our results show that DDPH (10 mg/kg) significantly increased hippocampal blood flowin vivo in cerebral ischemic rats, and exerted dose-dependent relaxation of isolated basilar arteries contracted by histamine or KCl in thein vitro rabbit model. DDPH (3 × 10–5 M) also inhibited histamine-stimulated extracellular calcium inlfux and intracellular calcium release. Our ifndings suggest that DDPH has a vasodilative effect bothin vivo andin vitro, which mediates a neuropro-tective effect on ischemic nerve tissue.

  5. Management of acute central retinal artery occlusion: Intravenous thrombolysis is feasible and safe.

    Science.gov (United States)

    Préterre, Cécile; Godeneche, Gaelle; Vandamme, Xavier; Ronzière, Thomas; Lamy, Matthias; Breuilly, Christophe; Urbanczyk, Cédric; Wolff, Valérie; Lebranchu, Pierre; Sevin-Allouet, Mathieu; Guillon, Benoit

    2017-01-01

    Background Although acute central retinal artery occlusion is as a stroke in the carotid territory (retinal artery), its management remains controversial. The aim of this study was to assess the feasibility and safety of intravenous thrombolysis delivered within 6 h of central retinal artery occlusion in French stroke units. Methods We performed a retrospective analysis of patients treated with intravenous alteplase (recombinant tissue-plasminogen activator), based on stroke units thrombolysis registers from June 2005 to June 2015, and we selected those who had acute central retinal artery occlusion. The feasibility was assessed by the ratio of patients that had received intravenous alteplase within 6 h after central retinal artery occlusion onset among those who had been admitted to the same hospital for acute central retinal artery occlusion. All adverse events were documented. Results Thirty patients were included. Visual acuity before treatment was limited to "hand motion", or worse, in 90% of the cases. The mean onset-to-needle time was 273 min. The individuals treated with intravenous alteplase for central retinal artery occlusion represented 10.2% of all of the patients hospitalized for central retinal artery occlusion in 2013 and 2014. We observed one occurrence of major bleeding, a symptomatic intracerebral hemorrhage. Conclusion When applied early on, intravenous thrombolysis appears to be feasible and safe, provided that contraindications are given due consideration. Whether intravenous thrombolysis is more effective than conservative therapy remains to be determined. In order to conduct a well-designed prospective randomized control trial, an organized network should be in place.

  6. Bilateral thalamic stroke due to occlusion of the artery of Percheron in a patient with patent foramen ovale: a case report

    Directory of Open Access Journals (Sweden)

    López-Serna Raúl

    2009-09-01

    Full Text Available Abstract Introduction Bilateral thalamic infarcts are rare presentations of stroke. They are the result of a complex combination of risk factors and a predisposing vessel distribution. The artery of Percheron, characterized by a single arterial trunk that irrigates both paramedian thalamic regions, can be occluded as a result of embolic diseases leading to bilateral paramedian thalamic infarcts. Clinical and image findings of this uncommon form of posterior circulation infarct are presented along with their anatomic and pathophysiologic correlates. Case presentation A 27-year-old Mexican man with no relevant medical history was admitted to hospital after he was found deeply stuporous. On admission, an urgent neuroimaging protocol for stroke, including magnetic resonance imaging and magnetic resonance imaging angiography, was performed. The scans revealed symmetric bilateral hyperintense paramedian thalamic lesions consistent with acute ischemic events. The posterior circulation was patent including the tip of the basilar artery and both posterior cerebral arteries, making the case compatible with occlusion of the artery of Percheron. Further evaluation with an aim to define the etiology revealed a patent foramen ovale as the cause of embolism. Conclusion Bilateral thalamic infarcts are unusual presentations of posterior circulation stroke; once they are diagnosed by an adequate neuroimaging protocol, a further evaluation to define the cause is necessary. Cardioembolism should always be considered in relatively young patients. A complete evaluation should be conducted by an interdisciplinary team including neurologists, cardiologists and neurosurgeons.

  7. Retinal Arterial Occlusive Diseasein a Young Patient with Cat Scratch Disease

    Directory of Open Access Journals (Sweden)

    Georgios Batsos

    2013-08-01

    Full Text Available Purpose: To report an unusual case of a branch retinal arterial occlusion and bilateral multifocal retinitis in a young woman with cat scratch disease. Methods: A 23-year-old woman was referred to our clinic complaining of a sudden scotoma in the upper part of the visual field of her left eye. Fundoscopy revealed occlusion of an inferior temporal branch of the retinal artery in the left eye and bilateral multifocal retinitis, which was confirmed by fluorescein angiography. Subsequent indocyanine angiography did not reveal choroidal involvement. Laboratory analysis showed rising IgG titers for Bartonellahenselae. Results: Cat scratch disease was diagnosed, and a 4-week course of doxycycline was initiated. The patient responded well to the antibiotics. Both retinitis and arterial occlusion were resolved, the visual field was regained and the patient reported elimination of her symptoms. Conclusions: Cat scratch disease should be considered in the differential diagnosis in young patients with retinal occlusive disease.

  8. Thrombolysis of the basilar artery: 5-year results from the Saarland stroke registry; Thrombolyse der A. basilaris: Ergebnisse im Saarland ueber einen Zeitraum von 5 Jahren

    Energy Technology Data Exchange (ETDEWEB)

    Grunwald, I.Q.; Struffert, T.; Roth, C.; Papanagiotou, P.; Scheuermann, J.; Voges, M.; Reith, W. [Universitaetsklinikum des Saarlandes Homburg (Germany). Klinik fuer Diagnostische und Interventionelle Neuroradiologie

    2005-05-01

    Acute thrombosis of the basilar artery has a fatal outcome if left untreated. The relatively good prognosis with intra-arterial thrombolysis makes it the therapy of choice for acute basilar thrombosis. In the Saarland stroke registry, we analyzed 47 patients with angiographically proven basilar artery thrombosis within the last 5 years. We observed a better outcome in patients with good income, with recanalization, and a short time between onset of symptoms and start of thrombolysis. The complications, such as intracerebral bleedings, occurred only in the group treated with rt-PA. Intra-arterial thrombolysis with urokinase or rt-PA is a relatively safe therapy, but should be performed in neuroradiological centers. With progressing symptoms the therapeutic window can be stretched up to 12 h, but coma lasting for more than 4 h is related to a bad outcome. (orig.) [German] Der akute Verschluss der A. basilaris fuehrt unbehandelt in der Regel rasch zum Tod. Aufgrund des zumeist fatalen Ausgangs unbehandelter Basilaristhrombosen und der relativ guten Prognose bei Behandlung mit lokaler intraarterieller Thrombolyse wird diese Therapie als das Mittel der Wahl bei akuter Basilaristhrombose angesehen. Anhand des Saarlaendischen Schlaganfallregisters wurden 47 Patienten mit einer nachgewiesenen Basilaristhrombose ueber einen Zeitraum von 5 Jahren in diese Studie eingeschlossen. Es konnte nachgewiesen werden, dass eine kurze Zeit bis zum Therapiebeginn, ein gutes Income sowie eine erfolgreiche Rekanalisation mit einem guten klinischen Outcome korreliert waren. Komplikationen traten ausnahmslos bei einer Lysetherapie mit rt-PA auf. Die intraarterielle Behandlung von Basilarisverschluessen mit Urokinase oder rt-PA sollte an spezialisierten, interventionellangiographisch taetigen Zentren vorgenommen werden. Bei fluktuierendem Beginn kann das Zeitfenster bis zu 12 h betragen, nach einer Komadauer von mehr als 4 h ist in der Regel kein guenstiges Outcome zu erwarten. (orig.)

  9. The Challenge of Managing Fusiform Basilar Artery Aneurysms: From Acute Ischemic Stroke to a Massive Subarachnoid Hemorrhage

    Directory of Open Access Journals (Sweden)

    Sofia Bezerra

    2011-02-01

    Full Text Available We present the case of a patient with acute brain stem ischemic stroke who was found to have a fusiform basilar aneurysm with a thrombus within the dilated vessel. Three days after the ischemic stroke, the patient had a massive subarachnoid hemorrhage and died. This case illustrates the difficulties in the acute management of ischemic events in patients with basilar fusiform aneurysms, because the natural history of this disease encompasses both bleeding and thrombosis.

  10. Power doppler ultrasound findings of renal infarct after experimental renal artery occlusion: comparison with spiral CT

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Seung Eun; Shinn, Kyung Sub; Kim, Hak Hee; Mun, Seok Hwan; Lee, Young Joon; Lee, Bae Young; Choi, Byung Gil; Lee, Jae Mun; Lee, Hee Jeong [The Catholic University of Korea College of Medicine, Seoul (Korea, Republic of)

    1999-02-01

    To evaluate the efficacy of power Doppler ultrasonography (PDUS) in depicting renal infarction in rabbits during experimental renal segmental arterial occlusion, and to compare the results with those of CT scanning. In 28 rabbits weighing 2.5 4kg, the segmental renal artery was occluded through the left main renal artery by embolization with Ivalon (Nycomed, Paris, France). Power Doppler ultrasonography and spiral CT scanning were performed before and at 2, 5, 8, 15, and 24 hours, and 3 and 7 days after occlusion of the segmental renal artery. The location of infarcted areas and collaterals, as seen on PDUS and CT scans, was evaluated by two radiologists. In all cases, as seen on power Doppler ultrasonography, infarcted areas-when compared with normal parenchyma, clearly demonstrated wedge-shaped perfusion defects in the kidney. The location of the lesion closely corresponded to the location seen during CT scanning. After renal arterial occlusion, transiently congested capsular arteries, which were named 'capsular sign', were seen in 63% of rabbits in the two and five-hour groups. No significant cortical rim sign was demonstrated on power Doppler ultrasonography, though it was noted on spiral CT at 15 and 24 hours, and 3 and 7 days after renal arterial occlusion. Power Doppler ultrasonography was useful for the diagnosis of renal infarction. Congested capsular artery seen in the early stage of renal infarction might be a characteristic finding of this condition, as seen on power Doppler ultrasonography.

  11. Middle cerebral artery occlusion in presence of low perfusion pressure increases infarct size in rats

    DEFF Research Database (Denmark)

    Sillesen, H; Nedergaard, Majken; Schroeder, T;

    1988-01-01

    A model was set up in order to evaluate the importance of hemispheric perfusion pressure when the middle cerebral artery (MCA) is occluded in anaesthetized rats. In 6 animals the internal carotid artery (ICA) was occluded prior to ipsilateral MCA occlusion; in 17 animals the MCA only was occluded...

  12. Classification of peripheral occlusive arterial diseases based on symptoms, signs and distal blood pressure measurements

    DEFF Research Database (Denmark)

    Tønnesen, K H; Noer, Ivan; Paaske, William

    1980-01-01

    Systolic blood pressures at toe and ankle were measured in 459 consecutive patients with occlusive arterial disease. Fifty-eight per cent had intermittent claudication with arterial disease of all degrees of severity. Seventeen per cent complained of rest pain having toe systolic pressures below 30...

  13. Effect of ST36 Acupuncture on Hyperventilation-Induced CO2 Reactivity of the Basilar and Middle Cerebral Arteries and Heart Rate Variability in Normal Subjects

    Directory of Open Access Journals (Sweden)

    Sang-Ho Hyun

    2014-01-01

    Full Text Available This study was conducted to verify the effect of acupuncture on cerebral haemodynamics to provide evidence for the use of acupuncture treatment as a complementary therapy for the high-risk stroke population. The effect of ST36 acupuncture treatment on the hyperventilation-induced CO2 reactivity of the basilar and middle cerebral arteries was studied in 10 healthy male volunteers (mean age, 25.2 ± 1.5 years using a transcranial Doppler sonography with an interval of 1 week between measurements, and a portable ECG monitoring system was used to obtain ECG data simultaneously. The CO2 reactivity of the basilar and middle cerebral arteries increased significantly after ST36 acupuncture treatment, whereas the mean arterial blood pressure and pulse rate did not change significantly. The high-frequency power significantly increased after ST36 acupuncture treatment, and the percentage increase of high-frequency power correlated significantly with the percentage increase in the CO2 reactivity of the contralateral middle cerebral artery. These data suggest that ST36 acupuncture treatment increases CO2 reactivity, indicating improvement of vasodilatory potential of the cerebral vasculature to compensate for fluctuations caused by changes in external conditions. The increase in parasympathetic tone by ST36 acupuncture treatment is responsible for this therapeutic effect.

  14. Mechanical Recanalization of Subacute Vessel Occlusion in Peripheral Arterial Disease with a Directional Atherectomy Catheter

    Energy Technology Data Exchange (ETDEWEB)

    Massmann, Alexander, E-mail: Alexander.Massmann@uks.eu; Katoh, Marcus [Saarland University Hospital, Department of Diagnostic and Interventional Radiology (Germany); Shayesteh-Kheslat, Roushanak [Saarland University Hospital, Department of General Surgery, Visceral, Vascular, and Pediatric Surgery (Germany); Buecker, Arno [Saarland University Hospital, Department of Diagnostic and Interventional Radiology (Germany)

    2012-10-15

    Purpose: To retrospectively examine the technical feasibility and safety of directional atherectomy for treatment of subacute infrainguinal arterial vessel occlusions. Methods: Five patients (one woman, four men, age range 51-81 years) with peripheral arterial disease who experienced sudden worsening of their peripheral arterial disease-related symptoms during the last 2-6 weeks underwent digital subtraction angiography, which revealed vessel occlusion in native popliteal artery (n = 4) and in-stent occlusion of the superficial femoral artery (n = 1). Subsequently, all patients were treated by atherectomy with the SilverHawk (ev3 Endovascular, USA) device. Results: The mean diameter of treated vessels was 5.1 {+-} 1.0 mm. The length of the occlusion ranged 2-14 cm. The primary technical success rate was 100%. One patient experienced a reocclusion during hospitalization due to heparin-induced thrombocytopenia. There were no further periprocedural complications, in particular no peripheral embolizations, until hospital discharge or during the follow-up period of 1 year. Conclusion: The recanalization of infrainguinal arterial vessel occlusions by atherectomy with the SilverHawk device is technically feasible and safe. In our limited retrospective study, it was associated with a high technical success rate and a low procedure-related complication rate.

  15. Iatrogenic central retinal artery occlusion after carotid body tumor embolization and excision

    Directory of Open Access Journals (Sweden)

    Rangel, Carlos M.

    2017-03-01

    Full Text Available Objective: To report a case of iatrogenic central retinal artery occlusion after embolization and surgical resection of carotid body paraganglioma.Methods: Case report Results: One adult female patient presented with persistent unilateral visual loss after embolization with Embosphere and Contour microparticles of carotid body tumor. Fluorescein angiography revealed intraluminal microspheres in the central retinal artery ramifications. OCT revealed intraretinal spherical, hyporeflective particles with posterior shadowing. Conclusions: Central retinal artery occlusion should be assessed as a possible complication after surgical repair of head and neck paragangliomas.

  16. Plaques of Nonstenotic Basilar Arteries with Isolated Pontine Infarction on Three-dimensional High Isotropic Resolution Magnetic Resonance Imaging

    Institute of Scientific and Technical Information of China (English)

    Xian-Jin Zhu; Wei-Jian Jiang; Lei Liu; Li-Bin Hu; Wu Wang; Zun-Jing Liu

    2015-01-01

    Background:There are few studies for evaluating plaque characteristics of nonstenotic basilar arteries (BA).Our aim was to determine entire BA plaques with a three-dimensional volumetric isotropic turbo spin-echo acquisition (VISTA) and investigate the differences between the patients with and without isolated pontine infarction (IPI).Methods:Twenty-four consecutive symptomatic patients with nonstenotic BA on time of flight magnetic resonance angiography (TOF MRA) were enrolled from China-Japan Friendship Hospital between January 2014 and December 2014.BA was classified as "normal" or"irregular" based on TOF MRA,and "normal wall","slight wall-thickening",and "plaque" based on three-dimensional VISTA images.Outcomes from MRA and VISTA were compared.Patients were categorized as IPI and non-IPI groups based on the diffusion-weighted imaging.Clinical and plaque characteristics were compared between the two groups.Results:A total of 1024 image slices including 311 (30.37%) plaque slices,427 (41.70%) slight wall-thickening slices,and 286 (27.93%) normal wall slices for the entire BA from 23 patients were finally included for analysis.VISTA images detected plaques in all the 9 (100%) irregular MRA patients and 7 of 14 (50%) normal MRA patients.IPI was found in 1 1 (47.83%) patients.Compared to non-IPI group,the IPI group had a higher percentage of plaque slices (P =0.001) and lower percentage of normal wall slices (P =0.014) than non-IPI group.Conclusions:Three-dimensional VISTA images enable detection of BA plaques not visualized by MRA.BA plaques could be found in both the IPI and non-IPI group.However,IPI group showed plaques more extensively in BA than the non-IPI group.

  17. Study on the travelling and anatomical variations of basilar artery via VCTDSA%基底动脉走行和变异的容积CT数字减影血管成像研究

    Institute of Scientific and Technical Information of China (English)

    唐贵超; 陈莉; 吕发金

    2013-01-01

    Objective To investigate the anatomical variations and travelling of basilar artery via volume computed tomography digital subtraction angiography (VCTDSA) and to investigate the relationship between the basilar artery bending and the development of intracranial segment of vertebral artery.Methods A total of 110 normal subjects underwent cerebral and cervical vessel VCTDSA were involved in the present study,and the images of basilar arteries were reconstructed by VR images.The development of vertebral artery,window variation and tortuosity of basilar artery,as well as the diameter and length of basilar artery were measured.The correlation between development of vertebral artery and tortuosity of basilar artery were analyzed.Results (1)In the 110cases,the rate of hypoplastic vertebral artery,tortuosity and window variation of basilar artery were 17.27% (19/110),22.73%(25/110) and 2.73%(3/110),respectively.(2)The average length and diameter of basilar artery were(28.25±3.88)mm and (3.86±0.54)mm,respectively.(3)The tortuosity and window variation of basilar artery showed positive correlation with the development of intracranial segment of vertebral artery(P<0.01,r=0.52).Conclusion VCTDSA could clearly show the anatomy and variability of basilar artery,and its anatomic valuable could act as the reference for the diagnosis of cerebral diseases in clinic.The hypoplasia of intracranial segment of vertebral artery could be correlate with tortuosity of basilar artery.%目的 运用容积CT数字减影血管成像(VCTDSA)研究基底动脉走行和变异,探讨基底动脉迂曲与椎动脉颅内段发育不良之间的关系.方法 观测2010年1月至2011年12月在重庆医科大学附属第一医院行VCTDSA检查、非脑卒中患者且头部或头颈VCTDSA检查未见病变者110例,在容积再现(VR)图像上观察双侧椎动脉颅内段发育情况、基底动脉有无迂曲、是否存在窗型变异,并分别测量基底动脉的长度与管径,同时

  18. Contemporary therapeutic strategies for occlusion of the artery of Percheron: a review of the literature.

    Science.gov (United States)

    Li, Xintong; Agarwal, Nitin; Hansberry, David R; Prestigiacomo, Charles J; Gandhi, Chirag D

    2015-02-01

    The artery of Percheron (AOP) is a rare anatomic variant of the paramedian thalamic-mesencephalic arterial supply, arising as a solitary arterial trunk from the P1 segment of the posterior cerebral artery. Its occlusion, commonly caused by cardioembolism, leads to distal bilateral paramedian thalamic ischemia, oftentimes affecting the midbrain and/or the anterior thalamus. AOP occlusion presents with a clinical triad of altered mental status, vertical gaze palsy, and memory impairment, along with other associated symptoms. Digital subtraction angiography is effective for detecting AOP, while diffusion weighted MRI is best for diagnosis of its occlusion. Our extensive literature search sought to determine the best forms of treatment for uncomplicated AOP occlusion, with the inclusion criterion of implementation of medical treatment or other forms of therapy in patient recovery from this condition. We conclude that intravenous heparin and thrombolysis with tissue plasminogen activator are effective firstline treatment options for emergent AOP occlusion followed by a prescription of long term anticoagulants, while non-emergent cases without midbrain involvement could be treated through rehabilitation and continual monitoring by medical staff. Clinical trials of higher power are needed for a more comprehensive analysis of the treatment options for AOP occlusion.

  19. Paraplegia after aortic and superior mesenteric artery stenting for occlusive disease.

    Science.gov (United States)

    Hans, Sachinder S; Ngo, William; McAllister, Michael

    2014-02-01

    Paraplegia after endovascular therapy for aortic and visceral artery occlusive disease is an extremely uncommon occurrence. Two cases of paraplegia after placement of an aortic covered stent for infrarenal aortic stenosis and a superior mesenteric artery stent for chronic visceral ischemia are presented. In both patients, embolization of the arterial supply to the spinal cord was the presumed cause. One patient had a slight recovery after intense physical therapy and rehabilitation. The second patient did not have any recovery from her paraplegia.

  20. Incidence and outcome of radial artery occlusion following transradial artery coronary angioplasty.

    Science.gov (United States)

    Stella, P R; Kiemeneij, F; Laarman, G J; Odekerken, D; Slagboom, T; van der Wieken, R

    1997-02-01

    Coronary angioplasty with 6F guiding catheters via the radial artery is associated with a minimal risk for major entry site-related complications. Although the incidence of radial artery occlusion (RAO) in the literature is approximately 30% after prolonged cannulations, little is known about the incidence and its clinical consequences of RAO following transradial percutaneous coronary angioplasty. In a prospective study, 563 patients with a normal Allen test were evaluated on patency and function of the radial artery after transradial angioplasty, by physical and ultrasound examination at discharge, and at 1 month follow-up. At discharge, 30 patients (5.3%) had clinical evidence of RAO. At follow-up, persistent RAO was found in 16 patients (2.8%). In this study we found a low incidence of RAO after transradial percutaneous coronary angioplasty. None of the patients with temporary or persistent RAO had any major clinical symptoms. Therefore, the occurrence of RAO can be considered a minor complication in patients with a previously good double blood supply to the hand.

  1. Carotid angioplasty with stenting for chronic internal carotid artery occlusion: technical note

    Energy Technology Data Exchange (ETDEWEB)

    Kobayashi, Nozomu; Tanasawa, Toshihiko; Okada, Takeshi; Endo, Otone; Yamamoto, Naohito [Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Department of Neurosurgery, Aichi (Japan); Miyachi, Shigeru; Hattori, Kenichi [Nagoya University Graduate School of Medicine, Department of Neurosurgery, Nagoya (Japan)

    2006-11-15

    Carotid angioplasty with stenting (CAS) is becoming accepted as an effective and reliable treatment option for severe carotid artery stenosis. However, it is rarely applied for carotid occlusion, especially in its chronic stage. We report our experience of CAS for chronic internal carotid artery occlusion representing compromised cerebral blood flow using various protection methods. A 77-year-old woman, who was already diagnosed with severe left internal carotid artery stenosis, suddenly had right hemiparesis and aphasia. At that time, she was treated conservatively because her neurological status was quite good, in spite of left carotid artery occlusion. Her symptoms improved in the short term, except slight aphasia, but deteriorated again 18 days from the onset, and magnetic resonance imaging (MRI) showed new ischemic lesions. CAS was then performed for the occluded carotid artery on the 23rd day from the first onset. Using the proximal protection technique, the occluded lesion was crossed carefully with a microguidewire. Stents were also placed successfully with the distal protection technique. The occluded carotid artery was completely recanalized without any unfavorable events or neurological deterioration. In this patient, CAS was successfully to treat chronic carotid artery occlusion. These procedures and techniques are reviewed and discussed. (orig.)

  2. Carotid Endarterectomy for Symptomatic Complete Occlusion of the Internal Carotid Artery

    Directory of Open Access Journals (Sweden)

    Cho,Yong-Pil

    2011-08-01

    Full Text Available We described 9 consecutive patients who underwent operative carotid artery exploration with attempted carotid endarterectomy (CEA for symptomatic internal carotid artery (ICA occlusion. Indications for this surgery based on vascular imaging included segmental occlusion of the proximal ICA and also extensive occlusion of the distal ICA in selected patients in whom color-flow duplex ultrasound showed a poorly echogenic or anechoic thrombus with a flow void, suggestive of an acute thrombus. CEA was performed successfully to restore blood flow in all 9 patients:CEA in 5 and CEA with Fogarty thrombectomy in 4. Postoperative magnetic resonance (MR angiography confirmed that revascularization had been successful in all 9 patients, and MR imaging displayed improved perfusion in 4 patients. Despite the lack of a generalized efficacy of surgical revascularization for symptomatic ICA occlusion, our study demonstrated that preoperative vascular imaging allows the selection of patients who may benefit from CEA.

  3. Uterine Artery Embolization Versus Laparoscopic Uterine Artery Occlusion: The Outcomes of a Prospective, Nonrandomized Clinical Trial

    Energy Technology Data Exchange (ETDEWEB)

    Mara, Michal; Kubinova, Kristyna, E-mail: kristyna.kubinova@gmail.com [General Faculty Hospital and 1st Medical Faculty of Charles University, Department of Obstetrics and Gynecology (Czech Republic); Maskova, Jana [Aberdeen Royal Infirmary, Department of Radiology (United Kingdom); Horak, Petr [General Faculty Hospital and 1st Medical Faculty of Charles University, Department of Obstetrics and Gynecology (Czech Republic); Belsan, Tomas [Central Military Hospital, Department of Radiology (Czech Republic); Kuzel, David [General Faculty Hospital and 1st Medical Faculty of Charles University, Department of Obstetrics and Gynecology (Czech Republic)

    2012-10-15

    Purpose: To compare outcomes of two different types of occlusive therapy of uterine fibroids. Methods: Women with fibroid(s) unsuitable for laparoscopic myomectomy (LM) were treated with uterine artery embolization (UAE) or laparoscopic uterine artery occlusion (LUAO). Results: Before the procedure, patients treated with UAE (n = 100) had a dominant fibroid greater in size (68 vs. 48 mm) and a mean age lower (33.1 vs. 34.9 years) than surgically treated patients (n = 100). After 6 months, mean shrinkage of fibroid volume was 53 % after UAE and 39 % after LUAO (p = 0.063); 82 % of women after UAE, but only 23 % after LUAO, had complete myoma infarction (p = 0.001). Women treated with UAE had more complications (31 vs. 11 cases, p = 0.006) and greater incidence of hysteroscopically verified intrauterine necrosis (31 vs. 3 %, p = 0.001). Both groups were comparable in markers of ovarian functions and number of nonelective reinterventions. The groups did not differ in pregnancy (69 % after UAE vs. 67 % after LUAO), delivery (50 vs. 46 %), or abortion (34 vs. 33 %) rates. The mean birth weight of neonates was greater (3270 vs. 2768 g, p = 0.013) and the incidence of intrauterine growth restriction lower (13 vs. 38 %, p = 0.046) in post-UAE patients. Conclusion: Both methods are effective in the treatment of women with future reproductive plans and fibroids not suitable for LM. UAE is more effective in causing complete ischemia of fibroids, but it is associated with greater risk of intrauterine necrosis. Both methods have low rate of serious complications (except for a high abortion rate).

  4. Incidentally diagnosed Takayasu arteritis on thyroid ultrasonography showing prominent collateral vessels of thyroidal arteries and common carotid artery occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Nam, Se Jin; Kim, Eun Kyung [Dept. of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2014-10-15

    We report a case of middle-aged woman incidentally diagnosed with Takayasu arteritis during the ultrasonography of a thyroid gland nodule. Prominent collaterals of the thyroidal arteries and a thin common carotid artery with mural thickening and deficient intraluminal flow signals were initially depicted on the ultrasonography with color Doppler. Subsequent magnetic resonance angiography and computed tomography aortography confirmed the diagnosis with the imaging features of a bilateral long segment common carotid artery occlusion and segmental stenosis of the left subclavian artery in addition to the suggestive physical findings.

  5. A comparison of pulmonary arterial occlusion algorithms for estimation of pulmonary capillary pressure.

    Science.gov (United States)

    Pellett, A A; Johnson, R W; Morrison, G G; Champagne, M S; deBoisblanc, B P; Levitzky, M G

    1999-07-01

    Using the arterial occlusion method, we compared five literature-based estimates of pulmonary capillary pressure (Ppc) with the corresponding double occlusion pressures (Pdo) in anesthetized dogs whose chests had been closed after sternotomy for instrumentation. Arterial occlusions were performed with a balloon-tipped pulmonary artery catheter that housed pressure transducers immediately proximal and distal to the balloon. Separation of the proximal and distal pressure waveforms during balloon inflation allowed us to precisely define the moment of occlusion. We fit a monoexponential curve to pressure data beginning 200 ms after the onset of occlusion and a biexponential curve to data beginning at the instant of occlusion, with data obtained over a range of vascular states (control, serotonin infusion, histamine infusion). In addition, we investigated the use of sampling of the raw data to estimate capillary pressure. Three of the five literature-based estimates of Ppc yielded values similar to Pdo. The optimal (least average difference from Pdo) interpolation/extrapolation time points of the curve fits varied, depending on the type of curve fitting and the state of the pulmonary vasculature. We also determined that a close approximation of Pdo may be derived from the raw data, as an alternative to exponential curve fitting.

  6. The modified pulse-spray method using Urokinase in subacute and chronic thrombotic arterial occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Youn Kil; Hahn, Seong Tae; Baek, Jee Hee; Kim, Choon Yul; Shinn, Kyung Sub [The Catholic Univ. College of Medicine, Seoul (Korea, Republic of)

    1996-01-01

    To evaluate the effectiveness and safety of the modified pulse-spray method using Urokinase(UK) in subacute and chronic thrombotic arterial occlusion. Modified pulse-spray methods using UK were performed in seven patients with subacute (1 week-1month) to chronic (1month-5years) occlusive symptoms such as limb pain, claudication and impotence. Angiographic examination revealed thrombotic occlusion of the aorta, common iliac arteries, brachial arterio-venous hemodialysis graft and femoro-popliteal bypass graft. The patients underwent thrombolysis using modified pulse-spray and additional constant infusion of UK. In the presence of underlying stenosis or organized clots, balloon angioplasty or stent placement was performed. Complete lysis was obtained in five of seven patients. For initial lysis, the mean dose of UK was 420,000 units, and the mean modified pulse-spray time was 50 minutes. Mean total dose of UK and mean total time for complete lysis were 800,000 units and 161 minutes, respectively. Thrombolysis of the femoro-popliteal bypass graft failed due to severe occlusion of the distal anastomosis. Partial lysis was achieved in one patient with aorto-illac occlusion, but further thrombolysis was stopped due to bleeding at the puncture site. The modified pulse-spray method using UK is effective in treating subacute and chronic arterial thrombotic occlusion. It augments the speed, safety and efficacy of thrombolysis. When underlying stenosis or organized clots remain after thrombolysis, ballon angioplasty or stent placement would be helpful.

  7. Bilateral Superior Cerebellar Artery Embolic Occlusion with a Fetal-Type Posterior Cerebral Artery Providing Collateral Circulation

    Directory of Open Access Journals (Sweden)

    Taylor J. Bergman

    2016-12-01

    Full Text Available Bilateral infarction of the superior cerebellar arteries with sparing of the rest of the posterior circulation, particularly the posterior cerebral arteries, is an uncommon finding in neurological practice. Most commonly, the deficits of the superior cerebellar arteries and posterior cerebral arteries occur together due to the close proximity of their origins at the top of the basilar artery. A patient was transferred to the neurological intensive care unit with a history of recent-onset falls from standing, profound hypertension, dizziness, and headaches. The neurological exam revealed cerebellar signs, including dysmetria of the right upper extremity and a decreased level of consciousness. Computed tomography of the head and neck revealed decreased attenuation throughout most of the cerebellar hemispheres suggestive of ischemic injury with sparing of the rest of the brain. Further investigation with a computed tomography angiogram revealed a fetal-type posterior cerebral artery on the right side that was providing collateral circulation to the posterior brain. Due to this embryological anomaly, the patient was spared significant morbidity and mortality that would have likely occurred had the circulation been more typical of an adult male.

  8. Internal carotid artery pseudo occlusion with embolic cerebral ischemia and low flow in the central retinal artery: a diagnostic challenge

    Directory of Open Access Journals (Sweden)

    Christoph Roehrer

    2011-08-01

    Full Text Available We present a rare case of internal carotid artery pseudoocclusion (ICAPO in a 60-yearold male Caucasian patient who experienced a reversible sudden loss of vision of the right eye for 10 min followed by recurrent blurring of vision as well as dysarthria and numbness in the left face. The referring ophthalmologist admitted the patient for suspicious occlusion of the internal carotid artery causing anterior ischemic optic neuropathy (AION.

  9. Endovascular Sharp Recanalization for Calcified Femoropopliteal Artery Occlusion

    Directory of Open Access Journals (Sweden)

    Hsuan-Li Huang

    2012-01-01

    Full Text Available Endovascular intervention of peripheral chronic total occlusion (CTO is technically challenging and time consuming. Various techniques and devices are used to facilitate lesion crossing and improve the success rate of the procedure. However, these new devices are quite expensive and not readily available. We report 2 cases of peripheral CTO wherein the occlusions were successfully crossed by using stiff end of Terumo glidewire. This sharp recanalization may be a useful technique for the recanalization of calcified peripheral CTOs when conventional techniques fail and new devices are not readily available, but it is accompanied by the risk of distal atheroembolism.

  10. Prevalence of stenoses and occlusions of brain-supplying arteries in young stroke patients.

    LENUS (Irish Health Repository)

    von Sarnowski, Bettina

    2013-03-06

    OBJECTIVE: Atherosclerosis is believed to be a minor cause of TIA and stroke in younger and middle-aged patients. However, data from large cohorts are limited. This study investigates the prevalence of extracranial and intracranial atherosclerosis in stroke and TIA patients aged 18-55 years in the multinational sifap1 study. METHODS: From the sifap1 cohort (n = 5,023), we analyzed a subset of patients with complete data from carotid ultrasound studies. Patients with arterial dissections, vasculitis, and mobile thrombi were excluded. Among the remaining 2,187 patients (men: n = 1,319; 18-44 years: n = 744), intracranial arteries were additionally examined with ultrasonography in 1,612 patients (73.7%). Patients were stratified by sex and age groups (younger: 18-44 years; middle-aged: 45-55 years). RESULTS: In patients with ischemic stroke, the overall prevalence of carotid artery stenoses and occlusions was 8.9% (younger: 4.9%; middle-aged: 11.0%), of which 81% were symptomatic. Nonstenotic carotid plaques were more common in men than in women (15.8% vs 7.7%; p < 0.001), and in middle-aged than in younger patients (17.0% vs 4.9%; p < 0.001). Supratentorial intracranial artery stenoses and occlusions amounted to 11.8%. Supratentorial stenoses occurred more frequently in middle-aged patients (13.0% vs 7.8%; p < 0.001), whereas occlusions were equally common (both 3.2%; not significant). CONCLUSIONS: We observed a substantial proportion of atherosclerotic carotid artery stenoses and occlusions in younger stroke patients. Intracranial stenoses and occlusions were even more prevalent than extracranial carotid artery disease. Together with nonstenotic plaques, one-fifth of patients (21.2%) had symptomatic or asymptomatic large-artery atherosclerosis, which should encourage future stroke prevention campaigns to target risk factor modification in young people.

  11. Basilar artery hypoplasia and its clinical significance%基底动脉发育不全及其临床意义

    Institute of Scientific and Technical Information of China (English)

    张道培; 张淑玲; 许予明

    2015-01-01

    基底动脉发育不全(basilar artery hypoplasia,BAH)在过去较少受到关注,但检出率的提高使得BAH的临床意义逐渐被认识.BAH与血管危险因素相互作用,可能促发后循环缺血事件的发生,脑诱发电位可作为早期检测这一病理生理学事件的重要手段.深入研究BAH的病理意义,有助于加深对后循环缺血事件发病机制的认识.%Basilar artery hypoplasia (BAH) has been paid less attention to in the past.However,the increased detection rate makes the clinical significance of BAH to be gradually recognized.BAH have interaction with vascular risk factors,and this may promote the occurrence of ischemic events in posterior circulation.Brain evoked potential can be used as an important means for early detection of this pathophysiological events.The depth study of pathological significance of BAH helps to deepen the understanding of the mechanisms of posterior circulation ischemic events.

  12. Initial experience in perfusion MR imaging of intracranial major artery occlusion with echo-planar technique

    Energy Technology Data Exchange (ETDEWEB)

    Tsuchiya, Kazuhiro; Mizutani, Yoshiyuki; Inaoka, Sayuki; Hachiya, Junichi [Kyorin Univ., Mitaka, Tokyo (Japan). School of Medicine

    1997-09-01

    The purpose of this study was to evaluate the usefulness of perfusion MR imaging using a single-shot echo-planar technique in occlusion of intracranial main arteries. Our patient group consisted of 16 patients with internal carotid artery occlusion (n=9), Moyamoya disease (n=4), and middle cerebral artery occlusion (n=3). We performed the echo-planar perfusion studies with a 1.5-T unit using a free-induction-decay-type echo-planar sequence. With a bolus injection of Gd-DTPA, 30 consecutive scans were obtained at 10 sections every 2 seconds. The data were analyzed in three ways: a time-intensity curves in the territory of the involved artery (n=16); semiquantitative flow map of each section representing signal changes due to passage of Gd-DTPA (n=15); and serial images at a selected section (n=7). The time intensity curves were abnormal in 13 patients. The peak of signal drop was delayed in all of them. Flow maps showed focal flow abnormalities in 11 patients, but they were apparently normal in 4 patients probably due to collateral flow. In serial images, delay in appearance and/or disappearance of Gd-DTPA was noted in 6 patients. In patients with occlusion of intracranial main arteries, MR single-shot echo-planar technique is of clinical use because it can provide information about hemodynamic changes in a short examination time, in multiple sections, and with good temporal resolution. (author)

  13. Effect of endovascular reperfusion in relation to site of arterial occlusion

    Science.gov (United States)

    Hamilton, Scott A.; Liebeskind, David S.; Tomsick, Tom A.; Demchuk, Andrew M.; Nogueira, Raul G.; Marks, Michael P.; Jahan, Reza; Gralla, Jan; Yoo, Albert J.; Yeatts, Sharon D.; Palesch, Yuko Y.; Saver, Jeffrey L.; Pereira, Vitor M.; Broderick, Joseph P.; Albers, Gregory W.; Lansberg, Maarten G.

    2016-01-01

    Objective: To assess whether the association between reperfusion and improved clinical outcomes after stroke differs depending on the site of the arterial occlusive lesion (AOL). Methods: We pooled data from Solitaire With the Intention for Thrombectomy (SWIFT), Solitaire FR Thrombectomy for Acute Revascularisation (STAR), Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution Study 2 (DEFUSE 2), and Interventional Management of Stroke Trial (IMS III) to compare the strength of the associations between reperfusion and clinical outcomes in patients with internal carotid artery (ICA), proximal middle cerebral artery (MCA) (M1), and distal MCA (M2/3/4) occlusions. Results: Among 710 included patients, the site of the AOL was the ICA in 161, the proximal MCA in 389, and the distal MCA in 160 patients (M2 = 131, M3 = 23, and M4 = 6). Reperfusion was associated with an increase in the rate of good functional outcome (modified Rankin Scale [mRS] score 0–2) in patients with ICA (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.7–7.2) and proximal MCA occlusions (OR 6.2, 95% CI 3.8–10.2), but not in patients with distal MCA occlusions (OR 1.4, 95% CI 0.8–2.6). Among patients with M2 occlusions, a subset of the distal MCA cohort, reperfusion was associated with excellent functional outcome (mRS 0–1; OR 2.2, 95% CI 1.0–4.7). Conclusions: The association between endovascular reperfusion and better clinical outcomes is more profound in patients with ICA and proximal MCA occlusions compared to patients with distal MCA occlusions. Because there are limited data from randomized controlled trials on the effect of endovascular therapy in patients with distal MCA occlusions, these results underscore the need for inclusion of this subgroup in future endovascular therapy trials. PMID:26802090

  14. Embolic intracranial arterial occlusion visualized by non-enhanced computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Tomita, Masaaki; Minematsu, Kazuo; Choki, Junichiro; Yamaguchi, Takenori (National Cardiovascular Center, Suita, Osaka (Japan))

    1984-12-01

    A 77-year-old woman with a history of valvular heart disease, atrial fibrillation and a massive infarction in the right cerebral hemisphere developed contralateral infarction due to occlusion of the internal carotid artery. A string-like structure with higher density than normal brain was demonstrated on non-enhanced computed tomography that was performed in the acute stage. This abnormal structure seen in the left hemisphere was thought to be consistent with the middle cerebral artery trunk of the affected side. Seventeen days after the onset, the abnormal structure was no more visualized on non-enhanced CT. These findings suggested that the abnormal structure with increased density was compatible with thromboembolus or intraluminal clot formed in the distal part of the occluded internal carotid artery. The importance of this finding as a diagnostic sign of the cerebral arterial occlusion was discussed.

  15. [Intracranial occlusion of the internal carotid artery after minor closed head injury].

    Science.gov (United States)

    Nakashima, S; Tomokiyo, M; Koga, H; Furukawa, Y; Nomura, S; Shimokawa, S; Nakagawa, S; Anegawa, S; Hayashi, T

    2001-10-01

    Thrombosis of the extracranial portion of the internal carotid artery as a result of nonpenetrating head and neck injury is not uncommon. However, intracranial occlusion of the internal carotid artery after minor head and neck injury without skull fracture is rare. We report a case of 14-year-old male who suffered a minor head injury during an athletic meeting of his school and developed a right hemiparesis and a lethargy state resulting from thrombosis of the supraclinoid portion of the left internal carotid artery. On admission, skull films and a CT scan revealed no abnormality. One hour later, he fully recovered. One day later, no definite lesions were detected on T1-weighted and T2-weighted image of MRI, but an abnormal high signal lesion in the left frontal lobe was detected on diffusion-weighted image of MRI. On additional MR angiography, intracranial occlusion of the internal carotid artery due to dissection was demonstrated.

  16. Effects of K+ channel agonists cromakalim and pinacidil on rat basilar artery smooth muscle cells are mediated by Ca(++)-activated K+ channels.

    Science.gov (United States)

    Stockbridge, N; Zhang, H; Weir, B

    1991-11-27

    Whole-cell and cell-free inside-out patch-clamp recording techniques were used to examine the actions of potassium channel openers pinacidil and cromakalim in enzymatically isolated smooth muscle cells of rat basilar artery. Delayed rectifier and calcium-dependent potassium currents were identified from the whole-cell recordings. Only the calcium-dependent potassium current was increased by cromakalim and pinacidil. Recordings from inside-out membrane patches revealed a large conductance voltage- and calcium-dependent potassium channel, which was blocked by charybdotoxin but unaffected by ATP less than 10 mM. Cromakalim and pinacidil increased the open probability of this channel. On the basis of these results, we suggest that such drugs, acting on cerebral arterial smooth muscle cell potassium channels, may be of some benefit in the treatment of cerebral vasospasm following subarachnoid hemorrhage.

  17. Permanent Distal Occlusion of Middle Cerebral Artery in Rat Causes Local Increased ETB, 5-HT1B and AT1 Receptor-Mediated Contractility Downstream of Occlusion

    DEFF Research Database (Denmark)

    Rasmussen, Marianne N P; Hornbak, Malene; Larsen, Stine S;

    2013-01-01

    a model of permanent distal occlusion of rat middle cerebral arteries, we investigated whether there was a regional difference in receptor-mediated contractility of segments located upstream and downstream of the occlusion site. The contractile response to endothelin, angiotensin and 5-hydroxytryptamine...... occlusion without significant visible infarct resulted in locally increased ETB, angiotensin type 1 and 5-hydroxytryptamine 1B receptor-mediated contractile responses only in segments located downstream of the occlusion site. This suggests lack of wall stress as an initiating trigger leading to regulation...

  18. Total left main coronary artery occlusion after aortic aneurysm repair and valve replacement.

    Science.gov (United States)

    DePace, N L; Lemole, G M; Wolf, N W; Dowinsky, S; Untereker, W; Spagna, P M

    1991-02-01

    A 38-year-old woman with complete occlusion of the left main coronary artery secondary to cannulation during aortic valve replacement is presented. The clinical course was characterized by progressive left ventricular dysfunction and congestive heart failure. Recognition of this potential problem when it occurs is important as to institute therapeutic measures which may interrupt a patient's progressive clinical deterioration.

  19. Assessment of collateral artery function and growth in a pig model of stepwise coronary occlusion

    NARCIS (Netherlands)

    de Groot, Daphne; Grundmann, Sebastian; Timmers, Leo; Pasterkamp, Gerard; Hoefer, Imo E.

    2011-01-01

    de Groot D, Grundmann S, Timmers L, Pasterkamp G, Hoefer IE. Assessment of collateral artery function and growth in a pig model of stepwise coronary occlusion. Am J Physiol Heart Circ Physiol 300: H408-H414, 2011. First published October 15, 2010; doi: 10.1152/ajpheart.00070.2010.-Therapeutic stimul

  20. Stent-assisted mechanical recanalization for symptomatic subacute or chronic middle cerebral artery occlusion

    Science.gov (United States)

    Guo, Dong; Ma, Ji; Li, Teng-Fei; Zhu, Ming; Han, Xin-Wei; Shui, Shao-Feng

    2015-01-01

    To assess the feasibility and short-term effects of treating patients with subacute or chronic middle cerebral artery (M1) occlusion by stent-assisted mechanical recanalization. Six patients with cerebral arteries occlusion underwent surgery. Six cerebral arteries occlusion in 5 patients were successfully recanalized. On postoperative day 1, four patients’ symptoms were relieved and two patients’ symptoms were exacerbated, of which one was significantly improved after 3 days, the other one’s symptoms were recovered to preoperative levels in 2 weeks. No patients died after surgery. No stroke or transient ischemic attack occurred. The average follow-up of was 4.2 months, no worsening of condition, recurrence or death occurred. The results indicate that for patients with subacute or chronic middle cerebral artery (M1) occlusion, mechanical recanalization was technically feasible under the premise of strict case screening. Mechanical recanalization is able to improve ischemic symptoms and promote dysfunction restoration. But its long-term effect remains to be evaluated by further large samples, long-term follow-up studies. PMID:26885148

  1. Arterial spin labeling in patients with chic cerebral artery steno-occlusive disease - Correlation with {sup 15}O-PET

    Energy Technology Data Exchange (ETDEWEB)

    Kamano, Hironori; Yoshiura, Takashi; Hiwatashi, Akio; Abe, Koichiro; Yamashita, Koji; Honda, Hiroshi [Dept. of Clinical Radiology, Graduate School of Medical Sciences, Kyushu Univ., Fukuoka (Japan)], e-mail: tsu@radiol.med.kyushu-u.ac.jp; Togao, Osamu [Dept. of Molecular Imaging and Diagnosis, Graduate School of Medical Sciences, Kyushu Univ., Fukuoka (Japan)

    2013-02-15

    Background: Heterogeneity of arterial transit time due to cerebral artery steno-occlusive lesions hampers accurate regional cerebral blood flow measurement by arterial spin labeling (ASL). Purpose: To assess the feasibility of regional cerebral blood flow measurement by ASL with multiple-delay time sampling in patients with steno-occlusive diseases by comparing with positron emission tomography (PET), and to determine whether regional arterial transit time measured by this ASL technique is correlated with regional mean transit time, a PET index of perfusion pressure. Material and Methods: Sixteen patients with steno-occlusive diseases received both ASL and {sup 15}O-PET. The mean regional cerebral blood flow measured by ASL and PET, regional arterial transit time by ASL, and regional mean transit time by PET were obtained by a region-of-interest analysis. Correlation between regional cerebral blood flow by ASL and that by PET, and correlation between regional arterial transit time by ASL and regional mean transit time by PET were tested using Pearson's correlation coefficient for both absolute and relative values. A multivariate regression analysis was performed to test whether regional arterial transit time by ASL was a significant contributor in modeling regional mean transit time by PET after controlling the effect of regional cerebral blood flow by ASL. Results: A significant positive correlation was found between regional cerebral blood flow by ASL and that by PET for both absolute (r = 0.520, P < 0.0001) and relative (r = 0.691, P < 0.0001) values. A significant positive correlation was found between regional arterial transit time by ASL and regional mean transit time by PET both for absolute (r = 0.369, P = 0.0002) and relative (r = 0.443, P < 0.0001) values. The regression analysis revealed that regional arterial transit time by ASL was a significant contributor in modeling regional mean transit time by PET after controlling regional cerebral blood flow by

  2. Transient Presyncope Secondary to Posterior Descending Artery Occlusion

    Directory of Open Access Journals (Sweden)

    Andrew D. Moffat

    2011-01-01

    Full Text Available We describe the case of a 64-year-old male initially presenting with presyncope and bradycardia, without any anginal symptoms or objective evidence of myocardial ischemia. A stress test induced no physical symptoms but revealed a left bundle branch block with multiple preventricular contractions on electrocardiogram. Subsequent catheterization revealed severe obstructive disease throughout the coronary arteries. He was treated percutaneously on two separate heart catheterizations. The presyncope and bradycardia resolved after reperfusion of the posterior descending artery.

  3. Differentiation of acute total occlusion of coronary artery from chronic total occlusion in coronary computed tomography angiography

    Energy Technology Data Exchange (ETDEWEB)

    Kwag, Hyon Joo [Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of)

    2012-08-15

    To compare the features of coronary computed tomography angiography (CCTA) imaging of the patients with acute total occlusion (ATO) of coronary artery with those of chronic total occlusion (CTO). CCTA of 26 patients with complete interruption of the coronary artery in CCTA and occlusion in conventional coronary angiography, were retrospectively analyzed. Discrimination between the ATO group (n = 11, patients with non ST elevation myocardial infarction or unstable angina) and the CTO group (n = 15, patients with stable angina or nonspecific symptom) was arbitrarily determined by clinical diagnosis. Lesion length, remodeling index (RI), plaque density measured by Hounsfield units (HU), plaque composition, percentage attenuation drop across the lesion, and presence of myocardial thinning were evaluated. Comparisons between the ATO and CTO groups revealed significantly shorter lesion length in the ATO group (0.40 cm vs. 1.87 cm, respectively; p = 0.001), and significantly higher RI (1.56 vs. 1.10, respectively; p = 0.004). Plaque density of the ATO group was lower (37.0 HU vs. 104.7 HU, respectively; p < 0.001) and non calcified plaque was frequently seen in the ATO group (72.7% vs. 26.7%, respectively; p = 0.02). Percentage attenuation drop across the lesion was lower for the ATO group (10.92% vs. 25.44%, respectively; p = 0.005). Myocardial thinning was exclusively observed in the CTO group (seven of 15 patients, p = 0.01). CCTA shows various statistically significant differences between the ATO and CTO groups.

  4. Postprandial lower limb pain: An unusual presentation of visceral arteries occlusion.

    Science.gov (United States)

    Patelis, Nikolaos; Papoutsis, Konstantinos; Liakopoulos, Dimitrios; Koutsoumpelis, Andreas; Bakogiannis, Christos; Georgopoulos, Sotirios

    2015-06-01

    This case report describes an atypical and unique presentation of mesenteric arteries occlusive disease. The patient presented with typical symptoms of chronic mesenteric ischemia, as well as with an atypical new symptom; postprandial buttock and lower limbs pain. Pain followed the time curve of the postprandial abdominal discomfort, starting 30 min after meals and gradually resolving within 2 h. The patient had been tolerating the signs of chronic mesenteric ischemia quite well by adjusting the quantity of food per meal to relieve symptoms. Angiography showed that the celiac artery, the superior mesenteric artery, and distal aorta were occluded, leaving the inferior mesenteric artery as the only feeding vessel of all abdominal viscera and both the lower limbs. Since an English medical literature search returned only one marginally similar case, we consider this case of iliac arteries' "steal syndrome" from the inferior mesenteric artery unique.

  5. Balloon Angioplasty and Drug Eluting Stenting for Treatment of Peripheral Arterial Occlusive Disease

    Directory of Open Access Journals (Sweden)

    Akın İzgi

    2010-08-01

    Full Text Available Peripheral arterial disease is one of the manifestations of systemic atherosclerosis. In the last decade, remarkable technological advances, especially in the stent area, have shifted revascularization strategies from traditional open surgical approaches toward less morbide percutaneous endovascular treatments. However, even with new designed nitinol bare stents, restenosis remains as the major obstacle of this procedures. More recently, drug eluting stent platforms have been used to treat atherosclerotic peripheral arterial disease. In this article, we reviewed new studies relevant to drug eluting stents for lower extremity peripheral arterial occlusive disease.

  6. Central retinal artery occlusion with concomitant ipsilateral cerebral infarction after cosmetic facial injections.

    Science.gov (United States)

    Hong, Jeong-Ho; Ahn, Seong Joon; Woo, Se Joon; Jung, Cheolkyu; Chang, Jun Young; Chung, Jin-Heon; Han, Moon-Ku

    2014-11-15

    We report 2 cases of central retinal artery occlusion with concomitant ipsilateral cerebral infarction after cosmetic facial injections and a literature review. The 2 patients were two healthy women, in which cosmetic facial injections with autologous fat and filler were performed, respectively. The patients had no light perception at the final visit and their conditions led to memory retrieval disturbance in case 1 and right arm weakness, dysarthria, facial palsy, and ophthalmoplegia in case 2. Neuroimaging showed multifocal small infarctions in the ipsilateral frontal lobe with occlusion of the ophthalmic artery in case 1 and multiple infarctions in the ipsilateral anterior and middle cerebral artery territories with subsequent hemorrhagic transformation in case 2. Poor visual prognosis and neurological complications can occur in healthy adults undergoing cosmetic facial injection, and all patients should be informed of this risk before the procedure.

  7. Complete occlusion of the proximal subclavian artery post-CABG: Presentation and treatment

    Science.gov (United States)

    Sadek, Mouhannad M; Ravindran, Aravindhan; Marcuzzi, Daniel W; Chisholm, Robert J

    2008-01-01

    Atherosclerotic disease of the proximal left subclavian artery is an uncommon cause of angina in the post-coronary artery bypass graft patient, and is termed coronary-subclavian steal syndrome. Typical manifestations include cardiac symptoms of angina and noncardiac symptoms of lightheadedness, left arm numbness or weakness, and a difference in blood pressure of more than 20 mmHg between both arms. A case of complete proximal occlusion of the subclavian artery is reported. The clinical picture, investigations and treatment are described. Historical treatments of occlusive disease include surgical bypass graft and, more recently, percutaneous transluminal angioplasty. The patient underwent percutaneous transluminal angioplasty with stenting by a retrograde approach, with an excellent short-term response, but ultimately required a carotid subclavian bypass due to restenosis. PMID:18612504

  8. 翼点入路手术治疗基底动脉顶端动脉瘤%Surgical treatment for basilar artery apex aneurysm via pterional approach

    Institute of Scientific and Technical Information of China (English)

    高成; 刘相轸; 陈会荣; 林成海; 李敬文; 赵振环

    2008-01-01

    目的 回顾分析基底动脉顶端动脉瘤的手术方法和疗效.方法 2002年1月至2006年1月手术治疗基底动脉顶端动脉瘤9例,其中男3例,女6例,年龄29~57岁(平均46.6±8.4岁).按照Hunt-Hess分级,Ⅰ级2例,Ⅱ级5例,Ⅲ级2例.全部患者采用翼点入路手术,术后复查脑血管造影,随访2个月-4年(平均19个月).结果 完全夹闭6例,不全夹闭1例,包裹2例.全部病人存活,按照GOS预后分级,Ⅴ级5例,Ⅳ级3例,Ⅲ级1例.结论 掌握手术技巧,熟悉脚间池的区域显微解剖,对具体病人进行个体化设计,是提高基底动脉顶端动脉瘤手术效果的关键.%Objective To review the method and outcome of surgical treatment for basilar artery apex aneurysms. Method Nine patients who suffered basilar artery apex aneurysms were operated from Jan. 2002 to Jan. 2006. Among these patients, 3 was man and 6 was women. The age is from 29 to 57 years and average is 46.6± 8.4. Two is grade Ⅰ, 5 is grade Ⅱ and 2 is grade Ⅲ according to the Hunt-Hess grading scale system. All patients were treated via pterional approach and post-operational DSA was done to evaluate the effect of operation. The period of follow-up was from 2 months to 4 years. Results None of the patients died of operation. Six aneurysms were clipped completely and 1 was clipped incompletely, and 2 was wrapping. According to the GOS scale, 5 patients were Ⅴ, 3 was Ⅳ and 1 was Ⅲ. Conclusions Surgical treatment is an important method for the therapy of the basilar artery apex aneurysms. Excellent surgical technique and familiarity with microanatomy of interpeduncular cistern is demanded for obtaining a good outcome.

  9. Oculomotor Paresis and Basilar Aneurysm

    OpenAIRE

    J Gordon Millichap

    1992-01-01

    The clinical and pathologic findings in a 10 month old girl with congenital heart diseasewho died after rupture of a congenital distal basilar artery aneurysm are reported from the University of Connecticut Health Center, Farmington, CT and the Children’s Hospital of Philadelphia, PA.

  10. Simultaneous occlusion of three cilioretinal arteries following scleral buckling surgery under local anesthesia

    Directory of Open Access Journals (Sweden)

    Napoli PE

    2016-09-01

    Full Text Available Pietro Emanuele Napoli,* Alberto Cuccu,* Roberta Farci, Maurizio Fossarello Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy *These authors contributed equally to this work Background: Cilioretinal artery (CRA occlusions are rare in young patients. In these cases, the most commonly associated causes are considered to be the same as those implicated in central retina artery occlusions, such as vasculitic processes, migraine, cardiac disorder, and coagulation abnormality. The aim of this article was to report for the first time the medical records and investigational results of an unusual case of simultaneous occlusion of three CRAs after scleral buckling surgery under local anesthesia.Methods: A complete ophthalmic examination, including color fundus image, fundus fluorescein angiography, optical coherence tomography, visual field, as well as systemic and laboratory assessments, was performed.Results: A case of contemporaneous blockage of three CRAs after ab externo surgery for retinal detachment in a 29-year-old Caucasian woman was reported. The interdisciplinary approach and the imaging results have allowed us the clinical definition of such a very rare case.Conclusion: Here, we reported that optical coherence tomography is an indispensable tool to better delineate the pathological process and follow atrophic changes in the macula, especially in cases in which fundus fluorescein angiography and systemic tests may be poorly informative. Keywords: cilioretinal artery occlusion, optical coherence tomography, retinal detachment

  11. Small bowel volvulus in pregnancy with associated superior mesenteric artery occlusion.

    Science.gov (United States)

    Esterson, Yonah B; Villani, Robert; Dela Cruz, Ronald A; Friedman, Barak; Grimaldi, Gregory M

    Here we report the case of a pregnant 28-year-old who presented with acute upper abdominal pain. CT demonstrated midgut volvulus with short segment occlusion of the superior mesenteric artery (SMA). Emergent detorsion of the small bowel was performed, at which time underlying intestinal malrotation was discovered. Following detorsion, the SMA had a bounding pulse and did not require thrombectomy or revascularization. Fewer than 25 cases of midgut volvulus during pregnancy have been reported over the past 20years. To our knowledge, this is the first report of maternal midgut volvulus in which imaging captures the resultant occlusion of the SMA.

  12. Multi-modal assessment of neurovascular coupling during cerebral ischaemia and reperfusion using remote middle cerebral artery occlusion

    DEFF Research Database (Denmark)

    Sutherland, Brad A; Fordsmann, Jonas C; Martin, Chris;

    2016-01-01

    how neurovascular coupling is affected hyperacutely during cerebral ischaemia and reperfusion. We have developed a remote middle cerebral artery occlusion model in the rat, which enables multi-modal assessment of neurovascular coupling immediately prior to, during and immediately following reperfusion....... Male Wistar rats were subjected to remote middle cerebral artery occlusion, where a long filament was advanced intraluminally through a guide cannula in the common carotid artery. Transcallosal stimulation evoked increases in blood flow, tissue oxygenation and neuronal activity, which were diminished...... by middle cerebral artery occlusion and partially restored during reperfusion. These evoked responses were not affected by administration of the thrombolytic alteplase at clinically used doses. Evoked cerebral blood flow responses were fully restored at 24 h post-middle cerebral artery occlusion indicating...

  13. Intra-arterial therapy for cardio embolic internal carotid artery terminus occlusion: The past and present status in real practice

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Seung Guk; Jung, Cheol Kyu; KIm, Jae Hyoung; Choi, Byung Se; Kim, Beomn Joon; Han, Moon Ku; Bae, Hee Joon [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Kwon, Bae Ju [Dept. of Radiology, Myongji Hospital, Goyang (Korea, Republic of); Cha, Sang Hoon [Dept. of Radiology, Chungbuk National University College of Medicine, Daejeon (Korea, Republic of)

    2015-10-15

    There is little data on the effect of intra-arterial therapy (IAT) in acute cardioembolic internal carotid artery terminus (ICAT) occlusion that has poor prognosis. We determined procedural and clinical outcomes in patients with acute cardioembolic ICAT occlusion treated with different methods of IAT. On retrospective review of our registry, patients with cardioembolic ICAT occlusion were categorized as thrombolytic-based IAT group (TLG) and thrombectomy-based IAT group (TEG) according to the primary endovascular technique. Subsequently, procedural and clinical outcomes were compared. Fifty-five patients had cardioembolic ICAT occlusion and 18 patients were assigned to TLG and 37 patients to TEG. The rate of complete reperfusion was significantly higher and the groin puncture to reperfusion time was significantly shorter in TEG than those in TLG. There was a trend towards functional outcome at 3 months in the TEG group; however, it was not statistically significant (p = 0.06). Age, baseline Albert Stroke program early CT score and puncture to reperfusion time were factors affecting unfavorable outcome at 3 months, on multivariable analysis. Thrombectomy-based IAT has advantages over thrombolytic-based IAT in terms of the reduction of groin puncture to reperfusion time and improvement of the rate of complete reperfusion.

  14. A Clinical Study on the Effect of Yinxing Damo (银杏达莫) Combined with Betahistine Hydrochloride Injection on Vertebral Basilar Artery Ischemic Vertigo

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    Objective: To evaluate the therapeutic efficacy of Yinxing Damo (银杏达莫, YXDM) combined with Betahistine Hydrochloride Injection (BHI) on vertebra basilar artery ischemic vertigo (VBIV).Methods: Ninety patients with VBIV were randomly divided into two groups; 45 patients (the treated group)were treated with YXDM and BHI intravenous dripping, once a day for 14 days. Another 45 patients (control clinical syndromes and the index of the transcranial Doppler (TCD) and hemorheology were observed. Results: The total effective rate was 100% in the treated group, which was better than that in the control group90.5%, (P<0.05). The indexes of TCD and hemorheology in the treated group were obviously improved after treatment, (P<0.01). Conclusion: YXDM combined with BHT injection had better effect in treating patients with VBIV is an ideal drug for VBIV.

  15. Sequential bilateral central retinal artery occlusion as the primary manifestation of systemic lupus erythematosus

    Institute of Scientific and Technical Information of China (English)

    ZOU Xuan; ZHUANG Yan; DONG Fang-tian; ZHANG Fan; CHEN You-xin

    2012-01-01

    Bilateral central retinal artery occlusion (CRAO) has been rarely reported as the primary manifestation in patients with systemic lupus erythematosus (SLE).The severe retinal vaso-occlusive diseases usually cause devastating and permanent damage to visual function in spite of vigorous treatment.A 42-year-old Chinese woman presented with abrupt bilateral vision loss.The diagnosis of bilateral CRAO was suggested by the ocular presentation and fluorescein angiography.Laboratory studies showed positive results of antinuclear antibody,anti-Ro/SSA anti-La/SSB; decreased levels of C3,C4 complement and normal levels of antiphospholipides antibodies (APAs).Her visual acuity deteriorated despite systemic steroid and immunosuppressant treatment.Severe vaso-occlusive retinopathy may be an earlier manifestation of SLE without elevated level of APAs.

  16. Combined central retinal artery and vein occlusion secondary to systemic non-Hodgkin′s lymphoma

    Directory of Open Access Journals (Sweden)

    Shukla Dhananjay

    2006-01-01

    Full Text Available We report a rare case of low-grade systemic B-cell non-Hodgkin′s lymphoma (NHL causing central retinal artery and vein occlusion, which was the only manifestation of disease recurrence. A young man with resolved systemic NHL underwent fluorescein angiography, magnetic resonance imaging and computed tomography to investigate a severe unilateral visual loss. A combined vascular occlusion was observed in the right eye. Neuroimaging detected optic nerve infiltration; but no systemic/ central nervous system involvement was observed. The patient was treated with high-doses of corticosteroids and optic nerve irradiation. The optic neuropathy and vascular occlusion were resistant to treatment. The subsequent neovascular glaucoma was treated by panretinal photocoagulation, which relieved the pain, but vision was not recovered. No further recurrence was observed over the following year.

  17. Probe exchange catheter used for angioplasty of total coronary artery occlusions.

    Science.gov (United States)

    Kiemeneij, F; Suwarganda, J S; van der Wieken, L R

    1990-04-01

    Percutaneous transluminal coronary angioplasty (PTCA) for total occlusions frequently fails, because the guidewire fails to pass the occlusion. With the use of the Probe exchange catheter (PEC), however, stiffness of the guidewire is increased and a higher pushability is obtained in order to manipulate the guidewire beyond the lesion. Once the guidewire has passed, the PEC is advanced and a non-over-the-wire dilatation catheter can be introduced through the PEC. This paper describes the technique in a representative case. The results of this technique in 19 consecutive patients with class III-IV/IV(NYHA) angina due to an occluded coronary artery are presented. In 16 patients the PEC reached the lesion (84%) and in all these patients the guidewire could pass the occlusion. A successful PTCA was performed in 14 patients (74%).

  18. Hemodynamic effects of intravenous PGE1 on patients with arterial occlusive disease of the leg.

    Science.gov (United States)

    Hirai, M; Nanki, M; Nakayama, R

    1985-07-01

    In 42 patients with arterial occlusive disease of the leg, the hemodynamic effects of prostaglandin E1 (PGE1) given intravenously were studied. Blood pressure of the leg and crest time of the pulse wave did not change significantly, while increases in blood flow at the calf and foot, amplitude of the pulse wave, velocity, and skin temperature at the foot and toes were significant. Skin temperature of the calf dropped significantly. The increase in blood flow, velocity, and skin temperature was significantly more dominant in the distal part of the leg than that in the proximal part. In separate observation of individuals, 12 of the 66 legs with arterial occlusive disease (18%) showed a decrease in skin temperature at the toes. The steal phenomenon was observed most frequently in limbs with rest pain, gangrene, or both.

  19. Vibrational angioplasty in recanalization of chronic femoropopliteal arterial occlusions: Single center experience

    Energy Technology Data Exchange (ETDEWEB)

    Kapralos, Ioannis, E-mail: jkapgr@yahoo.gr [251 Hellenic Air Force General Hospital, Athens (Greece); Kehagias, Elias, E-mail: eliaskmd@yahoo.gr [Interventional Radiology Unit, Department of Radiology, Faculty of Medicine, University of Crete, Heraklion, Crete (Greece); Ioannou, Christos, E-mail: ioannou@med.uoc.g [Faculty of Medicine, University of Crete, Heraklion, Crete (Greece); Bouloukaki, Izolde, E-mail: izolthi@gmail.com [Interventional Radiology Unit, Department of Radiology, Faculty of Medicine, University of Crete, Heraklion, Crete (Greece); Kostas, Theodoros, E-mail: kostasth@mailbox.gr [Faculty of Medicine, University of Crete, Heraklion, Crete (Greece); Katsamouris, Asterios, E-mail: asterios@med.uoc.gr [Faculty of Medicine, University of Crete, Heraklion, Crete (Greece); Tsetis, Dimitrios, E-mail: tsetis@med.uoc.gr [Interventional Radiology Unit, Department of Radiology, Faculty of Medicine, University of Crete, Heraklion, Crete (Greece)

    2014-01-15

    Purpose: This prospective study aims to present the overall success rate, safety and long-term outcome of vibrational angioplasty technique, in the treatment of chronic total femoropopliteal occlusions in our institute. Methods: Between October 2000 and December 2008, patients with chronic total femoropoliteal arterial occlusions, treated with vibrational angioplasty during the same session after a failed attempt with conventional recanalization technique, were included. Patient's follow up included serial ankle-brachial index measurements and arterial duplex ultrasound examinations at 1, 3, 6, 12, 24, 36 and 48 months. Results: Twenty-seven patients (16 males and 11 females) and twenty-eight lesions were included in our study. Twenty-five lesions (89.3%) were successfully recanalized. Pain relief was noticed in twenty-one cases. From ten lesions with tissue loss (ulcer or gangrene) in successfully recanalized occlusions, six healed without major, or minor amputation. One non-healing amputation stump was healed after recanalization, without further complications. Four limbs underwent amputation (one minor and three major) despite successful recanalization, however all had an excellent healing of the amputation stump without further complications. The Kaplan–Meier test demonstrated 90%, 85% and 70% amputation-free survival rate at 12, 24 and 36 months, respectively. No major or minor complications were encountered. Conclusions: Vibrational angioplasty is a safe, effective and durable endovascular technique for the treatment of chronic total occlusions in patients with limb ischemia that would be difficult to recanalize using conventional intraluminal techniques.

  20. Management of life-threatening celiac-hepatic arterial hemorrhage after pancreaticoduodenectomy: usefulness of temporary balloon occlusion

    Institute of Scientific and Technical Information of China (English)

    WANG Mao-qiang; GUO Li-ping; LIN Han-ying; DUAN Feng; LIU Feng-yong; WANG Zhi-jun

    2011-01-01

    When a large visceral artery is ruptured,uncontrolled bleeding may lead to hemodynamic collapse.Use of endovascular occlusion balloon catheter may provide rapid control of hemorrhage and facilitate definitive therapy.We reported two patients with massive hemorrhage from ruptured celiac-hepatic artery after pancreaticoduodenectomy,who were initially treated percutaneously by temporary selective balloon occlusion.They became critically hemodynamic unstable during the angiographic procedure.Through an 8Fr sheath,a 6Fr compliant latex occlusion balloon was placed proximal to the celiac trunk and inflated,and upon patient stabilization surgical revision and stent-graft placement were successfully performed in the two patients,respectively.Temporary selective balloon occlusion provides fast and effective bleeding control for patient with critically uncontrollable visceral arterial hemorrhage,permitting subsequent use of conventional techniques for management of the arterial bleeding source.

  1. Case Report: Calcific Aortic Valve Stenosis Due to Central Retinal Artery Occlusion

    Directory of Open Access Journals (Sweden)

    Ender Sener

    2013-10-01

    Full Text Available In this case, it was reported that a 48 year old male patient with spontaneous central retinal artery occlusion (CRAO due to calcific aortic valve stenosis. He had no other systemic disease. CRAO usually occurs in elder patients with systemic risk factors. CRAO results in sudden, painless and severe vision loss. Altough, CRAO is seen rarely under 50 year old, it may appear in younger patient with aortic valve disease and calcific aortic valve stenosis caused cardiac disease.

  2. Rare complication of circumflex artery occlusion during transfemoral aortic valve replacement (TAVR).

    Science.gov (United States)

    Mukherjee, Chirojit; Banusch, Joergen; Ender, Joerg

    2014-12-01

    Circumflex artery occlusion is an unusual but grave complication that can be intra-operatively challenging to identify. Various modalities of imaging are possible during transfemoral aortic valve replacement (TAVR). Fluoroscopy and/or transesophageal echocardiography maybe used for assessment during and after TAVR. Imaging dilemma can cause delay or alter diagnosis. We report a case of an imaging complication during TAVR which might have modified the outcome of the procedure.

  3. Successful recanalization of acute superior mesenteric artery thrombotic occlusion with primary aspiration thrombectomy

    Institute of Scientific and Technical Information of China (English)

    Hye; Jin; Yang; Young; Kwon; Cho; Yun; Ju; Jo; Yoon; Young; Jung; Seung; A; Choi; Suk; Hoon; Lee

    2010-01-01

    Prompt revascularization of the superior mesenteric artery(SMA) thrombotic occlusion can prevent intestinal infarction and decrease necrosis of the bowel segment.Herein,we describe two cases who underwent successful endovascular recanalization for acute SMA thrombosis using a primary aspiration thrombectomy because of possible consequent laparotomy for survey of bowel viability.The two patients had dramatic pain reliefimmediately after the procedure and remained symptomfree during the follow-up period.

  4. Endovascular Management of Long-Segmental Petrocavernous Internal Carotid Artery (Carotid S) Occlusion

    OpenAIRE

    Park, Soonchan; Park, Eun Suk; Kwak, Jae Hyuk; Lee, Dong-geun; Suh, Dae Chul; Kwon, Sun U.; Lee, Deok Hee

    2015-01-01

    Background and Purpose Long-segmental thrombotic occlusion of the distal internal carotid artery (ICA) sparing the cervical segment proximally and the supraclinoid segment distally, which could be termed ’Carotid S occlusion’, has an unusual clinical presentation. However, endovascular management of this lesion is challenging. The purpose of our study is to report our endovascular treatment clinical experience of the disease. Methods From March 2008 to June 2013, we could identify 14 patients...

  5. Experience of endovascular treatment of occlusion-stenotic lesions of cerebral arteries

    Directory of Open Access Journals (Sweden)

    Cherednichenko Yu.V.

    2016-03-01

    Full Text Available Objective — to evaluate the efficacy of endovascular techniques in the treatment of occlusion and stenotic lesions of the brachiocephalic and cerebral arteries, to define the ways of complications prevention. Materials and methods. 594 patients with occlusion and stenotic lesions of the brachiocephalic and cerebral arteries were operated by endovascular methods in endovascular center of Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnikov. 688 endovascular operations were carried out. Most part of the operations are carotid stenting (423 operations. All of these operations were carried out with the usage of different types of antiembolic protection systems: distal, proximal or their combination. Intracranial segments of cerebral arteries were operated in 43 cases. 169 operations of stenting of vertebral arteries in extracranial segments were performed. Subclavian arteries and brachiocephal truncus were operated in 53 cases. Results. Total removal of stenosis was achieved in 588 cases (98.99%. 509 patients (85.69% of cases had improvement in neurological status (on a scale NIHHS, Mrs., MoCA. 77 (12.96% patients had no deterioration of neurological status. Postoperative mortality was 1.01%. Common level of other complications was 4.3 %: cerebral complications - 2.7%. Discussion. The results of the endovascular treatment of occlusion and stenotic lesions of the cerebral arteries show high efficacy and low complication level. The ways of reduction complications level are identified. They are in a differentiated selection of antiembolic protection method, endovascular treatment planning, based on monitoring of changes in the brain hemoperfusion, the emphasis is on the use of the special neurologic deviсes. Conclusions. Endovascular treatment of occlusion and stenotic lesions of the cerebral arteries is effective with a small risk of complications. Risk can be reduced further by the differential choice of antiembolic protection

  6. Central retinal artery occlusion in association with fibromuscular dysplasia.

    Science.gov (United States)

    Altun, Ahmet; Altun, Gulengul; Olcaysu, Osman Okan; Kurna, Sevda Aydin; Aki, Suat Fazil

    2013-01-01

    A 14 year-old female, whose chief complaint was severe vision loss in the right eye for 2 days, presented to the Clinic of Ophthalmology of Fatih Sultan Mehmet Education and Research Hospital. The patient had been attending follow-up visits for 4 years, following a diagnosis of fibromuscular dysplasia by the Clinic of Pediatrics. The patient underwent a complete ophthalmo-logic, angiographic, hematologic, and systemic evaluation. Fundus fluorescein angiography was performed immediately, because of the cherry-red spot sign in the macula of the right eye. Fundus fluorescein angiography revealed evidence of marked stasis of the retinal arterial circulation in the right eye. Best corrected visual acuity was 20/400 in the right eye and 20/20 in the left eye.

  7. Hemiretinal Artery Occlusion in an 11-Year-Old Child with Dextrocardia

    Directory of Open Access Journals (Sweden)

    Diana E. Arévalo Simental

    2016-01-01

    Full Text Available Purpose. To report a case of hemiretinal artery occlusion in a child with dextrocardia, visceral heterotaxia, and secondary polycythemia. Methods. Complete clinical examination, fundus photography, and retinal fluorescein angiography were performed. Laboratory testing included complete blood cell count, homocysteine, protein c, protein s, activated protein s, methyltetrahydrofolate and homocysteine activator genes, factor leiden V gene, antithrombin III, and activated protein c resistance. In addition, transthoracic and transesophageal echocardiogram and cardiac catheterism were performed. Results. We report an 11-year-old boy with a sudden, painless visual loss in his right eye. His past medical history is remarkable for a congenital cardiac disease. He presented with vision of light perception in the right eye and a relative afferent pupillary defect. Fundus findings included a macular cherry-red spot and inferior hemiretinal whitening consistent with hemiretinal artery occlusion. Laboratory testing showed increased red blood cell (RBC count, hemoglobin, and hematocrit. The patient was treated with four phlebotomies with improvement of RBC count and after one month reperfusion of the retina and a visual acuity of 20/200 were observed. Thrombophilia and cardiac screening were negative, except for secondary polycythemia. Conclusion. Hemiretinal artery occlusion is extremely rare in children and is often associated with congenital cardiac disease and hypercoagulative states.

  8. [Perioperative myocardial ischemia in patients with peripheral arterial occlusive diseases].

    Science.gov (United States)

    Rapp, H J; Buselmeier, P; Gasteiger, P; Hoberg, E; Striebel, J P

    1990-04-01

    Patients with peripheral vascular disease (PVD) often have coronary artery disease (CAD) which means an increased risk during anesthesia. The prevalence of CAD is nearly 50% among such patients. Owing to claudication, diagnostic stress tests can rarely be performed in PVD patients. In order to evaluate the frequency of transient perioperative myocardial ischemia, Holter monitoring was performed in 30 consecutive PVD patients with ASA II-III and AVK scale (Fontaine) II-IV who were undergoing femoropopliteal bypass surgery. Patients who had left bundle branch block and left ventricular hypertrophy or were taking digitalis medication were excluded from Holter monitoring. The ST-segment analysis of the frequency modulated recordings (n = 19) revealed episodes of myocardial ischemia in 26% of the patients. Most (75%) of the episodes occurred preoperatively, and 25%, during or after the anesthesia or during preparation for it. Risk factors for CAD were more often found in patients with ST segment alterations than in patients without ST segment deviations, even though the preoperative antianginal medication administered was comparable in the two subgroups. It is concluded that in a considerable subset of PVD patients silent myocardial ischemia occurs, which can be related to the different perioperative intervals by means of ST segment analyses of Holter recordings. The ST segment may allow a better insight into the cardiac state of PVD patients. Further studies are necessary in larger populations to test our suspicion.

  9. Presumed toxoplasmic central retinal artery occlusion and multifocal retinitis with perivascular sheathing

    Directory of Open Access Journals (Sweden)

    Arai H

    2014-04-01

    Full Text Available Haruka Arai,1 Tsutomu Sakai,1 Kiichiro Okano,1 Ranko Aoyagi,1 Ayano Imai,2 Hiroshi Takase,2 Manabu Mochizuki,2 Hiroshi Tsuneoka11Department of Ophthalmology, Jikei University School of Medicine, Tokyo, Japan; 2Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, JapanAbstract: Central retinal artery occlusion (CRAO and multifocal retinitis with perivascular sheathing are rare in ocular toxoplasmosis. We report a case of toxoplasmic CRAO and multifocal retinitis with perivascular sheathing. A healthy 83-year-old male developed left panuveitis. Funduscopic examination of the left eye showed a swollen optic disc and sheathing of the retinal artery with a dense vitreous haze and a white retinal lesion. Serum anti-toxoplasma antibodies were positive in a latex agglutination assay. Vitrectomy was performed to improve visualization of the retinal lesions and for examination of causative microorganisms. A postoperative fundus examination revealed CRAO with optic disc involvement and multifocal retinitis with perivascular sheathing. Qualitative multiplex polymerase chain reaction detected the Toxoplasma gondii B1 gene in ocular fluid from both the aqueous and vitreous humor. The presumed diagnosis of ocular toxoplasmosis was made and treatment was started with prednisone and acetylspiramycin with subsequent improvement. Two months later, the patient developed active retinochoroiditis in the left eye. After 6 weeks of anti-toxoplasma therapy, the disease involuted. Retinal vascular occlusions and multifocal retinitis with perivascular sheathing are rare in toxoplasmosis. This is the first case report of toxoplasmic CRAO and multifocal retinitis with perivascular sheathing. The diagnosis of ocular toxoplasmosis should be considered in patients with retinal artery occlusions and multifocal retinitis with perivascular sheathing associated with inflammation.Keywords: ocular toxoplasmosis, toxoplasma retinochoroiditis

  10. PREDICTION OF THE BRAIN TOLERANCE TO CAROTID ARTERY OCCLUSION USING NONINVASIVE METHODS

    Institute of Scientific and Technical Information of China (English)

    仲骏; 王秉玉; 丁美修; 竺涵光

    2000-01-01

    Objectire To predict the tolerance of the brain to carotid occlusion using noninvasive methods.Methods The peak(pV) and mean blood flow velocity(mV) of middle cerebral artery (MCA) and anterior cerebral artery (ACA) and pulsatility index (PI) were measured pre-and postoperatively with transcranial Doppler ultrasound diagnosis system(TCD) associated with the regional cerebral oxygen (rSO2) and somatosensory evoked potentials (SSEPs) evaluation in 15 patients during manual compression, temporary occlusion and permanent occlusion of the carotid artery (CAO). Results There was no neurological deficit appearing during CAO in all the cases. The mV of ipsilateral MCA and ACA reduced (31.79±13.59)% (12.58%~56.16%) and reversed to 27.69±23.15cm/s and the rSO2 decreased (5.29±1.96)% (2%~9%). There was a linear correlation between percent change in m V of ipsilateral MCA and rSO2 fall (P=0.0001). No more than 50% attenuation of SSEPs occurred in all the cases. The difference of PI in all recording time was not significant in our study. The p V was correlated with m V (P=0.0001). No variables were different significantly between compression and occlusion. Conclusion A fall in velocity by more than 70%, in rSO2 by more than 10% or in SSEPs amplitude by more than 50% is compelling evidence for intolerance to CAO.

  11. Should embolectomy be performed in late acute lower extremity arterial occlusions?

    Directory of Open Access Journals (Sweden)

    Hikmet Iyem

    2009-07-01

    Full Text Available Hikmet Iyem, M Nesimi ErenDepartment of Cardiovascular Surgery, Dicle University, Diyarbakir, TurkeyBackground: We analyzed the embolectomy results and complications of patients who were operated on after a diagnosis of late acute arterial occlusion of lower extremities.Methods: A total of 122 patients operated on in our clinic between 2004 and 2009 for late acute arterial occlusion were included in the study. Late arterial occlusion was defined as occlusion occuring 72 hours after initial manifestation of the patient complaints related to the affected lower extremity.Results: Average age of the 122 patients (71 male, 51 female was 54.2 ± 16.8 years. In this cohort, 64.75% of patients had cardiac pathologies, while 28.68% had extracardiac causes; 1.64% patients had cathetherization, 0.81% patient had malignancy, and 2.46% patients had a history of trauma. In 1.64% of the cases, no reason for thromboembolysis could be found. Thirty-one patients (25.40% had additional surgical operations, 14 (11.47% had fasciotomy, and 9 (7.37% had amputation. Re-embolectomy was performed on 37 patients (30.32% who had ongoing ischemia after an operation. Additional surgical operations were performed on 31 patients (25.40% with ongoing ischemia. In 14 of these cases (11.47%, patients were treated with fasciotomy due to development of compartment syndrome. Amputation was performed on a total of 9 patients. Early in the postoperative phase, mortality was observed in 11 patients (9.01%.Conclusion: We believe that late embolectomies of acute late leg ischemia increases blood flow in the extremity and reduces the number of amputations required.Keywords: lower extremity, embolism, prognosis, treatment outcome

  12. Cerebellar infarction resulting from vertebral artery occlusion associated with a Jefferson fracture.

    Science.gov (United States)

    Muratsu, Hirotsugu; Doita, Minoru; Yanagi, Toshihide; Sekiguchi, Kenji; Nishida, Kotaro; Tomioka, Masao; Kurosaka, Masahiro

    2005-06-01

    Neurologic deficit secondary to a Jefferson fracture is rare, as the fracture fragments tend to spread outward. To the authors' knowledge, only five cases of vertebral artery injury associated with C1 fracture have been reported. A 75-year-old man with diffuse spinal hyperostosis hit the top of his head and sustained a Jefferson fracture. The patient presented with vertigo and slurred speech. Magnetic resonance (MR) imaging demonstrated cerebellar infarction, and MR angiography (MRA) showed bilateral vertebral artery occlusion associated with a Jefferson fracture. The patient was placed in a halo vest for a total of 11 weeks and treated with anticoagulant therapy. Vertigo gradually improved, and the patient was able to walk with a cane. Previously slurred speech was completely resolved. This case demonstrates that a Jefferson fracture can cause vertebral artery occlusion, resulting in cerebellar infarction. The clinician should be aware of the possibility and implications of vertebral artery injuries, especially if a fracture involving the foramen transversarium with displacement is documented or if there is a neurologic deficit above the level of injury. Advances in noninvasive imaging such as MRA will facilitate accurate evaluation of these potentially life-threatening vascular injuries.

  13. PHACES syndrome: a review of eight previously unreported cases with late arterial occlusions

    Energy Technology Data Exchange (ETDEWEB)

    Bhattacharya, J.J. [Department of Neuroradiology, Institute of Neurological Sciences, Southern General Hospital, 1345 Gowan Road, G51, Glasgow (United Kingdom); Luo, C.B.; Alvarez, H.; Rodesch, G.; Lasjaunias, P.L. [Neuroradiologie Diagnostique et Therapeutique, Hopital de Bicetre, Rue du General Leclerc 78, 94275, Le Kremlin-Bicetre (France); Pongpech, S. [Ramathibodi Hospital, Bangkok (Thailand)

    2004-03-01

    PHACE and PHACES are acronyms for a syndrome of variable expression comprising posterior cranial fossa malformations, facial haemangiomas, arterial anomalies, aortic coarctation and other cardiac disorders, ocular abnormalities and stenotic arterial disease. We review five girls and three boys aged 1 month-14 years with disorders from this spectrum. Six had large facial haemangiomas but recent reports suggest that small haemangiomas may occur; hence our inclusion of two possible cases. We also focus on the recently recognised feature of progressive intracranial arterial occlusions, present in four of our patients, later than previously recognised, from 4 to 14 years of age. We suggest that many elements of this disorder could reflect an abnormality of cell proliferation and apoptosis. (orig.)

  14. Nylon filament coated with paraffin for intraluminal permanent middle cerebral artery occlusion in rats.

    Science.gov (United States)

    Zuo, Xia-Lin; Wu, Ping; Ji, Ai-Min

    2012-06-21

    A variety of intraluminal nylon filament has been used in rat middle cerebral artery occlusion (MCAO) models. However the lesion extent and its reproducibility vary among laboratories. The properties of nylon filament play a part of reasons for these variations. In the present study, we used paraffin-coated nylon filament for rat MCAO model, tested the effects and advanced improvement for making the rat MCAO. Forty male Sprague-Dawley (SD) rats were randomized into two groups, MCAO with traditional uncoated nylon filament (uMCAO) and MCAO with paraffin-coated nylon filament (cMCAO), three rats as normal group and sham group respectively. Assessment included mortality rates, model success rates, neurological deficit evaluation, and infarct volume. The study showed two rats died in uMCAO group, no rat died in cMCAO group within the 12h. The model success rate of uMCAO was 100%, while the uMCAO group was 55% (n=20, two died within 12h, seven rats were excluded as the brain slices showed no TTC staining due to subarachanoid hemorrhage). Neurological evaluation demonstrated group cMCAO had more worse neurological outcomes than group uMCAO, and the difference was statistically signification (pnylon filament intraluminal occlusion provide better occlusion of middle cerebral artery than the uncoated nylon filament, improve the consistent of model, and raise the success rate to reduce the number of experimental animals. These positive results are much encouraging and interesting.

  15. Sequential neuronal and astrocytic changes after transient middle cerebral artery occlusion in the rat.

    Science.gov (United States)

    Chen, H; Chopp, M; Schultz, L; Bodzin, G; Garcia, J H

    1993-09-01

    The temporal evolution and spatial distribution of ischemic cell injury was investigated after transient middle cerebral artery (MCA) occlusion. Male Wistar rats (n = 61) were subjected to 2 h of MCA occlusion induced by advancing a nylon monofilament into the right internal carotid artery. Animals were killed after different durations of reperfusion, ranging from 4 to 166 h (n = 6-11 for each group). Neuronal injury and astrocytic reaction were evaluated using hematoxylin and eosin (H & E) and glial fibrillary acidic protein (GFAP) immunohistochemistry, respectively. Eosinophilic neurons were detected at 4 h of reperfusion in the basal ganglia, and at 10 h of reperfusion in the cortex. Focal brain infarct developed by 46 h of reperfusion, both in the cortex and the basal ganglia, and the volume remained constant between 46 and 166 h of reperfusion. Significant differences in astrocytic reaction were detected between the lesion and the periphery of the lesion at reperfusion times from 46 to 166 h; GFAP staining decreased in the core of the lesion and increased in the peripheral areas. Our data suggest that, after 2 h of MCA occlusion, brain tissue progresses from isolated neuronal injury to infarct with a time course dependent on anatomical site; and astrocytic reactivity, expressed by GFAP staining, reflects the outcome of the ischemic injury.

  16. MRI of cerebral ischaemia in rats with occlusion of the middle cerebral artery

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    Thuomas, K.AA. [Dept. of Diagnostic Radiology, University Hospital, Uppsala (Sweden); Kotwica, Z. [Dept. of Neurosurgery, University Hospital, Uppsala (Sweden); Bergstroem, K. [Dept. of Diagnostic Radiology, University Hospital, Uppsala (Sweden); Bolander, H. [Dept. of Neurosurgery, University Hospital, Uppsala (Sweden); Hillered, L. [Dept. of Neurosurgery, University Hospital, Uppsala (Sweden)]|[Dept. of Clinical Chemistry, University Hospital, Uppsala (Sweden); Olsson, Y. [Dept. of Neuropathology, University Hospital, Uppsala (Sweden); Ponten, U. [Dept. of Neurosurgery, University Hospital, Uppsala (Sweden); Persson, L. [Dept. of Neurosurgery, University Hospital, Uppsala (Sweden)

    1991-11-01

    The development of ischaemic brain oedema caused by middle cerebral artery (MCA) occlusion was studied by serial magnetic resonance imaging (MRI) in rats. Multiple spin echo sequences were used with TR = 1500 ms and TE = 30-240 ms (8 echos). Substraction images were obtained by subtracting the last three echos from the first echo. Fourteen rats were studied 3, 6, and 12 h and 1, 1.5, 3, 4, 6, and 8 days after MCA occlusion, and 2 of them also 3 and 6 weeks later. Two T2 components could be separated, a fast one representing bound water and a slow one representing free bulk water. MR showed T2 prolongation even on the first examination, and the highest values were observed 24 h after occlusion. The subsequent examinations showed a slow reduction in oedema. MR studies 3 and 6 weeks after occlusion revealed an area of very long T2, which correlated well with infarction shown by histology. The substraction images demonstrated both the infarct location and the oedematous changes in the surrounding uninfarcted tissue. MRI imaging employing T2 components and subtraction images appears to be a valuable method for observing the time course of the development and resolution of oedema in cerebral infarction. (orig.)

  17. Radioembolization of hepatic tumors. Flow redistribution after the occlusion of intrahepatic arteries

    Energy Technology Data Exchange (ETDEWEB)

    Lauenstein, T.C. [University Hospital Essen (Germany). Radiology; Heusner, T.A.; Antoch, G. [University Hospital Duesseldorf (Germany). Radiology; Hamami, M.; Bockisch, A. [University Hospital Essen (Germany). Dept. of Nuclear Medicine; Ertle, J.; Schlaak, J.F.; Gerken, G. [University Hospital Essen (Germany). Gastroenterology and Hepatology

    2011-11-15

    Radioembolization using 90yttrium is an emerging therapy option for unresectable liver malignancies. In order to reduce the number of yttrium injections, endovascular occlusion of a segmental hepatic artery has been proposed. The aim of this study was to assess whether sufficient vascular redistribution of the occluded liver segments through intrahepatic collaterals can be observed. 27 patients with hepatocellular carcinoma (n = 16) or hepatic metastases (n = 11) were studied. Hepatic angiography was performed on average 16 days prior to radioembolization. The segment II/III artery (n = 9) or the segment IV artery (n = 18) was occluded using coils. Technectium-99m-labeled macroaggregated albumin (99mTc-MAA) was injected into the right and the remaining part of the left hepatic artery in order to identify any hepatic volume not included in the perfused area. Patients underwent a SPECT/CT on average 1 h after the 99mTc-MAA injection. Two radiologists evaluated the SPECT/CT scans regarding the presence of non-perfused hepatic segments. Furthermore, hepatic perfusion was assessed by digital subtraction angiography (DSA) on the day of radioembolization. In 16 / 27 patients (59 %) a perfusion of the occluded liver segment was visible on the SPECT/CT scan. In 8 / 11 patients without flow redistribution at the time of the SPECT/CT, perfusion of the occluded segment through hepatic collaterals was observed during angiography prior to radioembolization. Hence, flow redistribution was eventually found in 24 / 27 patients (89 %). Flow redistribution after the occlusion of intrahepatic arteries prior to radioembolization can be successfully induced in the majority of patients with anatomical variants of the hepatic arteries. (orig.)

  18. CNS fungal meningitis to the "Top of the basilar"

    Institute of Scientific and Technical Information of China (English)

    Logan CS; Kirschner RC; Simonds GR

    2013-01-01

    Central nervous system(CNS) infections are a rare complication of epidural steroid injections and without strong clinical suspicion, fungal organisms may be overlooked among the long differential of causes of meningitis.Rare sequela of fungal meningitis is the development of stroke.To our knowledge, we present the first case of post epidural steroid injection(ESI) fungal meningitis leading toa basilar artery stroke, otherwise known as“top of the basilar” syndrome.We present a49-year-old female with a history ofESIs who presented to the emergency department with headache, neck stiffness, and abdominal pain.She was discharged after her labs and symptoms were deemed inconsistent with meningitis.She was eventually admitted and twelve days after her originalED visit, she was diagnosed with meningitis and started on anti-fungal treatment.She was discharged88 days later but was readmitted due to left sided weakness and mental status changes.She quickly lost motor and bulbar functions.AnMRA showed diminished distal flow through the basilar artery, suggesting near complete occlusion.Although appropriate long term anti-fungal treatment was started, the patient still succumbed to a rare vascular event.Physicians who are treating patients forESI meningitis should be aware of the potential for vasculitic and encephalitic complications.

  19. Novel risk factors for premature peripheral arterial occlusive disease in non-diabetic patients: a case-control study.

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    Annie M Bérard

    Full Text Available BACKGROUND: This study aimed to determine the prevalence of genetic and environmental vascular risk factors in non diabetic patients with premature peripheral arterial disease, either peripheral arterial occlusive disease or thromboangiitis obliterans, the two main entities of peripheral arterial disease, and to established whether some of them are specifically associated with one or another of the premature peripheral arterial disease subgroups. METHODS AND RESULTS: This study included 113 non diabetic patients with premature peripheral arterial disease (diagnosis <45-year old presenting either a peripheral arterial occlusive disease (N = 64 or a thromboangiitis obliterans (N = 49, and 241 controls matched for age and gender. Both patient groups demonstrated common traits including cigarette smoking, low physical activity, decreased levels of HDL-cholesterol, apolipoprotein A-I, pyridoxal 5'-phosphate (active form of B6 vitamin and zinc. Premature peripheral arterial occlusive disease was characterized by the presence of a family history of peripheral arterial and carotid artery diseases (OR 2.3 and 5.8 respectively, 95% CI, high lipoprotein (a levels above 300 mg/L (OR 2.3, 95% CI, the presence of the factor V Leiden (OR 5.1, 95% CI and the glycoprotein Ia(807T,837T,873A allele (OR 2.3, 95% CI. In thromboangiitis obliterans group, more patients were regular consumers of cannabis (OR 3.5, 95% CI and higher levels in plasma copper has been shown (OR 6.5, 95% CI. CONCLUSIONS: According to our results from a non exhaustive list of study parameters, we might hypothesize for 1 a genetic basis for premature peripheral arterial occlusive disease development and 2 the prevalence of environmental factors in the development of thromboangiitis obliterans (tobacco and cannabis. Moreover, for the first time, we demonstrated that the 807T/837T/873A allele of platelet glycoprotein Ia may confer an additional risk for development of peripheral

  20. Pseudo-occlusion of the anastomotic pathway between the celiac and superior mesenteric arteries in 15 cases

    Institute of Scientific and Technical Information of China (English)

    QI Yue-yong; ZOU Li-guang; WANG Wen-xian; XU Jian; CHEN Wei-jun; LIANG Ping

    2004-01-01

    To study the causes and value of the pseudo-occlusion of the anastomotic pathway between celiacand superior mesenteric arteries. Methods: 15 patients including 12 patients with hepatocellular carcinoma and 3 patients withhepatic hemangioma underwent superior mesenteric arteriography (SMA) and celiac arteriography (CA) in interventional thera-py. The angiographic features of the 15 cases were dynamically observed by 2 experienced radiologists in double-blind manner.Results: Similar interpretations were given by the 2 radiologists. In CA,pseudo-ooclusion occurred at the bifurcation of thecommon hepatic artery and the celiac artery in 8 cases, at the bifurcation of the common hepatic artery and the gastroduodenalartery in 6 cases and at the bifurcation of the right hepatic artery and the celiac artery in 1 case. No occlusion was found inSMA and the angiographic wire and catheter could pass easily through the occluded regions seen in CA. Conclusion: Pseudo-occlusion of the anastomotic pathway between the superior mesenteric and celiac arteries is rare phenomenon. Its cause was notidentified in our cases. It may result from the hemodynamic change or abnormality of the hepatic artery. It is very important tounderstand the existence of pseudo-occlusion in order to guide the catheterization in interventional therapy.

  1. 突发性聋患者椎-基底动脉血流动力学观察%The Vertebral Artery and Basilar Artery Haemodynamics of Sudden Deafness

    Institute of Scientific and Technical Information of China (English)

    邢英姿; 王东海; 侯庆军; 罗宏伟; 梁振

    2014-01-01

    目的:探讨不同频率突发性聋患者的椎-基底动脉血流动力学改变特点。方法以90例突发性聋患者为研究对象,根据听阈曲线类型分为低中频下降组、高频下降组及全频下降组,每组30例,正常对照组30例,各组均行经颅多普勒(transcranial doppler ,TCD)检查,探测双侧椎动脉(vertebral artery ,VA )、基底动脉(basilar artery ,BA),分别记录比较各组收缩期流速(systolic velocity ,Vs)、舒张期流速(diastolic velocity ,Vd)、脉冲指数(pulsitility index ,PI)、阻力指数(resistance index ,RI)。结果①低中频组、高频组、全频组突聋患者椎-基底动脉血流异常率分别为63.33%(19/30)、90.0%(27/30)和90.0%(27/30),对照组异常率为0%,高频及全频组患者血流异常率较低中频组高(P<0.05);高频组患者 VA、BA 以高流速检出较多,全频组患者低流速检出较多(P<0.05)。②突发性聋患者VA、BA的PI、RI与对照组比较差异无统计学意义(P>0.05),高频组VA、BA的Vs、Vd均高于对照组(P<0.05),低中频组BA的Vs高于对照组(P<0.05)。结论突聋患者尤其是高频、全频听力下降者椎-基底动脉血流动力学异常率明显增加。%Objective To explore different characteristics of the vertebral artery and basilar artery haemody-namics in different frequencies to provide a theoretical basis for clinical treatment .Methods 90 cases of sudden deaf-ness were induded and according to hearing curve ,the cases were divided into three groups with 30 cases for each while the control group had 30 subjects .All cases were examined by TCD ,the VA ,BA test .Results Compared with group of median and low frequency sudden deafness ,the abnormal blood flow rate were found with decreased hearing(P0 .05) .High frequency hearing loss compared with the con-trol group patients with sudden deafness

  2. Evaluation of Endarterectomy Recanalization under Ultrasound Guidance in Symptomatic Patients with Carotid Artery Occlusion.

    Directory of Open Access Journals (Sweden)

    Yumei Liu

    Full Text Available Rigorous screening and good imaging would help perform surgery on carotid artery occlusion CAO safely and effectively. The purpose of this study was to retrospectively evaluate carotid endarterectomy (CEA recanalization in patients with common carotid artery occlusion (CCAO or internal carotid artery occlusion (ICAO with color Doppler flow imaging (CDFI. A total of 59 patients undergoing CEA were enrolled. According to the results of CEA, the patients were divided into successful recanalization (group A and unsuccessful recanalization (group B groups. The original diameter, lesion length, proximal-to-distal diameter ratio and echo characteristics of the lesion within the lumen of the carotid artery were recorded before CEA and compared between the two groups. In regards to the achievement of repatency by CEA, the overall success rate was 74.6% (44/59, the success rate in CCAO patients was 75.9% (22/29 and the success rate in ICAO patients was 73.3% (22/30. There was no significant difference in the success rates between the CCAO and ICAO patients (χ2 = 0.050, P = 0.824. The overall rate of stroke and death within 30 postoperative days was 5.1% (3/59. For the CCAO patients, the lesion length in group A was shorter than that in group B (t = 3.221, P = 0.004. For the ICAO patients, the original diameter of the distal ICA was broader (t = 6.254, P = 0.000 and the proximal-to-distal ICA diameter ratio was smaller (t = 8.036, P = 0.000 in group A than in group B. The rate of recanalization for lumens with a homogeneous echo pattern (hypoecho or isoecho was significantly higher than that for lumens with echo heterogeneity for both the CCAO and ICAO patients (χ2 = 14.477, P = 0.001; χ2 = 10.519, P = 0.003. However, for both the CCAO and ICAO patients, there was no difference in the rate of recanalization between patients with hypoecho and isoecho lesions (χ2 = 0.109, P = 0.742; χ2 = 0.836, P = 0.429. The original diameter, proximal-to-distal ICA

  3. Acute and chronic spectral domain optical coherence tomography features of branch retinal artery occlusion

    Science.gov (United States)

    Rodrigues, Ian Aureliano Stephen

    2013-01-01

    Branch retinal artery occlusion (BRAO) is a common vascular occlusive disorder. BRAO involving the posterior pole is usually symptomatic, but occasionally has very limited clinical features. We describe 2 cases where the underlying pathology was initially unclear and the diagnosis therefore not reached at presentation. Use of the latest retinal imaging, spectral domain optical coherence tomography (SD-OCT) enabled correct diagnosis of BRAO. The images demonstrate and contrast the fine changes that can be seen in the acute and chronic phases of this condition and illustrate how the pathogenesis of BRAO is confined to the outer retinal layers. We believe the subtle presentations of this common condition that we discuss highlight how diagnosis of BRAO can often be challenging, but may be facilitated by the use of SD-OCT retinal imaging. PMID:23661655

  4. In vivo MRI assessment of permanent middle cerebral artery occlusion by electrocoagulation: pitfalls of procedure

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    Chauveau Fabien

    2010-02-01

    Full Text Available Abstract Permanent middle cerebral artery (MCA occlusion (pMCAO by electrocoagulation is a commonly used model but with potential traumatic lesions. Early MRI monitoring may assess pMCAO for non-specific brain damage. The surgical steps of pMCAO were evaluated for traumatic cerebral injury in 22 Swiss mice using diffusion and T2-weighted MRI (7T performed within 1 h and 24 h after surgery. Temporal muscle cauterization without MCA occlusion produced an early T2 hyperintensity mimicking an infarct. No lesion was visible after temporal muscle incision or craniotomy. Early MRI monitoring is useful to identify non-specific brain injury that could hamper neuroprotective drugs assessment.

  5. Percutaneous laser thermal angioplasty: initial clinical results with a laser probe in total peripheral artery occlusions.

    Science.gov (United States)

    Cumberland, D C; Sanborn, T A; Tayler, D I; Moore, D J; Welsh, C L; Greenfield, A J; Guben, J K; Ryan, T J

    1986-06-28

    A metal-tipped laser fibre was used during percutaneous angioplasty of femoral/popliteal or iliac artery occlusions in 56 patients. Primary success was achieved in 50 (89%) of these total occlusions, providing a channel for subsequent balloon dilatation. Before the procedure, 18 lesions had been judged untreatable by conventional angioplasty and four of the six failures were in these. Complications directly attributable to the laser probe were one case of vessel perforation and two cases of entry into vessel walls; these had no sequelae. Other acute complications were a distal thrombosis in a non-heparinised patient, requiring local streptokinase treatment, and two reocclusions and one transient peripheral embolic episode in the first 24 hours. The laser probe technique has potential for increasing the proportion of patients suitable for angioplasty.

  6. Central Retinal Artery Occlusion in a Patient with Metabolic Syndrome X

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    Sonja Predrag Cekić

    2010-01-01

    Full Text Available Purpose: To report a case of central retinal artery occlusion (CRAO in a patient with metabolic syndrome X. Case Report: A 64 year-old-man presented with abrupt, painless, and severe loss of vision in his left eye. Indirect ophthalmoscopy disclosed signs compatible with CRAO and laboratory investigations revealed erythrocyte sedimentation rate of 74 mm/h, C-reactive protein (CRP level of 21 mg/l, hyperglycemia, hyperuricemia, hypertriglyceridemia and hypercholesterolemia. Fluorescein angiography and immunological studies excluded other systemic disorders. The patient met the full criteria of the National Cholesterol Education Program for metabolic syndrome X. Conclusion: In addition to different vascular complications such as stroke, and cardiovascular disease, metabolic syndrome X may be associated with retinal vascular occlusions.

  7. Surgical salvage of acute renal artery occlusion in the setting of a solitary kidney.

    Science.gov (United States)

    Stone, Patrick; Mossalllati, Adam S; Schlarb, Haley; Schlarb, Chris

    2014-04-01

    Management of acute renal artery occlusion in patients with a solitary kidney has a poorly defined prognosis. Loss of renal function is reported by some when acute warm ischemia reaches 2 hours. We report a unique case of a patient that had a 24-hour onset of anuria and acute renal failure upon arrival to the hospital. Nuclear imaging showed trace uptake of the right kidney, without evidence of excretion. Conventional digital subtraction angiography was performed; however, evidence of nephrogram or distal filling of the renal artery was not demonstrated. Secondary to conflicting studies, a computed tomography of the abdomen and pelvis with intravenous contrast revealed only minimal cortical perfusion despite complete occlusion of the previously grafted right renal artery. Patient was taken for urgent hepatorenal bypass surgery. Intraoperative return of urine output occurred immediately after completion of the bypass. Hemodialysis, which was required preoperatively, was stopped after renal salvage, the patient has maintained a normal glomerular filtration rate and patency of her bypass by duplex follow-up.

  8. Central retinal artery occlusion following laser treatment for ocular ischemic aortic arch syndrome

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    Shah, Payal J.

    2015-12-01

    Full Text Available Objective: Ocular ischemic syndrome is a rare blinding condition generally caused by disease of the carotid artery. We describe a 69-year-old female with a 50 pack-year smoking history with aortic arch syndrome causing bilateral ocular ischemic syndrome. Methods: The patient presented with progressive visual loss and temple pain. Slit lamp biomicroscopy revealed bilateral iris neovascularization. This finding prompted a cardiovascular work up. Panretinal photocoagulation with retrobulbar block was performed in the right eye. Results: A temporal artery biopsy was negative. The carotid duplex sound showed only a 1–39% stenosis. MRA revealed a more proximal occlusion of the aortic branch for which she underwent subclavian carotid bypass surgery. At the one month follow up, the right eye suffered profound vision loss secondary to a central retinal artery occlusion. Conclusion: Ocular neovascularization may be one of the clinical manifestations of aortic arch syndrome. This case also illustrates the limitations of relying solely on carotid duplex ultrasound testing. We caution against overly aggressive panretinal photocoagulation utilizing retrobulbar anesthesia.

  9. Prophylactic balloon occlusion of internal iliac arteries in women with placenta accreta: Literature review and analysis

    Energy Technology Data Exchange (ETDEWEB)

    Dilauro, M.D.; Dason, S. [McMaster University, Michael G. DeGroote School of Medicine (Canada); Athreya, S., E-mail: sathreya@stjoes.ca [Diagnostic Imaging, St Joseph' s Healthcare Hamilton, Ontario (Canada)

    2012-06-15

    Aim: To review the literature on the use of prophylactic balloon occlusion alone and in conjunction with arterial embolization of the internal iliac arteries in women with placenta accreta. Materials and methods: The PubMed, MEDLINE, CINAHL, EMBASE, and Cochrane Library databases were searched for keywords related to this technique and its use in the avoidance of caesarean hysterectomy. The relevant published articles were selected and then searched for further references. Results: The literature search found 15 case reports and five studies for a total of 20 articles. The use of balloon catheters to prevent post-partum haemorrhage in women with placenta accreta is controversial with some investigators reporting reduced blood loss and transfusion requirements while others reporting no benefit. This procedure does not appear to reduce operative time or hospital stay. Some groups have described catheter-related complications, such as maternal thromboembolic events and the need for stent placement and/or arterial bypass. Thus far, there is no reported maternal or foetal mortality related to this procedure. Conclusion: Current evidence is based upon case reports and small retrospective studies. Larger studies or randomized controlled trials are essential in order to demonstrate the safety and efficacy of bilateral iliac balloon occlusion. The creation of a data registry would also facilitate the reporting of this technique.

  10. Incidence and Clinical Features of Neovascularization of the Iris following Acute Central Retinal Artery Occlusion

    Science.gov (United States)

    Jung, Young Ho; Ahn, Seong Joon; Hong, Jeong-Ho; Park, Kyu Hyung; Han, Moon-Ku; Jung, Cheolkyu

    2016-01-01

    Purpose To investigate the incidence of neovascularization of the iris (NVI) and clinical features of patients with NVI following acute central retinal artery occlusion (CRAO). Methods A retrospective review of 214 consecutive CRAO patients who visited one tertiary hospital between January 2009 and January 2015 was conducted. In total, 110 patients were eligible for this study after excluding patients with arteritic CRAO, a lack of follow-up, iatrogenic CRAO secondary to cosmetic filler injection, or NVI detected before CRAO attack. Fluorescein angiography (FA) was applied until retinal arterial reperfusion was achieved, typically within 1 to 3 months. Results The incidence of NVI was 10.9% (12 out of 110 patients). Neovascular glaucoma was found in seven patients (6.4%). The mean time to NVI diagnosis after CRAO events was 3.0 months (range, 1 week to 15 months). The cumulative incidence was 5.5% at 3 months, 7.3% at 6 months, and 10.9% at 15 months. Severely narrowed ipsilateral carotid arteries were observed in only three patients (27.3%). The other nine patients (75.0%) showed no predisposing conditions for NVI, such as proliferative diabetic retinopathy or central retinal vein occlusion. Reperfusion rate and prevalence of diabetes were significantly different between patients with NVI and patients without NVI (reperfusion: 0% [NVI] vs. 94.7% [no NVI], p < 0.001; diabetes: 50.0% [NVI] vs. 17.3% [no NVI], p = 0.017). Conclusions CRAO may lead to NVI and neovascular glaucoma caused by chronic retinal ischemia from reperfusion failure. Our results indicate that follow-up fluorescein angiography is important to evaluate retinal artery reperfusion after acute CRAO events, and that prophylactic treatment such as panretinal photocoagulation should be considered if retinal arterial perfusion is not recovered. PMID:27729755

  11. COMBINED INTRAOPERATIVE ILIAC ARTERY STENTSAND FEMORO-POPLITEAL BYPASS FOR MULTILEVEL ATHEROSCLEROTIC OCCLUSIVE DISEASE

    Institute of Scientific and Technical Information of China (English)

    刘昌伟; 管珩; 李拥军; 郑曰宏; 刘卫

    2001-01-01

    Objective. To review our preliminary experience and evaluate our early results of a combined intraopemtive iliac angioplasty and stenting with infrainguinal revascularization in multilevel atherosclerotic occlusive disease. Methods. From July 1999 to April 2000, intraoperative iliac angiOplasty and stenting combined with simultaneous femoro-pepliteal bypass were pedormed on 12 lower extremities of 10 patients suffering from multilevel athemsclemtic occlusive disease. There were 8 men and 2 women, average 72 years. The indicationsf or procedures included disabling claudication in 3 and rest pain in 7 patients. Results. Eleven iliac angioplasty and stem procedures combined with simultaneous 9 femoro-popliteal by-pass and 3 femoro-femoral-popliteal bypass were performed in 12 limbs of 10 patients. Angioplasty and stem placement was technically successful in all patients. One contralateral femoral-popliteal bypass was failure after femoro-femoral-popliteal bypass. There were no additional instances of procedural or postoperative morbidity or mortality. Mean follow-up was 5 months (range 1 -10 months). During the follow-up period, one femoro-infrapoplitealgraft became occluded after 7 months and above-knee amputation was required. The cumulative primary patencyrate of stented iliac arteries, femoro-femoral bypass grafts and femoro-popliteal bypass grafts were 100% (11/11), 100% (3/3) and 90. 9% (10/11) in the follow-up period, respectivdy. The amputation rate was 8. 3%(1/12). Conclusions. Intraoperative iliac artery PTA and stent placement can be safely and effectively pedormed simultaneously with infrainguinal revascularization for multilevel atherosclerotic occlusive disease by skilled vascular surgeon, using a portable C ann fluoroscopy in the operating room. Furthermore, iliac artery PTA and stenting was valuable adjunct to distal bypass either to improve inflow and outflow, or to reduce the extent of traditionalsurgical intervention, and also, any angioplasty and

  12. COMBINED INTRAOPERATIVE ILIAC ARTERY STENTS AND FEMORO-POPLITEAL BYPASS FOR MULTILEVEL ATHEROSCLEROTIC OCCLUSIVE DISEASE

    Institute of Scientific and Technical Information of China (English)

    刘昌伟; 管珩; 李拥军; 郑曰宏; 刘卫

    2001-01-01

    Objective. To review our preliminary experience and evaluate our early results of a combined intraoperative iliac angioplasty and stenting with infrainguinal revascularization in multilevel atherosclerotic occlusive disease.``Methods. From July 1999 to April 2000, intraoperative iliac angioplasty and stenting combined with simultaneous femoro-popliteal bypass were performed on 12 lower extremities of 10 patients suffering from multilevel atherosclerotic occlusive disease. There were 8 men and 2 women, average 72 years. The indications for procedures included disabling claudication in 3 and rest pain in 7 patients.``Results. Eleven iliac angioplasty and stent procedures combined with simultaneous 9 femoro-popliteal bypass and 3 femoro-femoral-popliteal bypass were performed in 12 limbs of 10 patients. Angioplasty and stent placement was technically successful in all patients. One contralateral femoral-popliteal bypass was failure after femorofemoral-popliteal bypass. There were no additional instances of procedural or postoperative morbidity or mortality. Mean follow-up was 5 months (range 1 ~ 10 months). During the follow-up period, one femoro-infrapoplitealgraft became occluded after 7 months and above-knee amputation was required. The cumulative primary patency rate of stented iliac arteries, femoro-femoral bypass grafts and femoro-popliteal bypass grafts were 100% ( 11 /11), 100% (3/3) and 90. 9% (10/11) in the follow-up period, respectively. The amputation rate was 8.3%(1/12).``Conclusions. Intraoperative iliac artery PTA and stent placement can be safely and effectively performed simultaneously with infrainguinal revascularization for multilevel atherosclerotic occlusive disease by skilled vascular surgeon, using a prtable C arm fluoroscopy in the operating room. Furthermore, iliac artery PTA and stenting was valuable adjunct to distal bypass either to improve inflow and outflow, or to reduce the extent of traditional surgical intervention, and also, any

  13. QUALITY OF LIFE IN PATIENTS WITH PERIPHERAL ARTERIAL OCCLUSIVE DISEASE ATTENDING TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Rahul J

    2013-12-01

    Full Text Available Peripheral arterial occlusive disease (PAOD is a prevalent atherosclerotic disorder characterized by exertional limb pain , loss of limband a high mortality rate.All the aspects of health status , life style , life satisfaction , mental state or well - being to gether reflect the multi - dimensional nature of Quality of Life in an individual . MATERIAL &METHODS: A cross sectional study was conducted over a period of 6 months from October 2012 to march 2013. P atients with signs and symptoms of peripheral arterial occlusive disease were ref erred for further evaluation by Color Doppler Ultrasonography to the Department of Radiodiagnosis. The evaluation of QO L in respondents with PAOD was performed , by means of WHO QOL - BREF questionnaire , after obtaining clearance from the Institution’s Ethics Committee. RESULTS: - The mean scores in each of the four domains for both men and women were found to be similar. The difference between men and women was not found to be statist ically significant for any of the four domains.The mean scores of the gangrene absent groups and gangrene present groups were found to differ significantly inthe domainsof physical (p=0.025 , psychological (p=0.031 , environmental(p=0.048and social relatio ns (p=0.017. The mean scores of the age groups of 70 years were found to differ significantly in the domains of physical (p=0.046 , psychological (p=0.037.The mean scores , of thegroups according to the Stage of PAD in accordance with Fontaine classification , were found to differ significantly in thedomains of physical (p=0.0316 , psychological (p=0.0241 , environmental(p=0.0472and social relations (p=0.0126. KEYWORDS: - Quality of life (QOL , WHOQOL BREF , Peripheral arterial occlusive disease ( PAOD

  14. Intraoperative bleeding control during cesarean delivery of complete placenta previa with transient occlusion of uterine arteries.

    Science.gov (United States)

    Kim, Ju Hyun; Joung, Eun-Ju; Lee, Soo-Jung; Kwack, Jae Young; Kwon, Yong Soon

    2015-11-01

    There are few methods to control heavy intra-operative bleeding during cesarean delivery of placenta previa. Transient occlusion of uterine arteries (TOUA) during operation has previously been reported as a quick and safe method to control intra-operative uterine bleeding. We reported 2 cases of cesarean delivery with complete placenta previa in which TOUA was performed to safely reduce intra-operative complication, especially heavy intra-operative bleeding. In the 2 cases, cesarean deliveries were safe and without any complications under the TOUA method. TOUA can be a good method to control heavy intra-operative bleeding during cesarean delivery of complete placenta previa with risk of heavy bleeding.

  15. Endoscopy-based early enterostomy closure for superior mesenteric arterial occlusion

    Institute of Scientific and Technical Information of China (English)

    Takatsugu; Oida; Hisao; Kano; Kenji; Mimatsu; Atsushi; Kawasaki; Youichi; Kuboi; Nobutada; Fukino; Sadao; Amano

    2010-01-01

    AIM:To evaluate the efficacy of endoscopic examination of blood flow and edema in the remnant bowel.METHODS:We retrospectively studied 15 patients who underwent massive bowel resection with enterostomy for superior mesenteric arterial occlusion (SMAO); the patients were divided into a delayed closure group (D group) and an early closure group (E group).RESULTS:The mean duration from initial operation to enterostomy closure was significantly shorter in the E group (18.3 ± 2.1 d) than in the D group (34.3 ± 5...

  16. Neuroretinitis with Branch Retinal Artery Occlusion in a 15-Year-Old Female

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    Sina Ahmadi

    2013-11-01

    Full Text Available We report a case of Bartonella henselae neuroretinitis with significant disc and peripapillary edema, branch retinal artery occlusion without macula involvement and well preserved central vision. A 15-year-old female presented with loss of vision over 4 weeks in the left eye. She had a history of cat exposure, but a cat scratch, insect bite or conjunctivitis was not reported. An inferotemporal arcuate scotoma developed during the acute phase and persisted over the course of the follow-up.

  17. Central retinal artery occlusion in the 9 years old girl (Clinical case report

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    E. Yu. Markova

    2014-07-01

    Full Text Available 9 years old girl was admitted to the Ophthalmological Department of Morozov Pediatric City Clinical Hospital with sudden persistent painless loss of vision of the left eye. Other organs and systems were without any changes. After ophthalmological examination (OS — white edema of central and peripapillar retina, a cherry red spot at the fovea the diagnosis of central retinal artery occlusion OS was formed, and treatment was started immediately. CRAO practically does not occur in pediatric ophthalmological practice. Therefore this clinical case can be of interest to clinicians and pediatric ophthalmologists.

  18. Oclusão arterial aguda por derivados da ergotamina Acute arterial occlusion caused by ergotamine derivatives

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    Edison Barreto de Souza

    2009-09-01

    Full Text Available Os derivados da ergotamina compõem diversas drogas amplamente utilizadas no tratamento de ataques agudos de migrânea. A intoxicação por estas substâncias resulta geralmente de sua administração crônica, promovendo sintomas secundários ao espasmo arterial e à consequente isquemia distal. Neste artigo, é relatado o caso de uma paciente de 47 anos com diagnóstico de oclusão arterial aguda em membros inferiores secundária ao uso de derivados da ergotamina. Após a suspensão da droga e a prescrição de anticoagulantes, vasodilatadores e antiagregante plaquetário, a paciente evoluiu com melhora da dor, da parestesia e com o retorno da coloração normal e dos pulsos distais em membros inferiores.Ergotamine derivatives include several drugs widely used in the treatment of acute migraine attacks. Intoxication by these substances generally results from chronic administration, promoting symptoms secondary to arterial spasm and the consequent distal ischemia. The authors report the case of a 47-year old patient with acute arterial occlusion in lower limbs secondary to the use of ergotamine derivatives. After drugs were suspended and anticoagulants, vasodilators and antiplatelet drugs were prescribed, the patient progressed with improvement of pain, paresthesia and return of normal skin color and distal pulses in lower limbs.

  19. Aneurysms of Peripancreatic Arterial Arcades Coexisting with Celiac Trunk Stenosis or Occlusion: Single Institution Experience.

    Science.gov (United States)

    Antoniak, Robert; Grabowska-Derlatka, Laretta; Nawrot, Ireneusz; Cieszanowski, Andrzej; Rowiński, Olgierd

    2017-01-01

    Introduction. True aneurysms of peripancreatic arterial arcades (PAAAs) are rare. Most of them coexist with celiac axis stenosis/occlusion due to median arcuate ligament (MAL) compression or atherosclerosis. The aim of this study was to evaluate the cause of celiac axis lesion and characterize the anatomy of the aneurysms. These findings may have important management implications. Material and Methods. A retrospective analysis of 15 patients with true PAAAs was performed. The diagnosis was established by contrast-enhanced CT, using a 64-MDCT scanner. We evaluated the most probable cause of celiac axis lesion. Aneurysms were characterized by their number, location, size, and morphology. Location of the aneurysms was classified either as pancreaticoduodenal arteries (PDA) or as dorsal pancreatic arteries (DPA) as they may represent different collateral pathways between superior mesenteric artery and celiac trunk. Results. A total of 32 true PAAAs were identified. Celiac trunk was occluded in 12 patients and critically narrowed in 3 patients. Celiac axis lesion was categorized as secondary to MAL compression in 14 cases and due to atherosclerosis in 1 case. The most common location of the aneurysms was inferior pancreaticoduodenal arteries. Only in 1 case aneurysms involved both PDA and DPA. Conclusions. Coexistence of PAAAs with celiac axis compression as well as involvement of either PDAs or DPAs has important therapeutic implications. The uninvolved collateral pathway may be sufficient to preserve effective circulation in celiac trunk branches in case of resection or embolization of the aneurysms. However, further studies are crucial to confirm our findings.

  20. New stent developments for peripheral arterial occlusive disease; Neue Stententwicklungen fuer die periphere arterielle Verschlusskrankheit

    Energy Technology Data Exchange (ETDEWEB)

    Tepe, G. [Romed Kliniken, Klinikum Rosenheim, Institut fuer Diagnostische und Interventionelle Radiologie, Rosenheim (Germany)

    2010-01-15

    Infrainguinal peripheral occlusive disease is increasingly being treated by endovascular techniques. Bare metal stainless steel, self-expanding nitinol stents, drug-eluting and covered stents (stent grafts) are becoming increasingly more important adjuncts to percutaneous translumninal angioplasty in the treatment of peripheral artery disease. In this article the available evidence supporting the use of stents in the femoropopliteal and tibial arteries will be described as well as their limitations. Future stent developments will also be discussed. (orig.) [German] Die endovaskulaere Therapie spielt bei der Therapie der peripheren arteriellen Verschlusskrankheit (PAVK) eine wichtige Rolle. Unbeschichtete ballonexpandierbare Stahlstents, selbstexpandierende Nitinolstents sowie medikamentenbeschichtete und ''covered stents'' (Stentgrafts) haben eine zunehmende Bedeutung als Zusatztherapie zusammen mit der primaeren Ballonangioplastie gewonnen. In diesem Artikel wird die klinische Evidenz beschrieben, die die Anwendung von Stents im Bereich der femoropoplitealen und tibialen Strombahn unterstuetzt. Limitationen sowie zukuenftige Stententwicklungen werden ebenfalls diskutiert. (orig.)

  1. Familial antiphospholipid syndrome presenting as bivessel arterial occlusion in a 17-year-old girl.

    Science.gov (United States)

    Jelušić, Marija; Starčević, Katarina; Vidović, Mandica; Dobrota, Savko; Potočki, Kristina; Banfić, Ljiljana; Anić, Branimir

    2013-05-01

    This article presents a case of a 17-year-old girl with primary antiphospholipid syndrome developing subacute signs of hand and leg ischaemia caused by radiologically verified radial and popliteal artery occlusion. She is successfully treated with a thrombolytic agent (alteplase) and recovers completely. Her laboratory results came positive for all three subtypes of antiphospholipid antibodies. This kind of antiphospholipid syndrome presentation is a very rare entity in itself. Shortly afterwards her mother is diagnosed with primary antiphospholipid syndrome as well. A familial form of antiphospholipid syndrome is suspected. Combination of a familial antiphospholipid syndrome presenting as bivessel arterial thrombosis is a unique case, to the best of our knowledge, never described in the literature before.

  2. 椎-基底动脉的应用解剖学研究%Applied anatomy research of vertebral basilar artery

    Institute of Scientific and Technical Information of China (English)

    尹金鹏

    2015-01-01

    目的:对椎-基底动脉的应用解剖学进行研究分析,为颈椎手术治疗提供依据。方法选取当地实验中心的15具成人尸体的头部标本进行研究,对标本进行灌注和解剖,观察右侧和左侧椎动脉穿越第六颈椎处外径和椎动脉起始处外径,比较右侧和左侧大脑后动脉与基底动脉、小脑上动脉与基底动脉、小脑下后动脉与椎动脉、小脑下前动脉与基底动脉、锁骨下动脉与椎动脉的夹角,同时对比右侧和左侧大脑后动脉起始处外径、小脑上动脉起始处外径、小脑下前动脉起始处外径、小脑下后动脉起始处外径。结果右侧椎动脉穿越第六颈椎处外径和椎动脉起始处外径均低于左侧椎动脉穿越第六颈椎处外径和椎动脉起始处外径,差异具有统计学意义(P<0.05)。右侧大脑后动脉与基底动脉、小脑上动脉与基底动脉、锁骨下动脉与椎动脉的夹角高于左侧锁骨下动脉与椎动脉的夹角,而右侧小脑下后动脉与椎动脉、小脑下前动脉与基底动脉夹角低于左侧小脑下后动脉与椎动脉、小脑下前动脉与基底动脉夹角,差异具有统计学意义(P<0.05)。右侧小脑下前动脉起始处外径高于左侧小脑下前动脉起始处外径,差异具有统计学意义(P<0.05)。结论椎动脉、椎基底动脉、小脑下前动脉起始处外径左、右两侧起始处的夹角存在一定的差异性,呈现出不对称性,这对颈椎外科手术及血管介入治疗具有重要的指导作用。%Objective To study applied anatomy of vertebral basilar artery and provide basis for cervical spine surgery. Methods choose 15 adult cadavers at local experiment center and study their head specimens by perfusion and anatomy, and o bserve external diameter of part of right and left vertebral artery crossing the 6th cervical vertebra, and starting point of vertebra l artery, and compare intersection angle between

  3. Alteration of Basilar Artery Rho-Kinase and Soluble Guanylyl Cyclase Protein Expression in a Rat Model of Cerebral Vasospasm following Subarachnoid Hemorrhage

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    Chih-Jen Wang

    2014-01-01

    Full Text Available Background and Purpose. The vasoconstrictor endothelin-1 (ET-1 has been implicated in the pathogenesis of cerebral vasospasm following subarachnoid hemorrhage (SAH. Previous results showed that CGS 26303, an endothelin converting enzyme (ECE inhibitor, effectively prevented and reversed arterial narrowing in animal models of SAH. In the present study, we assessed the effect of CGS 26303 on neurological deficits in SAH rats. The involvement of vasoactive pathways downstream of ET-1 signaling in SAH was also investigated. Methods. Sprague-Dawley rats were divided into five groups (n=6/group: (1 normal control, (2 SAH, (3 SAH+vehicle, (4 SAH+CGS 26303 (prevention, and (5 SAH+CGS 26303 (reversal. SAH was induced by injecting autologous blood into cisterna magna. CGS 26303 (10 mg/kg was injected intravenously at 1 and 24 hr after the initiation of SAH in the prevention and reversal protocols, respectively. Behavioral changes were assessed at 48 hr after SAH. Protein expression was analyzed by Western blots. Results. Deficits in motor function were obvious in the SAH rats, and CGS 26303 significantly improved the rate of paraplegia. Expressions of rho-kinase-II and membrane-bound protein kinase C-δ and rhoA were significantly increased, while those of soluble guanylyl cyclase α1 and β1 as well as protein kinase G were significantly decreased in the basilar artery of SAH rats. Treatment with CGS 26303 nearly normalized these effects. Conclusions. These results demonstrate that the rhoA/rho-kinase and sGC/cGMP/PKG pathways play pivotal roles in cerebral vasospasm after SAH. It also shows that ECE inhibition is an effective strategy for the treatment of this disease.

  4. 基底动脉狭窄与认知功能改变的临床分析%Relation between basilar artery stenosis and cognitive impairment

    Institute of Scientific and Technical Information of China (English)

    李慧英; 黄一宁; 叶长青; 白静

    2012-01-01

    Objective To study the relation between autoregulation of bilateral posterior cerebral artery flow and cognitive function in patients with basilar artery stenosis. Methods Fifteen patients with basilar artery stenosis were divided into stenosis group without cerebral infaction(n = 9) and stenosis group with cerebral infaction(n = 6). Ten healthy volunteers served as a control group. Autoregulation of bilateral posterior cerebral artery flow was assessed by transcranial Doppler ultrasound breath holding test and oblique test. Executive function,structural skill,auditory, visual and logical memory, information processing speed and visuospatial ability were assayed according to the overall neurophysiolgy test and Montreal cognitive assessment(MCA). Results The information processing speed and visuospatial ability were significantly lower in stenosis group with cerebral infarction than in control group(P<0. 05). The visuospatial ability was significantly higher in stenosis group with cerebral infarction than in stenosis group without cerebral infarction(P<0. 05). The breath holding index of posterior cerebral artery and the proportion of anterior and posterior circulating vascular motion reactivity were significantly lower in stenosis group with cerebral infarction and stenosis group without cerebral infarction than in control group (P<0. 05). The proportion of anterior and posterior circulating vascular motion reactivity was positively related with the visuospatial ability (r=0. 830, P<0. 05). Conclusion Patients with basilar artery stenosis may have cognitive impairment at different severity before cerebral infarction and its hemodynamic change is related with cognitive impairment.%目的 探讨基底动脉狭窄患者双侧大脑后动脉的脑血流自动调节变化与认知功能改变之间的关系.方法 选择基底动脉狭窄患者15例,并根据有无脑梗死分为狭窄无梗死组9例和狭窄梗死组6例,另选健康体检者10例为对照组.应用

  5. Different patterns of intestinal response to injury after arterial, venous or arteriovenous occlusion in rats

    Institute of Scientific and Technical Information of China (English)

    Francisco Javier Guzmán-de la Garza; Carlos Rodrigo Cámara-Lemarroy; Gabriela Alarcón-Galván; Paula Cordero-Pérez; Linda Elsa Mu(n)oz-Espinosa; Nancy Esthela Fernández-Garza

    2009-01-01

    AIM: To investigate the differences in injury patterns caused by arterial, venous or arteriovenous mesenteric occlusion.METHODS: Male Wistar rats were separated equally into four groups. Occlusion was performed by clamping the superior mesenteric artery (A), the mesenteric vein (V) or both (AV) for 30 min, followed by 60 min of reperfusion. A control group received sham surgery only. Intestinal sections were examined for histological damage and serum tumor necrosis factor-α (TNF-α), endothelin-1 (ET-1), P-selectin, antithrombin Ⅲ (ATⅢ) and soluble intracellular adhesion molecule-1 (ICAM-1) concentrations were measured.RESULTS: All groups showed significant mucosal injury compared to controls. Furthermore, mucosal injury was significantly more severe in the V and AV groups compared to the A group (3.6 ± 0.55, 3.4 ± 0.55 and 2 ± 0.71, respectively, P = 0.01). ICAM-1 was similarly elevated in all groups, with no significant differences between the groups. P-selectin levels were significantly elevated in the V and AV groups but not the A group (1.4 ± 0.5 ng/mL, 2.52 ± 0.9 ng/mL and 0.02 ± 0.01 ng/mL,respectively, P = 0.01) and ET-1 was significantly elevated in the A and V groups but not the AV group (0.32 ± 0.04 pg/mL, 0.36 ± 0.05 pg/mL and 0.29 ± 0.03 pg/mL, respectively, P = 0.01) compared to sham controls. ATⅢ levels were markedly depleted in the V and AV groups, but not in the A group (29.1 ± 5.2 pg/mL,31.4 ± 21.8 pg/mL and 55.8 ± 35.6 pg/mL ,respectively, P = 0.01), compared to controls. Serum TNF-α was significantly increased in all groups compared to sham controls (1.32 ± 0.87 ng/mL, 1.79 ± 0.20 ng/mL and 4.4 ± 0.69 ng/mL, for groups A, V and AV,respectively, P = 0.01), with higher values in the AV group.CONCLUSION: Different patterns of response to ischemia/reperfusion are associated with venous, arterial or arteriovenous occlusion. Venous and arteriovenous occlusion was associated with the most severe alterations.

  6. Superior mesenteric arterial branch occlusion causing partial jejunal ischemia: a case report

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    Van De Winkel Nele

    2012-02-01

    Full Text Available Abstract Introduction Ischemic bowel disease comprises both mesenteric ischemia and colonic ischemia. Mesenteric ischemia can be divided into acute and chronic ischemia. These are two separate entities, each with their specific clinical presentation and diagnostic and therapeutic modalities. However, diagnosis may be difficult due to the vague symptomatology and subtle signs. Case presentation We report the case of a 68-year-old Caucasian woman who presented with abdominal discomfort, anorexia, melena and fever. A physical examination revealed left lower quadrant tenderness and an irregular pulse. Computed tomography of her abdomen as well as computed tomography enterography, enteroscopy, angiography and small bowel enteroclysis demonstrated an ischemic jejunal segment caused by occlusion of a branch of the superior mesenteric artery. The ischemic segment was resected and an end-to-end anastomosis was performed. The diagnosis of segmental small bowel ischemia was confirmed by histopathological study. Conclusion Mesenteric ischemia is a pathology well-known by surgeons, gastroenterologists and radiologists. Acute and chronic mesenteric ischemia are two separate entities with their own specific clinical presentation, radiological signs and therapeutic modalities. We present the case of a patient with symptoms and signs of chronic mesenteric ischemia despite an acute etiology. To the best of our knowledge, this is the first report presenting a case of acute mesenteric ischemia with segmental superior mesenteric artery occlusion.

  7. Evaluation of MR angiography and blood flow measurement in abdominal and peripheral arterial occlusive disease

    Energy Technology Data Exchange (ETDEWEB)

    Tabuchi, Kenji [Dokkyo Univ. School of Medicine, Mibu, Tochigi (Japan)

    2000-03-01

    To assess the characteristics of blood flow measurement with MR Angiography (MRA) to evaluate the status of vascular stenoses, two or three dimensional time-of-flight MRA and velocity-encoded cine MR were performed in the 230 segments of 35 patients, with abdominal and peripheral arterial occlusive diseases. In 11 of these 35 patients digital subtraction angiography was additionally underwent, and the stenotic findings was compared with MRA. There were 17 segments in which the velocity could not be measured, because the blood flow exceeded the upper limit of peak-encoded velocity (VENC) which was set at 120 cm/sec. Therefore, it is necessary to set the upper limit of VENC at higher than 120 cm/sec. There were 11 stenotic findings in DSA and 20 stenotic findings in MRA. Pulsatility Index (PI=(max velocity-min. velocity)/average velocity) were used for evaluating the blood flow waveform, and there were significant difference between the 11 stenotic findings of DSA and the others'. In summery, MRA was considered as useful examination to assess the degree of the vascular stenoses in abdominal and peripheral arterial occlusive disease. (author)

  8. Strophanthus hispidus attenuates the Ischemia-Reperfusion induced myocardial Infarction and reduces mean arterial pressure in renal artery occlusion

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    Rohit Gundamaraju

    2014-01-01

    Full Text Available Background: The myocardium is generally injured in the case of reperfusion injury and arterial damage is caused by hypertension. In reference to these statements, the present study was focused. Cardiac glycosides were said to have protective effects against myocardial infarction and hypertension. Strophanthus hispidus was thus incorporated in the study. Objective: The prime objective of the study was to investigate the protective effects of Strophanthus hispidus against ischemia-reperfusion myocardial Infarction and renal artery occluded hypertension in rats. Materials and Methods: The animal model adopted was surgically-induced myocardial ischemia, performed by means of left anterior descending coronary artery occlusion (LAD for 30 min followed by reperfusion for another 4 h. Infarct size was assessed by using the staining agent TTC (2,3,5-triphenyl tetrazolium chloride. Hypertension was induced by clamping the renal artery with renal bulldog clamp for 4 h. Results: The study was fruitful by the effect of Strophanthus hispidus on infarction size, which got reduced to 27.2 ± 0.5and 20.0 ± 0.2 by 500 mg/Kg and 1000 mg/Kg ethanolic extracts which was remarkably significant when compared with that of the control group 52.8 ± 4.6. The plant extract did reduce heart rate at various time intervals. There was also a protective effect in the case of mean arterial blood pressure were the 500 mg/Kg and 1000 mg/Kg of the plant extract did reduce the hypertension after 60 minutes was 60.0 ± 4.80 and 50.50 ± 6.80. Conclusion: The results suggest that 500 mg/Kg and 100 mg/Kg ethanolic extract of Strophanthus hispidus was found to possess significant cardiac protective and anti-hypertensive activity.

  9. Clinical significance of posterior cerebral artery stenosis/occlusion in moyamoya disease

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    Kuroda, Satoshi; Ishikawa, Tatsuya; Iwasaki, Yoshinobu [Hokkaido Univ., Sapporo (Japan). Graduate School of Medicine; Houkin, Kiyohiro [Sapporo Medical Univ. (Japan)

    2002-12-01

    The present study was aimed at clarifying the clinical significance of posterior cerebral artery (PCA) stenosis/occlusion in pediatric and adult moyamoya disease. This study included a total of 132 patients (52 children and 80 adults) who were diagnosed as by cerebral angiography having moyamoya disease. CT or MRI was performed to examine the location of cerebral infarction in all subjects. Cerebral blood flow and vasoreactivity to acetazolamide were measured in 80 patients before surgery, using single photon emission computed tomography (SPECT). Three-dimensional MR angiography (3D-MRA) was repeated in 32 pediatric patients after surgery in order to clarify the natural course of the PCA stenosis/occlusion. Of 264 sides in 132 patients, PCA stenosis/occlusion was observed in 50 sides of 40 patients (30.3%). Its incidence was significantly higher in ischemic-type patients than in hemorrhagic-type and asymptomatic patients, and was higher in patients in the advanced stage of the disease. The hemisphere ipsilateral to PCA stenosis/occlusion had higher incidence of ischemic symptoms, cerebral infarction, and impaired cerebral hemodynamics. Transient ischemic attack (TIA) (hemianopsia) or cerebral infarction in the occipital lobe was noted in 4 (10%) of 40 patients during follow-up periods after bypass surgery for anterior circulation. Of 32 pediatric patients, none showed progression of PCA stenosis on 3D-MRA during follow-up periods. The present study showed that the involvement of PCA could increase the risk of TIA and/or cerebral infarction in both anterior and posterior circulation areas, suggesting that the PCA plays an important collateral role in moyamoya disease. (author)

  10. Ulnar Artery Compression: A Feasible and Effective Approach to Prevent the Radial Artery Occlusion after Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Jun Tian

    2015-01-01

    Full Text Available Background: Radial artery (RA occlusion (RAO is not rare in patients undergoing coronary intervention by transradial approach (TRCI. Predictors of and prevention from RAO have not been systematically studied. This study aimed to analyze the risk factors of the weakness of RA pulsation (RAP and its predictive value for RAO after TRCI, and simultaneously to describe a feasible and effective approach to maintain RA patency. Methods: Between June 2006 and March 2010, all patients who underwent TRCI were classified according to the weakness of RAP after removing compression bandage with confirmation by Doppler ultrasound for the first 30 consecutive patients. Among a total of 2658 patients studied, 187 (7% patients having a weaker RAP were prospectively monitored. At 1 h after bandage removal, the ulnar artery in puncture side of all patients was blocked with manual compression to favor brachial and collateral artery blood flow through the RA until a good RAP was restored. The primary analysis was the occurrence of RAO. Results: Doppler ultrasound demonstrated the significant reduction of both systolic velocity (61.24 ± 3.95 cm/s vs. 72.31 ± 3.57 cm/s and diastolic velocity (1.83 ± 0.32 cm/s vs. 17.77 ± 3.97 cm/s in RA at access side as compared to the contralateral RA (all P < 0.001, but these velocities in ipsilateral ulnar artery (81.2 ± 2.16 cm/s and 13.1 ± 2.86 cm/s, respectively increased profoundly. The average time of ulnar artery compression was 4.1 ± 1.2 h (ranged 2.5-6.5 h. There were two patients experienced persistent RAO with a success rate of 98.9% and RAO in 0.075% of patients after ulnar artery compression was applied. The pulsation of the ulnar artery after compression was removed had not been influenced by the compression. Conclusions: After intervention using TRCI approach, the presence of a weaker RAP is an indicator of imminent RAO. The continuing compression of ipsilateral ulnar artery is an effective approach to

  11. Ulnar Artery Compression: A Feasible and Effective Approach to Prevent the Radial Artery Occlusion after Coronary Intervention

    Institute of Scientific and Technical Information of China (English)

    Jun Tian; Yu-Shun Chu; Jing Sun; Tie-Min Jiang

    2015-01-01

    Background:Radial artery (RA) occlusion (RAO) is not rare in patients undergoing coronary intervention by transradial approach (TRCI).Predictors of and prevention from RAO have not been systematically studied.This study aimed to analyze the risk factors of the weakness of RA pulsation (RAP) and its predictive value for RAO after TRCI,and simultaneously to describe a feasible and effective approach to maintain RA patency.Methods:Between June 2006 and March 2010,all patients who underwent TRCI were classified according to the weakness of RAP after removing compression bandage with confirmation by Doppler ultrasound for the first 30 consecutive patients.Among a total of 2658 patients studied,187 (7%) patients having a weaker RAP were prospectively monitored.At 1 h after bandage removal,the ulnar artery in puncture side of all patients was blocked with manual compression to favor brachial and collateral artery blood flow through the RA until a good RAP was restored.The primary analysis was the occurrence of RAO.Results:Doppler ultrasound demonstrated the significant reduction of both systolic velocity (61.24 ± 3.95 cm/s vs.72.31 ± 3.57 cm/s)and diastolic velocity (1.83 ± 0.32 cm/s vs.17.77 ± 3.97 cm/s) in RA at access side as compared to the contralateral RA (all P < 0.001),but these velocities in ipsilateral ulnar artery (81.2 ± 2.16 cm/s and 13.1 ± 2.86 cm/s,respectively) increased profoundly.The average time of ulnar artery compression was 4.1 ± 1.2 h (ranged 2.5-6.5 h).There were two patients experienced persistent RAO with a success rate of 98.9% and RAO in 0.075% of patients after ulnar artery compression was applied.The pulsation of the ulnar artery after compression was removed had not been influenced by the compression.Conclusions:After intervention using TRCI approach,the presence of a weaker RAP is an indicator of imminent RAO.The continuing compression of ipsilateral ulnar artery is an effective approach to maintain RA patency.

  12. Unilateral central retinal artery occlusion as the sole presenting sign of Susac syndrome in a young man: case report

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    Samira Luiza dos Apóstolos-Pereira

    2013-06-01

    Full Text Available We report the case of a 24-year-old man presenting with sudden visual loss in the left eye from a central retinal artery occlusion. An extensive clinical investigation revealed no etiology. Three weeks later, however, the patient developed hearing loss followed by encephalopathy and multiple branch retinal artery occlusions in the right eye. Fluorescein angiography confirmed retinal vascular occlusions with no sign of vasculitis. The neurological examination revealed a diffuse encephalopathy while the MRI scan disclosed several small areas of infarcts in the brain. Bilateral sensorineural hearing loss was confirmed on audiometry. The patient was diagnosed with Susac syndrome and treated with methylprednisolone and cyclophosphamide, resulting in slight improvement and stabilization. This case shows that Susac syndrome may be diagnosed late due to the absence at onset of one or more of the symptoms of the classic triad (encephalopathy, multiple branch retinal artery occlusions and hearing loss. This case also serves to emphasize that Susac syndrome should be considered in the differential diagnosis of central retinal artery occlusion, even in apparently healthy young men.

  13. [Percutaneous angioplasty of the left renal artery in a patient with acute infarction of the left kidney with persistent occlusion of the right renal artery treated with angiotensin converting enzyme inhibitor].

    Science.gov (United States)

    Latacz, Paweł; Rudnik, Andrzej; Gutowska, Aleksandra; Zając, Mariola; Kondys, Marek; Ludyga, Tomasz; Kazibudzki, Marek; Cierpka, Lech

    2011-01-01

    A case of a 67 year-old woman with acute renal syndrome during treatment of angiotensin converting enzyme is presented. In angiography was affirmed acute occlusion left renal artery (LRA) with chronic occlusion right renal artery. Percutaneous angioplasty with implantation stent of the LRA were performed with optimal effect. In this article, the clinical management of patients with angiographically documented acute occlusion renal artery is discussed.

  14. A ruptured aneurysm arising at the leptomeningeal collateral circulation from the extracranial vertebral artery to the posterior inferior cerebellar artery associated with bilateral vertebral artery occlusion.

    Science.gov (United States)

    Chonan, Masashi; Nishimura, Shinjitu; Kimura, Naoto; Ezura, Masayuki; Uenohara, Hiroshi; Tominaga, Teiji

    2014-02-01

    We report an extremely rare case of a small ruptured aneurysm of the leptomeningeal collateral circulation from the vertebral artery (VA) to the posterior inferior cerebellar artery (PICA); this aneurysm was associated with bilateral VA occlusion. A 72-year-old woman with sudden headache, nausea, and subarachnoid hemorrhage (SAH) was admitted to our hospital. On admission, no evidence of cerebral signs or cranial nerve palsy was found. Computed tomography imaging showed SAH predominantly in the posterior fossa, and digital subtraction angiography revealed bilateral VA occlusion and the left VA aneurysm located proximal to the VA union. In addition, a small aneurysm was observed at the leptomeningeal collateral circulation located between the extracranial left VA and the left PICA. The patient underwent radical surgery on the day of the onset of the symptoms associated with SAH. However, the VA aneurysm was unruptured and surgically trapped. The small aneurysm arising at the leptomeningeal collateral circulation was ruptured during the surgery and was electrocoagulated; the collateral circulation was preserved, and no neurologic deficits were observed. The postoperative course was uneventful. SAH with the occlusion of major vessels should be diagnosed with utmost caution to allow preoperative neurologic and radiological assessments.

  15. Dexamethasone Implant (Ozurdex in a Case with Unilateral Simultaneous Central Retinal Vein and Branch Retinal Artery Occlusion

    Directory of Open Access Journals (Sweden)

    Taylan Ozturk

    2015-02-01

    Full Text Available Simultaneous branch retinal artery and vein occlusion is a rare condition that may cause severe visual loss, and its treatment is often unrewarding. Herein, we report a case with simultaneous central retinal vein and branch retinal artery occlusion; it was successfully treated with a single dexamethasone intravitreal implant. The affected eye attained a visual acuity level of 20/25 from the visual acuity of hand motions at presentation with a residual, but relatively diminished, altitudinal scotoma during a follow-up period of 6 months.

  16. Bilateral internal carotid artery and vertebral artery dissections with retinal artery occlusion after a roller coaster ride - case report and a review.

    Science.gov (United States)

    Ozkan Arat, Yonca; Volpi, John; Arat, Anıl; Klucznik, Richard; Diaz, Orlando

    2011-01-01

    We present the first case of a woman with no significant medical history who developed dissections of bilateral carotid and bilateral vertebral arteries, as well as a retinal artery occlusion, after a roller coaster ride. A 35-year-old woman developed right-sided neck pain followed by a frontal headache immediately after a roller coaster ride. Five days after the incident, she developed complete loss of vision in her right eye for two hours. Subsequently, the vision improved but remained significantly decreased. On presentation, her visual acuity was 20/200 in the right and 20/20 in the left eye. Her fundus exam revealed retinal edema in the superotemporal retinal artery distribution without any visible emboli. Her neurological exam was otherwise normal. The cerebral angiogram showed bilateral internal carotid and vertebral artery dissections. The patient remained stable with conservative therapy without further worsening of vision or any new neurological deficits. Outcomes for cervicocephalic arterial dissection are usually favorable, but early diagnosis is critical for initiation of appropriate treatment of possible complications. Physicians must have a high index of suspicion for arterial dissection when patients note any headache, neck pain or vertigo triggered by violent motion after leisure activities such as roller coaster rides.

  17. Role of basilar artery hypoplasia in patients with pontine penetrating artery infarction%基底动脉发育不全在脑桥穿支动脉梗死患者中的作用研究

    Institute of Scientific and Technical Information of China (English)

    张道培; 许予明; 张洪涛; 张淑玲

    2012-01-01

    目的 探讨基底动脉发育不全(BAH)与脑桥穿支动脉梗死的关系及其临床特点.方法 选择头颅MRI确诊的急性脑梗死患者328例,根据诊断分为BAH组27例和无BAH组301例.其中急性后循环穿支动脉梗死患者79例,通过头颅磁共振血管造影术评估基底动脉直径(BAH定义为直径<2 mm)、椎动脉V4段发育不全(V4AH)及胚胎大脑后动脉(FTP)情况.结果 BAH组后循环梗死、动脉发育不全(单侧V4AH、双侧V4AH、单侧FTP、双侧FTP、双侧V4AH和FTP)比例明显高于无BAH组(P<0.01).79例急性后循环穿支动脉梗死患者中,BAH 24例(30.4%),其中脑桥穿支动脉梗死15例(62.5%),后循环其他部位穿支动脉梗死9例(37.5%).在脑桥穿支动脉梗死患者中,合并BAH的比例明显高于未合并BAH的比例(62.5% vs 12.7%,P<0.01).结论 BAH与脑桥穿支动脉梗死的发生有密切关系,这些患者多合并V4AH和FTP.%Objective To study the relation between basilar artery hypoplasia(BAH) and pontine penetrating artery infarction and the clinical characteristics of BAH patients. Methods Three hundred and twenty-eight patients with acute cerebral infarction established by head MRI were divided into BAH group(n = 27) and non-BAH group(n = 301) according to their diagnosis. Basilar artery diameter (which was defined <2 mm according to BAH) , vertebral artery V4 hypoplasia (V4AH) and fetal type posterior(FTP) artery condition were assessed in 79 patients with acute posterior penetrating artery circulation ischemic stroke according to MRI. Results The proportions of posterior circulation ischemic stroke and the unilateral V4AH,bilateral V4AH,unilateral FTP,bilateral FTP, bilateral V4AH and FTP were significantly higher in BAH group than in non-BAH group(P<0. 01). Of the 79 patients with acute posterior circulation penetrating artery infarction,24(30. 4%)were diagnosed with BAH including 15(62. 5%) with pontine penetrating artery infarction and 9(37. 5

  18. Symptomatic non-atherosclerotic bilateral extracranial vertebral artery occlusion treated with extracranial to intracranial bypass: case report Oclusão sintomática não-aterosclerótica da artéria vertebral extracraniana tratada com bypass: relato de caso

    Directory of Open Access Journals (Sweden)

    Leodante B. da Costa

    2006-09-01

    Full Text Available Posterior fossa ischemia is not a very frequent situation. It is responsible for about 25% of all ischemic strokes, and the vast majority of the cases are related to atherosclerotic stenosis of the vertebral and/or basilar arteries. Acute ischemia can also occur in the setting of vertebral artery dissection, traumatic or spontaneous. Recently, blunt trauma has been increasingly recognized as a cause for craniocervical artery injury. The management options for both traumatic and atherosclerotic lesions of the posterior fossa are still under debate. We present a case of a delayed onset of hemodynamic ischemic symptoms due to bilateral vertebral artery occlusion probably related to remote trauma to the head and neck in a 55-year-old-man treated successfully with extracranial to intracranial bypass.Acidentes vasculares cerebrais (AVC isquêmicos no sistema vertebro-basilar não são frequentes. Representam cerca de 25% dos AVCs isquêmicos, e a maioria é relacionada com aterosclerose das artérias vertebrais e/ou basilar. Isquemia aguda pode também ser resultado de dissecções da artéria vertebral, traumáticas ou espontâneas. Recentemente, traumatismos fechados têm sido cada vez mais reconhecidos como causa de lesão das artérias craniocervicais, podendo ou não resultar em sintomas isquêmicos. O tratamento para estas lesões, sejam traumáticas ou ateroscleróticas, ainda é motivo de debate. Relatamos o caso de um homem de 55 anos com sintomas isquêmicos, hemodinâmicos, tardios, devido a oclusão bilateral das artérias vertebrais, provavelmente relacionada a lesão traumática das artérias vertebrais, tratada com sucesso com bypass extra-intracraniano.

  19. Adaptation in properties of skeletal muscle to coronary artery occlusion/reperfusion in rats

    Energy Technology Data Exchange (ETDEWEB)

    Ogoh, Shigehiko [Univ. of North Texas, Fort Worth, TX (United States). Health Science Center; Hirai, Taku [Kyoto Univ. (Japan). Graduate School of Medicine; Nohara, Ryuuji [Kitano Hospital, Osaka (Japan); Taguchi, Sadayoshi [Kyoto Univ. (Japan). Graduate School of Human and Environmental Studies

    2002-10-01

    The present study was designed to determine if changes in function and metabolism of heart muscle induce alterations in characteristics of skeletal muscle. We investigated the histochemical and biochemical properties of soleus (SOL) and extensor digitorum longus (EDL) muscles in Wistar rats at the chronic phase after coronary artery occlusion/reperfusion. The size of myocardial infarct region was evaluated using a high resolution pinhole single photo emission computed tomography (SPECT) system. 4wk after left coronary artery occlusion/reperfusion, the SOL and EDL of hindlimb were dissected out and immersed in isopentane cooled with liquid nitrogen for subsequent histochemical and biochemical analysis. From SPECT imaging, the blood circulation was recovered, but the recovery of fatty acid metabolism was not observed in infarct region of heart. Citrate synthase (CS) and 3-hydroxyacyl-CoA dehydrogenase (HAD) activities in infarct region of heart were lower in the myocardial infarction (MI, n=6) group compared with that of age-matched sham-operated (Sham, n=6) group. In addition, heart muscle hypertrophy caused by the dysfunction in MI group was observed. In skeletal muscle, the atrophy and transition of fiber type distribution in MI group, reported in previous studies of heart failure, were not observed. However, the succinate dehydrogenase (SDH) activity in the slow twitch oxidative (SO) from SOL of MI group decreased by 9.8% and in the fast twitch oxidative glycolytic fibers (FOG), 8.0% as compared with sham group. Capillary density of the SO fibers from SOL of MI group also reduced by 18.5% and in the FOG fibers, 18.2% as compared with Sham group. Decreased capillary density in this study related significantly to decreased SDH activity of single muscle fibers in chronic phase of perfusion after surgical infarction. Our results make it clear that there is a difference in the reaction of skeletal muscle to coronary artery occlusion/reperfusion compared with chronic

  20. Early retinal inflammatory biomarkers in the middle cerebral artery occlusion model of ischemic stroke

    Science.gov (United States)

    Ritzel, Rodney M.; Pan, Sarah J.; Verma, Rajkumar; Wizeman, John; Crapser, Joshua; Patel, Anita R.; Lieberman, Richard; Mohan, Royce

    2016-01-01

    Purpose The transient middle cerebral artery occlusion (MCAO) model of stroke is one of the most commonly used models to study focal cerebral ischemia. This procedure also results in the simultaneous occlusion of the ophthalmic artery that supplies the retina. Retinal cell death is seen days after reperfusion and leads to functional deficits; however, the mechanism responsible for this injury has not been investigated. Given that the eye may have a unique ocular immune response to an ischemic challenge, this study examined the inflammatory response to retinal ischemia in the MCAO model. Methods Young male C57B/6 mice were subjected to 90-min transient MCAO and were euthanized at several time points up to 7 days. Transcription of inflammatory cytokines was measured with quantitative real-time PCR, and immune cell activation (e.g., phagocytosis) and migration were assessed with ophthalmoscopy and flow cytometry. Results Observation of the affected eye revealed symptoms consistent with Horner’s syndrome. Light ophthalmoscopy confirmed the reduced blood flow of the retinal arteries during occlusion. CX3CR1-GFP reporter mice were then employed to evaluate the extent of the ocular microglia and monocyte activation. A significant increase in green fluorescent protein (GFP)-positive macrophages was seen throughout the ischemic area compared to the sham and contralateral control eyes. RT–PCR revealed enhanced expression of the monocyte chemotactic molecule CCL2 early after reperfusion followed by a delayed increase in the proinflammatory cytokine TNF-α. Further analysis of peripheral leukocyte recruitment by flow cytometry determined that monocytes and neutrophils were the predominant immune cells to infiltrate at 72 h. A transient reduction in retinal microglia numbers was also observed, demonstrating the ischemic sensitivity of these cells. Blood–eye barrier permeability to small and large tracer molecules was increased by 72 h. Retinal microglia exhibited enhanced

  1. Correlation of liver enzymes and sonographic findings with pulsatile index of middle cerebral and basilar arteries in nonalcoholic fatty liver

    Directory of Open Access Journals (Sweden)

    Gholamreza Rezamand

    2014-04-01

    Conclusion: Considering the increase of cerebral arteries PI in advanced liver disease, absence of increase in vascular PI of patients in the present study could be attributed to the short duration of disease from diagnosis to perform TCD, lack of advanced liver involvement (absence of liver dysfunction and the response effect to treatment before the TCD. Therefore, to assess vascular changes over time, repeating the TCD with assess other parameters such as Fibroscan and K18 factor that has more compatibility of liver function, could help to understand the pathophysiology of liver diseases and its effect on vascular resistance.

  2. Determinants of leptomeningeal collateral flow in stroke patients with a middle cerebral artery occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Seeters, Tom van; Velthuis, Birgitta K. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Biessels, Geert Jan; Kappelle, L.J. [University Medical Center Utrecht, Department of Neurology, Brain Center Rudolf Magnus, Utrecht (Netherlands); Graaf, Yolanda van der [University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht (Netherlands); Collaboration: on behalf of the Dutch acute stroke study (DUST) investigators

    2016-10-15

    Poor leptomeningeal collateral flow is related to worse clinical outcome in acute ischemic stroke, but the factors that determine leptomeningeal collateral patency are largely unknown. We explored the determinants of leptomeningeal collateral flow and assessed their effect on the relation between leptomeningeal collateral flow and clinical outcome. We included 484 patients from the Dutch acute stroke study (DUST) with a middle cerebral artery (MCA) occlusion. The determinants of poor leptomeningeal collateral flow (≤50 % collateral filling) were identified with logistic regression. We calculated the relative risk (RR) of poor leptomeningeal collateral flow in relation to poor clinical outcome (90-day modified Rankin Scale 3-6) using Poisson regression and assessed whether the determinants of leptomeningeal collateral flow affected this relation. Leptomeningeal collateral flow was poor in 142 patients (29 %). In multivariable analyses, higher admission glucose level (odds ratio (OR) 1.1 per mmol/L increase (95 % CI 1.0-1.2)), a proximal MCA occlusion (OR 1.9 (95 % CI 1.3-3.0)), and an incomplete posterior circle of Willis (OR 1.7 (95 % CI 1.1-2.6)) were independently related to poor leptomeningeal collateral flow. Poor leptomeningeal collateral flow was related to poor clinical outcome (unadjusted RR 1.7 (95 % CI 1.4-2.0)), and this relation was not affected by the determinants of leptomeningeal collateral flow. Our study shows that admission glucose level, a proximal MCA occlusion, and an incomplete ipsilateral posterior circle of Willis are determinants of leptomeningeal collateral flow that represent a combination of congenital, acquired, and acute factors. After adjustment for these determinants, leptomeningeal collateral flow remains related to clinical outcome. (orig.)

  3. Percutaneous laser-assisted recanalization of long chronic iliac artery occlusions: primary and mid-term results

    Energy Technology Data Exchange (ETDEWEB)

    Balzer, Joern O.; Gastinger, Verena; Thalhammer, Axel; Vogl, Thomas J. [Johann Wolfgang Goethe University, Department of Diagnostic and Interventional Radiology, University Clinic, Frankfurt/Main (Germany); Ritter, Ralf G.; Schmitz-Rixen, Thomas [Johann Wolfgang Goethe University, Department of Vascular and Endovascular Surgery, University Clinic, Frankfurt/Main (Germany); Lindhoff-Last, Edelgard [Johann Wolfgang Goethe University, Center of Internal Medicine I, Division of Angiology, University Clinic, Frankfurt/Main (Germany)

    2006-02-01

    We report the primary and mid-term outcome of patients with long chronic iliac artery occlusions after percutaneous excimer-laser-assisted interventional recanalization. Between 2000 and 2001, 43 patients with 46 chronic occlusions of either the common iliac artery (n=27), the external iliac artery (n=13) or both (n=3) underwent laser-assisted percutaneous transluminal angioplasty and implantation of stents. The average length of the occlusion was 57.1{+-}26 mm. After laser-assisted angioplasty and implantation of a total of 60 stents, the patients were followed up for up to 4 years. Patency rates were analyzed by ankle-brachial index (ABI) measurement and duplex ultrasound. The primary technical success rate was 95.3%, with a major complication rate of 6.9%. Clinical improvement as categorized by the Rutherford guidelines could be observed in 97.6% of cases. The ABI of all patients improved from an average of 0.46{+-}0.08 before intervention to 0.97{+-}0.13 at the end of the follow-up period. The overall primary patency rate was 86.1%. Four reinterventions were successful (secondary patency rate 95.4%). The mid-term results of the percutaneous recanalization of iliac artery occlusions with primary and secondary patency rates of 86.1 and 95.4% are similar to those of the treatment of short stenoses. (orig.)

  4. Microglia and macrophages express tumor necrosis factor receptor p75 following middle cerebral artery occlusion in mice

    DEFF Research Database (Denmark)

    Lambertsen, Kate Lykke; Clausen, Bettina Hjelm; Fenger, Claus;

    2007-01-01

    of the TNF receptors, TNF-p55R and TNF-p75R, from 1 to 10 days following permanent occlusion of the middle cerebral artery in mice. Using quantitative polymerase chain reaction (PCR), we observed that the relative level of TNF-p55R mRNA was significantly increased at 1-2 days and TNF-p75R m......RNA was significantly increased at 1-10 days following arterial occlusion, reaching peak values at 5 days, when microglial-macrophage CD11b mRNA expression was also increased. In comparison, the relative level of TNF mRNA was significantly increased from 1 to 5 days, with peak levels 1 day after arterial occlusion...... was expressed in resident microglia and blood-borne macrophages located in the peri-infarct and infarct 1 and 5 days after arterial occlusion, which was supported by Western blotting. The data show that increased expression of the TNF-p75 receptor following induction of focal cerebral ischemia in mice can...

  5. Microglia and macrophages express tumor necrosis factor receptor p75 following middle cerebral artery occlusion in mice

    DEFF Research Database (Denmark)

    Lambertsen, K.L.; Clausen, B.H.; Fenger, C.;

    2006-01-01

    of the TNF receptors, TNF-p55R and TNF-p75R, from 1 to 10 days following permanent occlusion of the middle cerebral artery in mice. Using quantitative polymerase chain reaction (PCR), we observed that the relative level of TNF-p55R mRNA was significantly increased at 1-2 days and TNF-p75R m......RNA was significantly increased at 1-10 days following arterial occlusion, reaching peak values at 5 days, when microglial-macrophage CD11b mRNA expression was also increased. In comparison, the relative level of TNF mRNA was significantly increased from 1 to 5 days, with peak levels 1 day after arterial occlusion...... was expressed in resident microglia and blood-borne macrophages located in the peri-infarct and infarct 1 and 5 days after arterial occlusion, which was supported by Western blotting. The data show that increased expression of the TNF-p75 receptor following induction of focal cerebral ischemia in mice can...

  6. Exercise training restores coronary arteriolar dilation to NOS activation distal to coronary artery occlusion - Role of hydrogen peroxide

    NARCIS (Netherlands)

    Thengchaisri, Naris; Shipley, Robert; Ren, Yi; Parker, Janet; Kuo, Lih

    2007-01-01

    Objective - Exercise training has been shown to restore vasodilation to nitric oxide synthase (NOS) activation in arterioles distal to coronary artery occlusion. Because reactive oxygen species are generated during NOS uncoupling and the production of vasodilator H2O2 is increased during exercise in

  7. Healing of ulcers on the feet correlated with distal blood pressure measurements in occlusive arterial disease

    DEFF Research Database (Denmark)

    Holstein, P; Lassen, N A

    1980-01-01

    The frequency of healing in subchronic ulcers in 66 feet in 62 patients with arterial occlusive disease was correlated with the systolic digital blood pressure (SDBP) and the systolic ankle blood pressure (SABP), both measured with a strain gauge, and with the skin perfusion pressure on the heel...... of healing correlated significantly with the three distal blood pressure parameters investigated, the closest correlation being with the SDBP measured at the final examination, i.e. just after healing of the ulcer or just before an inevitable major amputation. Of the 22 cases with SDBP below 20 mmHg only two...... (SPPH) as measured with a photocell. Thirty-two patients (35 feet with ulcerations) had diabetes mellitus. The treatment was conservative. In 42 feet the ulcers healed after an average period of 5.8 months; in 24 feet major amputation became necessary after an average of 4.3 months. The frequency...

  8. Vibration sense and sympathetic vasoconstrictor activity in patients with occlusive arterial disease

    DEFF Research Database (Denmark)

    Bjerre-Jepsen, K; Henriksen, O; Parm, Martin Lehnsbo;

    1983-01-01

    The function of sympathetic vasoconstrictor fibres was studied in 18 patients with occlusive arterial disease of the legs and somatic neuropathy, as evidenced as an increased vibration perception threshold. Nine patients suffered from long-term diabetes mellitus. Sympathetic vasoconstrictor...... function was studied by the capability of the local sympathetic venoarteriolar reflex (Henriksen 1977) elicited by lowering the leg to induce an arteriolar constriction in subcutaneous tissue at the ankle level. Blood flow was measured by the local isotope washout technique. In only five patients with loss...... of vibration sense, abnormal vasoconstrictor function was found. In three of these patients, the abnormal response most likely could be ascribed to impaired function of the vascular smooth muscle cells. Neither in diabetics nor in non-diabetics could an abnormal vibration sense be taken as evidence for loss...

  9. 都梁软胶囊治疗基底动脉型偏头痛39例%Clinical Therapy Observation of Duliang Soft Capsule for Treating Basilar Artery Migraine in 39 Cases

    Institute of Scientific and Technical Information of China (English)

    陈忠伦; 王欣; 段劲峰

    2012-01-01

    目的 观察都梁软胶囊时基底动脉型偏头痛的治疗效果.方法 将76例患者随机分成治疗组(39例)和对照组(37例),治疗组联合服用都梁软胶囊和尼莫地平,对照组单用尼莫地平,治疗2周,观察疼痛及伴随症状的变化.结果 治疗组比对照组疼痛强度降低更明显(P<0.05),总有效率亦高于对照组(P<0.05).结论联合服用都梁软胶囊治疗基底动脉型偏头痛安全、有效.%Objective To investigate the effect of Duliang Soft Capsule in treating basilar artery migraine. Methods 76 cases of basilar artery migraine were randomly divided into two groups, the treatment group( 39 cases) and the control group( 37 cases ). The treatment group was given Duliang Soft Capsule plus nimodipine, while the control group received nimodipine alone. The change of pain and accompanied symptoms were observed after 2 - week treatment. Results The pain intensity in the treatment group was significantly decreased than the control group( P < 0. 05 ), the total effective rate was also higher than that in the control group( P < 0.05). Conclusion The combination use of Duliang Soft Capsule is safe and effective to treat basilar artery migraine.

  10. Functional real-time optoacoustic imaging of middle cerebral artery occlusion in mice.

    Directory of Open Access Journals (Sweden)

    Moritz Kneipp

    Full Text Available BACKGROUND AND PURPOSE: Longitudinal functional imaging studies of stroke are key in identifying the disease progression and possible therapeutic interventions. Here we investigate the applicability of real-time functional optoacoustic imaging for monitoring of stroke progression in the whole brain of living animals. MATERIALS AND METHODS: The middle cerebral artery occlusion (MCAO was used to model stroke in mice, which were imaged preoperatively and the occlusion was kept in place for 60 minutes, after which optoacoustic scans were taken at several time points. RESULTS: Post ischemia an asymmetry of deoxygenated hemoglobin in the brain was observed as a region of hypoxia in the hemisphere affected by the ischemic event. Furthermore, we were able to visualize the penumbra in-vivo as a localized hemodynamically-compromised area adjacent to the region of stroke-induced perfusion deficit. CONCLUSION: The intrinsic sensitivity of the new imaging approach to functional blood parameters, in combination with real time operation and high spatial resolution in deep living tissues, may see it become a valuable and unique tool in the development and monitoring of treatments aimed at suspending the spread of an infarct area.

  11. Primary angioplasty for infarction due to isolated right ventricular artery occlusion

    Institute of Scientific and Technical Information of China (English)

    Anwar; A; Chahal; Min-Young; Kim; Alexander; N; Borg; Yahya; Al-Najjar

    2014-01-01

    We report an unusual case of an isolated right ventricular infarction with haemodynamic compromise caused by spontaneous isolated proximal occlusion of the right ventricular branch of the right coronary artery(RCA), successfully treated by balloon angioplasty. A 58-yearold gentleman presented with epigastric pain radiating into both arms. Electrocardiograph with right ventricular leads confirmed ST elevation in V4 R and a diagnosis of isolated right ventricular infarction was made. Urgent primary percutaneous intervention was performed which revealed occlusion of the right ventricular branch of the RCA. During the procedure, the patient’s blood pressure dropped to 80/40 mm Hg, and echocardiography showed impaired right ventricular systolic function. Despite aggressive fluid resuscitation, the patient remained hypotensive, continued to have chest pain and persistent electrocardiograph changes, and hence balloon angioplasty was performed on the proximal right ventricular branch which restored flow to the vessel and revealed a severe ostial stenosis. This was treated with further balloon angioplasty which restored TIMI 3 flow with resolution of patient’s symptoms. Repeat echocardiography showed complete resolution of theST-elevation in leads V4 R and V5 R and partial resolution in V1. Subsequent dobutamine-stress echocardiography at 4 wk showed good left and right ventricular contractions. The patient was discharged after a 3-d inpatient stay without any complications.

  12. Diagnostic Pitfalls in Postinterventional Intraarterial Magnetic Resonance Angiography after Recanalization of Femoropopliteal Arterial Occlusions

    Energy Technology Data Exchange (ETDEWEB)

    Huegli, R.W.; Aschwanden, M.; Kos, S.; Rasmus, M.; Jaeger, K.; Jacob, A.L.; Bilecen, D. (Dept. of Radiology and Dept. of Angiology, Univ. Hospital of Basel, Basel (Switzerland))

    2008-12-15

    Background: Magnetic resonance (MR)-guided vascular interventions are of increasing interest, and, with the use of contrast-enhanced techniques, intraarterial contrast-enhanced MR angiography (ia-ce-MRA) competes with intraarterial digital subtraction angiography (ia-DSA) for the diagnostic evaluation of the infrainguinal vessel tree. Purpose: To assess the diagnostic value of ia-ce-MRA and high-resolution T1-weighted (hr-T1w) imaging compared to the gold-standard ia-DSA for residual stenosis and local dissections after femoropopliteal recanalization in patients with peripheral arterial occlusive disease (PAOD). Material and Methods: Eight patients with PAOD and short vessel occlusion of their femoropopliteal arteries underwent recanalization and balloon positioning under DSA. Patients were transferred to a short-bore MR scanner. Percutaneous transluminal angioplasty (PTA) was accomplished under MR fluoroscopy. Pre- and postinterventional ia-ce three-dimensional (3D) gradient-echo MRA with gadopentate dimeglumine was performed using the intraarterial introducer sheath. Maximum intensity projections (MIP) and multiplanar reconstructions (MPR) were calculated from the data set. High-resolution T1w images of the angioplasty region before and after dilatation were acquired. Control ia-DSA images were obtained. Results: The postinterventional angioplasty results for stenosis grading were comparable in ia-MRA and ia-DSA. Only two of five local dissections in ia-DSA were visualized with the ia-ce-MRA runs including MIPs and MPRs. To clearly depict dissection, hr-T1w images were needed. Conclusion: Grading of stenotic lesions with ia-ce-MRA after PTA is comparable to ia-DSA. Intraarterial ce-MRA with calculated MIPs and MPRs is only partially sufficient to visualize local dissections after PTA. High-resolution T1w images are required for precise diagnosis of dissections in magnetic resonance tomography

  13. Diagnostic Pitfalls in Postinterventional Intraarterial Magnetic Resonance Angiography after Recanalization of Femoropopliteal Arterial Occlusions

    Energy Technology Data Exchange (ETDEWEB)

    Huegli, R.W.; Aschwanden, M.; Kos, S.; Rasmus, M.; Jaeger, K.; Jacob, A.L.; Bilecen, D. [Dept. of Radiology and Dept. of Angiology, Univ. Hospital of Basel, Basel (Switzerland)

    2008-12-15

    Background: Magnetic resonance (MR)-guided vascular interventions are of increasing interest, and, with the use of contrast-enhanced techniques, intraarterial contrast-enhanced MR angiography (ia-ce-MRA) competes with intraarterial digital subtraction angiography (ia-DSA) for the diagnostic evaluation of the infrainguinal vessel tree. Purpose: To assess the diagnostic value of ia-ce-MRA and high-resolution T1-weighted (hr-T1w) imaging compared to the gold-standard ia-DSA for residual stenosis and local dissections after femoropopliteal recanalization in patients with peripheral arterial occlusive disease (PAOD). Material and Methods: Eight patients with PAOD and short vessel occlusion of their femoropopliteal arteries underwent recanalization and balloon positioning under DSA. Patients were transferred to a short-bore MR scanner. Percutaneous transluminal angioplasty (PTA) was accomplished under MR fluoroscopy. Pre- and postinterventional ia-ce three-dimensional (3D) gradient-echo MRA with gadopentate dimeglumine was performed using the intraarterial introducer sheath. Maximum intensity projections (MIP) and multiplanar reconstructions (MPR) were calculated from the data set. High-resolution T1w images of the angioplasty region before and after dilatation were acquired. Control ia-DSA images were obtained. Results: The postinterventional angioplasty results for stenosis grading were comparable in ia-MRA and ia-DSA. Only two of five local dissections in ia-DSA were visualized with the ia-ce-MRA runs including MIPs and MPRs. To clearly depict dissection, hr-T1w images were needed. Conclusion: Grading of stenotic lesions with ia-ce-MRA after PTA is comparable to ia-DSA. Intraarterial ce-MRA with calculated MIPs and MPRs is only partially sufficient to visualize local dissections after PTA. High-resolution T1w images are required for precise diagnosis of dissections in magnetic resonance tomography.

  14. Screen-imaging guidance using a modified portable video macroscope for middle cerebral artery occlusion

    Institute of Scientific and Technical Information of China (English)

    Xingbao Zhu; Xinghua Pan; Junli Luo; Yun Liu; Guolong Chen; Song Liu; Qiangjin Ruan; Xunding Deng; Dianchun Wang; Quanshui Fan

    2012-01-01

    The use of operating microscopes is limited by the focal length. Surgeons using these instruments cannot simultaneously view and access the surgical field and must choose one or the other. The longer focal length (more than 1 000 mm) of an operating telescope permits a position away from the operating field, above the surgeon and out of the field of view. This gives the telescope an advantage over an operating microscope. We developed a telescopic system using screen-imaging guidance and a modified portable video macroscope constructed from a Computar MLH-10 × macro lens, a DFK-21AU04 USB CCD Camera and a Dell laptop computer as monitor screen. This system was used to establish a middle cerebral artery occlusion model in rats. Results showed that magnification of the modified portable video macroscope was appropriate (5-20 ×) even though the Computar MLH-10 × macro lens was placed 800 mm away from the operating field rather than at the specified working distance of 152.4 mm with a zoom of 1-40 ×. The screen-imaging telescopic technique was clear, life-like, stereoscopic and matched the actual operation. Screen-imaging guidance led to an accurate, smooth, minimally invasive and comparatively easy surgical procedure. Success rate of the model establishment evaluated by neurological function using the modified neurological score system was 74.07%. There was no significant difference in model establishment time, sensorimotor deficit and infarct volume percentage. Our findings indicate that the telescopic lens is effective in the screen surgical operation mode referred to as "long distance observation and short distance operation" and that screen-imaging guidance using an modified portable video macroscope can be utilized for the establishment of a middle cerebral artery occlusion model and micro-neurosurgery.

  15. Screen-imaging guidance using a modified portable video macroscope for middle cerebral artery occlusion.

    Science.gov (United States)

    Zhu, Xingbao; Luo, Junli; Liu, Yun; Chen, Guolong; Liu, Song; Ruan, Qiangjin; Deng, Xunding; Wang, Dianchun; Fan, Quanshui; Pan, Xinghua

    2012-04-25

    The use of operating microscopes is limited by the focal length. Surgeons using these instruments cannot simultaneously view and access the surgical field and must choose one or the other. The longer focal length (more than 1 000 mm) of an operating telescope permits a position away from the operating field, above the surgeon and out of the field of view. This gives the telescope an advantage over an operating microscope. We developed a telescopic system using screen-imaging guidance and a modified portable video macroscope constructed from a Computar MLH-10 × macro lens, a DFK-21AU04 USB CCD Camera and a Dell laptop computer as monitor screen. This system was used to establish a middle cerebral artery occlusion model in rats. Results showed that magnification of the modified portable video macroscope was appropriate (5-20 ×) even though the Computar MLH-10 × macro lens was placed 800 mm away from the operating field rather than at the specified working distance of 152.4 mm with a zoom of 1-40 ×. The screen-imaging telescopic technique was clear, life-like, stereoscopic and matched the actual operation. Screen-imaging guidance led to an accurate, smooth, minimally invasive and comparatively easy surgical procedure. Success rate of the model establishment evaluated by neurological function using the modified neurological score system was 74.07%. There was no significant difference in model establishment time, sensorimotor deficit and infarct volume percentage. Our findings indicate that the telescopic lens is effective in the screen surgical operation mode referred to as "long distance observation and short distance operation" and that screen-imaging guidance using an modified portable video macroscope can be utilized for the establishment of a middle cerebral artery occlusion model and micro-neurosurgery.

  16. Computational fluid dynamics evaluation of flow reversal treatment of giant basilar tip aneurysm.

    Science.gov (United States)

    Alnæs, Martin Sandve; Mardal, Kent-Andre; Bakke, Søren; Sorteberg, Angelika

    2015-10-01

    Therapeutic parent artery flow reversal is a treatment option for giant, partially thrombosed basilar tip aneurysms. The effectiveness of this treatment has been variable and not yet studied by applying computational fluid dynamics. Computed tomography images and blood flow velocities acquired with transcranial Doppler ultrasonography were obtained prior to and after bilateral endovascular vertebral artery occlusion for a giant basilar tip aneurysm. Patient-specific geometries and velocity waveforms were used in computational fluid dynamics simulations in order to determine the velocity and wall shear stress changes induced by treatment. Therapeutic parent artery flow reversal lead to a dramatic increase in aneurysm inflow and wall shear stress (30 to 170 Pa) resulting in an increase in intra-aneurysmal circulation. The enlargement of the circulated area within the aneurysm led to a re-normalization of the wall shear stress and the aneurysm remained stable for more than 8 years thereafter. Therapeutic parent artery flow reversal can lead to unintended, potentially harmful changes in aneurysm inflow which can be quantified and possibly predicted by applying computational fluid dynamics.

  17. A bypass case due to an acute inferior myocardial infarction caused by vascular occlusion of the left subclavian artery and left anterior descending artery

    Directory of Open Access Journals (Sweden)

    Altas Y

    2016-07-01

    Full Text Available Yakup Altas, Ali Veysel Ulugg Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey Abstract: ST segment elevation is the most common electrocardiographic finding in acute myocardial infarction. ST elevation in chest leads generally represents left anterior descending artery occlusion, while elevation in DII and III, and aVF represents right coronary and circumflex artery occlusion. A female patient aged 66 years was admitted to our emergency service with ST elevation in leads DIII and aVF. A diagnosis of acute inferior myocardial infarction was made. The patient’s history included coronary artery bypass graft involving the left internal mammary artery to the left anterior descending coronary artery and aorta to the right coronary artery. The patient was taken to the cardiac catheterization laboratory for primary percutaneous coronary intervention and a lesion in the left anterior descending artery was identified. Additionally, the left subclavian artery was totally occluded. Following intervention to the lesion, the patient was discharged on day 4 of admission. Keywords: electrocardiography, myocardial infarction, coronary circulation

  18. Case of “Slow” Stroke from Carotid Artery Occlusion Treated by Delayed but Cautious Endovascular Intervention

    Directory of Open Access Journals (Sweden)

    Kachi Illoh

    2011-01-01

    Full Text Available In a challenging case of carotid occlusion with slowly evolving stroke, we used brain imaging to facilitate endovascular revascularization resulting in the relief of the patient's symptoms. Patients with carotid occlusion and continued neurological worsening or fluctuations present enormous treatment challenges. These patients may present “slow” strokes with subacute infarcts that present significant challenges and risks during attempts at revascularization of the occluded artery. We present such a case in which we used multimodal imaging techniques, including MR-perfusion, to facilitate endovascular revascularization. Our approach of delayed but cautious intra-arterial thrombolytic therapy, guided by brain imaging, and followed by stent placement across the residual stenosis, enabled revascularization of the occluded artery without overt in-hospital complications.

  19. Central Retinal Artery Occlusion- A rare complication of oral contraceptive pills

    Directory of Open Access Journals (Sweden)

    Nidhi Pancholi

    2013-07-01

    Full Text Available Aim: To propose a hypothesis of causal association between central retinal artery occlusion (CRAO and oral contraceptive pills (OCPCase Summary:A case report-A 22 yr old, female presented with sudden painless loss of vision in OS [Right Eye] for 1 day. VA [Visual Activity] in OS was PL PR [Perception of Light and Projection of Rays] Faulty with RAPD [Relative Afferent Papillary Defect] with normal for fifteen minutes, given five hundred mg of acetazolamide orally stat, 0.4 ml of anterior chamber paracentesis done, 5400 IU LMW [Low Molecular Weight] heparin given SC[Subcutaneous] with carbogen inhalation. Retrospectively she was on oral contraceptives(Mala D for 1 month. She was not hypertensive or diabetic with normal blood, coagulation profile & carotid Doppler. She was evaluated by an intern to find the cause of coagulation disorder and was found to be normal. On first day FFA [Fundus Florescien Angiography] showed no blockage with normal cilioretinal artery perfusion established. Visual fields after one week showed central tubular vision and OCT [Ocular Coherent Tomography] showed normal fovea. After 2 weeks vision was 20/80 with persistent RAPD papilla macular bundle being perfused.

  20. Mesenteric lymph reperfusion exacerbates spleen injury caused by superior mesenteric artery occlusion shock

    Energy Technology Data Exchange (ETDEWEB)

    Li, L.L.; Zhang, C.H.; Liu, J.C.; Yang, L.N.; Niu, C.Y.; Zhao, Z.G. [Institute of Microcirculation, Hebei North University, Zhangjiakou, Hebei, China, Institute of Microcirculation, Hebei North University, Zhangjiakou, Hebei (China)

    2014-04-15

    The intestinal lymph pathway plays an important role in the pathogenesis of organ injury following superior mesenteric artery occlusion (SMAO) shock. We hypothesized that mesenteric lymph reperfusion (MLR) is a major cause of spleen injury after SMAO shock. To test this hypothesis, SMAO shock was induced in Wistar rats by clamping the superior mesenteric artery (SMA) for 1 h, followed by reperfusion for 2 h. Similarly, MLR was performed by clamping the mesenteric lymph duct (MLD) for 1 h, followed by reperfusion for 2 h. In the MLR+SMAO group rats, both the SMA and MLD were clamped and then released for reperfusion for 2 h. SMAO shock alone elicited: 1) splenic structure injury, 2) increased levels of malondialdehyde, nitric oxide (NO), intercellular adhesion molecule-1, endotoxin, lipopolysaccharide receptor (CD14), lipopolysaccharide-binding protein, and tumor necrosis factor-α, 3) enhanced activities of NO synthase and myeloperoxidase, and 4) decreased activities of superoxide dismutase and ATPase. MLR following SMAO shock further aggravated these deleterious effects. We conclude that MLR exacerbates spleen injury caused by SMAO shock, which itself is associated with oxidative stress, excessive release of NO, recruitment of polymorphonuclear neutrophils, endotoxin translocation, and enhanced inflammatory responses.

  1. Extracerebral Tissue Damage in the Intraluminal Filament Mouse Model of Middle Cerebral Artery Occlusion

    Science.gov (United States)

    Vaas, Markus; Ni, Ruiqing; Rudin, Markus; Kipar, Anja; Klohs, Jan

    2017-01-01

    Middle cerebral artery occlusion is the most common model of focal cerebral ischemia in the mouse. In the surgical procedure, the external carotid artery (ECA) is ligated; however, its effect on the tissue supplied by the vessel has not been described so far. C57BL/6 mice underwent 1 h of transient MCAO (tMCAO) or sham surgery. Multi-spectral optoacoustic tomography was employed at 30 min after surgery to assess oxygenation in the temporal muscles. Microstructural changes were assessed with magnetic resonance imaging and histological examination at 24 h and 48 h after surgery. Ligation of the ECA resulted in decreased oxygenation of the left temporal muscle in most sham-operated and tMCAO animals. Susceptible mice of both groups exhibited increased T2 relaxation times in the affected muscle with histological evidence of myofibre degeneration, interstitial edema, and neutrophil influx. Ligatures had induced an extensive neutrophil-dominated inflammatory response. ECA ligation leads to distinct hypoxic degenerative changes in the tissue of the ECA territory and to ligature-induced inflammatory processes. An impact on outcome needs to be considered in this stroke model. PMID:28348545

  2. Branch Retinal Artery Occlusion in a Patient with Patent Foramen Ovale

    Directory of Open Access Journals (Sweden)

    Nasser Shoeibi

    2013-01-01

    Full Text Available Purpose: To report branch retinal artery occlusion (BRAO in a patient with patent foramen ovale (PFO. Case Report: A 29-year-old female patient was referred for sudden onset superior visual field defect in her left eye. Ocular examination revealed visual acuity of 20/32 in the affected eye along with a positive relative afferent pupillary defect. A calcified white embolus was noted at the first bifurcation of the inferior temporal artery in her left eye together with mild retinal edema. With a diagnosis of BRAO, the patient received oral acetazolamide, topical timolol, ocular massage and anterior chamber paracentesis. The visual field defect partially recovered and the embolus moved to the third bifurcation level as revealed by fundus examination. An extensive workup, including neurology, rheumatology, cardiology and hematology consultation, carotid ultrasonography, transthoracic/transesophageal echocardiography and laboratory testing was performed. All results were within normal limits except for a small-sized PFO detected by transesophageal echocardiography. Low-dose aspirin therapy was initiated and over the subsequent two years, no other embolic event occurred. Conclusion: The association between PFO and BRAO has not yet been reported. Intracardiac right-to-left shunting through a PFO, accentuated by Valsalva maneuver, may predispose to embolic events while the source of initial thrombosis remains unknown.

  3. 基底动脉发育不良与后循环梗死的相关性%Association between basilar artery hypoplasia and posterior circulation infarction

    Institute of Scientific and Technical Information of China (English)

    张志勇; 刘尊敬; 田朝晖; 唐文雄; 刘玮; 薛爽; 焦劲松

    2014-01-01

    其卒中防治工作。%Objective To explore the relationship between basal artery hypoplasia ( BAH ) and posterior circulation ischemic stroke and its clinical characteristics to improve the understanding of BAH. Methods A total of 328 hospitalized patients from April 2012 to April 2014 were enrolled retrospectively. With normal course and regular shape of basilar artery on brain magnetic resonance angiography ( MRA) , other causes of posterior circulation ischemic stroke were excluded.They were divided into BAH ( n=48 ) and non-BAH (n=280) groups according to the morphology and diameter of basilar artery on head MRA. We compared the general information and intracranial vascular variations between two groups, especially the incidence rate of posterior circulation infarction and mean blood flow velocity ( Vm ) of basal artery by analyzing clinical information and MRI findings.Meantime, their clinical outcomes were observed through follow-ups.And detailed clinical features were discussed for the patients with posterior circulation infarction in the BAH group.Results ( 1 ) The concurrent lesions included vertebral artery intracranial segment hypoplasia (n=24, VAH), fetal type posterior artery (n=18, FTPA), persistent trigeminal artery (n=1) and giant fenestration variation on vertebral artery ( n=1 ) in the BAH group.In comparison, it was more liable to cranial vascular variations in the BAH group ( P BAH group ( P<0.05).(3) these cases with stroke in two groups had no mortality during a follow-up period of 4-28 months.There were 3 cases with recurrent posterior circulation stroke in the non-BAH group.The number of cases with mRS scoring 2 points or less in the BAH group was more than that in the non-BAH group at discharge, 30 or 90 days after discharge ( P<0.05 ) .( 4 ) these cases with posterior circulation stroke in the BAH group often presented as lacunar syndrome (9/17), paramedian infarction in pons (9/17) and bilateral VAH plus unilateral FTPA (8/17).Conclusion As a relatively rare disease, BAH

  4. 球囊扩张Apollo支架植入术治疗症状性基底动脉狭窄%Treatment of symptomatic basilar artery stenosis with balloon expandable Apollo stent

    Institute of Scientific and Technical Information of China (English)

    张帆; 蔡玉琴; 郭贵军; 郜利会; 吕彦锋; 徐国栋; 孟庆溪

    2012-01-01

    Objective To observe the safety and effectiveness of balloon expandable Apollo stent for the treatment of symptomatic basilar artery stenosis. Methods Eighteen patients with symptomatic basilar artery stenosis (all >70%) were treated with Apollo stent The mean time of clinical follow-up was 11 months. Clinical evaluation was performed based on the modified Rankin Scale (mRS). Results The stent placement was technically successful in all 18 patients. Clinical symptoms were improved in 16 patients after stenting. The mRS scores of 14 patients after stenting were ≤2, while of 4 patients were >2. Conclusion Balloon expandable Apollo stem placement is a safe and efficacious alternative for the treatment of symptomatic basilar stenosis.%目的 观察球囊扩张支架植入术治疗症状性基底动脉狭窄的疗效及安全性.方法 应用Apollo支架治疗18例症状性基底动脉严重狭窄(>70%)患者,术后平均随访11个月,以改良Rankin量表(mRS)评分为基础评价治疗效果.结果 对所有患者均成功植入支架,16例患者临床症状得到不同程度改善;18例中,14例mRS评分≤2分,4例mRS评分>2分.结论 球囊扩张支架植入术治疗症状性基底动脉狭窄安全、有效.

  5. Large deep infarcts found in proximal middle cerebral artery steno-occlusive disease: MRI and angiographic findings

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    Yi, Bum Ha; Kim, Eui Jong; Choi, Woo Suk; Jang, Dae Il; Chung, Kyung Cheon; Oh, Joo Hyung; Yoon, Yup; Hong, Hoon Pyo [Kyunghee Univ. Hospital, Seoul (Korea, Republic of)

    1998-11-01

    To determine the nature of large deep-seated infarcts without cortical infarct in patients with steno-occlusive disease of the proximal middle cerebral artery (MCA) using magnetic resonance images (MRI) and angiography. By means of MRI and MR angiography (MRA), we examined 24 patients with large deep cerebral infarctions (>3cm in size) involving the basal ganglia, corona radiata and/or centrum semiovale, as well as steno-occlusive lesion of the proximal MCA. According to location, infarctions were classified into five groups, as follows:Group 1:basal ganlgia and corona radiata; 2:basal ganglia, corona radiata and centrum semiovale;3:corona radiata and centrum semiovale;4:corona radiata;5:basal ganglia only. We evaluated the topography of the lesions and correlated the results with the findings of angiography (all 24 MRA;the 13:conventional angiography). Involvement of the head of the caudate nucleus and the internal capsule were also evaluated. Fifteen of 24 cases (63%) were assigned to group 1 (4 proximal MCA(M1) occlusion and 11 stenosis), and five of 24 (21%) with M1 occlusions to group 2. Group 3 comprised only one case with M1 occlusion. Two cases with both occlusion and stenosis were included in group 4, and only one case-with M1 stenosis-in group 5. Infarctions at the caudate nucleus were seen in five cases, and at the internal capsule in two. On conventional angiography (13 cases) cortical branches of the MCA were delineated through the leptomeningeal collaterals of anterior or posterior cerebral arteries. Most large deep cerebral infarctions found in proximal MCA diseases are thought to extend cephalad to the corona radiata. When large deep-seated infarctions with proximal MCA occlusion is observed more frequently than stenosis.=20.

  6. Nitrogen monoxide vector of ultrasonic atomizing inhalation improves vertebro-basilar artery insufficiency Hemodynamic changes are detected by transcranial Doppler test

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    BACKGROUND: Latest researches at home and abroad indicate that glycerol trinitrate plays its function because it can metabolize into nitrogen monoxide (NO) in vivo.OBJECTIVE: To study the therapeutic effects of NO vector of ultrasonic atomizing inhalation on vertebro-basilar artery insufficiency (VBI) through transcranial Doppler (TCD) detection and serum NO content and indirect effect of TCD on cerebral blood flow changes.DESIGN: Randomized grouping and controlled clinical study.SETTING: Department of Neurology, the Fourth People's Hospital of Jinan.PARTICIPANTS: A total of 130 patients who were diagnosed as VBI were selected from Department of Neurology, the Fourth People's Hospital of Jinan from December 2001 to December 2005. The involved inpatients were checked by CT and MRI, and met the VBI diagnostic standard enacted by the Fourth National Academic Meeting of Cerebrovascular Disease in 1995. All patients and their relatives provided the confirmed consent. They were randomly divided into low-dose treatment group (n =60), high-lose treatment group (n =30) and control group (n =40).METHODS: Patients in the low-dose and high-dose treatment groups were given ultrasonic atomizing inhalation of 3 mg and 5 mg glycerol trinitrate, respectively, for 20 minutes, once a day. In addition,ligustrazine and energy mixture were used once a day for three days in a course. Cases in the control group were only given ligustrazine and energy mixture. All selected cases accepted TCD, blood NO content was checked at the time of beginning, after the first time and after a period of treatment. According to the TCD test, VBI patients were divided into two groups (high-low flow velocity). The vertebral artery (VA) and basal artery (BA) of left or right sides were detected by 2 Hz detector via occipital window.MAIN OUTCOME MEASURES: ① Blood flow velocity of systolic phase, blood flow velocity of diastole phase and vascular resistance in left and right VA and BA detected by using TCD

  7. 补阳还五汤治疗椎基底动脉供血不足所致眩晕34例%Treating 34 cases of vertigo caused by vertebro-basilar artery insufficiency with the Buyanghuanwu decoction

    Institute of Scientific and Technical Information of China (English)

    万继松; 田中旺

    2012-01-01

      Objective: To observe the clinical effect of the Buyang Huanwu decoction in treating vertigo caused by vertebro-basilar artery insufficiency. Methods: The Buyang Huanwu decoction was given once a day modified with different symptoms. There were 20 days in each course of treatment. The clinical effect was observed after 2 courses of treatment. Results: The total effective rate was 91%. Conclusion: The Buyang Huanwu decoction had significant effect in treating vertigo caused by vertebro-basilar artery insufficiency.%  目的:观察补阳还五汤治疗椎基底动脉供血不足所致眩晕的临床疗效。方法:给予补阳还五汤,并随证加味治疗,1剂/d,20d 为1个疗程,2个疗程后观察疗效。结果:总有效率91%。结论:补阳还五汤治疗基底动脉供血不足所致眩晕疗效显著。

  8. A REPORT OF CENTRAL RETINAL ARTERY OCCLUSION (CRAO , IN YOUNG MALES IN ITS INITIAL MANIFESTATION, AS PRIMAR Y ANTIPHOSPHOLIPID SYNDROME

    Directory of Open Access Journals (Sweden)

    Rani

    2013-05-01

    Full Text Available ABSTRACT: AIM: To report a case of Central Retinal Artery Occlusi on (CRAO in young males in its initial manifestation as Primary Antiphospholipid Syndrome. METHODS: 32 year healthy male, with abrupt sudden painless loss of vision in r ight eye since 48 hours, with Grade 2 Relative afferent pupillary defect, visual acuity of hand movements in OD and 6/18 in OS. Fundoscopy disclosed signs compatible of central reti nal artery occlusion confirmed with FFA. Carotid Doppler imaging and echocardiography was done to determine the source. RESULTS: Antiphospholipid antibody cofactor, beta2-glycoprotein 1 antibodies, IgM, was positive with titre of more than 94 un its/ml on two occasions, 1 2 weeks apart, with normal range being less than 20 units/ml for each isotope (IgG, IgM, or IgA .According to the 2006 revised Sapporo criteria Antiphospholipid syndrome was diagnosed. Thor ough examination excluded other system involvement. Immunological studies excluded other systemic disorders. CONCLUSIONS: In literature, prevalence of CRAO is 0.85% for every 100000 and prevalence of Antiphospholipid Syndrome in patients showing a major retinal vascula r obstruction is 5% - 33%. Antiphospholipid syndrome should be ruled out in every young patient who presents with Central retinal artery occlusion. Association must be considered, as Central retinal artery occlusion could be the initial manifestation of ant iphospholipid syndrome with high risk of recurrence.

  9. [Case of cerebellar and spinal cord infarction presenting with acute brachial diplegia due to right vertebral artery occlusion].

    Science.gov (United States)

    Fujii, Takayuki; Santa, Yo; Akutagawa, Noriko; Nagano, Sukehisa; Yoshimura, Takeo

    2012-01-01

    A 73-year-old man was admitted for evaluation of sudden onset of dizziness, bilateral shoulder pain, and brachial diplegia. Neurological examination revealed severe bilateral weakness of the triceps brachii, wrist flexor, and wrist extensor muscles. There was no paresis of the lower limbs. His gait was ataxic. Pinprick and temperature sensations were diminished at the bilateral C6-C8 dermatomes. Vibration and position senses were intact. An MRI of the head revealed a right cerebellar infarction and occlusion of the right vertebral artery. An MRI of the cervical spine on T₂ weighted imaging (T₂WI) showed cord compression at the C3/4-C5/6 level secondary to spondylotic degeneration without any intramedullary signal changes of the cord. On the following day, however, high-signal lesions on T₂WI appeared in the C5-C6 spinal cord, suggesting cord infarction. Unilateral vertebral artery occlusion does not usually result in cervical cord infarction because of anastomosis of arteries. Because of the long-term mechanical compression in our case, it was likely that cervical cord ischemia was present before the onset of symptoms. On the basis of chronic cord compression, our case suggests that occlusion of a unilateral vertebral artery could cause cervical cord infarction.

  10. [Balloon occlusion test of the internal carotid artery for evaluating resectability of blood vessel infiltrating cervical metastasis of advanced head and neck cancers--Heidelberg experience].

    Science.gov (United States)

    Dietz, A; von Kummer, R; Adams, H P; Kneip, M; Galito, P; Maier, H

    1993-11-01

    During the last two years 17 patients of the ENT-Department of the University of Heidelberg suffering from squamous-cell carcinomas of the head and neck underwent a balloon occlusion test of the internal carotid artery (ICA). The investigation was performed because of tumorous infiltration of the large cervical vessels. The balloon occlusion of the ICA was accomplished at the Department of Neuroradiology of the University of Heidelberg. While stopping bloodflow in the ICA of one side for 15-20 min, clinical, electrophysiological and Doppler sonographic monitoring was performed, to detect severe cerebral complications. The specific electrophysiological monitoring contained the detection of MSSEP's (median nerve stimulated somatosensorial evoked potentials) and TCMEP's (transcortical motor evoked potentials) during test occlusion. Balloon occlusion was not possible in three patients because of severe arteriosclerosis. Test occlusion had to be discontinued in three patients because of clinical complications (temporary amaurosis, orthostatic complications). Finally, seven patients showed contraindications during test occlusion for permanent occlusion of the ICA. Four patients had a permanent occlusion of the ICA after tumour resection. In two patients the ICA was removed without problems in test occlusion. The third patient underwent a permanent carotid occlusion because of bleeding complications (in spite of poor clinical tolerance of the test occlusion). In the fourth patient, only intraoperative neuromonitoring with MSSEP's was conducted before permanent carotid occlusion. All four patients did not show any neurological deficits after resection of the ICA. Neurophysiological monitoring played an important role in predicting cerebral complications after permanent occlusion of the ICA.

  11. Reversibility of retinal ischemia due to central retinal artery occlusion by hyperbaric oxygen

    Directory of Open Access Journals (Sweden)

    Hadanny A

    2016-12-01

    Full Text Available Amir Hadanny,1,2 Amit Maliar,1 Gregory Fishlev,1 Yair Bechor,1 Jacob Bergan,1 Mony Friedman,1 Isaac Avni,2,3 Shai Efrati1,2,4,5 1Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel; 2Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; 3Opthalmology Department, Assaf Harofeh Medical Center, Zeirifin, Israel; 4Research and Development Unit, Assaf Harofeh Medical Center, Zerifin, Israel; 5Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel Purpose: Ischemic retinal damage can be reversed by hyperbaric oxygen therapy (HBOT as long as irreversible infarction damage has not developed. However, the time window till irreversible damage develops is still unknown. The study aim was to evaluate the effect of HBOT and determine possible markers for irreversible retinal damage.Materials and methods: Retrospective analysis of 225 patients treated with HBOT for central retinal artery occlusion (CRAO in 1999–2015. One hundred and twenty-eight patients fulfilled inclusion/exclusion criteria: age >18 years, symptoms <20 hours, and best-corrected visual acuity (BCVA <0.5 logMAR.Results: Time delay from symptoms to treatment was 7.8±3.8 hours. The BCVA was significantly improved after HBOT, from 2.14±0.50 to 1.61±0.78 (P<0.0001. The proportion of patients with clinically meaningful visual improvement was significantly higher in patients without cherry-red spot (CRS compared to patients with CRS at presentation (86.0% vs 57.6%, P<0.0001. The percentage of patients with final BCVA better than 1.0 was also significantly higher in patients without CRS vs patients with CRS at presentation (61.0% vs 7.1%, P<0.0001. There was no correlation between CRS and the time from symptoms. HBOT was found to be safe, and only 5.5% of patients had minor, reversible, adverse events.Conclusion: HBOT is an effective treatment for non-arteritic CRAO as long as CRS has not formed. The fundus findings, rather

  12. Foot CT perfusion in patients with peripheral arterial occlusive disease (PAOD): A feasibility study

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    Iezzi, R., E-mail: roberto.iezzi@rm.unicatt.it [Department of Bioimaging and Radiological Sciences, Institute of Radiology, “A. Gemelli” Hospital – Catholic University, L.go A Gemelli 8, 00168 Rome (Italy); Santoro, M., E-mail: dott.santoromarco@gmail.com [Department of Bioimaging and Radiological Sciences, Institute of Radiology, “A. Gemelli” Hospital – Catholic University, L.go A Gemelli 8, 00168 Rome (Italy); Dattesi, R., E-mail: robertadattesi@gmail.com [Department of Bioimaging and Radiological Sciences, Institute of Radiology, “A. Gemelli” Hospital – Catholic University, L.go A Gemelli 8, 00168 Rome (Italy); La Torre, M.F. [Department of Bioimaging and Radiological Sciences, Institute of Radiology, “A. Gemelli” Hospital – Catholic University, L.go A Gemelli 8, 00168 Rome (Italy); Tinelli, G., E-mail: tinelli@rm.unicatt.it [Department of Vascular Surgery, “A. Gemelli” Hospital – Catholic University, L.go A Gemelli 8, 00168 Rome (Italy); Snider, F., E-mail: fsnider@rm.unicatt.it [Department of Vascular Surgery, “A. Gemelli” Hospital – Catholic University, L.go A Gemelli 8, 00168 Rome (Italy); Bonomo, L., E-mail: lbonomo@rm.unicatt.it [Department of Bioimaging and Radiological Sciences, Institute of Radiology, “A. Gemelli” Hospital – Catholic University, L.go A Gemelli 8, 00168 Rome (Italy)

    2013-09-15

    Purpose: To prospectively assess the technical feasibility and reproducibility of quantitative foot perfusion multidetector-row computed tomography (MDCT) in patients with peripheral occlusive artery disease (PAOD) and to evaluate perfusion parameters changes after endovascular treatment. Materials and methods: Institutional review board approval and informed patient consent were obtained. 10 patients older than 65 years (mean 74.1 years, range 66–95 years) with PAOD and who were referred to our department for single-limb endovascular treatment were enrolled prospectively. All patients underwent foot CT perfusion examinations before and within 72 h after endovascular treatment. A 64-row CT lightspeed VCT scanner (GE Medical Systems) was used with acquisition of eight contiguous 5-mm reconstructed sections (60-s acquisition time; 40 mL Iomeprol 400 mgI/mL, @4 mL/s). Data were analyzed by two blinded readers using commercially available software to calculate perfusion parameters. Inter-observer and intra-observer agreement of perfusion CT analysis was assessed using Bland–Altman analyses and intra-class correlation coefficient (ICC). Changes in perfusion parameters after endovascular treatment were assessed using Wilcoxon's test. Results: Good inter-observer and intra-observer agreement was obtained in all patients. Good agreement was obtained for perfusion parameters for the untreated foot and in repeated studies. By comparing perfusion parameters in the treated foot, a significantly shorter mean transit time (MTT) was obtained. Conclusions: Foot CT perfusion is a feasible and reproducible technique. A significant decrease of MTT between pre- and post-revascularization suggests improved flow in the below-the-knee arteries.

  13. Mapping the dynamics of brain perfusion using functional ultrasound in a rat model of transient middle cerebral artery occlusion.

    Science.gov (United States)

    Brunner, Clément; Isabel, Clothilde; Martin, Abraham; Dussaux, Clara; Savoye, Anne; Emmrich, Julius; Montaldo, Gabriel; Mas, Jean-Louis; Baron, Jean-Claude; Urban, Alan

    2017-01-01

    Following middle cerebral artery occlusion, tissue outcome ranges from normal to infarcted depending on depth and duration of hypoperfusion as well as occurrence and efficiency of reperfusion. However, the precise time course of these changes in relation to tissue and behavioral outcome remains unsettled. To address these issues, a three-dimensional wide field-of-view and real-time quantitative functional imaging technique able to map perfusion in the rodent brain would be desirable. Here, we applied functional ultrasound imaging, a novel approach to map relative cerebral blood volume without contrast agent, in a rat model of brief proximal transient middle cerebral artery occlusion to assess perfusion in penetrating arterioles and venules acutely and over six days thanks to a thinned-skull preparation. Functional ultrasound imaging efficiently mapped the acute changes in relative cerebral blood volume during occlusion and following reperfusion with high spatial resolution (100 µm), notably documenting marked focal decreases during occlusion, and was able to chart the fine dynamics of tissue reperfusion (rate: one frame/5 s) in the individual rat. No behavioral and only mild post-mortem immunofluorescence changes were observed. Our study suggests functional ultrasound is a particularly well-adapted imaging technique to study cerebral perfusion in acute experimental stroke longitudinally from the hyper-acute up to the chronic stage in the same subject.

  14. The free radical spin-trap alpha-PBN attenuates periinfarct depolarizations following permanent middle cerebral artery occlusion in rats without reducing infarct volume

    DEFF Research Database (Denmark)

    Christensen, Thomas; Bruhn, Torben; Diemer, Nils Henrik

    2003-01-01

    The effect of the free radical spin-trap alpha-phenyl-butyl-tert-nitrone (alpha-PBN) in permanent focal cerebral ischemia in rats was examined in two series of experiments. In the first, rats were subjected to permanent occlusion of the middle cerebral artery (MCAO) and treated 1 h after occlusion...

  15. Cerebroprotective Effect of Moringa oleifera against Focal Ischemic Stroke Induced by Middle Cerebral Artery Occlusion

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    Woranan Kirisattayakul

    2013-01-01

    Full Text Available The protection against ischemic stroke is still required due to the limitation of therapeutic efficacy. Based on the role of oxidative stress in stroke pathophysiology, we determined whether Moringa oleifera, a plant possessing potent antioxidant activity, protected against brain damage and oxidative stress in animal model of focal stroke. M. oleifera leaves extract at doses of 100, 200 and 400 mg·kg−1 was orally given to male Wistar rats (300–350 g once daily at a period of 2 weeks before the occlusion of right middle cerebral artery (Rt.MCAO and 3 weeks after Rt.MCAO. The determinations of neurological score and temperature sensation were performed every 7 days throughout the study period, while the determinations of brain infarction volume, MDA level, and the activities of SOD, CAT, and GSH-Px were performed 24 hr after Rt.MCAO. The results showed that all doses of extract decreased infarction volume in both cortex and subcortex. The protective effect of medium and low doses of extract in all areas occurred mainly via the decreased oxidative stress. The protective effect of the high dose extract in striatum and hippocampus occurred via the same mechanism, whereas other mechanisms might play a crucial role in cortex. The detailed mechanism required further exploration.

  16. Cerebroprotective effect of Moringa oleifera against focal ischemic stroke induced by middle cerebral artery occlusion.

    Science.gov (United States)

    Kirisattayakul, Woranan; Wattanathorn, Jintanaporn; Tong-Un, Terdthai; Muchimapura, Supaporn; Wannanon, Panakaporn; Jittiwat, Jinatta

    2013-01-01

    The protection against ischemic stroke is still required due to the limitation of therapeutic efficacy. Based on the role of oxidative stress in stroke pathophysiology, we determined whether Moringa oleifera, a plant possessing potent antioxidant activity, protected against brain damage and oxidative stress in animal model of focal stroke. M. oleifera leaves extract at doses of 100, 200 and 400 mg·kg(-1) was orally given to male Wistar rats (300-350 g) once daily at a period of 2 weeks before the occlusion of right middle cerebral artery (Rt.MCAO) and 3 weeks after Rt.MCAO. The determinations of neurological score and temperature sensation were performed every 7 days throughout the study period, while the determinations of brain infarction volume, MDA level, and the activities of SOD, CAT, and GSH-Px were performed 24 hr after Rt.MCAO. The results showed that all doses of extract decreased infarction volume in both cortex and subcortex. The protective effect of medium and low doses of extract in all areas occurred mainly via the decreased oxidative stress. The protective effect of the high dose extract in striatum and hippocampus occurred via the same mechanism, whereas other mechanisms might play a crucial role in cortex. The detailed mechanism required further exploration.

  17. The Effect of Photoluminescence of Bioceramic Irradiation on Middle Cerebral Arterial Occlusion in Rats

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    Lei Zhang

    2016-01-01

    Full Text Available The purpose of this study is to determine the possible effect of photoluminescence of bioceramic (PLB on ischemic cerebral infarction (stroke, by using an animal model of transient middle cerebral artery occlusion (MCAO. Sprague-Dawley rats were used to induce MCAO to block the origin of the left MCAO; three months later, the positive chronic stroke rats were selected by running tunnel maze; the MCAO rats with significant chronic stroke and neurological defects were used for treadmill experiments with varying speed settings to test their capability for restoration after muscular fatigue under conditions of with and without PLB irradiation. As a result, PLB irradiation could improve exercise completion rate and average running speed during slow and fast treadmill settings. After PLB irradiation, the selected MCAO rats successfully completed all the second-round treadmill exercises at the maximum speed setting, and they had better restoration from muscular fatigue. An in vitro cell study on astrocytes of rats by bioceramic irradiation further demonstrated increased intracellular nitric oxide. To explain these results, we suggest that cortical brain stimulation of microcirculation and enhancement of peripheral muscular activity are the main causes of the improved exercise performance in MCAO rats by PLB.

  18. Acute Central Retinal Artery Occlusion Associated with Intraocular Silicone Oil Tamponade

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    Mehmet Yasin Teke

    2012-05-01

    Full Text Available Many systemic and ocular factors may cause acute central retinal artery occlusion (CRAO. Herein, we aimed to describe a case of CRAO due to intraocular silicone oil (SO tamponade. To the best of our knowledge, a case like our has not been reported previously. A 58-yearold male patient had undergone combined pars plana vitrectomy-lensectomy and intraocular SO for lens luxation and vitreus hemorrhage associated with a blunt ocular trauma in his right eye. Two weeks after the surgery, he presented with acute vision loss in the same eye. He was diagnosed with acute CRAO and it should be related with mechanical press or raised intraocular pressure (IOP associated with SO. He was treated by partial removal of SO immediately. In spite of the regression of retina edema, his visual acuity did not improve due to optic atrophy. SO may cause CRAO due to raised IOP and/or its mechanical pressure and this complication must be kept in mind. (Turk J Oph thal mol 2012; 42: 238-40

  19. Blockage of transient receptor potential vanilloid 4 inhibits brain edema in middle cerebral artery occlusion mice.

    Science.gov (United States)

    Jie, Pinghui; Tian, Yujing; Hong, Zhiwen; Li, Lin; Zhou, Libin; Chen, Lei; Chen, Ling

    2015-01-01

    Brain edema is an important pathological process during stroke. Activation of transient receptor potential vanilloid 4 (TRPV4) causes an up-regulation of matrix metalloproteinases (MMPs) in lung tissue. MMP can digest the endothelial basal lamina to destroy blood brain barrier, leading to vasogenic brain edema. Herein, we tested whether TRPV4-blockage could inhibit brain edema through inhibiting MMPs in middle cerebral artery occlusion (MCAO) mice. We found that the brain water content and Evans blue extravasation at 48 h post-MCAO were reduced by a TRPV4 antagonist HC-067047. The increased MMP-2/9 protein expression in hippocampi of MCAO mice was attenuated by HC-067046, but only the increased MMP-9 activity was blocked by HC-067047. The loss of zonula occludens-1 (ZO-1) and occludin protein in MCAO mice was also attenuated by HC-067047. Moreover, MMP-2/9 protein expression increased in mice treated with a TRPV4 agonist GSK1016790A, but only MMP-9 activity was increased by GSK1016790A. Finally, ZO-1 and occludin protein expression was decreased by GSK1016790A, which was reversed by an MMP-9 inhibitor. We conclude that blockage of TRPV4 may inhibit brain edema in cerebral ischemia through inhibiting MMP-9 activation and the loss of tight junction protein.

  20. Transplantation of mobilized peripheral blood mononuclear cells for peripheral arterial occlusive disease of the lower extremity

    Institute of Scientific and Technical Information of China (English)

    Xiaofeng YANG; Yanxiang WU; Hongmei WANG; Yifeng XU; Bo XU; Xin LU; Yibin ZANG; Fa WANG; Yue ZHANG

    2006-01-01

    Objectives To assess the clinical efficacy, safety, and feasibility of autologous transplantation of mobilized peripheral blood mononuclear cells (PBMNCs) for patients with peripheral arterial occlusive disease (PAOD) of the lower extremity. Methods A total of 152 patients with PAOD of the lower extremity were enrolled into this non-controlled observational study from November 2003 to March 2006. All patients received subcutaneous injections of recombinant human granulocyte colony-stimulating factor (G-CSF, 450600 μg/day) for 5 days in order to mobilize stem/progenitor cells; their PBMNCs were collected and transplanted by multiple intramuscular injections into ischemic limbs. Patients were followed up for at least 12 weeks. Results At 12 weeks, primarymanifestations,including lower limb pain and coldness, were significantly improved in 137 (90.1%) of the patients; limb ulcers improved or healed in 46 (86.8%) of the 53 patients, while 25 of the 48 (47.9%) patients with limb gangrene remained steady or improved. Ankle-brachial index (ABI) improved in 33 (22%) of the cases, and TcPO2 increased in 45 (30%) of the cases. Angiography before treatment, and at 12 weeks after treatment, was performed in 10 of the patients and showed formation of new collateral vessels. No severe adverse effects or complications specifically related to cell transplantation were observed. Conclusion Autologous transplantation of G-CSF-mobilized PBMNCs might be a safe and effective treatment for lower limb ischemic disorder.(J Geriatr Cardiol 2006; 3:178-80.)

  1. Intertester reliability of brachial artery flow-mediated vasodilation using upper and lower arm occlusion in healthy subjects

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    Ludmila M Cosio-Lima

    2008-06-01

    Full Text Available Ludmila M Cosio-Lima1, Richard Seip2, Paul D Thompson2, Marie A Lagasse2, Tabitha H Hodges11University of West Florida, Pensacola, FL, USA; 2Hartford Hospital, Hartford, CT, USAAbstract: The assessment of endothelial function as brachial artery flow-mediated vasodilatation is a widely used technique that determines the effect of risk factor intervention and may have the potential to predict the clinical benefit of antiatherogenic therapy. Previous studies suggest that flow-mediated dilation is greater using the upper-arm occlusion technique, but no data are available to compare intertester reliability between technicians. This study was undertaken to compare the amount of hyperemia between upper and lower occlusion techniques and to determine reproducibility between testers. Nineteen healthy adults, ages 25 to 50, were included in the study. Brachial artery vasodilatation was measured 1 and 3 minutes post cuff deflation and was compared with the baseline and expressed as a percent change. There was a tester effect in the percent change in diameter across all measurements. The results of this study reveal inconsistencies between testers when using a blood pressure cuff to induce hyperemia for the assessment of endothelial function through brachial artery flow-mediated vasodilation. However, upper arm as compared to lower arm blood pressure cuff occlusion results in significantly greater hyperemia and vasodilatation, even though there was a difference in measurements between testers.Keywords: endothelial function, flow-mediated vasodilatation, hyperemia

  2. First reported revascularization of complex occlusion of the right coronary artery using the IVUS-guided reverse CART technique via a gastroepiploic artery graft.

    Science.gov (United States)

    Dai, Jian; Katoh, Osamu; Zhou, Hua; Kyo, Eisho

    2016-02-01

    When patients who have previously undergone coronary artery bypass graft surgery develop ischemia symptoms that cannot be controlled by optimal medical therapy, repeat revascularization is indicated. The revascularization strategy should be based on individual clinical and anatomical characteristics. We report here a challenging patient who presented with recurrent stable angina due to worsening of a proximal right coronary artery (RCA) stenosis to chronic total occlusion (CTO) after anastomosis of the right gastroepiploic artery (GEA) to the posterior descending artery. A soft guidewire was advanced through the right GEA collateral channel to the distal end of the CTO, but the dedicated CTO guidewires could not be advanced across the severely calcified CTO using the retrograde wire crossing or kissing wire techniques. The RCA was eventually revascularized by implantation of drug-eluting stents using the intravascular ultrasound-guided reverse controlled antegrade and retrograde subintimal tracking technique.

  3. 血管内栓塞治疗基底动脉顶端动脉瘤%Endovascular Embolization of Basilar Artery Apex Aneurysms

    Institute of Scientific and Technical Information of China (English)

    阮玉山; 卢桂花; 罗昱; 谭源福; 张超元; 肖绍文

    2011-01-01

    Objective To evaluate the therapeutic effect of endovascular embolization for basilar artery apex aneurysms.Methods A retrospective analysis was performed on 17 patients with posterior circulation aneurysms who underwent endovascular embolization between July 2000 and December 2010. In the patients, 6 cases received the treatment in 2 days after acute bleeding stage, 11 cases were treated at 3 to 10 days post-hemorrhage. Three cases with wide necked intracranial aneurysm received the interventional therapy by self expanding stent (Neuroform) and separable detachable coil. The separable detachable coils were occluded in the aneurysms in 14 cases. Glasgow outcome scale (GOS) was conducted to evaluate the outcomes afterwards. Results Complete embolization ( 100% ) was achieved in 10 cases, 3 aneurysms were 95% embolized, and 3 were 90% embolized. Perforation during embolization occurred in one patient who died in the next day. No re-bleeding case but 2 cases of recurrence were found during a follow-up of 6 -36 months (mean, 15 months) post-embolization. According to GOS, good outcome was achieved in 12 cases, mild disability ( being able to look after themselves in daily life) in 3, and severe disability in 1. Conclusion Endovascular embolization is a minimally invasive, relatively safe and effective method for posterior circulation aneurysms.%目的 评价血管内栓塞治疗基底动脉顶端动脉瘤的疗效.方法 回顾性分析2000年7月~2010年12月血管内栓塞治疗17例基底动脉顶端动脉瘤的临床资料.6例在出血2天内、11例在出血3~10天内进行血管内栓塞治疗.应用Neuroform支架辅助弹簧圈栓塞宽颈动脉瘤3例,弹簧圈栓塞14例.结果 17例中成功栓塞16例,其中10例100%栓塞,3例95%栓塞,3例90%栓塞,术中动脉瘤破裂1例(弹簧罔栓塞,次日死亡).出院时格拉斯哥预后评分(GOS),恢复良好12例;中度病残,但生活能自理3例;重度病残,生活不能自理1例.16例随访6

  4. Fatal Vertebral Artery Injury in Penetrating Cervical Spine Trauma

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    Chadi Tannoury

    2015-01-01

    Full Text Available Study Design. This case illustrates complications to a vertebral artery injury (VAI resulting from penetrating cervical spine trauma. Objectives. To discuss the management of both VAI and cervical spine trauma after penetrating gunshot wound to the neck. Summary of Background Data. Vertebral artery injury following cervical spine trauma is infrequent, and a unilateral VAI often occurs without neurologic sequela. Nevertheless, devastating complications of stroke and death do occur. Methods. A gunshot wound to the neck resulted in a C6 vertebral body fracture and C5–C7 transverse foramina fractures. Neck CT angiogram identified a left vertebral artery occlusion. A cerebral angiography confirmed occlusion of the left extracranial vertebral artery and patency of the remaining cerebrovascular system. Following anterior cervical corpectomy and stabilization, brainstem infarction occurred and resulted in death. Results. A fatal outcome resulted from vertebral artery thrombus propagation with occlusion of the basilar artery triggering basilar ischemia and subsequent brainstem and cerebellar infarction. Conclusions. Vertebral artery injury secondary to cervical spine trauma can lead to potentially devastating neurologic sequela. Early surgical stabilization, along with anticoagulation therapy, contributes towards managing the combination of injuries. Unfortunately, despite efforts, a poor outcome is sometimes inevitable when cervical spine trauma is coupled with a VAI.

  5. Total-body 3D magnetic resonance angiography influences the management of patients with peripheral arterial occlusive disease

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    Goyen, Mathias; Herborn, Christoph U.; Debatin, Joerg F. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany); Kroeger, Knut [University Hospital Essen, Department of Angiology, Essen (Germany); Ruehm, Stefan G. [David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, CA (United States)

    2006-03-15

    High-resolution total-body 3D MR angiography (MRA) has recently become available, revealing additional clinically relevant disease in patients with peripheral arterial occlusive disease (PAOD). However, the actual impact of total-body MRA on patient management in patients with PAOD has not been investigated so far. Two hundred forty-nine consecutive patients with angiographically proven PAOD were prospectively examined by means of contrast-enhanced total-body 3D MRA on a 1.5-T MR scanner. All correlative imaging studies performed within 60 days of total-body MRA were included in the efficacy analysis. Additional clinically relevant disease (luminal narrowing >50%, aneurysmal changes or dissections) was found in 73 segments (52 patients), including the renal arteries (36 segments), carotid arteries (28 segments), subclavian arteries (four segments) and abdominal aortic aneurysms (AAA) (five segments). Of the 73 segments, 36 were deemed necessary for further investigation by means of focused MRA examinations; the diagnosis was confirmed in all cases. Within the 60-day follow-up period, interventional or surgical therapy outside the peripheral arterial tree was performed in nine patients (11 segments), including carotid endatherectomy and renal artery angioplasty. The outlined total-body 3D MRA approach permits a comprehensive evaluation of the arterial system in patients with atherosclerosis and does indeed have an impact on patient management in patients with PAOD. (orig.)

  6. TRPA1 Mediates Amplified Sympathetic Responsiveness to Activation of Metabolically Sensitive Muscle Afferents in Rats with Femoral Artery Occlusion

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    Jihong eXing

    2015-09-01

    Full Text Available Autonomic responses to stimulation of mechanically and metabolically sensitive muscle afferent nerves during static contraction are augmented in rats with femoral artery occlusion. Moreover, metabolically sensitive transient receptor potential cation channel subfamily A, member 1 (TRPA1 has been reported to contribute to sympathetic nerve activity (SNA and arterial blood pressure (BP responses evoked by static muscle contraction. Thus, in the present study, we examined the mechanisms by which afferent nerves’ TRPA1plays a role in regulating amplified sympathetic responsiveness due to a restriction of blood flow directed to the hindlimb muscles. Our data show that 24-72 hrs of femoral artery occlusion 1 upregulates the protein levels of TRPA1 in dorsal root ganglion (DRG tissues; 2 selectively increases expression of TRPA1 in DRG neurons supplying metabolically sensitive afferent nerves of C-fiber (group IV; and 3 enhances renal SNA and BP responses to AITC (a TRPA1 agonist injected into the arterial blood supply of the hindlimb muscles. In addition, our data demonstrate that blocking TRPA1 attenuates SNA and BP responses during muscle contraction to a greater degree in ligated rats than those responses in control rats. In contrast, blocking TRPA1 fails to attenuate SNA and BP responses during passive tendon stretch in both groups. Overall, results of this study indicate that alternations in muscle afferent nerves’TRPA1 likely contribute to enhanced sympathetically mediated autonomic responses via the metabolic component of the muscle reflex under circumstances of chronic muscle ischemia.

  7. Microscopic anatomy of the human vertebro-basilar system

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    Renato P. Chopard

    1991-12-01

    Full Text Available Concerning the structure of connective-muscular components the authors studied the walls of the terminal segments of the vertebral arteries as well as the basilar artery, utilizing the following staining methods: Azan modified by Heideinheim, Weigert's resorcin-fuchsin, and Weigert modified by van Gieson. It was established that wall of the vertebro-basilar system exhibits a mixed structure, muscular and elastic, by means of which the vessels are adjusted to the specific blood circulation conditions. Thus, vertebral arteries show in the most external layer of tunica media an evident external elastic lamina. In contrast, in the basilar artery the elastic tissue is localized mainly in the tunica media, and is distributed heterogeneously. In its caudal segment the elastic fibers are situated in the most internal layer of tunica media, and in the cranial segment the elastic component is homogenously distributed in the whole of tunica media.

  8. 'Top of the basilar' syndrome. Clinico-radiological evaluation

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    Sato, Masaharu; Kuroda, Ryotaro; Nakatani, Jiro; Watanabe, Masaru; Akai, Fumiharu; Ioku, Masahiko

    1988-06-01

    Seventeen patients (age 23 - 81) having the ''top of the basilar'' syndrome were the subjects of this study. They were evaluated clinico-radiologically. The diagnosis of this syndrome was made by computerized tomography. The infarcted lesions of each patient were widely distributed in many areas among the thalamus, midbrain, pons, cerebellum, and occipital lobe. Both the thalami were involved in 8 patients. When the thalamus was involved bilaterally, the low density areas of both the thalami were demonstrated to be almost the same in size and symmetric in localization by computerized tomography, showing a characteristic pattern. Further, magnetic resonance imaging could reveal small lesions in the brain stem minutely. Angiography revealed that stenosis or occlusion was within the circle of 2 cm in diameter surrounding the five-forked road of the top of the basilar artery in 84.6 %. Recanalization of the occluded artery occurred in 61.5 %, which suggests that the embolism plays an important role in appearance of this syndrome. In spite of frequent recanalization hemorrhagic infarction never occurred. The prognosis was very poor.

  9. Clinicopathological correlation of parapapillary atrophy in monkeys with experimental glaucoma and temporary central retinal artery occlusion

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    Jost B Jonas

    2014-01-01

    Full Text Available Objective: To investigate the clinicopathological correlation of parapapillary atrophy. Materials and Methods: The study included 16 eyes of rhesus monkeys (Macaca mulatta - 4 eyes with experimental glaucoma, 11 eyes after experimental temporary occlusion of the central retinal artery, and 1 normal eye. On histological sections, we measured zones with different histological characteristics.On fundus photographs, alpha zone and beta zone of parapapillary atrophy were measured and correlated with the histological data. Results: The size of the clinical alpha zone of parapapillary atrophy was significantly correlated with the size of the histological region with irregularities of the retinal pigment epithelium (P = 0.05; correlation coefficient r = 0.49 and with the size of the histological region with a decreased density of retinal photoreceptors (P = 0.01; r = 0.60. The size of clinical beta zone of parapapillary atrophy significantly correlated with the size of the histological region with complete loss of the retinal pigment epithelium (P <0.001; r = 0.91, with the size of the histological zone with a complete loss of photoreceptors (P <0.001; r = 0.81, and with the size of the histological zone with a closed choriocapillaris (P <0.001; r = 0.89. Conclusions: The clinically seen alpha zone of parapapillary atrophy correlates with histological parapapillary irregularities of the retinal pigment epithelium and decreased density of retinal photoreceptors. The clinically seen beta zone of parapapillary atrophy correlates with histological complete loss of the retinal pigment epithelium and of the photoreceptors, and a closure of the choriocapillaris.

  10. Association of lower urinary tract syndrome with peripheral arterial occlusive disease

    Science.gov (United States)

    Lin, Wei-Yu; Andersson, Karl-Erik; Lin, Cheng-Li; Kao, Chia-Hung; Wu, Hsi-Chin

    2017-01-01

    Purpose To describe atherosclerosis may lead to chronic bladder ischemia, eventually resulting in lower urinary tract syndrome (LUTS), and peripheral arterial occlusive disease (PAOD). We investigated the association of LUTS with PAOD. Methods This nationwide population-based cohort study was based on data from the Taiwan National Health Insurance Database from 2000 to 2010; follow-up lasted until the end of 2011. We identified patients with newly diagnosed LUTS by using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Results In total, 36,042 and 36,042 patients were enrolled in LUTS and non-LUTS cohorts, respectively. After adjustment for age, sex, and comorbidities, the risk of subsequent PAOD was 1.36-fold higher [95% confidence interval (CI) = 1.26–1.46] in the LUTS cohort than in the non-LUTS cohort. The adjusted risk of PAOD was the highest in patients with LUTS without any comorbidity [adjusted hazard ratio (aHR) = 1.93, 95% CI = 1.54–2.41]. The age-specific relative risk of PAOD was significantly higher in all age groups, particularly in those aged <49 years (aHR = 1.80, 95% CI = 1.39–2.34], in the LUTS cohort than in the non-LUTS cohort. Conclusion LUTS is a risk factor for PAOD. Physicians should consider the possibility of underlying PAOD in patients with LUTS aged <49 years and without cardiovascular comorbidities. Additional studies developing strategies for decreasing the risk of PAOD are warranted. PMID:28301517

  11. Heel-rise test in the assessment of individuals with peripheral arterial occlusive disease

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    Monteiro DP

    2013-01-01

    Full Text Available Débora Pantuso Monteiro,1 Raquel Rodrigues Britto,2 Ana Clara Ribeiro Lages,3 Marluce Lopes Basílio,3 Monize Cristine de Oliveira Pires,3 Maria Luiza Vieira Carvalho,1 Ricardo Jayme Procópio,4 Danielle Aparecida Gomes Pereira21Rehabilitation Sciences of the Universidade Federal de Minas Gerais, Belo Horizonte-MG, Brazil; 2Physiotherapy Department of the School of Physical Education, Physiotherapy and Occupational Therapy of the Universidade Federal de Minas Gerais, Belo Horizonte-MG, Brazil; 3Private Practice, Belo Horizonte-MG, Brazil; 4Hospital das Clínicas of the Universidade Federal de Minas Gerais, Belo Horizonte-MG, BrazilIntroduction: The Heel-Rise Test (HRT is a clinical instrument relevant to vascular rehabilitation that has been proposed to assess the function of the triceps surae muscle. To use HRT in the assessment of individuals with peripheral arterial occlusive disease (PAOD, its ability to detect differences in the functional performance of patients with PAOD must be verified.Aim: To verify whether the test is sensitive in differentiating between individuals with PAOD with distinct functional capacities.Materials and methods: A transversal study in which individuals with PAOD were assessed using the HRT, the Walking Impairment Questionnaire (WIQ, and the Shuttle Walk Test. The following variables were analyzed: number of plantar flexions performed in the HRT (time in seconds and velocity (plantar flexions per second when performing plantar flexions up to the point of volunteer fatigue, maximum distance walked in the Shuttle Walk Test, and scores obtained in each WIQ domain.Results: Twenty-five individuals (14 male were included in the study, with a mean age of 63.36 ± 9.83 years. The variables number of plantar flexions and time to perform the HRT were sensitive enough to differentiate between distinct functional capacities in individuals with PAOD (P = 0.003 and P = 0.009, respectively. However, this result was not found

  12. Endovascular Therapeutic Occlusion of the Posterior Cerebral Artery: An Option for Ruptured Giant Aneurysm in a Child.

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    Demartini, Zeferino; Matos, Luiz Afonso Dias; Dos Santos, Marcio Luis Tostes; Cardoso-Demartini, Adriane de Andre

    2016-01-01

    The incidence of intracranial aneurysms in the pediatric population is low, and surgical clipping remains a good long-term treatment option. However, posterior circulation aneurysms are even more complex to manage in children than in adults. We report a case of a giant aneurysm of the posterior cerebral artery in a 10-year-old boy presenting with subarachnoid hemorrhage. Endovascular treatment with platinum coils was performed with total occlusion of the aneurysm and the affected arterial segment without complications. The patient achieved good recovery, and a late control angiogram confirmed exclusion of the aneurysm. Occurrence of special features of cerebral aneurysm in children, in comparison to adults, is also described. Parent artery sacrifice is an effective therapeutic option, but long-term follow-up is necessary to avoid recurrence and rebleeding.

  13. Acute Stroke and Obstruction of the Extracranial Carotid Artery Combined with Intracranial Tandem Occlusion: Results of Interventional Revascularization

    Energy Technology Data Exchange (ETDEWEB)

    Lescher, Stephanie, E-mail: stephanie.lescher@kgu.de; Czeppan, Katja; Porto, Luciana [Hospital of Goethe University, Institute of Neuroradiology (Germany); Singer, Oliver C. [Hospital of Goethe University, Department of Neurology (Germany); Berkefeld, Joachim [Hospital of Goethe University, Institute of Neuroradiology (Germany)

    2015-04-15

    PurposeDue to high thrombus load, acute stroke patients with tandem obstructions of the extra- and intracranial carotid arteries or the middle cerebral artery show a very limited response to systemic thrombolysis. Interventional treatment with mechanical thrombectomy—often in combination with acute stenting of underlying atherosclerotic stenosis or dissection—is increasingly used. It has been shown that such complex interventions are technically feasible. The lack of optimal management strategies and clinical data encouraged us to review our acute stroke interventions in patient with anterior circulation tandem lesions to determine lesion patterns, interventional approaches, and angiographic or clinical outcomes.Patients and MethodsWe retrospectively analyzed a series of 39 consecutive patients with intracranial vessel occlusion of the anterior circulation simultaneously presenting with high-grade cervical internal carotid artery (ICA) stenosis or occlusion.ResultsEmergency ICA stent implantation was technically feasible in all patients, and intracranial recanalization with TICI ≥ 2b was reached in a large number of patients (64 %). Good clinical outcomes (mRS ≤ 2 at 3 months) were achieved in one third of the patients (36 %). Symptomatic hemorrhages occurred in four patients (10 %). Mortality was 10 %.ConclusionEndovascular recanalization of acute cervical carotid artery occlusion was technically feasible in all patients, and resulted in high extra- and intracranial revascularization rates. A trend for favorable clinical outcome was seen in a higher TICI score, younger age, good collateral status, and combined IV rTPA and endovascular therapy.

  14. Endovascular treatment of aortoiliac aneurysms: From intentional occlusion of the internal iliac artery to branch iliac stent graft

    Institute of Scientific and Technical Information of China (English)

    Stevo Duvnjak

    2016-01-01

    Approximately 20%-40% of patients with abdominal aortic aneurysms can have unilateral or bilateral iliac artery aneurysms and/or ectasia. This influences and compromises the distal sealing zone during endovascular aneurysm repair. There are a few endovascular techniques that are used to treat these types of aneurysms, including intentional occlusion/over-stenting of the internal iliac artery on one or both sides, the "bell-bottom" technique, and the more recent method of using an iliac branch stent graft. In some cases, other options include the "snorkel and sandwich" technique and hybrid interventions. Pelvic ischemia, represented as buttock claudication, has been reported in 16%-55% of cases; this is followed by impotence, which has been described in 10%-17% of cases following internal iliac artery occlusion. The bellbottom technique can be used for a common iliac artery up to 24 mm in diameter given that the largest diameter of the stent graft is 28 mm. There is a paucity of data and evidence regarding the "snorkel and sandwich" technique, which can be used in a few clinical scenarios. The hybrid intervention is comprised of a surgical operation, and is not purely endovascular. The newest branch stent graft technology enables preservation of the anterograde flow of important side branches. Technical success with the newest technique ranges from 85%-96.3%, and in some small series, technical success is 100%. Buttock claudication was reported in up to 4% of patients treated with a branch stent graft at 5-year follow-up. Mid- and short-term follow-up results showed branch patency of up to 88% during the 5-6-year period. Furthermore, branch graft occlusion is a potential complication, and it has been described to occur in 1.2%-11% of cases. Iliac branch stent graft placement represents a further development in endovascular medicine, and it has a high technical success rate without serious complications.

  15. Hemodynamic changes in a rat parietal cortex after endothelin-1-induced middle cerebral artery occlusion monitored by optical coherence tomography

    Science.gov (United States)

    Liu, Jian; Ma, Yushu; Dou, Shidan; Wang, Yi; La, Dongsheng; Liu, Jianghong; Ma, Zhenhe

    2016-07-01

    A blockage of the middle cerebral artery (MCA) on the cortical branch will seriously affect the blood supply of the cerebral cortex. Real-time monitoring of MCA hemodynamic parameters is critical for therapy and rehabilitation. Optical coherence tomography (OCT) is a powerful imaging modality that can produce not only structural images but also functional information on the tissue. We use OCT to detect hemodynamic changes after MCA branch occlusion. We injected a selected dose of endothelin-1 (ET-1) at a depth of 1 mm near the MCA and let the blood vessels follow a process first of occlusion and then of slow reperfusion as realistically as possible to simulate local cerebral ischemia. During this period, we used optical microangiography and Doppler OCT to obtain multiple hemodynamic MCA parameters. The change trend of these parameters from before to after ET-1 injection clearly reflects the dynamic regularity of the MCA. These results show the mechanism of the cerebral ischemia-reperfusion process after a transient middle cerebral artery occlusion and confirm that OCT can be used to monitor hemodynamic parameters.

  16. Endovascular Management of Acute Embolic Occlusion of the Superior Mesenteric Artery: A 12-Year Single-Centre Experience

    Energy Technology Data Exchange (ETDEWEB)

    Raupach, J., E-mail: janraupach@seznam.cz; Lojik, M., E-mail: miroslav.lojik@fnhk.cz; Chovanec, V., E-mail: chovanec.v@seznam.cz; Renc, O., E-mail: ondrejrenc@seznam.cz [Faculty of Medicine at Charles University and University Hospital, Department of Radiology (Czech Republic); Strýček, M., E-mail: m.strycek@gmail.com [Faculty of Medicine at Charles University (Czech Republic); Dvořák, P., E-mail: petr.dvorak@fnhk.cz; Hoffmann, P., E-mail: hoffmpet@fnhk.cz [Faculty of Medicine at Charles University and University Hospital, Department of Radiology (Czech Republic); Guňka, I., E-mail: gunka@email.cz; Ferko, A., E-mail: a.ferko@seznam.cz [Faculty of Medicine at Charles University and University Hospital, Department of Surgery (Czech Republic); Ryška, P., E-mail: ryska@fnhk.cz [Faculty of Medicine at Charles University and University Hospital, Department of Radiology (Czech Republic); Omran, N., E-mail: nidal81@gmail.com [Faculty of Medicine at Charles University and University Hospital, Department of Cardiac Surgery (Czech Republic); Krajina, A., E-mail: krajina@fnhk.cz; Čabelková, P., E-mail: pavla.cabelkova@fnhk.cz [Faculty of Medicine at Charles University and University Hospital, Department of Radiology (Czech Republic); Čermáková, E., E-mail: cermakovae@lfhk.cuni.cz [Faculty of Medicine at Charles University, Computer Technology Center (Czech Republic); Malý, R., E-mail: malyr@volny.cz [Faculty of Medicine at Charles University and University Hospital, Department of Medicine (Czech Republic)

    2016-02-15

    PurposeRetrospective evaluation of 12-year experience with endovascular management of acute mesenteric ischemia (AMI) due to embolic occlusion of the superior mesenteric artery (SMA).Materials and methodsFrom 2003 to 2014, we analysed the in-hospital mortality of 37 patients with acute mesenteric embolism who underwent primary endovascular therapy with subsequent on-demand laparotomy. Transcatheter embolus aspiration was used in all 37 patients (19 women, 18 men, median age 76 years) with embolic occlusion of the SMA. Adjunctive local thrombolysis (n = 2) and stenting (n = 2) were also utilised.ResultsWe achieved complete recanalization of the SMA stem in 91.9 %. One patient was successfully treated by surgical embolectomy due to a failed endovascular approach. Subsequent exploratory laparotomy was performed in 73.0 % (n = 27), and necrotic bowel resection in 40.5 %. The total in-hospital mortality was 27.0 %.ConclusionPrimary endovascular therapy for acute embolic SMA occlusion with on-demand laparotomy is a recommended algorithm used in our centre to treat SMA occlusion. This combined approach for the treatment of AMI is associated with in-hospital mortality rate of 27.0 %.

  17. Liposome-encapsulated hemoglobin alleviates brain edema after permanent occlusion of the middle cerebral artery in rats.

    Science.gov (United States)

    Kawaguchi, Akira T; Kurita, Daisaku; Furuya, Hiroyuki; Yamano, Mariko; Ogata, Yoshitaka; Haida, Munetaka

    2009-02-01

    Liposome-encapsulated hemoglobin (LEH) was proven to be protective in cerebral ischemia/reperfusion injury. The present study evaluated LEH in a rat model of permanent middle cerebral artery (MCA) occlusion to clarify its effect during ischemia and reperfusion. Five minutes after thread occlusion of the MCA, rats were infused with 10 mL/kg of LEH (LEH, n = 13), and compared with normal controls (n = 11). Additional animals received the same MCA occlusion with no treatment (CT, n = 11), saline (saline, n = 10), empty liposome solution (EL, n = 13), or washed red blood cells (RBC, n = 7). Severity of brain edema was determined 24 h later by signal strength in T2-weighted magnetic resonance imaging of the cortex, striatum, hippocampus, and pyriform lobe. The results showed that brain edema/infarction observed in any vehicle-infused control was significantly more severe than in LEH-treated rats. There was a tendency toward aggravated edema in rats receiving ELs. LEH infusion at a dose of 10 mL/kg significantly reduced edema formation as compared to other treatments in a wide area of the brain 24 h after permanent occlusion of the MCA. Low oncotic pressure of EL and LEH solution (vehicle solution) appeared to cause nonsignificant aggravation of edema and reduced protective effects of LEH.

  18. Femoro-popliteal artery occlusions treated by percutaneous transluminal angioplasty and enclosed thrombolysis

    DEFF Research Database (Denmark)

    Tønnesen, K H; Holstein, P; Andersen, E

    1991-01-01

    Removal of fibrin from the site of a newly dilated femoro-popliteal occlusion may be an attractive way of preventing rethrombosis. A double balloon catheter with a dilating tip balloon and an occlusive balloon 10, 15 or 20 cm approximately were introduced percutaneously. Following successful dila...

  19. 黄豆苷元联合倍他司汀治疗椎-基底动脉供血不足96例%Treating 96 cases of vertebro-basilar artery insufficiency with Daidzein and Betahistine

    Institute of Scientific and Technical Information of China (English)

    赵亚恒; 阴伟利; 钱仁义

    2015-01-01

    目的:观察黄豆苷元联合倍他司汀治疗椎-基底动脉供血不足的临床疗效。方法:将96例椎-基底动脉供血不足患者随机分成治疗组和对照组,治疗组应用黄豆苷元联合倍他司汀片,对照组应用倍他司汀片。结果:治疗组总有效率为87.5%,对照组总有效率为79.17%,差异有统计学意义(P<0.0l)。结论:黄豆苷元联合倍他司汀片组的疗效高于倍他司汀片组,故黄豆苷元联合倍他司汀是治疗老年人椎-基底动脉供血不足型眩晕的有效方法。%Objective:To observe clinical efficacy of Daidzein and Betahistine on vertebro-basilar artery insufficiency. Methods:96 cases were randomly divided into the treatment group and the control group. The treatment group took Daidzein and Betahistine; the control group took Betahistine. Results: The total efficiency was 87.5%in the treatment group and 79.1%in the control group. P<0.01. Conclusion:Treating vertebro-basilar artery insufficiency with Daidzein and Betahistine could receive better efficacy.

  20. Vascular growth responses to chronic arterial occlusion are unaffected by myeloid specific focal adhesion kinase (FAK) deletion

    Science.gov (United States)

    Heuslein, Joshua L.; Murrell, Kelsey P.; Leiphart, Ryan J.; Llewellyn, Ryan A.; Meisner, Joshua K.; Price, Richard J.

    2016-05-01

    Arteriogenesis, or the lumenal expansion of pre-existing arterioles in the presence of an upstream occlusion, is a fundamental vascular growth response. Though alterations in shear stress stimulate arteriogenesis, the migration of monocytes into the perivascular space surrounding collateral arteries and their differentiation into macrophages is critical for this vascular growth response to occur. Focal adhesion kinase’s (FAK) role in regulating cell migration has recently been expanded to primary macrophages. We therefore investigated the effect of the myeloid-specific conditional deletion of FAK on vascular remodeling in the mouse femoral arterial ligation (FAL) model. Using laser Doppler perfusion imaging, whole mount imaging of vascular casted gracilis muscles, and immunostaining for CD31 in gastrocnemius muscles cross-sections, we found that there were no statistical differences in perfusion recovery, arteriogenesis, or angiogenesis 28 days after FAL. We therefore sought to determine FAK expression in different myeloid cell populations. We found that FAK is expressed at equally low levels in Ly6Chi and Ly6Clo blood monocytes, however expression is increased over 2-fold in bone marrow derived macrophages. Ultimately, these results suggest that FAK is not required for monocyte migration to the perivascular space and that vascular remodeling following arterial occlusion occurs independently of myeloid specific FAK.

  1. Delayed onset of fatal basilar thrombotic embolus after whiplash injury

    DEFF Research Database (Denmark)

    Viktrup, L; Knudsen, G M; Hansen, S H

    1995-01-01

    BACKGROUND: Whiplash injuries are generally seen after rear-end rather than frontal car collisions. Previous reports have documented death up to 8 days after serious whiplash injury. We report a case of lethal basilar thrombotic embolus that occurred 2 months after the patient's injury...... in a collision. CASE DESCRIPTION: After whiplash trauma in a car accident, a 50-year-old taxi driver suffered from headache and episodic visual disturbances. Two months after the accident he suddenly lost consciousness and was admitted to the hospital. A CT scan performed at that time was indicative of basilar...... thrombosis. The patient died 3 days later. The autopsy revealed a thrombosis in the right vertebral artery and a thrombotic embolus in the basilar artery. Microscopically, a lesion of the right vertebral artery was found at the level of the atlantoaxial joint. CONCLUSIONS: We conclude that the whiplash...

  2. Long-term results of open and endovascular revascularization of superficial femoral artery occlusive disease

    Science.gov (United States)

    Scali, Salvatore T.; Rzucidlo, Eva M.; Bjerke, Aja A.; Stone, David H.; Walsh, Daniel B.; Goodney, Philip P.; Chang, Catherine K.; Powell, Richard J.

    2017-01-01

    Background First-line treatment for patients with superficial femoral arterial (SFA) occlusive disease has yet to be determined. This study compared long-term outcomes between primary SFA stent placement and primary femoral-popliteal bypass. Periprocedural patient factors were examined to determine their effect on these results. Methods All femoral-popliteal bypasses and SFA interventions performed in consecutive patients with symptoms Rutherford 3 to 6 between 2001 and 2008 were reviewed. Time-dependent outcomes were analyzed using the Kaplan-Meier method and log-rank test. Cox proportional hazards were performed to determine predictors of graft patency. Multivariate analysis was completed to identify patient covariates most often associated with the primary therapy. Results A total of 152 limbs in 141 patients (66% male; mean age, 66 ± 22 years) underwent femoral-popliteal bypass, and 233 limbs in 204 patients (49% male; mean age, 70 ± 11 years) underwent SFA interventions. Four-year primary, primary-assisted, and secondary patency rates were 69%, 78%, and 83%, respectively, for bypass patients and 66%, 91%, and 95%, respectively, for SFA interventions. Six-year limb salvage was 80% for bypass vs 92% for stenting (P = .04). Critical limb ischemia (CLI) and renal insufficiency were predictors of bypass failure. Claudication was a predictor of success for SFA stenting. Three-year limb salvage rates for CLI patients undergoing surgery and SFA stenting were 83%. Amputation-free survival at 3 years for CLI patients was 55% for bypass and 59% for SFA interventions. Multivariate predictors (odds ratios and 95% confidence intervals) of covariates most frequently associated with first-line SFA stenting were TransAtlantic Inter-Society Consensus II A and B lesions (5.9 [3.4-9.1], P 70 years (2.1 [1.4-3.1], Ppatients were more likely to have nondiabetic status (5.6 [3.3-9.4], P patient-specific covariates, and anatomic lesion classification have significant association

  3. Carotid endarterectomy in patients with occlusion of the contralateral carotid artery. Perioperative risk and late results

    DEFF Research Database (Denmark)

    Sillesen, H; Schroeder, T; Rasmussen, L;

    1987-01-01

    Recent reports on the outcome of carotid endarterectomy in patients with contralateral occlusion have been conflicting. Therefore, we reviewed 51 cases identified, among 675 consecutive carotid endarterectomies. A perioperative mortality of 2% and a permanent morbidity rate of 16% was observed....... Compared with a complication rate of about 5% previously reported from this institution, this clearly indicates contralateral carotid occlusion as a major risk factor in carotid surgery. Though not statistically significant, patients with severely reduced cerebral perfusion pressure (CPP) had suffered more...

  4. Upper limb artery segmental occlusions due to chronic use of ergotamine combined with itraconazole, treated by thrombolysis

    Directory of Open Access Journals (Sweden)

    Nodari Franco

    2011-08-01

    Full Text Available Abstract Background The ergotamine tartrate associated with certain categories of drugs can lead to critical ischemia of the extremities. Discontinuation of taking ergotamine is usually sufficient for the total regression of ischemia, but in some cases it could be necessary thrombolytic and anticoagulant therapy to avoid amputation. Case report A woman of 62 years presented with a severe pain left forearm appeared 10 days ago, with a worsening trend. The same symptoms appeared after 5 days also in the right forearm. Physical examination showed the right arm slightly hypothermic, with radial reduced pulse in presence of reduced sensitivity. The left arm was frankly hypothermic, pulse less on radial and with an ulnar humeral reduced pulse, associated to a decreased sensitivity and motility. Clinical history shows a chronic headache for which the patient took a daily basis for years Cafergot suppository (equivalent to 3.2 mg of ergotamine. From about ten days had begun therapy with itraconazole for vaginal candidiasis. The Color-Doppler ultrasound shown arterial thrombosis of the upper limbs (humeral and radial bilateral, with minimal residual flow to the right and no signal on the humeral and radial left artery. Results Angiography revealed progressive reduction in size of the axillary artery and right humeral artery stenosis with right segmental occlusions and multiple hypertrophic collateral circulations at the elbow joint. At the level of the right forearm was recognizable only the radial artery, decreased in size. Does not recognize the ulnar, interosseous artery was thin. To the left showed progressive reduction in size of the distal subclavian and humeral artery, determined by multiple segmental steno-occlusion with collateral vessels serving only a thin hypotrophic interosseous artery. Arteriographic findings were compatible with systemic drug-induced disease. The immediate implementation of thrombolysis, continued for 26 hours, with

  5. Basilar artery hemodynamics quantitative analysis of the patients with vertigo by 3.0 T MR%眩晕患者基底动脉血流动力学3.0T磁共振研究

    Institute of Scientific and Technical Information of China (English)

    宋利宏; 李晖; 刘怀军

    2013-01-01

    Objective To investigate the hemodynamics of basilar artery and its blood-supply area in patients with vertigo by 3.0 T MR.Methods Fifty patients with vertigo were selected as case group and 50 healthy volunteers were selected as control group.All subjects in the case group and in control group were examined by brain magnetic resonance imaging (MRI),magnetic resonance angiography(MRA),fast cine phase contrast(Fast CINE PC) and flow-sensitive alternating inversion recovery sequence (FAIR).After image postprocessing,the velocity and the blood flow volume of basilar artery were measured and calculated.The FAIR value of bilateral occipital lobe,cerebellum,pons and medulla oblongata was measured.Statistical testing was performed.Results The average velocity,peak velocity and blood flow volume of the basilar artery in case group were significantly lower than those in the control group(the average velocity:(22.47 ±9.14) cm/s vs (31.41 ±5.97) cm/s,t =-5.79,P < 0.0001 ; peak velocity:(31.60 ± 13.18) cm/s vs (44.00 ± 7.84) cm/s,t =-5.71,P <0.0001 ;blood flow volume:(91.14 ±43.92) ml/min vs (127.49 ± 28.33) ml/min,t =-4.92,P <0.0001).The perfusion of the posterior circulation in the case group was lower than that in the control group ((882.35 ±35.22) vs (906.34 ±36.82),t =-3.33,P =0.0012).The average velocity,peak velocity and blood flow volume of the basilar artery in case group whose brain parenchyma and blood vessels were normal were (26.31 ±5.16) cm/s,(36.33 ±6.60) cm/s,(95.38 ±28.16) ml/min respectively,which were all less than those in the control group (average velocity:t =-2.72,P =0.0086 ; peak velocity:t =-3.12,P =0.0027 ;blood flow volume:t =-3.53,P =0.0008).The perfusion of the basilar artery blood-supply area in case group whose brain parenchyma and blood vessels were normal was (904.00 ± 35.82),there was no difference when compared with the control group (906.00 ± 36.82,t =-0.20,P =0.8427).Conclusion Whether the brain parenchyma and blood

  6. Color Doppler imaging features in patients presenting central retinal artery occlusion with and without giant cell arteritis

    Directory of Open Access Journals (Sweden)

    Catalin Jianu Dragos

    2016-01-01

    Full Text Available Introduction. Central retinal artery obstruction (CRAO represents an abrupt diminution of blood flow through the CRA that is severe enough to cause ischemia of the inner retina with permanent unilateral visual loss. We presented the role of color Doppler imaging (CDI of orbital vessels and of extracranial duplex sonography (EDS in the etiological diagnosis of CRAO in two patients with clinical suspicion of unilateral CRAO. Case report. Patients were examined following the protocol which included CDI of orbital vessels and EDS. Both patients had no emboli visible on ophthalmoscopy. The B-scan ultrasound evaluation of the first patient found a small round, moderately reflective echo within the right optic nerve, 1.5 mm behind the optic disc (emboli of cholesterol. CDI of retrobulbar vessels revealed the normal right ophthalmic artery (OA hemodynamic parameters, but the first patient had no arterial flow signal on CDI at the distance of 1.5 mm behind the right optic disc. In contrast, the left eye had the normal aspect on CDI of retrobulbar vessels. The right internal carotid artery EDS identified a severe stenosis at its origin as CRA’s emboli source. The second patient had characteristic CDI findings for giant cell arteritis (GCA with eye involvement: severe diminished blood flow velocities, especially end-diastolic velocities, in both CRAs. Less abnormalities were observed in the posterior ciliary arteries, and in the ophthalmic arteries. The second patient had no systemic symptoms or signs of GCA. Conclusion. In the presented cases, the ultrasound investigation enabled prompt differentiation between central retinal artery occlusion of embolic mechanism and CRAO caused by GCA.

  7. Multiple level arterial occlusions of the leg. Reliability of indirect thigh pressures in the assessment of proximal arterial obstruction

    DEFF Research Database (Denmark)

    Noer, Ivan; Tønnesen, K H; Lassen, N A

    1981-01-01

    placed as proximally as possible on the thigh. The proximal pressures measured by the two techniques were found to correlate well. Thus, the atraumatic cuff pressure technique is validated which can be of use in evaluating multilevel occlusions and the associated run off problem involved in partial...

  8. Efficacy analysis of alprostadil combined with betahistine in treating vertebral-basilar artery insufficiency%前列地尔联合倍他司汀治疗椎-基底动脉供血不足的疗效分析

    Institute of Scientific and Technical Information of China (English)

    肖有为; 许彩芹; 庞燕; 刘宇鹏

    2011-01-01

    目的 观察前列地尔联合倍他司汀治疗椎-基底动脉供血不足的临床疗效.方法 将136例椎-基底动脉供血不足患者随机分为前列地尔联合倍他司汀治疗组(68例)和倍他司汀对照组(68例),观察临床疗效及治疗前后椎-基底动脉平均血流速度的改善情况.结果 治疗组治愈率及总有效率高于对照组(P<0.05);治疗组各动脉平均血流速度均明显较对照组改善(P<0.05).结论 前列地尔联合倍他司汀治疗椎-基底动脉供血不足疗效显著.%Objective To observe the clinical efficacy of alprostadil combined with betahistine in treating vertebral-basilar artery insufficiency.Methods 136 patients with vertebral-basilar artery insufficiency were randomly divided into alprostadil combined with betahistine treatment group (68 cases) and betahistine control group (68 cases), clinical efficacy and the improvement of vertebral-basilar artery mean blood flow rate was observed before and after treatment.Results The cure rate and total effective rate of treatment group were higher ( P < 0.05 ); Artery mean blood flow velocity of treatment group were improved significantly than that in control group ( P < 0.05 ).Conclusion It is effective to treat the vertebral-basilar artery insufficiency with alprostadil combined with betahistine.

  9. The MRI and clinical research in 20 cases with top of the basilar artery syndrome%基底动脉尖综合征20例的MRI与临床研究

    Institute of Scientific and Technical Information of China (English)

    王建军; 陶黎; 赵红; 郑长亮

    2016-01-01

    Objective:To induce the MRI and clinical features in patients with top of the basilar artery syndrome(TOBS).Methods:The clinical and MRI data of the 20 patients with TOBS and the total cerebral angiography data of some patients were analyzed retrospectively,then we summarized their characteristics.Results:The TOBS would grow progressively more debilitating with time. The main clinical manifestations were disturbance of consciousness,abnormal movement of the eyeball, abnormal pupil and hemiplegia.MRI showed the infarction in thalamus,midbrain,bridge,temporal lobe,occipital lobe.4 patients showed vertebral basilar artery with severe stenosis or plaque formation in whole cerebral angiography examination.After treatment,6 cases died,8 cases not recovered and 6 cases improved.Conclusion:The prognosis of TOBS is poor.When there is a sign or imaging changes in 2 or more basal artery lesions,we should take TOBS into account and give timely treatment.%目的:归纳基底动脉尖综合征(TOBS)的MRI及临床特征。方法:回顾性分析20例TOBS患者的临床、MRI资料及部分患者的全脑血管造影资料,并总结其特点。结果:TOBS发病后均呈进行性加重,临床主要表现为意识障碍、眼球运动异常、瞳孔异常、偏瘫;MRI示丘脑、中脑、桥脑、颞叶、枕叶梗死;其中患者行全脑血管造影检查显示椎基底动脉重度狭窄或斑块形成4例。治疗后死亡6例,无恢复8例,好转6例,结论:TOBS预后差,当有基底动脉供血范围内2个以上病灶体征或影像学改变时,应考虑TOBS并及时治疗。

  10. Inferior Pancreaticoduodenal Artery Aneurysms Associated with Occlusive Lesions of the Celiac Axis: Diagnosis, Treatment Options, Outcomes, and Review of the Literature

    Energy Technology Data Exchange (ETDEWEB)

    Flood, Karen, E-mail: karenrogers@doctors.org.uk; Nicholson, Anthony A. [Leeds Teaching Hospitals, Department of Radiology (United Kingdom)

    2013-06-15

    Purpose. To describe the presentation, treatment, and outcomes for 14 patients with aneurysms of the inferior pancreaticoduodenal arteries associated with occlusive lesions of the celiac axis, and to review the literature for similar cases. Methods, Over a period of 12 years, 14 patients (10 women and 4 men) ranging in age from 26 to 50 (mean 46) years were demonstrated to have aneurysms of the inferior pancreaticoduodenal artery origin associated with stenosis or occlusion of the celiac axis. All patients were treated by a combination of surgery and interventional radiology. Results. Outcome data collected between 3 months and 4 years (mean 2 years) demonstrated that all aneurysms remained excluded, and all 14 patients were well. The 49 case reports in the literature confirm the findings of this cohort. Conclusion. In inferior pancreaticoduodenal artery aneurysm resulting from celiac occlusive disease, endovascular treatment is best achieved by stenting the celiac axis and/or embolizing the aneurysm when necessary.

  11. Distance to thrombus on MR angiography predicts outcome of middle cerebral artery occlusion treated with IV thrombolysis

    Energy Technology Data Exchange (ETDEWEB)

    Gawlitza, Matthias; Quaeschling, Ulf; Schob, Stefan; Hoffmann, Karl-Titus; Lobsien, Donald [University Hospital Leipzig, Department of Neuroradiology, Leipzig (Germany); Friedrich, Benjamin; Schaudinn, Alexander [University Hospital Leipzig, Department of Diagnostic and Interventional Radiology, Leipzig (Germany); Hobohm, Carsten [University Hospital Leipzig, Department of Neurology, Leipzig (Germany)

    2015-10-15

    The distance to thrombus (DT) on CT angiography was recently proposed as a predictor of outcome in patients treated by intravenous thrombolysis (IVT) for stroke due to occlusion of the middle cerebral artery (MCA). The purpose of the present study was to validate its inter-rater reliability and its prognostic value on contrast-enhanced magnetic resonance angiography (CE-MRA). Furthermore, we investigated the relation between DT and FLAIR-vascular hyperintensities (FVH) as a surrogate of collateral circulation and hypoperfusion. Patients with acute MCA occlusions treated by IVT and diagnosed with magnetic resonance imaging (MRI) were included. Two readers measured DT. FVH and acute DWI lesion volumes were quantified. Clinical status was determined using the initial NIH stroke scale (NIHSS) and 90-day modified Rankin Scale (90d mRS). Sixty-one patients showed a lesion on diffusion-weighted magnetic resonance images and an occlusion of the MCA on CE-MRA. We found significant inverse correlations between DT and NIHSS scores at admission (ρ = -0.29; P = 0.02), DT and mRS at 90 days (ρ = -0.29; P = 0.04), and between DT and FVH (ρ = -0.32; P = 0.01). For a DT <22 mm, the likelihood of an unfavorable outcome (90d mRS 3-6 or NIHSS score improvement of ≤10 points at discharge) was >50 %. Initial DWI lesion volumes showed no correlation with the outcome. Excellent inter-rater agreement for DT was observed (Cronbach's α = 0.98; P < 0.001). DT on CE-MRA is reliably measurable, correlates inversely with FLAIR-vascular hyperintensities, and predicts outcome in patients with acute MCA occlusion treated with IVT. (orig.)

  12. Loss of visual evoked potential following temporary occlusion of the superior hypophyseal artery during aneurysm clip placement surgery. Case report.

    Science.gov (United States)

    Goto, Tetsuya; Tanaka, Yuichiro; Kodama, Kunihiko; Kusano, Yoshikazu; Sakai, Keiichi; Hongo, Kazuhiro

    2007-10-01

    The authors report a case in which a 62-year-old woman with a history of subarachnoid hemorrhage due to a ruptured aneurysm was found to have a de novo paraclinoid aneurysm in the right internal carotid artery during a routine medical examination. Surgical clip placement was performed via a contralateral pterional approach under visual evoked potential (VEP) monitoring. The superior hypophyseal artery (SHA) was found to originate from the aneurysm body. The artery was temporarily occluded prior to application of the clip to the aneurysm neck. The VEP signal was lost 3 minutes after the SHA was occluded, and the potentials gradually recovered 10 minutes after the artery was released. The disappearance of VEP signal was reproducible with SHA occlusion. The clip was applied to the aneurysm body to preserve the origin of the SHA. The patient did not have any deterioration of vision after surgery. Intraoperative VEP monitoring can be used to help determine whether the SHA can be sacrificed safely.

  13. Fermented soybeans, Chungkookjang, prevent hippocampal cell death and β-cell apoptosis by decreasing pro-inflammatory cytokines in gerbils with transient artery occlusion.

    Science.gov (United States)

    Park, Sunmin; Kim, Da Sol; Kang, Sunna; Moon, Bo Reum

    2016-02-01

    Since Chungkookjang, a short-term fermented soybean, is known to improve glucose metabolism and antioxidant activity, it may prevent the neurological symptoms and glucose disturbance induced by artery occlusion. We investigated the protective effects and mechanisms of traditional (TFC) and standardized Chungkookjang fermented with Bacillus licheniformis (BLFC) against ischemia/reperfusion damage in the hippocampal CA1 region and against hyperglycemia after transient cerebral ischemia in gerbils. Gerbils were subjected to either an occlusion of the bilateral common carotid arteries for 8 min to render them ischemic or a sham operation. Ischemic gerbils were fed either a 40% fat diet containing 10% of either cooked soybean (CSB), TFC, or BLFC for 28 days. Neuronal cell death and cytokine expression in the hippocampus, neurological deficit, serum cytokine levels, and glucose metabolism were measured. TFC and BLFC contained more isoflavonoid aglycones than CSB. Artery occlusion increased the expressions of IL-1β and TNF-α as well as cell death in the hippocampal CA1 region and induced severe neurological symptoms. CSB, TFC, and BLFC prevented the neuronal cell death and the symptoms such as dropped eyelid, bristling hair, reduced muscle tone and flexor reflex, and abnormal posture and walking patterns, and suppressed cytokine expressions. CSB was less effective than TFC and BLFC. Artery occlusion induced glucose intolerance due to decreased insulin secretion and β-cell mass. TFC and BLFC prevented the impairment of glucose metabolism by artery occlusion. Especially TFC and BLFC increased β-cell proliferation and suppressed the β-cell apoptosis by suppressing TNF-α and IL-1β which in turn decreased cleaved caspase-3 that caused apoptosis. In conclusion, TFC and BLFC may prevent and alleviate neuronal cell death in the hippocampal CA1 region and neurological symptoms and poststroke hyperglycemia in gerbils with artery occlusion. This might be associated with

  14. Optic nerve fast axonal transport abnormalities in primates. Occurrence after short posterior ciliary artery occlusion.

    Science.gov (United States)

    Radius, R L

    1980-11-01

    Fast axonal transport abnormalities in primate (Aotus trivirgatus) optic nerve were studied in ten eyes at various intervals after occlusion of the lateral short posterior ciliary circulation. Evidence of focal axonal ischemia, as indicated by swelling of mitochondria and dissolution of cytoplasmic detail, was noted as early as one hour after occlusion. Accumulation of mitochondria, microvesicles, and dense bodies, indicating focal interruption of axonal transport mechanisms, was noted in eyes examined at 2, 4, and 6 hours. This accumulation of organelles was limited to the region of the lamina cribrosa. Nerve head abnormalities were not seen in two eyes studied at two weeks.

  15. Prevention of occlusive arterial thrombus formation by a single loading dose of prasugrel suppresses neointimal hyperplasia in mice.

    Science.gov (United States)

    Ohno, Kousaku; Tomizawa, Atsuyuki; Jakubowski, Joseph A; Mizuno, Makoto; Sugidachi, Atsuhiro

    2015-12-01

    The present study examined the effects of prasugrel in a mouse model of thrombosis-induced neointimal hyperplasia. Following carotid artery injury by application of ferric chloride solution, thrombus formation was assessed on Day 1 and neointimal thickening was assessed on Day 21. Single administrations of prasugrel at 0.3-3mg/kg (p.o.) resulted in a dose-related and sustained inhibition of ADP-induced platelet aggregation through 24h. Single and multiple (1 and 3 weeks) administration of prasugrel (3mg/kg loading and 1mg/kg/day maintenance doses) resulted in a marked inhibition of neointimal thickening in the injured artery. In the dose-response study, a single administration of prasugrel at 0.3-3mg/kg (p.o.) dose-relatedly inhibited thrombus formation and neointimal thickening on Days 1 and 21, respectively. The degree of neointimal hyperplasia in the injured artery correlated significantly with the thrombus indices, time to occlusion and patency rate. To explore possible mechanisms of inhibition of neointimal hyperplasia by prasugrel, mRNA expression levels of inflammatory and fibrosis markers were determined in injured arteries. Prasugrel treatment resulted in reduced MCP-1, ICAM-1 and TGF-β mRNA levels on Day 2 (24h after the injury) and Day 8 (1 week after the injury) in the target arteries. In conclusion, we found that a single oral loading dose of prasugrel markedly prevented neointimal hyperplasia by inhibiting platelet activation and thrombus formation and was associated with inhibition of the expression of inflammatory and fibrosis markers, including MCP-1, ICAM-1 and TGF-β, in the injured arteries.

  16. An unusual case of multiple aortic abnormalities: total occlusion of aortic arch, left external iliac artery, and bicuspid aortic valve in a 21-year-old man.

    Science.gov (United States)

    Tanindi, Asli; Tavil, Yusuf; Mutluay, Ruya; Taktak, Hacer; Cengel, Atiye

    2007-03-01

    An unusual case of total occlusion of aorta just distal to the left subclavian artery, bicuspid aortic valve, and occluded left external iliac artery in a 21-year-old man who was admitted with headache and severe hypertension is presented. We wish to report this case because so far there have been none reported with such multiple aortic abnormalities, although several documented cases of isolated total occlusion of aorta exist. Our patient underwent a successful surgical correction, i.e., patch plasty to the coarcted segment and end to side - end to side aortal-aortal bypass with Dacron graft.

  17. Optimal stimulation parameters for Renzhong (DU 26) electro-acupuncture for improving motor function in a rat model of middle cerebral artery occlusion

    Institute of Scientific and Technical Information of China (English)

    Lin Han; Shu Wang; Jinquan Ma; Wenping Yao; Yan Shen; Xuemin Shi

    2011-01-01

    The selection of electro-acupuncture parameters remains poorly unified between clinical studies. The present study observed the effects of electro-acupuncturing Renzhong (DU 26) with different stimulation parameters on motor function recovery following middle artery occlusion injury in rats. Results showed an optimal stimulation parameter for Renzhong electro-acupuncture that was low frequency and mild current (2 Hz, 1 mA) significantly improved cortical excitability and conductive function, and promoted recovery in a rat model of motor function in middle artery occlusion. Frequency had a greater impact than current or interaction, and played a critical role in electro-acupuncture therapy.

  18. Should incidental asymptomatic angiographic stenoses and occlusions be treated in patients with peripheral arterial disease?

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2009-09-01

    The clinical importance of angiographically detected asymptomatic lower-limb stenoses and occlusions is unknown. This study aims to (i) assess the clinical outcome of asymptomatic lesions in the lower limb, (ii) identify predictors of clinical deterioration, and (iii) determine which asymptomatic lower-limb lesions should be treated at presentation.

  19. ECG-triggered non-contrast-enhanced MR angiography (TRANCE) versus digital subtraction angiography (DSA) in patients with peripheral arterial occlusive disease of the lower extremities

    Energy Technology Data Exchange (ETDEWEB)

    Gutzeit, Andreas [Cantonal Hospital Winterthur, Department of Radiology, Winterthur (Switzerland); Paracelsus Medical University Salzburg, Department of Radiology, Salzburg (Austria); Sutter, Reto [Cantonal Hospital Winterthur, Department of Radiology, Winterthur (Switzerland); University Hospital Balgrist, Department of Radiology, Zurich (Switzerland); Froehlich, Johannes M.; Roos, Justus E.; Sautter, Thomas; Schoch, Erik; Giger, Barbara; Weymarn, Constantin von; Binkert, Christoph A. [Cantonal Hospital Winterthur, Department of Radiology, Winterthur (Switzerland); Wyss, Michael [University and ETH Zurich, Institute for Biomedical Engineering, Zurich (Switzerland); Graf, Nicole [University Hospital of Zurich, Clinical Trials Center, Center for Clinical Research, Zurich (Switzerland); Jenelten, Regula [Cantonal Hospital Winterthur, Department of Angiology, Winterthur (Switzerland); Hergan, Klaus [Paracelsus Medical University Salzburg, Department of Radiology, Salzburg (Austria)

    2011-09-15

    To prospectively determine the diagnostic value of electrocardiography-triggered non-contrast-enhanced magnetic resonance angiography (TRANCE) of the lower extremities including the feet versus DSA. All 43 patients with symptomatic peripheral arterial occlusive disease (PAOD) underwent TRANCE before DSA. Quality of MRA vessel depiction was rated by two independent radiologists on a 3-point scale. Arterial segments were graded for stenoses using a 4-point scale (grade 1: no stenosis; grade 2: moderate stenosis; grade 3: severe stenosis; grade 4: occlusion). Findings were compared with those of DSA. In the 731 vessel segments analysed, intra-arterial DSA revealed 283 stenoses: 33.6% moderate, 16.6% severe and 49.8% occlusions. TRANCE yielded a mean sensitivity, specificity, positive and negative predictive value and diagnostic accuracy to detect severe stenoses or occlusions of 95.6%, 97.4%, 87.2%, 99.2%, 97.1% for the thigh segments and 95.2%, 87.5%, 83.2%, 96.6%, 90.5% for the calf segments. Excellent overall image quality was observed for TRANCE in 91.4% versus 95.7% (DSA) for the thigh and in 60.7% versus 91.0% for the calves, while diagnostic quality of the pedal arteries was rated as insufficient. TRANCE achieves high diagnostic accuracy in the thigh and calf regions, whereas the pedal arteries showed limited quality. (orig.)

  20. Intra-arterial MR-angiography on an open-bore MR-scanner compared to digital-subtraction angiography of the infra-popliteal runoff in patients with peripheral arterial occlusive disease

    Energy Technology Data Exchange (ETDEWEB)

    Huegli, Rolf W. [Department of Radiology University Hospital of Basel, Petersgraben 4, 4031 Basel (Switzerland)], E-mail: rhuegli@uhbs.ch; Thalhammer, Christoph [Department of Angiology, University Hospital of Basel, Petersgraben 4, 4031 Basel (Switzerland)], E-mail: cthalhammer@uhbs.ch; Jacob, Augustinus L. [Department of Radiology University Hospital of Basel, Petersgraben 4, 4031 Basel (Switzerland)], E-mail: ajacob@uhbs.ch; Jaeger, Kurt [Department of Angiology, University Hospital of Basel, Petersgraben 4, 4031 Basel (Switzerland)], E-mail: kjaeger@uhbs.ch; Bilecen, Deniz [Department of Radiology University Hospital of Basel, Petersgraben 4, 4031 Basel (Switzerland)], E-mail: dbilecen@uhbs.ch

    2008-06-15

    Purpose: To evaluate the diagnostic value of contrast-enhanced intra-arterial 3D-MR-angiography (IA-MRA) of the infra-popliteal arteries in an open-bore magnet. Number, severity of arterial lesions, and artefacts were compared to routinely performed intra-arterial digital-subtraction angiography (IA-DSA) in patients suffering from symptomatic peripheral arterial occlusive disease (PAOD). Material and methods: Fifteen patients admitted for PAOD underwent percutaneous transluminal angioplasty (PTA) by IA-DSA. After PTA, IA-MRA of the infra-popliteal station was performed on an open-bore 1.5 T MR-scanner applying a low dose intra-arterial contrast-enhanced 3D-gradient-echo-MRA with gadopentate dimeglumine. The reading was performed by three blinded readers distinguishing moderate ({<=}50%), significant stenoses (51-99%) and vessel occlusions. Imaging artefacts were recorded and binary classified as not disturbing or compromising the observation of the arterial tree. Results: Overall IA-DSA revealed 36 moderate stenoses ({<=}50%), 38 significant stenoses (51-99%), and 10 vessel occlusions. For the detection of significant stenoses and occlusions, the overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy of IA-MRA were 96%, 83%, 88%, 94% and 90%. The only observed artefact was venous overlay in four stations. The readout was not hampered in any case. Conclusion: Intra-arterial contrast-enhanced 3D-gradient-echo-MRA on an open-bore MR-scanner offers an acceptable diagnostic accuracy in diagnosing peripheral arterial occlusive disease in the infra-popliteal region and correlates well with DSA.

  1. Parent artery occlusion with Onyx for distal aneurysms of posterior inferior cerebellar artery: A single-centre experience in a series of 15 patients

    Directory of Open Access Journals (Sweden)

    Qi Wu

    2013-01-01

    Full Text Available Background: Aneurysms located at distal posterior inferior cerebellar artery (PICA are rare. These aneurysms are difficult for surgical or endovascular treatment, especially for ruptured aneurysms. Aims: To investigate the clinical and radiologic efficacy of parent artery occlusion (PAO with embolic agent Onyx in the treatment of distal PICA aneurysm. Materials and Methods: Case records of 15 consecutive patients with 15 ruptured distal PICA aneurysms treated with Onyx embolization were reviewed retrospectively. The follow-up ranged between 6 and 52 months. Cerebral angiography or cerebra computed tomography-angiogram (CTA was performed for follow-up radiological study. Two aneurysms had origin from tonsillomedullary segment, nine from telovelotonsillar segments, and four from cortical segments. All patients were treated with Onyx to occlude aneurysm and proximal portion of vessel in front of aneurysm via endovascular approach. Results: Aneurysm was occluded completely in every patient. One patient died because of intra-procedure haemorrhage. Fourteen patients had good recovery and the last follow-up Glasgow outcome scale was 5. Head CT scan was performed in every survived patient before discharge. CT in 3 patients revealed cerebellar infarctions but without any neurological deficits. None of the 14 patients had rebleeding or fresh neurologic deficits during the follow-up period. Aneurysmal recanalization had not been observed in any of the survived patients. Conclusions: Onyx occlusion of proximal parent artery and aneurysm in the treatment of distal PICA aneurysm is safe and effective according to this study. Morphology and location of aneurysm are important to decide the therapeutic strategy.

  2. Clinical Features,Treatment and Prognosis of Top of the Basilar Artery Syndrome%基底动脉尖综合征的临床表现、治疗及预后分析

    Institute of Scientific and Technical Information of China (English)

    许名远; 查达珍; 郑叶祥; 郑志雄; 李脚跟

    2015-01-01

    目的:总结基底动脉尖综合征( TOBS)的临床表现、治疗及预后。方法回顾性分析2009年6月—2014年3月在福建医科大学附属闽东医院住院治疗的15例TOBS患者的临床资料,总结其临床表现、治疗及预后。结果 TOBS患者以中老年男性多见,临床主要表现为不同程度的意识障碍、眼球运动障碍、瞳孔改变,CT或MRI可以发现基底动脉顶端血管供血区双侧两处以上梗死灶,以丘脑、中脑多见。患者均行机械取栓、溶栓、抗凝等治疗,预后较好。结论 TOBS临床表现形式多样,病死率较高,早期诊断和及时治疗可明显改善患者预后。%Objective To summarize the clinical features, treatment and prognosis of top of the basilar artery syndrome( TOBS). Methods A total of 15 patients with TOBS were selected in Mindong Hospital Affiliated to Fujian Medical University from June 2009 to March 2014,and their clinical data was retrospectively analyzed,the clinical features,treatment and prognosis of TOBS summarized. Results Middle-aged and aged male was main crowd,the main clinical features included varying degrees of conscious disturbance,eyeball movement disorder and pupil changes. CT or MRI showed over 2 infarct lesions of both sides of top of the basilar artery,commonly in thalamus and midbrain. All of the patients were treated with mechanical thrombus extraction,thrombolysis and anticoagulation therapy,and the prognosis was good. Conclusion The clinical features of TOBS was various, and the case fatality rate was high, early diagnosis and timely treatment can effectively improve the prognosis.

  3. Cerebral blood flow and cerebrovascular reserve capacity in patients with occlusion or severe stenosis of cerebral arterial trunk

    Energy Technology Data Exchange (ETDEWEB)

    Yoshinaga, Shinya; Tanaka, Akira; Nakayama, Yoshiya; Tomonaga, Masamichi [Fukuoka Univ., Chikushino (Japan). Chikushi Hospital

    1997-12-01

    The cerebral blood flow (CBF) and the cerebrovascular reserve capacity (CVRC) were sequentially measured using a xenon enhanced CT scan in patients with transient ischemic attack or minor stroke due to an occlusion or a severe stenosis of the cerebral arterial trunk. The patients consisted of twelve males and one female ranging from 37 to 71 years of age (53 years on average). The vascular lesion was located in the internal carotid artery (7 patients) and in the middle cerebral artery (6 patients). Eleven patients received antiplatelet drug therapy, while two other patients underwent STA-MCA anastomosis. The CBF measurements were initially done within one month after the attack and then from 6 to 24 months (12 months on average) after the first study. Only one of 13 patients demonstrated a reattack during the period of observation and the CVRC decreased to 0% from the 14% level observed prior to the reattack, although the CBF was preserved. In the other twelve patients without a reattack, the CVRC was found to improve to 29.4% from 9.9% with statistical significance, even though the CBF remained the same in the first study. This study suggests hemodynamic insult to be closely related to the decreased in the CVRC, while STA-MCA anastomosis does not for prevent hemodynamic reattack based on a decrease in the CVRC in the early stage. (author)

  4. Acute Thrombotic Occlusion of the Popliteal Artery following Knee Dislocation: A Case Report of Management, Local Unit Practice, and a Review of the Literature

    Science.gov (United States)

    Hindi, Fadi; Ettles, Callum; Pemberton, Mark

    2017-01-01

    Arterial complications following traumatic knee injury are relatively rare but mandate timely recognition and treatment to avoid significant comorbidity and medicolegal ramifications. In this report we describe a case of acute thrombotic occlusion of the popliteal artery occurring after knee dislocation, successfully repaired by intimal fixation and a limited venous patch reconstruction. We present a review of local practice in screening vascular injuries following knee dislocation, aligned with a review of the literature and considerations for practice. PMID:28246569

  5. 基底动脉狭窄对孤立性脑桥梗死预后的预测作用研究%Basilar Artery Stenosis is an Independent Predictor of Poor Outcomes at Discharge in Patients with Isolated Pontine Infarction

    Institute of Scientific and Technical Information of China (English)

    鞠奕; 陈梅梅; 李娜; 赵性泉; 王春雪; 王拥军

    2012-01-01

    Objective To compare the clinical presentation, intracranial and extracranial artery stenosis, and the short-term outcomes in patients with basilar artery(BA) stenosis with those without BA stenosis, and to investigate the associations between BA stenosis and poor outcomes in the patients with isolated pontine infarction at discharge. Methods In this prospective study, we recruited patients who were hospitalized for isolated pontine infarction within 7 days of symptom onset from October 2007 to August 2008. We compared the differences in risk factors, clinical features, the baseline neurologic impairment and the outcomes at discharge in patients with and without BA stenosis. Results A total of 101 patients with isolated pontine infarction were included in this study. Differences in central facial palsy and dysphagia(P=0.008 and 0.002) were observed among the 2 groups(with and without moderate to severe BA stenosis/occlusion). When the 2 groups were compared, the neurological impairments on admission were more severe in patients with moderate to severe BA stenosis/occlusion than in patients without BA stenosis(P=0.002). Those with moderate to severe BA stenosis/occlusion had higher incidences of concomitant stenosis of intracranial and/or extracranial artery than those without BA stenosis(P=0.009). The multivariable logistic-regression analysis showed that the significant outcome differences between patients with and without moderate to severe BA stenosis/occlusion when adjusted for potential confounding factors(OR 2.7,95%I 1.07-7.02, P=0.04). Conclusions Patients of isolated pontine infarction with moderate to severe BA stenosis/occlusion had higher incidences of concomitant stenosis of other intracranial and/or extracranial artery. Moderate to severe BA stenosis/occlusion was an independent predictor for poor outcomes at discharge after stroke onset in patients with isolated pontine infarction.%目的 比较伴或不伴基底动脉狭窄的孤立性脑桥梗死

  6. Microglial and macrophage reactions mark progressive changes and define the penumbra in the rat neocortex and striatum after transient middle cerebral artery occlusion

    DEFF Research Database (Denmark)

    Lehrmann, E; Christensen, Thomas; Zimmer, J

    1997-01-01

    Transient middle cerebral artery occlusion in rats leads to infarction of the lateral part of the striatum and adjacent neocortex, with selective neuronal necrosis in the bordering penumbral zones. Administration of glutamate, cytokine, and leukocyte antagonists have rescued mainly neocortical ne...... pattern attract special attention, as these cells may constitute specific targets for therapeutic intervention....

  7. Evaluation of the cerebral vasodilatory capacity by the acetazolamide test before EC-IC bypass surgery in patients with occlusion of the internal carotid artery

    DEFF Research Database (Denmark)

    Vorstrup, S; Brun, B; Lassen, N A

    1986-01-01

    and angiographical findings were operated. The majority of the patients had suffered a minor stroke with or without subsequent transient ischemic attacks. They were studied at least 6 weeks following the stroke. All patients had an occlusion of the relevant internal carotid artery. To identify preoperatively...

  8. Ophthalmologists saving life of a young patient presenting with sudden simultaneous bilateral retinal artery occlusions secondary to calcific emboli of cardiac origin

    Directory of Open Access Journals (Sweden)

    Kavita R Bhatnagar

    2013-01-01

    Full Text Available We present a case report of a young 35-year-old previously healthy male with simultaneous central retinal artery occlusion in the right eye and branch retinal artery occlusion in the left eye with visible calcific emboli in both eyes from calcified mitral valve diagnosed on trans-esophageal echocardiography. Patient underwent an urgent life-saving mitral valve replacement surgery within 2 days as Ophthalmologists immediately referred him to Cardiologist moment they visualized calcific emboli in both eyes with bilateral retinal artery occlusions on fundoscopy. Bilateral retinal artery occlusions suggest a source of emboli at the level of the heart or aortic arch. All patients with retinal ischemia should have a complete cardiovascular evaluation supplemented by Transesophageal echocardiography. Many times an Ophthalmologist might be the physician of first contact for patients with cardiac diseases and awareness of the disease is therefore important for all Ophthalmologists. Timely referral and management by Cardiologist/cardiac surgeon may protect patient against serious life-threatening complications.

  9. Prevalence and impact of a chronic total occlusion in a non-infarct-related artery on long-term mortality in diabetic patients with ST elevation myocardial infarction

    NARCIS (Netherlands)

    Claessen, B.E.P.M.; Hoebers, L.P.; van der Schaaf, R.J.; Kikkert, W.J.; Engstrom, A.E.; Vis, M.M.; Baan, J.,Jr; Koch, K.T.; Meuwissen, M.; van Royen, N.; de Winter, R.J.; Tijssen, J.G.P.; Piek, J.J.; Henriques, J.P.S.

    2010-01-01

    Background Recently, a chronic total occlusion (CTO) in a non-infarct-related artery (non-IRA) and not multivessel disease (MVD) alone was identified as an independent predictor of mortality after ST elevation myocardial infarction (STEMI). Patients with diabetes mellitus (DM) constitute a patient g

  10. A Rare Cause of Stroke in Young Adults: Occlusion of the Middle Cerebral Artery by a Meningioma Postpartum

    Directory of Open Access Journals (Sweden)

    Stéphane Mathis

    2013-01-01

    Full Text Available Meningioma is the most common nonglial intracranial primary tumor. It is a slowly growing tumor and presents clinically by causing seizures along with neurological or neuropsychological deficit. However, acute presentation of meningioma is possible. We are reporting a case of cerebral infarction due to a sphenoid wing meningothelial meningioma (with progesterone receptor positivity leading to an occlusion of the middle cerebral artery (MCA in a 30-year-old right-handed woman (1 month after childbirth. After surgery, no new neurological event occurred, and she recovered most of her neurological functions. Strokes due to meningioma are a highly rare clinical occurrence but should be given serious consideration, particularly in young patients.

  11. Asymmetry in the brain influenced the neurological deficits and infarction volume following the middle cerebral artery occlusion in rats

    Directory of Open Access Journals (Sweden)

    Zhang Meizeng

    2008-12-01

    Full Text Available Abstract Background Paw preference in rats is similar to human handedness, which may result from dominant hemisphere of rat brain. However, given that lateralization is the uniqueness of the humans, many researchers neglect the differences between the left and right hemispheres when selecting the middle cerebral artery occlusion (MCAO in rats. The aim of this study was to evaluate the effect of ischemia in the dominant hemisphere on neurobehavioral function and on the cerebral infarction volume following MCAO in rats. Methods The right-handed male Sprague-Dawley rats asserted by the quadrupedal food-reaching test were subjected to 2 hours MCA occlusion and then reperfusion. Results The neurological scores were significantly worse in the left MCAO group than that in the right MCAO group at 1 h, 24 h, 48 h and 72 h (p 0.05 respectively. There was a trend toward better neurobehavioral function recovery in the right MCAO group than in the left MCAO group. The total infarct volume in left MCAO was significantly larger than that in the right (p Conclusion The neurobehavioral function result and the pathological result were consistent with the hypothesis that paw preference in rats is similar to human handedness, and suggested that ischemia in dominant hemisphere caused more significant neurobehavioral consequence than in another hemisphere following MCAO in adult rats. Asymmetry in rat brain should be considered other than being neglected in choice of rat MCAO model.

  12. Clinical evaluation of an arterial-spin-labeling product sequence in steno-occlusive disease of the brain.

    Directory of Open Access Journals (Sweden)

    Matthias A Mutke

    Full Text Available INTRODUCTION: In brain perfusion imaging, arterial spin labeling (ASL is a noninvasive alternative to dynamic susceptibility contrast-magnetic resonance imaging (DSC-MRI. For clinical imaging, only product sequences can be used. We therefore analyzed the performance of a product sequence (PICORE-PASL included in an MRI software-package compared with DSC-MRI in patients with steno-occlusion of the MCA or ICA >70%. METHODS: Images were acquired on a 3T MRI system and qualitatively analyzed by 3 raters. For a quantitative analysis, cortical ROIs were placed in co-registered ASL and DSC images. Pooled data for ASL-cerebral blood flow (CBF and DSC-CBF were analyzed by Spearman's correlation and the Bland-Altman (BA-plot. RESULTS: In 28 patients, 11 ASL studies were uninterpretable due to patient motion. Of the remaining patients, 71% showed signs of delayed tracer arrival. A weak correlation for DSC-relCBF vs ASL-relCBF (r = 0.24 and a large spread of values in the BA-plot owing to unreliable CBF-measurement was found. CONCLUSION: The PICORE ASL product sequence is sensitive for estimation of delayed tracer arrival, but cannot be recommended to measure CBF in steno-occlusive disease. ASL-sequences that are less sensitive to patient motion and correcting for delayed blood flow should be available in the clinical setting.

  13. Transcatheter occlusion of a large coronary artery fistula using a patent ductus arteriosus occluder.

    Science.gov (United States)

    Białkowski, Jacek; Szkutnik, Małgorzata; Fiszer, Roland; Zembala, Marian

    2011-01-01

    A large fistula from the left coronary artery to the right ventricle was successfully closed percutaneously in a 40 year-old patient using a patent ductus arteriosus occluder. The device was positioned and deployed via the venous system using a guidewire that had been advanced via the aorta, coronary artery and fistula to the venous circulation (arterio-venous loop creation). No complications were reported at follow-up.

  14. Relationship between glutamate in the limbic system and hypothalamus-pituitary-adrenal axis after middle cerebral artery occlusion in rats

    Institute of Scientific and Technical Information of China (English)

    何明利; 陈漫娥; 王景周; 郭光华; 郑衍平; 蒋晓江; 张猛

    2003-01-01

    Objective To investigate the features of glutamate activity in the limbic system and the effects of glutamate on the activation of the hypothalamus-pituitary-adrenal (HPA) axis throughout both acute cerebral ischemia and reperfusion.Methods The changes in glutamate content in the nervous cell gap, in corticotrophin releasing hormone (CHR) mRNA expression level in brain tissue, and in adrenocorticotropic hormone in blood plasma at different time-points after middle cerebral artery occlusion (MCAO) in rats were determined respectively with high-performance liquid chomatography (HPLC) and in situ hybridization.Results Glutamate content in the hippocampus and the hypothalamus increased rapidly at ischemia 15 minutes, and reached peak value (the averages were 21.05 mg/g±2.88 mg/g and 14.20 mg/g±2.58 mg/g, respectively) at 1 hour after middle cerebral artery occlusion. During recirculation, it returned rapidly to the baseline level. At 24 hours after reperfusion, it went up once more, and remained at a relative high level until 48 hours after reperfusion, and then declined gradually. CRH mRNA expression levels in the temporal cortex, hippocampus and hypothalamus were enhanced markedly at 1 hour ischemia and were maintained until 96 hours after reperfusion. At the same time, adrenocorticotropic hormone level in plasma was relatively increased. In the peak stage of reperfusion injury, there was a significantly positive correlation (n=15, r=0.566, P<0.05) of the glutamate contents in the hypothalamus with the number of cells positive for CRH mRNA expression level in the hypothalamus.Conclusion It is probable that the CRH system in the central nervous system is mainly distributed in the limbic system, and glutamate might be one of the trigger factors to induce excessive stress response in the HPA axis.

  15. Surgery-related thrombosis critically affects the brain infarct volume in mice following transient middle cerebral artery occlusion.

    Directory of Open Access Journals (Sweden)

    Xiaojie Lin

    Full Text Available Transient middle cerebral artery occlusion (tMCAO model is widely used to mimic human focal ischemic stroke in order to study ischemia/reperfusion brain injury in rodents. In tMCAO model, intraluminal suture technique is widely used to achieve ischemia and reperfusion. However, variation of infarct volume in this model often requires large sample size, which hinders the progress of preclinical research. Our previous study demonstrated that infarct volume was related to the success of reperfusion although the reason remained unclear. The aim of present study is to explore the relationship between focal thrombus formation and model reproducibility with respect to infarct volume. We hypothesize that suture-induced thrombosis causes infarct volume variability due to insufficient reperfusion after suture withdrawal. Seventy-two adult male CD-1 mice underwent 90 minutes of tMCAO with or without intraperitoneal administration of heparin. Dynamic synchrotron radiation microangiography (SRA and laser speckle contrast imaging (LSCI were performed before and after tMCAO to observe the cerebral vascular morphology and to measure the cerebral blood flow in vivo. Infarct volume and neurological score were examined to evaluate severity of ischemic brain injury. We found that the rate of successful reperfusion was much higher in heparin-treated mice compared to that in heparin-free mice according to the result of SRA and LSCI at 1 and 3 hours after suture withdrawal (p<0.05. Pathological features and SRA revealed that thrombus formed in the internal carotid artery, middle cerebral artery or anterior cerebral artery, which blocked reperfusion following tMCAO. LSCI showed that cortical collateral circulation could be disturbed by thrombi. Our results demonstrated that suture-induced thrombosis was a critical element, which affects the success of reperfusion. Appropriate heparin management provides a useful approach for improving reproducibility of reperfusion

  16. [Basilar ectasia and stroke: clinical aspects of 21 cases].

    Science.gov (United States)

    de Oliveira, R de M; Cardeal, J O; Lima, J G

    1997-09-01

    Ectasia of the basilar artery (EB) occurs when its diameter is greater than normal along all or part of its course, and/or when it is abnormally tortuous. EB may cause cranial nerve dysfunction, ischemic stroke or subarachnoid hemorrhage, pseudotumor or hydrocephalus. We tried to describe cases of stroke associated with EB, analyze its frequency, clinical aspects, and the mechanisms involved in different forms of its presentation. We found 21 patients with stroke and EB. The association between EB and stroke was more prevalent in males over the age of fifty. Main symptoms were hemiparesia, cranial nerves dysfunction, and cerebellar ataxia. Cerebral infarcts associated with EB were due to different mechanisms: arterial thrombosis, artery-to-artery embolism, mass effect with angulation and obstruction of the vertebral and basilar branches.

  17. Investigation of arterial gas occlusions. [effect of noncondensable gases on high performance heat pipes

    Science.gov (United States)

    Saaski, E. W.

    1974-01-01

    The effect of noncondensable gases on high-performance arterial heat pipes was investigated both analytically and experimentally. Models have been generated which characterize the dissolution of gases in condensate, and the diffusional loss of dissolved gases from condensate in arterial flow. These processes, and others, were used to postulate stability criteria for arterial heat pipes under isothermal and non-isothermal condensate flow conditions. A rigorous second-order gas-loaded heat pipe model, incorporating axial conduction and one-dimensional vapor transport, was produced and used for thermal and gas studies. A Freon-22 (CHCIF2) heat pipe was used with helium and xenon to validate modeling. With helium, experimental data compared well with theory. Unusual gas-control effects with xenon were attributed to high solubility.

  18. Sesamin attenuates behavioral, biochemical and histological alterations induced by reversible middle cerebral artery occlusion in the rats.

    Science.gov (United States)

    Khan, Mohd Moshahid; Ishrat, Tauheed; Ahmad, Ajmal; Hoda, Md Nasrul; Khan, M Badruzzaman; Khuwaja, Gulrana; Srivastava, Pallavi; Raza, Syed Shadab; Islam, Fakhrul; Ahmad, Saif

    2010-01-05

    Restoration of blood flow to an ischemic brain region is associated with generation of reactive oxygen species (ROS) with consequent reperfusion injury. ROS cause lipid peroxidation, protein oxidation, and DNA damage, all of which are deleterious to cells. So diminishing the production of free radicals and scavenging them may be a successful therapeutic strategy for the protection of brain tissue in cerebral stroke. The present study investigated the neuroprotective effect of sesamin (Sn) to reduce brain injury after middle cerebral artery occlusion (MCAO). The middle cerebral artery (MCA) of adult male Wistar rat was occluded for 2h and reperfused for 22h. Sesamin is the most abundant lignan in sesame seed oil is a potent antioxidant. Sesamin (30 mg/kg) was given orally twice, 30 min before the onset of ischemia and 12h after reperfusion. The initial investigations revealed that sesamin reduced the neurological deficits in terms of behavior and reduced the level of thiobarbituric acid reactive species (TBARS), and protein carbonyl (PC) in the different areas of the brain when compared with the MCAO group. A significantly depleted level of glutathione and its dependent enzymes (glutathione peroxidase [GPx] and glutathione reductase [GR]) in MCAO group were protected significantly in MCAO group treated with sesamin. The present study suggests that sesamin may be able to attenuate the ischemic cell death and plays a crucial role as a neuroprotectant in regulating levels of reactive oxygen species in the rat brain. Thus, sesamin may be a potential compound in stroke therapy.

  19. Clinico-anatomical correlations of left posterior cerebral artery occlusion. Alexia without agraphia, color anomia, and memory disturbance

    Energy Technology Data Exchange (ETDEWEB)

    Isono, Osamu; Shiota, Junichi; Kawamura, Mitsuru; Hirayama, Keizou; Maki, Toshiyuki.

    1988-11-01

    The relation between neurological signs and symptoms and computed tomography (CT) and magnetic resonance imaging (MRI) was examined in 11 cases of occlusion of the left posterior cerebral artery. All the patients were righthanded. Right homonimous hemianopia was noted in 8 cases, right upper quadrantanopia in 2 cases, and right lower quadrantanopia in 1 case. Of the 11 cases, alexia without agraphia was noted in 9 cases, all 9 of which showed lesions of inferior occipital cortex (lingual and fusiform gyri) and subjacent white matter. Lesions of splenium were found in only 5 of the cases of alexia without agraphia. In 2 cases with neither alexia nor agraphia, lesions were seen in the medial occipital cortex and the subjacent white matter but not in the inferior occipital lobe. Three patients had color anomia which was accompanied by memory disturbances and alexia without agraphia. In 2 of these 3, lesions were widespread in the region of the left posterior cerebral artery. Memory disturbances were observed in 6 cases, all of which also showed alexia without agraphia. The lesions extended not only of the inferior surface of the occipital lobe and along the interhemispheric fissure, but also of hippocampal and parahippocampal gyri. In 3 cases of alexia without agraphia in which no memory distrubance was found, the symptoms of alexia were slight and disappeared at an early stage. (J.P.N.).

  20. Calibrated MRI to evaluate cerebral hemodynamics in patients with an internal carotid artery occlusion

    NARCIS (Netherlands)

    De Vis, Jill B.; Petersen, Esben T.; Bhogal, Alex; Hartkamp, Nolan S.; Klijn, Catharina J. M.; Kappelle, L. J.; Hendrikse, J.

    2015-01-01

    The purpose of this study was to assess whether calibrated magnetic resonance imaging (MRI) can identify regional variances in cerebral hemodynamics caused by vascular disease. For this, arterial spin labeling (ASL)/blood oxygen level-dependent (BOLD) MRI was performed in 11 patients (65 +/- 7 years

  1. Strategies for Successful Percutaneous Revascularization of Chronic Total Occlusion of the Femoropopliteal Arteries When the Antegrade Passage of a Guide Wire Fails

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hui Jin; Park, Sang Woo; Chang, So Il; Jeon, Hae Jeong; Park, Jeong Hee [Konkuk University Hospital, Konkuk University School of Medicine, Seoul (Korea, Republic of)

    2012-07-15

    To evaluate the efficacy of various strategies for revascularization of chronic total occlusion of femoropopliteal arteries when the guide wire does not pass in an anterograde direction. Twenty-four patients with totally occluded femoropopliteal arteries (mean occlusion length 13.75 cm; range, 6-22 cm) were treated by using a retrograde approach and two novel catheters. After successful recanalization or reentry, balloon angioplasty followed by stent placement was performed to complete the revascularization. In 16 cases in which to cross the occlusion via intraluminal or subintimal route was failed, we used Frontrunner catheters in five cases and Outback catheters in 11 cases. In eight cases in which to reenter after subintimal passage of the guide wire was failed, we used Outback catheters. Successful recanalization was achieved intraluminally or subintimally in all cases. One perforation occurred during subintimal passage of the guide wire that was controlled by recanalization of another subintimal tract. There were no cases of distal thromboembolism or other complications. A retrograde approach and using the Frontrunner and Outback catheters are safe and effective for successful revascularization of chronic total occlusion of femoropopliteal arteries. In particular, they are useful when the initial antegrade attempts at recanalization have failed.

  2. Clinical and imaging manifestations of the top - of - the - basilar artery syndrome%基底动脉尖综合征的临床及影像特点分析

    Institute of Scientific and Technical Information of China (English)

    马世江

    2011-01-01

    Objective Clinical manifestation and imaging abnormalities of the top - of - the -basilar artery syndrome (TOBS) have been summarized. Methods Clinical data of 30 patients with TOBS were reviewed retrospectively. Results Most of the cases were middle or old aged. Cerebral thrombosis and cerebral embolism were the major cause of TOBS. The high risk factors included hypertension, diabetes, heart disease, hypercholesterol, and so on. The clinical manifestation comprised the sudden vertigo or unconsciouseness with the dismovement of the eyeballs and the abnormality of the pupils , as well as the dyskinesia, partial blindness or cortical blindness and dystrophy. Computerized tomography(CT)was insensitive for acute infarction. Diffusion weighted imaging ( DWI) demarcated the lesions of infarction in patients with TOBS. Magnetic resonance angiography(MRA) clearly visualized the vertebral arteries, basilar artery and posterior cerebral rteries. Conclusions Diagnosis of TOBS depends on clinical presentation and imaging changes. Magnetic resonance imaging ( MRl) , especially DWI,is superior to CT in early diagnosis of TOBS. Systemic and comprehensive treatment may improve the survival rate of the TOBS patients.%目的 探讨基底动脉尖综合征(TOBS)的病因、临床表现和影像学表现,加深对这种疾病的认识.方法 回顾性分析38例TOBS患者的原始性资料.结果 TOBS患者以中老年为主,主要病因为脑栓塞及脑血栓形成,高危因素有高血压、糖尿病、心脏病、高血脂等,临床表现多以突然眩晕或意识障碍起病,合并眼球运动障碍及瞳孔异常、运动障碍、偏盲、可伴有行为异常等,CT不能清楚显示TOBS早期梗死病灶,磁共振弥散加权扫描(DWI)能准确显示TOBS梗死病灶部位及数目,磁共振血管成像(MRA)能直接反应椎动脉、基底动脉及大脑后动脉情况.结论 TOBS主要依赖临床及影像学表现综合诊断,磁共振检查对于早期诊断基底动脉

  3. Diagnosis of occlusive lesions of upper extremity arteries in patients with thromboangiitis obliterans.

    Science.gov (United States)

    Pokrovskiĭ, A V; Kuntsevich, G I; Dan, V N; Chupin, A V; Kalinin, A A; Alekperov, R T; Makhmudova, L S

    2003-01-01

    The study accrued 84 patients suffering from thromboangiitis obliterans (TO) examined and treated at the A.V. Vishnevsky Institute of Surgery, RAMS, over the period 1988 to 2002. Based on the complaints on the part of the upper extremities the patients were distributed into four groups. Sixteen (19.1%) TO patients did not make any complaints on the part of the arms (degree I ischemia). Thirty-eight (45.2%) patients complained of numbness and paresthesia, chiefly of the tips of the fingers on both hands (degree II ischemia). Six (7.1%) persons complained of pains in the hands at physical exercise (decree III ischemia). Ulcers and necroses of the fingers were present in 24 (28.6%) patients (degree IV ischemia). The diagnostic procedures for arterial lesion of the upper extremities included laboratory investigations, duplex scanning of the great arteries, of the arteries of the hands, fingers and nail matrix, wide-field capillaroscopy, oxygen tension measurements, and angiography as well. Comparison of the clinical manifestations of arterial lesion of the upper extremities in TO patients to the data supplied by different research methods has revealed a direct correlation between the degree of ischemia and the pathomorphological as well as functional changes which increased as the ischemic syndrome was aggravated. As a result of the present work, there have been studied and systematized the criteria for the diagnosis of the degree of arterial lesion of the upper extremities in TO patients, based on the data, supplied by duplex scanning, capillaroscopy, measurements of transcutaneous oxygen tension and angiography. In addition, there has been studied the role of the humoral component of immunity in the delineation of inflammatory activity in patients with TO.

  4. Transient Occlusion of Bilateral Internal Iliac Arteries Facilitates Bloodless Operative Field in Subcapsular Prostatectomy

    Directory of Open Access Journals (Sweden)

    Takumi Takeuchi

    2012-01-01

    Full Text Available Transurethral resection of the prostate is the gold standard of surgical treatment for benign prostatic hyperplasia (BPH. Nevertheless, open subcapsular prostatectomy is still performed for large BPH. While enucleation of prostatic adenoma is being performed, unneglectable bleeding can occur and surgeons need to rush to remove adenomas, often using fingers and in a blinded fashion. The blood supply to the prostatic capsule and adenoma can be reduced to a marked extent in subcapsular prostatectomy if the bilateral internal iliac arteries are transiently occluded. Thus, a bloodless operative field is reasonably acquired during enucleation of adenoma, which would, otherwise, be a cause for concern to surgeons due to bleeding. It is not always applicable, but it could be an option if the estimated volume of BPH is more than 100 mL. In two cases, bilateral internal iliac arteries were occluded with Bulldog clamps, and then adenomas of 159 and 97 g were enucleated.

  5. Hyperbaric oxygenation effects determination in the therapy of chronic occlusive lower extremities arteries disease by the use of perfusion scintigraphy

    Directory of Open Access Journals (Sweden)

    Zoranović Uroš

    2010-01-01

    inoperable occlusive disease of the lower leg arteries significantly increases after the application of HBO treatment.

  6. Permanent occlusion of feeding arteries and draining veins in solid mouse tumors by vascular targeted photodynamic therapy (VTP with Tookad.

    Directory of Open Access Journals (Sweden)

    Noa Madar-Balakirski

    Full Text Available BACKGROUND: Antiangiogenic and anti-vascular therapies present intriguing alternatives to cancer therapy. However, despite promising preclinical results and significant delays in tumor progression, none have demonstrated long-term curative features to date. Here, we show that a single treatment session of Tookad-based vascular targeted photodynamic therapy (VTP promotes permanent arrest of tumor blood supply by rapid occlusion of the tumor feeding arteries (FA and draining veins (DV, leading to tumor necrosis and eradication within 24-48 h. METHODOLOGY/PRINCIPAL FINDINGS: A mouse earlobe MADB106 tumor model was subjected to Tookad-VTP and monitored by three complementary, non-invasive online imaging techniques: Fluorescent intravital microscopy, Dynamic Light Scattering Imaging and photosensitized MRI. Tookad-VTP led to prompt tumor FA vasodilatation (a mean volume increase of 70% with a transient increase (60% in blood-flow rate. Rapid vasoconstriction, simultaneous blood clotting, vessel permeabilization and a sharp decline in the flow rates then followed, culminating in FA occlusion at 63.2 sec+/-1.5SEM. This blockage was deemed irreversible after 10 minutes of VTP treatment. A decrease in DV blood flow was demonstrated, with a slight lag from FA response, accompanied by frequent changes in flow direction before reaching a complete standstill. In contrast, neighboring, healthy tissue vessels of similar sizes remained intact and functional after Tookad-VTP. CONCLUSION/SIGNIFICANCE: Tookad-VTP selectively targets the tumor feeding and draining vessels. To the best of our knowledge, this is the first mono-therapeutic modality that primarily aims at the larger tumor vessels and leads to high cure rates, both in the preclinical and clinical arenas.

  7. Rodent stroke induced by photochemical occlusion of proximal middle cerebral artery: Evolution monitored with MR imaging and histopathology

    Energy Technology Data Exchange (ETDEWEB)

    Chen Feng [Department of Radiology, Faculty of Medicine, Catholic University of Leuven (Belgium); Department of Radiology, Zhong Da Hospital, Southeast University, Nanjing (China); Suzuki, Yasuhiro [Department of Molecular and Vascular Biology, Faculty of Medicine, Catholic University of Leuven (Belgium); Department of Pharmacology, Hamamashu University, Hamamashu (Japan); Nagai, Nobuo [Department of Molecular and Vascular Biology, Faculty of Medicine, Catholic University of Leuven (Belgium); Jin, Lixin [Department of Radiology, Faculty of Medicine, Catholic University of Leuven (Belgium); Yu Jie [Department of Radiology, Faculty of Medicine, Catholic University of Leuven (Belgium); Wang Huaijun [Department of Radiology, Faculty of Medicine, Catholic University of Leuven (Belgium); Marchal, Guy [Department of Radiology, Faculty of Medicine, Catholic University of Leuven (Belgium); Ni Yicheng [Department of Radiology, Faculty of Medicine, Catholic University of Leuven (Belgium)]. E-mail: Yicheng.Ni@med.kuleuven.ac.be

    2007-07-15

    Purpose: To longitudinally investigate stroke in rats after photothrombotic occlusion of proximal middle cerebral artery (MCA) with magnetic resonance imaging (MRI) in correlation with histopathology. Materials and methods: Forty-two rats were subjected to photochemical MCA occlusion and MRI at 1.5 T, and sacrificed in seven groups (n = 6 each) at the following time points: 1, 3, 6 and 12 h, and at day 1, 3 and 9. T2-weighted (T2WI) and diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) map was performed in all rats. Contrast-enhanced T1-weighted imaging (CE-T1WI) was compared to intravital staining with Evans blue in one group for assessing blood-brain barrier (BBB) integrity. The brain was stained histochemically with triphenyl tetrazolium chloride (TTC) and processed for pathological assessment. The evolutional changes of relative lesion volume, signal intensity (SI), and the BBB integrity on MRI with corresponding histopathology were evaluated. Results: The ischemic lesion volume reached a maximum around 12 h to day 1 as visualized successively by DWI, ADC map and T2WI, implicating the evolving pathology from cytotoxic edema through vasogenic edema to tissue death. The ADC of brain infarction underwent a significant reversion after 12 h, reflecting the colliquative necrosis. On CE-T1WI, BBB leakage peaked at 6 h and at day 3 with a transitional partial recovery around 24 h. The infarct volume on T2WI, DWI and ADC map matched well with that on TTC staining at 12 h and at day 1 (p > 0.05). Conclusion: The evolution of the present photothrombotic stroke model in rats could be characterized by MRI. The obtained information may help longitudinal studies of cerebral ischemia and anti-stroke agents using the same model.

  8. Resolution of Internal Carotid Dissection with Middle Cerebral Artery Occlusion in Pregnancy

    Directory of Open Access Journals (Sweden)

    Nicole Ulrich

    2015-01-01

    Full Text Available Introduction. Cervical artery dissection (CAD is a common cause of stroke in younger patients. While the incidence of stroke in pregnancy is increasing, CAD remains a rare cause of ischemic stroke in the pregnant population, with only 30 cases described in the literature, most in the postpartum period. Methods. The case of a pregnant patient at 18 weeks of gestation presenting with CAD and ischemic stroke following intercourse is discussed. Discussion. CAD results from an intimal tear in the carotid artery, allowing accumulation of blood in the vessel wall. Stroke results from embolization of thrombogenic material in the wall. Etiology includes minor trauma, connective tissue disorders, or anatomic variations of the carotid artery. Most patients present with headache and/or neck pain, while ischemic symptoms are seen in at least 50% of patients. In the pregnant population, imaging with MRI or MRA of the head and neck aids in diagnosis. Once the diagnosis is made, patients are treated with either anticoagulation or antiplatelet medications. The optimal treatment in both pregnant and nonpregnant patients has not been well-studied. Conclusion. CAD is an important diagnosis to consider in a pregnant patient with persistent headache, especially if neurological symptoms are present. Imaging should be quickly obtained so treatment can be initiated.

  9. Interesting Basis of Vertebrobasilar Arterial Territory

    Directory of Open Access Journals (Sweden)

    Kavian Ghandehari

    2012-07-01

    Full Text Available Background: Vertebrobasilar arterial territory nourishes one-quarter of human brain. It constitutes some vital and strategic parts of the central nervous system.Methods: A number of keywords (vertebral, basilar, artery, and territory were searched in MEDLINE (Ovid and PubMed as well as Google, ProQuest, Scopus, Cochrane Library, and Science Direct online electronic search engines. Only articles containing all keywords were included. The final search was performed on October, 1, 2012. We also reviewed archives of libraries in Mashhad University of Medical Sciences (Iran for all anatomy, embryology, neurology, and neuroscience books and journals about vertebrobasilar arterial territories.Results: The vertebrobasilar arterial (VA system has a high incidence of variations, anomalies, and persistent fetal vessels. Two important anatomic facts explain why VA origin lesions seldom cause chronic hemodynamically significant low flow to the vertebrobasilar system. First, the VAs are paired vessels that unite to form a single basilar artery. Second, the extracranial VA gives off numerous muscular and other branches as it ascends in the neck. Thus, in the VA system, there is much more potential for development of adequate collateral circulation. Even when there is bilateral occlusion of the VAs at their origins, patients do not often develop posterior circulation infarcts.Conclusion: VA origin disease is more benign than ICA origin disease from hemodynamic aspect. This important point could make influence in therapeutic interventional decisions in asymptomatic VA origin stenosis

  10. Quantitative Doppler ultrasound evaluation of occlusive arterial disease in the lower limb

    DEFF Research Database (Denmark)

    Bagi, P; Sillesen, H; Hansen, H J

    1988-01-01

    duration of PRT was used for comparison with ankle/brachial pressure index (A/B index) and angiography. A highly significant correlation was found between PRT and A/B index (r = -0.75, P less than 0.001). Based on receiver operating characteristic curves an overall diagnostic accuracy of 90% in diagnosing......Forty consecutive patients with lower limb arterial disease were evaluated using a multi-gated pulsed Doppler system. Doppler signals were sampled at 4 sites in each limb, and following spectral analysis, the pulse rise time (PRT) was measured. The value obtained at the location giving the longest...

  11. SPECT with N-isopropyl-p iodoamphetamine in occlusive cerebrovascular diseases.

    Science.gov (United States)

    Higa, T; Tanaka, T; Ikekubo, K; Komatsu, T; Torizuka, K

    1986-12-01

    The role of SPECT imaging with N-isopropyl-p iodoamphetamine (I-123 IMP) in the detection of angiographically documented occlusive cerebrovascular diseases was evaluated in 24 patients, and the results of regional cerebral blood flow (rCBF) were compared with x-ray CT. Twelve patients had internal carotid occlusion, ten had intracranial occlusion beyond the circle of Willis, one had common carotid occlusion, and one had basilar artery occlusion. SPECT images were obtained with a gamma camera, which was rotated 360 degrees around the patient's head 30 minutes after an intravenous injection of 3 mCi of I-123 IMP. CT images in the transverse plane were obtained, and the regions of reduced attenuation were identified for comparison of topographic extension of the lesion with the regions of decreased rCBF seen on SPECT. In six cases, the lesions seen on the SPECT images were distinctly more extensive than those seen on CT. In the remaining 18 cases, the extent of the lesion was identical on both CT and SPECT images. Radiochemical and radionuclide impurities, the distance of the detector from the head, and the nature of the collimator affected the SPECT results. I-123 IMP SPECT imaging complements CT findings in detecting the ischemic zones beyond the regions identified on CT images, and may have a major rule in the management of patients with occlusive cerebrovascular diseases.

  12. Protective Effects of Overexpression of bcl-xl Gene on Local Cerebral Infarction in Transgenic Mice Undergoing Permanent Occlusion of Middle Cerebral Artery

    Institute of Scientific and Technical Information of China (English)

    Furong WANG; Yongsheng JIANG; Suming ZHANG; Wenwu XIAO; Suiqiang ZHU

    2008-01-01

    In order to investigate the protective effects of the overexpression of bcl-xl gene on local cerebral infarction in the transgenic mice subject to permanent occlusion of middle cerebral artery, the models of bcl-xl transgenic mice were established and subjected to cerebral infarction by intralu- minal occlusion of the middle cerebral artery. The infarct volume and the neurological scores were observed and comparison between the wild type mice and the transgenic mice was made. It was found that the infarct volume and the neurological scores in the transgenic mice were significantly decreased as compared with those in the wild type mice. It was suggested that the overexpression of bcl-xl gene in transgenic mice could reduce the infarct volume and improve the neurological function of the mice.

  13. Parent vessel occlusion for traumatic pseudoaneurysm of P3 segment of posterior cerebral artery:A case report and review of literatures

    Institute of Scientific and Technical Information of China (English)

    Xu Gaofeng; Xie Wanfu; Li Ruichun; Wang Maode

    2011-01-01

    Traumatic intracranial pseudoaneurysms (TIPA) are rare and pseudoaneurysm of P3 segment of the posterior cerebral artery (PCA) is extremely rarely reported. A 27-year-old man suffered from blunt head injury and underwent diagnostic procedure with head CT scans,cerebral CT angiograms (CTA) and digital subtraction angiograms (DSA). An abnormal high-density lesion was detected at the left side of quadrigeminal cistern and a pseudoaneurysm showed at the P3 segment of PCA. The pseudoaneurysm was successfully treated with parent artery occlusion (PAO). Making an exact preoperative diagnosis of traumatic intracranial pseudoaneurysms is of great importance. Endovascular techniques allow a safe approach to complex intracranial lesion,so endovascular management of PCA pseudoaneurysms becomes safe and effective. However,the pseudoaneurysm may not be amenable to coil placement under some conditions,thus,occlusion of the parent vessel may be a preferable treatment.

  14. Effects of percutaneous transluminal angioplasty on muscle BOLD-MRI in patients with peripheral arterial occlusive disease: preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    Huegli, Rolf W. [University Hospital Basel, Department of Radiology, Division of Interventional Radiology, Basel (Switzerland)]|[Kantonsspital Bruderholz, Department of Radiology, Bruderholz (Switzerland); Schulte, Anja-Carina [University of Basel, Biocenter, Basel (Switzerland); Aschwanden, Markus; Thalhammer, Christoph [University Hospital Basel, Department of Angiology, Basel (Switzerland); Kos, Sebastian; Jacob, Augustinus L.; Bilecen, Deniz [University Hospital Basel, Department of Radiology, Division of Interventional Radiology, Basel (Switzerland)

    2009-02-15

    The purpose was to evaluate the effect of percutaneous transluminal angioplasty (PTA) of the superficial femoral artery (SFA) on the blood oxygenation level-dependent (BOLD) signal change in the calf musculature of patients with intermittent claudication. Ten patients (mean age, 63.4 {+-} 11.6 years) with symptomatic peripheral arterial occlusive disease (PAOD) caused by SFA stenoses were investigated before and after PTA. Patients underwent BOLD-MRI 1 day before and 6 weeks after PTA. A T2*-weighted single-shot multi-echo echo-planar MR-imaging technique was applied. The BOLD measurements were acquired at mid-calf level during reactive hyperaemia at 1.5 T. This transient hyperperfusion of the muscle tissue was provoked by suprasystolic cuff compression. Key parameters describing the BOLD signal curve included maximum T2*(T2*{sub max}), time-to-peak to reach T2*{sub max} (TTP) and T2* end value (EV) after 600 s of hyperemia. Paired t-tests were applied for statistic comparison. Between baseline and post-PTA, T2*{sub max} increased from 11.1{+-}3.6% to 12.3{+-}3.8% (p=0.51), TTP decreased from 48.5{+-}20.8 s to 35.3{+-}11.6 s (p=0.11) and EV decreased from 6.1{+-}6.4% to 5.0{+-}4.2% (p=0.69). In conclusion, BOLD-MRI reveals changes of the key parameters T2*{sub max}, TTP, and EV after successful PTA of the calf muscles during reactive hyperaemia. (orig.)

  15. 温泉游泳训练对飞行员椎-基底动脉血流动力学影响的研究%Research on the effects of swimming training in thermal spring on pilots'basilar vertebral artery hemodynamic changes

    Institute of Scientific and Technical Information of China (English)

    王忠波; 李欣; 段虹; 吴燕红; 姚永杰; 李建香

    2011-01-01

    Objective To observe the effects of swimming training in thermal spring on pilots' basilar vertebral artery ( BA) hemo-dynamic changes during the convalescence. Methods Twenty four healthy male pilots in active service were selected as subjects. During the period of convalescence they were arranged to perform a four-week swimming training program ( 5days/week). Their ver-tebral artery hemodynamic changes before and after training were measured with transcranial Doppler ultrasound apparatus. Results After four-week swimming training in thermal water, pilots' posterior cerebral artery ( PC A) , vertebral artery ( VA) , basilar ver-tebral artery (BA) , peak systolic velocity ( Vs) , diastasis velocity ( Vd) , average maximum velocity ( Vm) , pulsatility index (PI) , resistive index (RI) were compared with pre-training, the difference showed statistical significance ( P < 0. 01). Conclu-sion During the convalescence, swimming training in thermal spring can increase the flow velocity and vascular compliance of pos-terior cerebral artery ( PCA) , vertebral artery ( VA) and basilar vertebral artery (BA) to improve the hemodynamic index.%目的 观察健康疗养期间,温泉游泳训练对飞行员椎动脉血流动力学指标的影响.方法 24名飞行员在健康疗养期间,进行连续4周,每周5d的温泉游泳训练.训练前后采用经颅多普勒超声仪检测椎动脉血流动力学指标.结果 与训练前相比,游泳训练4周后飞行员双侧大脑后动脉(PCA)、双侧大脑椎动脉(VA)、基底动脉(BA)、收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)、峰值平均血流速度(Vm),脉动指数(PI)、阻力指数(RI),训练后与训练前比较,差异有统计学意义(P<0.01).结论 健康疗养期间,温泉游泳训练可提高大脑后动脉、椎动脉、基底动脉的血流速度及血管顺应性,明显改善血流动力学指标.

  16. Hybrid treatment of bullet embolism at the abdominal aortic bifurcation, complicated with thoracoabdominal aorta pseudoaneurysm and common iliac artery occlusion: case report

    Directory of Open Access Journals (Sweden)

    Patrick Bastos Metzger

    2014-03-01

    Full Text Available Embolization due to a firearm projectile entering the bloodstream is a rare event that is unlikely to be suspected during initial treatment of trauma patients. We describe and discuss a case of bullet embolism of the abdominal aortic bifurcation, complicated by a pseudoaneurysm of the thoracoabdominal aorta and occlusion of the right common iliac artery, but successfully treated using a combination of endovascular methods and conventional surgery.

  17. Reduced blood flow response to acetazolamide reflects pre-existing vasodilation and decreased oxygen metabolism in major cerebral arterial occlusive disease

    Energy Technology Data Exchange (ETDEWEB)

    Yamauchi, Hiroshi; Okazawa, Hidehiko; Kishibe, Yoshihiko; Sugimoto, Kanji; Takahashi, Masaaki [Research Institute, Shiga Medical Center, 5-4-30 Moriyama, Moriyama-city, Shiga 524-8524 (Japan)

    2002-10-01

    A decrease in the cerebral blood flow (CBF) response to acetazolamide may indicate an increase in cerebral blood volume (CBV) caused by reduced perfusion pressure in patients with major cerebral artery steno-occlusive lesions. However, a decrease in cerebral metabolic rate of oxygen (CMRO{sub 2}) caused by ischemic changes may also decrease the CBF response to acetazolamide by decreasing the production of carbon dioxide. The purpose of this study was to determine whether the values of CBV and CMRO{sub 2} are independent predictors of the CBF response to acetazolamide in major cerebral arterial occlusive disease. We used positron emission tomography to study 30 patients with major cerebral artery steno-occlusive lesions. The CBF response to acetazolamide was assessed by measuring baseline CBF and CBF 10 min after an intravenous injection of 1 g of acetazolamide. Multivariate analysis was used to test the independent predictive value of the CBV and CMRO{sub 2} at baseline with respect to the percent change in CBF during acetazolamide administration. Both increased CBV and decreased CMRO{sub 2} were significant and independent predictors of the reduced CBF response to acetazolamide. CBV accounted for 25% of the variance in the absolute change in CBF during acetazolamide administration and 42% of the variance in the percent change in CBF, whereas CMRO{sub 2} accounted for 19% and 4% of the variance, respectively. In patients with major cerebral arterial occlusive disease, a decrease in CMRO{sub 2} may contribute to the reduced CBF response to acetazolamide, although an increase in CBV appears to be the major contributing factor. (orig.)

  18. 长段股胭动脉硬化闭塞的腔内治疗%Endovascular treatment of long femoro-popliteal arterial occlusions of lower extremities

    Institute of Scientific and Technical Information of China (English)

    管圣

    2009-01-01

    Objective To explore the feasibility and outcome of percutaneous transluminal angioplasty (PTA) as a primary treatment modality long femoro-popliteal arterial occlusions in critical limb ischemia.Methods Ten cases with 10 lesions in their femoro-popliteal arterial occlusions were treated with PTA, and the symptoms, intraoperative and postoperative DSA characteristics were retrospectively analyzed. Short-term follow-up were obtained in 8 cases. Results The technical success rate related to procedure was 90% and 12 stents were placed after PTA in femoro-popliteal arterial occlusions. One case was suffered fromamputa-lion due to development of compartment syndrome. The primary patency rate and recurrence rate of 12 months after procedure were 70% and 30% respectively. Conclusion Patients with critical limb ischemia could be beneficial from PTA in long femoro-popliteal arterial occlusions.%目的 评价血管腔内治疗长段股腘动脉硬化闭塞的临床效果.方法 2006年4月~2009年1月采用血管腔内治疗长段股胭动脉硬化闭塞10例,10条肢体术中同时行股胭动脉血管腔内球囊扩张成及支架植入术.结果 手术技术成功率是90%,放置10个支架,术后12个月通畅率为70%,术后血管再狭窄率30%.结论 血管腔内成形治疗长段股胭动脉硬化闭塞是一种安全有效的治疗方法.

  19. Hippophae salicifolia D.Don berries attenuate cerebral ischemia reperfusion injury in a rat model of middle cerebral artery occlusion

    Institute of Scientific and Technical Information of China (English)

    Santhrani Thakur; Pradeepthi Chilikuri; Bindu Pulugurtha; Lavanya Yaidikar

    2015-01-01

    Objective: To investigate the protective effect of Hippophae salicifolia D.Don (H. salicifolia) berries extract against cerebral reperfusion injury induced neurobehavioral and neurochemical changes in a rat model of middle cerebral artery occlusion (MCAO). Methods: Rats were pretreated with alcoholic extract of H. salicifolia (250 and 500 mg/kg) for 14 d and focal cerebral ischemia was induced by MCAO. After 60 min of MCAO, reperfused for 24 h, a battery of behavioral tests were assessed the extent of neurological deficits. Infarct volume and brain edema were measured in 2,3,5-triphenyltetrazolium chloride stained brain sections. TNF-α, oxidative stress parameters like reduced glutathione, calcium, glutamate, malondialdehyde and apoptotic parameters like caspase-3, and caspase-9 were estimated in the brain homogenates. Results:Pretreatment with alcoholic extract of H. salicifolia at doses of 250 and 500 mg/kg significantly improved the neurobehavioral alterations and reduced the infarct volume, edema induced by ischemia reperfusion injury. H. salicifolia significantly prevented ischemia induced increase in malondialdehyde, glutamate, calcium, caspase-3, caspase-9 and TNF-αlevels as compared to ischemic animals. Conclusions: Our results indicate that H. salicifolia mitigated the ischemia reperfusion induced neuronal damage.

  20. Excess salt increases infarct size produced by photothrombotic distal middle cerebral artery occlusion in spontaneously hypertensive rats.

    Directory of Open Access Journals (Sweden)

    Hiroshi Yao

    Full Text Available Cerebral circulation is known to be vulnerable to high salt loading. However, no study has investigated the effects of excess salt on focal ischemic brain injury. After 14 days of salt loading (0.9% saline or water, spontaneously hypertensive rats (SHR and normotensive Wistar-Kyoto rats (WKY were subjected to photothrombotic middle cerebral artery occlusion (MCAO, and infarct volume was determined at 48 h after MCAO: albumin and hemoglobin contents in discrete brain regions were also determined in SHR. Salt loading did not affect blood pressure levels in SHR and WKY. After MCAO, regional cerebral blood flow (CBF, determined with two ways of laser-Doppler flowmetry (one-point measurement or manual scanning, was more steeply decreased in the salt-loaded group than in the control group. In SHR/Izm, infarct volume in the salt-loaded group was 112±27 mm3, which was significantly larger than 77±12 mm3 in the control group (p = 0.002, while the extents of blood-brain barrier disruption (brain albumin and hemoglobin levels were not affected by excess salt. In WKY, salt loading did not significantly increase infarct size. These results show the detrimental effects of salt loading on intra-ischemic CBF and subsequent brain infarction produced by phototrhombotic MCAO in hypertensive rats.

  1. Integrated Analysis of Expression Profile Based on Differentially Expressed Genes in Middle Cerebral Artery Occlusion Animal Models

    Directory of Open Access Journals (Sweden)

    Huaqiang Zhou

    2016-05-01

    Full Text Available Stroke is one of the most common causes of death, only second to heart disease. Molecular investigations about stroke are in acute shortage nowadays. This study is intended to explore a gene expression profile after brain ischemia reperfusion. Meta-analysis, differential expression analysis, and integrated analysis were employed on an eight microarray series. We explored the functions and pathways of target genes in gene ontology (GO enrichment analysis and constructed a protein-protein interaction network. Meta-analysis identified 360 differentially expressed genes (DEGs for Mus musculus and 255 for Rattus norvegicus. Differential expression analysis identified 44 DEGs for Mus musculus and 21 for Rattus norvegicus. Timp1 and Lcn2 were overexpressed in both species. The cytokine-cytokine receptor interaction and chemokine signaling pathway were highly enriched for the Kyoto Encyclopedia of Genes and Genomes (KEGG pathway. We have exhibited a global view of the potential molecular differences between middle cerebral artery occlusion (MCAO animal model and sham for Mus musculus or Rattus norvegicus, including the biological process and enriched pathways in DEGs. This research helps contribute to a clearer understanding of the inflammation process and accurate identification of ischemic infarction stages, which might be transformed into a therapeutic approach.

  2. Herbal Formula Danggui-Shaoyao-San Promotes Neurogenesis and Angiogenesis in Rat Following Middle Cerebral Artery Occlusion

    Science.gov (United States)

    Ren, Changhong; Wang, Brian; Li, Ning; Jin, Kunlin; Ji, Xunming

    2015-01-01

    Current studies demonstrated that traditional Chinese herbal formula Danggui-Shaoyao-San (DSS) is not only used for the treatment of menstrual disorder, but has also found its use in neurological diseases. However, the neuroprotective role of DSS on ischemia-induced brain injury is still unclear. The aim of the present study is to explore the effect of DSS in ischemic brain injury. Total 30 adult female Sprague–Dawley rats underwent 90 min transient middle cerebral artery occlusion (MCAO). DSS (600 mg/kg) was administered through the intragastric route at the time of reperfusion and then performed every day thereafter until sacrifice. Results showed that DSS treatment significantly improved neurobehavioral outcomes (N=10 per group, P<0.05). Immunohistochemical staining showed that microvessel density in the perifocal region of DSS-treated rats was significantly increased compared to the saline-treated group (N=4 per group, P<0.01). Similarly, the numbers of BrdU+/DCX+ cells in the subventricular zone were increased in DSS-treated rats compared to the saline-treated group (P<0.05). Furthermore, we demonstrated that DSS treatment activated vascular endothelial growth factor (N=4 per group, P<0.05) and promoted eNOS phosphorylation (N=4 per group, P<0.05). Thus, we concluded that DSS promoted focal angiogenesis and neurogenesis, and attenuated ischemia-induced brain injury in rats after MCAO, suggesting that DSS is a potential drug for ischemic stroke therapy. PMID:26236546

  3. Protective effect of extract of Cordyceps sinensis in middle cerebral artery occlusion-induced focal cerebral ischemia in rats

    Directory of Open Access Journals (Sweden)

    Tang Huiling

    2010-10-01

    Full Text Available Abstract Background Ischemic hypoxic brain injury often causes irreversible brain damage. The lack of effective and widely applicable pharmacological treatments for ischemic stroke patients may explain a growing interest in traditional medicines. From the point of view of "self-medication" or "preventive medicine," Cordyceps sinensis was used in the prevention of cerebral ischemia in this paper. Methods The right middle cerebral artery occlusion model was used in the study. The effects of Cordyceps sinensis (Caterpillar fungus extract on mortality rate, neurobehavior, grip strength, lactate dehydrogenase, glutathione content, Lipid Peroxidation, glutathione peroxidase activity, glutathione reductase activity, catalase activity, Na+K+ATPase activity and glutathione S transferase activity in a rat model were studied respectively. Results Cordyceps sinensis extract significantly improved the outcome in rats after cerebral ischemia and reperfusion in terms of neurobehavioral function. At the same time, supplementation of Cordyceps sinensis extract significantly boosted the defense mechanism against cerebral ischemia by increasing antioxidants activity related to lesion pathogenesis. Restoration of the antioxidant homeostasis in the brain after reperfusion may have helped the brain recover from ischemic injury. Conclusions These experimental results suggest that complement Cordyceps sinensis extract is protective after cerebral ischemia in specific way. The administration of Cordyceps sinensis extract significantly reduced focal cerebral ischemic/reperfusion injury. The defense mechanism against cerebral ischemia was by increasing antioxidants activity related to lesion pathogenesis.

  4. Protective effect of extract of Cordyceps sinensis in middle cerebral artery occlusion-induced focal cerebral ischemia in rats

    Science.gov (United States)

    2010-01-01

    Background Ischemic hypoxic brain injury often causes irreversible brain damage. The lack of effective and widely applicable pharmacological treatments for ischemic stroke patients may explain a growing interest in traditional medicines. From the point of view of "self-medication" or "preventive medicine," Cordyceps sinensis was used in the prevention of cerebral ischemia in this paper. Methods The right middle cerebral artery occlusion model was used in the study. The effects of Cordyceps sinensis (Caterpillar fungus) extract on mortality rate, neurobehavior, grip strength, lactate dehydrogenase, glutathione content, Lipid Peroxidation, glutathione peroxidase activity, glutathione reductase activity, catalase activity, Na+K+ATPase activity and glutathione S transferase activity in a rat model were studied respectively. Results Cordyceps sinensis extract significantly improved the outcome in rats after cerebral ischemia and reperfusion in terms of neurobehavioral function. At the same time, supplementation of Cordyceps sinensis extract significantly boosted the defense mechanism against cerebral ischemia by increasing antioxidants activity related to lesion pathogenesis. Restoration of the antioxidant homeostasis in the brain after reperfusion may have helped the brain recover from ischemic injury. Conclusions These experimental results suggest that complement Cordyceps sinensis extract is protective after cerebral ischemia in specific way. The administration of Cordyceps sinensis extract significantly reduced focal cerebral ischemic/reperfusion injury. The defense mechanism against cerebral ischemia was by increasing antioxidants activity related to lesion pathogenesis. PMID:20955613

  5. Apparent diffusion coefficient evaluation for secondary changes in the cerebellum of rats after middle cerebral artery occlusion

    Institute of Scientific and Technical Information of China (English)

    Yunjun Yang; Lingyun Gao; Jun Fu; Jun Zhang; Yuxin Li; Bo Yin; Weijian Chen; Daoying Geng

    2013-01-01

    Supratentorial cerebral infarction can cause functional inhibition of remote regions such as the ce-rebel um, which may be relevant to diaschisis. This phenomenon is often analyzed using positron emission tomography and single photon emission CT. However, these methods are expensive and radioactive. Thus, the present study quantified the changes of infarction core and remote regions after unilateral middle cerebral artery occlusion using apparent diffusion coefficient values. Diffu-sion-weighted imaging showed that the area of infarction core gradual y increased to involve the cerebral cortex with increasing infarction time. Diffusion weighted imaging signals were initial y in-creased and then stabilized by 24 hours. With increasing infarction time, the apparent diffusion coefficient value in the infarction core and remote bilateral cerebel um both gradual y decreased, and then slightly increased 3-24 hours after infarction. Apparent diffusion coefficient values at mote regions (cerebel um) varied along with the change of supratentorial infarction core, suggesting that the phenomenon of diaschisis existed at the remote regions. Thus, apparent diffusion coeffi-cient values and diffusion weighted imaging can be used to detect early diaschisis.

  6. Evaluation of the fetal dose during prophylactic placement of internal iliac artery balloon occlusion catheters in placenta accreta

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dong Sik [Dept. of Radiology, Gachon University Gil hospital, Incheon (Korea, Republic of); Ahn, Sung Min [Dept. of Radiological Science, Gachon University, Incheon (Korea, Republic of)

    2016-09-15

    Placenta accrete patients whose mother mortality rates are rather high due to massive bleeding during childbirth need to have Prophylactic placement of Internal Iliac Artery Balloon Occlusion Catheters procedure to reduce amount of blood loss and inoperative transfusion. Nevertheless, studies for mothers inevitably exposed to dose during PIIABOCs procedure have not been published many yet. Therefore, this study is to investigate exact information on radiation dose exposed to fetus during PIIABOCs procedure. Average effective dose of fetus per organ is 2.38∼8.83 mGy, measured highest at beam center and followed by eyeball, stomach and bladder. The result showed that the longer fluoroscopy time is used, the closer beam center is and the thicker abdominal thickness is, the more effective dose on fetus is increasing. When using the collimator and protection shown to decrease the effective dose and when using higher the patient table shown to decrease the effective dose. It has been reported that the threshold of deterministic effect is about 100mGy. Deterministic effect was regarded as a factor that would influence on fetus exposed by medical radiation than stochastic effect. Consequently, it concluded that dose exposed on fetus in PIIABOCs procedure was approximately 10% of threshold of deterministic effect with effective dose of 0.49∼18.27 mGy.

  7. Protective Effects of Focal Ischemic Preconditioning and HSP70 Expression on Middle Cerebral Artery Occlusion in Rats

    Institute of Scientific and Technical Information of China (English)

    ZHAO Jianhua; SUN Senggang; CHEN Xiaowu

    2006-01-01

    To systematically evaluate the importance of protein synthesis in ischemic preconditioning (PC)-induced ischemic tolerance (IT), temporary middle cerebral artery occlusion (MCAO)by Longa (20 min) was used for PC (ischemic precondioning). Twenty-four hours of reperfusion was allowed after PC and before permanent MCAO to establish ischemic tolerance (IT) to compare with non-PC (sham-operated) rats (n=5 for each group). Infarct size and neurological deficits were measured 24 h after PMCAO. Samples of brain were taken for the determination of HSP70 expression by Western blot analysis. The effects of the protein synthesis inhibitor cycloheximide administered just before PC or administered long after PC but just before PMCAO on IT were also determined (n=5 for each group). Our results showed that hemispheric infarct was significantly reduced (P<0.01) only if PC was performed after 24 h, and PC significantly (P<0.05) reduced neurological deficits (similar to reductions in infarct size). Cycloheximide eliminated ischemic PC-induced IT effects on both brain injury and neurological deficits if administered before PC but not if administered long after PC but before PMCAO. PC produced no brain injury but did increase HSP70 protein 24 h after PC. Cycloheximide eliminated that effect. The results suggest that PC is a powerful inducer of ischemic brain tolerance as reflected by the preservation of brain tissue and motor function. PC induces IT that is dependent on de novo protein synthesis.

  8. The myopathy of peripheral arterial occlusive disease: part 1. Functional and histomorphological changes and evidence for mitochondrial dysfunction.

    Science.gov (United States)

    Pipinos, Iraklis I; Judge, Andrew R; Selsby, Joshua T; Zhu, Zhen; Swanson, Stanley A; Nella, Aikaterini A; Dodd, Stephen L

    In recent years, an increasing number of studies have demonstrated that a myopathy is present, contributes, and, to a certain extent, determines the pathogenesis of peripheral arterial occlusive disease (PAD). These works provide evidence that a state of repetitive cycles of exercise-induced ischemia followed by reperfusion at rest operates in PAD patients and mediates a large number of structural and metabolic changes in the muscle, resulting in reduced strength and function. The key players in this process appear to be defective mitochondria that, through multilevel failure in their roles as energy, oxygen radical species, and apoptosis regulators, produce and sustain a progressive decline in muscle performance. In this 2-part review, we highlight the currently available evidence that characterizes the nature and mechanisms responsible for this myopathy. In part 1, the authors review the functional and histomorphological characteristics of the myopathy and focus on the biochemistry and bioenergetics of its mitochondriopathy. In part 2, they then review accumulating evidence that oxidative stress related to ischemia reperfusion is probably the major operating mechanism of PAD myopathy. Important new findings of a possible neuropathy and a shift in muscle fiber type are also reviewed. Learning more about these mechanisms will enhance our understanding of the degree to which they are preventable and treatable.

  9. Lack of functional P2X7 receptor aggravates brain edema development after middle cerebral artery occlusion.

    Science.gov (United States)

    Kaiser, Melanie; Penk, Anja; Franke, Heike; Krügel, Ute; Nörenberg, Wolfgang; Huster, Daniel; Schaefer, Michael

    2016-09-01

    Effective therapeutic measures against the development of brain edema, a life-threatening complication of cerebral ischemia, are necessary to improve the functional outcome for the patient. Here, we identified a beneficial role of purinergic receptor P2X7 activation in acute ischemic stroke. Involvement of P2X7 in the development of neurological deficits, infarct size, brain edema, and glial responses after ischemic cerebral infarction has been analyzed. Neurologic evaluation, magnetic resonance imaging, and immunofluorescence assays were used to characterize the receptor's effect on the disease progress during 72 h after transient middle cerebral artery occlusion (tMCAO). Sham-operated animals were included in all experiments for control purposes. We found P2X7-deficient mice to develop a more prominent brain edema with a trend towards more severe neurological deficits 24 h after tMCAO. Infarct sizes, T2 times, and apparent diffusion coefficients did not differ significantly between wild-type and P2X7(-/-) animals. Our results show a characteristic spatial distribution of reactive glia cells with strongly attenuated microglia activation in P2X7(-/-) mice 72 h after tMCAO. Our data indicate that P2X7 exerts a role in limiting the early edema formation, possibly by modulating glial responses, and supports later microglia activation.

  10. Awake extracorporeal membrane oxygenation (ECMO) as bridge to recovery after left main coronary artery occlusion: a promising concept of haemodynamic support in cardiogenic shock.

    Science.gov (United States)

    Alozie, Anthony; Kische, Stephan; Birken, Thomas; Kaminski, Alexander; Westphal, Bernd; Nöldge-Schomburg, Gabriele; Ince, Hüseyin; Steinhoff, Gustav

    2014-10-01

    Cardiogenic shock following acute myocardial infarction is associated with high mortality rate. Different management concepts including fluid management, inotropic support, intra aortic balloon counterpulsation (IABP) and extracorporeal membrane oxygenation (ECMO) mainly in mechanically ventilated patients have been used as cornerstones of management. However, success rates have been disappointing. Few reports suggested that ECMO when performed under circumvention of mechanical ventilation, may offer some survival benefits. We herein present our experience with the use of veno-arterial ECMO as bridge to recovery in an awake and spontaneously breathing patient after left main coronary artery occlusion complicated by cardiogenic shock.

  11. Therapeutic effects of different durations of acupuncture on rats with middle cerebral artery occlusion

    Directory of Open Access Journals (Sweden)

    Chao Zhang

    2015-01-01

    Full Text Available Acupuncture is regarded as an effective therapy for cerebral ischemia. Different acupuncture manipulations and durations may result in different therapeutic effects. In the present study, the Neiguan (PC6 acupoint of rats with occluded middle cerebral arteries was needled at a fixed frequency (3 Hz with different durations, i.e., 5, 60 and 180 seconds under a twisting-rotating acupuncture method. Results showed that different durations of acupuncture had different therapeutic effects, with 60 seconds yielding a better therapeutic effect than the other two groups. This duration of treatment demonstrated rapid cerebral blood flow, encouraging recovery of neurological function, and small cerebral infarct volume. Experimental findings indicated that under 3 Hz frequency, the treatment of needling Neiguan for 60 seconds is effective for ischemic stroke

  12. Does Preinterventional Flat-Panel Computer Tomography Pooled Blood Volume Mapping Predict Final Infarct Volume After Mechanical Thrombectomy in Acute Cerebral Artery Occlusion?

    Energy Technology Data Exchange (ETDEWEB)

    Wagner, Marlies, E-mail: marlies.wagner@kgu.de [Hospital of Goethe University, Institute of Neuroradiology (Germany); Kyriakou, Yiannis, E-mail: yiannis.kyriakou@siemens.com [Siemens AG, Health Care Sector (Germany); Mesnil de Rochemont, Richard du, E-mail: mesnil@em.uni-frankfurt.de [Hospital of Goethe University, Institute of Neuroradiology (Germany); Singer, Oliver C., E-mail: o.singer@em.uni-frankfurt.de [Hospital of Goethe University, Department of Neurology (Germany); Berkefeld, Joachim, E-mail: berkefeld@em.uni-frankfurt.de [Hospital of Goethe University, Institute of Neuroradiology (Germany)

    2013-08-01

    PurposeDecreased cerebral blood volume is known to be a predictor for final infarct volume in acute cerebral artery occlusion. To evaluate the predictability of final infarct volume in patients with acute occlusion of the middle cerebral artery (MCA) or the distal internal carotid artery (ICA) and successful endovascular recanalization, pooled blood volume (PBV) was measured using flat-panel detector computed tomography (FPD CT).Materials and MethodsTwenty patients with acute unilateral occlusion of the MCA or distal ACI without demarcated infarction, as proven by CT at admission, and successful Thrombolysis in cerebral infarction score (TICI 2b or 3) endovascular thrombectomy were included. Cerebral PBV maps were acquired from each patient immediately before endovascular thrombectomy. Twenty-four hours after recanalization, each patient underwent multislice CT to visualize final infarct volume. Extent of the areas of decreased PBV was compared with the final infarct volume proven by follow-up CT the next day.ResultsIn 15 of 20 patients, areas of distinct PBV decrease corresponded to final infarct volume. In 5 patients, areas of decreased PBV overestimated final extension of ischemia probably due to inappropriate timing of data acquisition and misery perfusion.ConclusionPBV mapping using FPD CT is a promising tool to predict areas of irrecoverable brain parenchyma in acute thromboembolic stroke. Further validation is necessary before routine use for decision making for interventional thrombectomy.

  13. Mapping of Autogenous Saphenous Veins as an Imaging Adjunct to Peripheral MR Angiography in Patients with Peripheral Arterial Occlusive Disease and Peripheral Bypass Grafting: Prospective Comparison with Ultrasound and Intraoperative Findings

    OpenAIRE

    Ann-Marie Bintu Munda Jah-Kabba; Guido Matthias Kukuk; Dariusch Reza Hadizadeh; Frank Träber; Arne Koscielny; Mustapha Sundifu Kabba; Frauke Verrel; Hans Heinz Schild; Winfried Albert Willinek

    2014-01-01

    BACKGROUND: Mapping of the great saphenous vein is very important for planning of peripheral and coronary bypass surgery. This study investigated mapping of the great saphenous vein as an adjunct to peripheral MR angiography using a blood pool contrast agent in patients who were referred for evaluation of peripheral arterial occlusive disease and bypass surgery. METHODS: 38 patients with peripheral arterial occlusive disease (21 men; mean age: 71 years, range, 44-88 years) underwent periphera...

  14. Study of basilar artery hemodynamic changes in cervical rotation and flexion by color Doppler ultrasound%彩色多普勒超声对正常人头颈部分别向左右转动后基底动脉血流的观察

    Institute of Scientific and Technical Information of China (English)

    杨玉杰; 李敬府; 白志勇; 王金锐

    2009-01-01

    Objective To evaluate the basilar artery hemodynamical changes in cervical rotation and ventral flexion by color Doppler flow imaging(CDFI). Methods Basilar artery blood flow were detected during cervical With cervical right lateral,left lateral rotation and ventral flexion, the detection ratio of basilar artery by ultrasound were 89% ,84% ,81% respectively. There were no difference in statistics between the detction ratio of three kinds during cervical flexion,peak systolic velocity(PSV) and end-diastolic velocity(EDV) decreased apparently during left lateral rotation,which did not change during right lateral rotation. No changing was found with resistant index between the three kinds of cervical position. Conclusions The hemodynamic changing of basilar artery during cervical rotation and flexion could be detected by CDFI accurately,which might be useful in clinical study.%目的 应用彩色多普勒超声评价正常人头颈部分别向左右转动后基底动脉(BA)血流动力学参数.方法 应用彩色多普勒超声对62例正常人在俯卧位低头以及头颈部分别向左右转动90°后三种姿势下,观察BA血流,并对其血流动力学指标进行对比分析.结果 ①三种姿势下BA的检出率:俯卧位低头为89%,头颈部左转为84%,头颈部右转为81%,三种姿势下BA血流的显示率比较差异无统计学意义(P>0.05).②椎动脉颁段内径:左侧大于右侧[左侧(0.34±0.06)cm对右侧(0.32±0.05)cm,P0.05),三种姿势下阻力指数差异无统计学意义(P>0.05).结论 彩色多普勒超声对BA检出率高,能够准确清晰地显示不同姿势下BA的血流动力学情况,提示正常人头颈部向左转时对BA血流有影响,对研究椎-基底动脉系血流动力学有着重要的临床意义.

  15. Comparison of transient arterial occlusion and muscle exercise provocation for assessment of perfusion reserve in skeletal muscle with real-time contrast-enhanced ultrasound

    Energy Technology Data Exchange (ETDEWEB)

    Krix, Martin, E-mail: martin.krix@kabelbw.de [German Cancer Research Center, Research Program Imaging and Radiooncology, Department of Radiology, INF 280, D-69120 Heidelberg (Germany); Bracco Imaging Germany, Max-Stromeyer-Str. 116, D-78467 Konstanz (Germany); Krakowski-Roosen, Holger [German Cancer Research Center, Department of Translational Oncology, INF 280, D-69120 Heidelberg (Germany); Armarteifio, Erick [University Hospital of Heidelberg, Department of Diagnostic and Interventional Radiology, INF 110, D-69120 Heidelberg (Germany); Fuerstenberger, Susanne [University Hospital of Heidelberg, Department of Vascular Surgery, INF 110, D-69120 Heidelberg (Germany); Delorme, Stefan [German Cancer Research Center, Research Program Imaging and Radiooncology, Department of Radiology, INF 280, D-69120 Heidelberg (Germany); Kauczor, Hans-Ulrich; Weber, Marc-Andre [University Hospital of Heidelberg, Department of Diagnostic and Interventional Radiology, INF 110, D-69120 Heidelberg (Germany)

    2011-06-15

    Objective: Contrast-enhanced ultrasound (CEUS) is able to quantify muscle perfusion and changes in perfusion due to muscle exercise in real-time. However, reliable measurement of standardized muscle exercise is difficult to perform in clinical examinations. We compared perfusion reserve assessed by CEUS after transient arterial occlusion and exercise to find the most suitable measurement for clinical application. Methods: Contrast pulse sequencing (7 MHz) during continuous IV infusion of SonoVue (4.8 mL/300 s) was used in 8 healthy volunteers to monitor muscle perfusion of the gastrocnemius muscle during transient (1 min) arterial occlusion produced by a thigh cuff of a venous occlusion plethysmograph. Isometric muscle exercise (50% of individual maximum strength for 20 s) was subsequently performed during the same examination, and several CEUS parameters obtained from ultrasound-signal-intensity-time curves and its calculation errors were compared. Results: The mean maximum local blood volume after occlusion was 13.9 [{approx}mL] (range, 4.5-28.8 [{approx}mL]), and similar values were measured after sub-maximum exercise 13.8 [{approx}mL], (range, 4.6-22.2 [{approx}mL]. The areas under the curve during reperfusion vs. recovery were also similar (515.2 {+-} 257.5 compared to 482.2 {+-} 187.5 [{approx}mL s]) with a strong correlation (r = 0.65), as were the times to maximum (15.3 s vs. 15.9 s), with a significantly smaller variation for the occlusion method ({+-}2.1 s vs. {+-}9.0 s, p = 0.03). The mean errors for all calculated CEUS parameters were lower for the occlusion method than for the exercise test. Conclusions: CEUS muscle perfusion measurements can be easily performed after transient arterial occlusion. It delivers data which are comparable to CEUS measurements after muscle exercise but with a higher robustness. This method can be easily applied in clinical examination of patients with e.g. PAOD or diabetic microvessel diseases to assess perfusion reserve.

  16. Intravenous thrombolysis or endovascular therapy for acute ischemic stroke associated with cervical internal carotid artery occlusion: the ICARO-3 study.

    Science.gov (United States)

    Paciaroni, Maurizio; Inzitari, Domenico; Agnelli, Giancarlo; Caso, Valeria; Balucani, Clotilde; Grotta, James C; Sarraj, Amrou; Sung-Il, Sohn; Chamorro, Angel; Urra, Xabier; Leys, Didier; Henon, Hilde; Cordonnier, Charlotte; Dequatre, Nelly; Aguettaz, Pierre; Alberti, Andrea; Venti, Michele; Acciarresi, Monica; D'Amore, Cataldo; Zini, Andrea; Vallone, Stefano; Dell'Acqua, Maria Luisa; Menetti, Federico; Nencini, Patrizia; Mangiafico, Salvatore; Barlinn, Kristian; Kepplinger, Jessica; Bodechtel, Ulf; Gerber, Johannes; Bovi, Paolo; Cappellari, Manuel; Linfante, Italo; Dabus, Guilherme; Marcheselli, Simona; Pezzini, Alessandro; Padovani, Alessandro; Alexandrov, Andrei V; Shahripour, Reza Bavarsad; Sessa, Maria; Giacalone, Giacomo; Silvestrelli, Giorgio; Lanari, Alessia; Ciccone, Alfonso; De Vito, Alessandro; Azzini, Cristiano; Saletti, Andrea; Fainardi, Enrico; Orlandi, Giovanni; Chiti, Alberto; Gialdini, Gino; Silvestrini, Mauro; Ferrarese, Carlo; Beretta, Simone; Tassi, Rossana; Martini, Giuseppe; Tsivgoulis, Georgios; Vasdekis, Spyros N; Consoli, Domenico; Baldi, Antonio; D'Anna, Sebastiano; Luda, Emilio; Varbella, Ferdinando; Galletti, Giampiero; Invernizzi, Paolo; Donati, Edoardo; De Lodovici, Maria Luisa; Bono, Giorgio; Corea, Francesco; Sette, Massimo Del; Monaco, Serena; Riva, Maurizio; Tassinari, Tiziana; Scoditti, Umberto; Toni, Danilo

    2015-02-01

    The aim of the ICARO-3 study was to evaluate whether intra-arterial treatment, compared to intravenous thrombolysis, increases the rate of favourable functional outcome at 3 months in acute ischemic stroke and extracranial ICA occlusion. ICARO-3 was a non-randomized therapeutic trial that performed a non-blind assessment of outcomes using retrospective data collected prospectively from 37 centres in 7 countries. Patients treated with endovascular treatment within 6 h from stroke onset (cases) were matched with patients treated with intravenous thrombolysis within 4.5 h from symptom onset (controls). Patients receiving either intravenous or endovascular therapy were included among the cases. The efficacy outcome was disability at 90 days assessed by the modified Rankin Scale (mRS), dichotomized as favourable (score of 0-2) or unfavourable (score of 3-6). Safety outcomes were death and any intracranial bleeding. Included in the analysis were 324 cases and 324 controls: 105 cases (32.4 %) had a favourable outcome as compared with 89 controls (27.4 %) [adjusted odds ratio (OR) 1.25, 95 % confidence interval (CI) 0.88-1.79, p = 0.1]. In the adjusted analysis, treatment with intra-arterial procedures was significantly associated with a reduction of mortality (OR 0.61, 95 % CI 0.40-0.93, p = 0.022). The rates of patients with severe disability or death (mRS 5-6) were similar in cases and controls (30.5 versus 32.4 %, p = 0.67). For the ordinal analysis, adjusted for age, sex, NIHSS, presence of diabetes mellitus and atrial fibrillation, the common odds ratio was 1.15 (95 % IC 0.86-1.54), p = 0.33. There were more cases of intracranial bleeding (37.0 versus 17.3 %, p = 0.0001) in the intra-arterial procedure group than in the intravenous group. After the exclusion of the 135 cases treated with the combination of I.V. thrombolysis and I.A. procedures, 67/189 of those treated with I.A. procedures (35.3 %) had a favourable outcome, compared to 89/324 of

  17. Chronic Supplementation of Paeonol Combined with Danshensu for the Improvement of Vascular Reactivity in the Cerebral Basilar Artery of Diabetic Rats

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    Peng-Cheng Qiu

    2012-11-01

    Full Text Available One of the leading causes of death in the world is cerebrovascular disease. Numerous Chinese traditional medicines, such as Cortex Moutan (root bark of Paeonia suffruticosa Andrew and Radix Salviae miltiorrhizae (root and rhizome of Salvia miltiorrhiza Bunge, protect against cerebrovascular diseases and exhibit anti-atherosclerotic effects. Traditional medicines have been routinely used for a long time in China. In addition, these two herbs are prescribed together in clinical practice. Therefore, the pharmacodynamic interactions between the active constituents of these two herbs, which are paeonol (Pae and danshensu (DSS, should be particularly studied. The study of Pae and DSS can provide substantial foundations in understanding their mechanisms and empirical evidence to support clinical practice. This study investigated the effects and possible mechanisms of the pharmacodynamic interaction between Pae and DSS on cerebrovascular malfunctioning in diabetes. Experimental diabetes was induced in rats, which was then treated with Pae, DSS, and Pae + DSS for eight weeks. Afterward, cerebral arteries from all groups were isolated and equilibrated in an organ bath with Krebs buffer and ring tension. Effects of Pae, DSS, and Pae + DSS were observed on vessel relaxation with or without endothelium as well as on the basal tonus of vessels from normal and diabetic rats. Indexes about oxidative stress were also determined. We report that the cerebral arteries from diabetic rats show decreased vascular reactivity to acetylcholine (ACh which was corrected in Pae, DSS, and Pae + DSS treated groups. Furthermore, phenylephrine (PE-induced contraction response decreased in the treated groups. Phenylephrine and CaCl2-induced vasoconstrictions are partially inhibited in the three treated groups under Ca2+-free medium. Pre-incubated with tetraethylammonium, a non-selective K+ channel blocker, the antagonized relaxation responses increased in DSS and Pae + DSS

  18. Percutaneous Aspiration Thrombectomy for the Treatment of Arterial Thromboembolic Occlusions Following Percutaneous Transluminal Angioplasty

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    Schleder, Stephan, E-mail: stephan.schleder@ukr.de [University Hospital Regensburg, Department of Radiology (Germany); Diekmann, Matthias [Radiology Center Rahlstedt (Germany); Manke, Christoph [General Hospital Fulda, Department of Radiology (Germany); Heiss, Peter [University Hospital Regensburg, Department of Radiology (Germany)

    2015-02-15

    PurposeThis study was designed to evaluate the technical success and the early clinical outcome of patients undergoing percutaneous aspiration thrombectomy (PAT) for the treatment of arterial thromboembolism following percutaneous infrainguinal transluminal angioplasty (PTA).MethodsIn this single-center study, during a period of 7 years retrospectively, 47 patients (22 male, 47 %) with a mean age of 73 (range 53–96) years were identified in whom PAT was performed for the treatment of thromboembolic complications of infrainguinal PTA. Primary technical success was defined as residual stenosis of <50 % in diameter after sole PAT, whereas secondary technical success was defined as residual stenosis of <50 % in diameter after PAT and additional PTA and/or stenting. Clinical outcome parameters (e.g., need for further intervention, minor/major amputation) were evaluated for the 30-day postinterventional period.ResultsPrimary technical success was achieved in 64 % of patients (30/47); secondary technical success was obtained in 96 % of patients (45/47). Clinical outcome data were available in 38 patients. In 87 % of patients (33/38), there was no need for further intervention within the 30-day postinterventional period. In three patients, minor amputations were conducted due to preexisting ulcerations (Rutherford Category 5 respectively).ConclusionsPAT enables endovascular treatment of iatrogenic thromboembolic complications after PTA with good technical and early clinical results and minimal morbidity.

  19. Correlation between mesenteric fat thickness and serum apolipoproteins in patients with peripheral arterial occlusive disease

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    Perelas Apostolos

    2012-10-01

    Full Text Available Abstract Background Visceral fat possesses the most detrimental potential for cardiovascular morbidity through the release of adipokines, as well as metabolic and proinflammatory mediators, which adversely affect metabolic and vascular homeostasis. Among the different types of visceral adipose tissue, mesenteric fat is considered particularly detrimental, due to its close proximity to the portal circulation, affecting directly the liver, which is the main regulator of body metabolic homeostasis. Mesenteric fat can be reliably estimated using abdominal ultrasonography, the only available imaging method able to depict individual mesenteric leaves. Aim of the present study was to investigate the correlation of mesenteric fat thickness (MFT with serum apolipoprotein levels in patients undergoing digital subtraction angiography in a single center. Methods 35 male patients with peripheral arterial disease were examined. After careful examination of the periumbilical area, the mesenteric leaves were identified. The maximal distance between each pair of sequential leaves was measured, and the mean value of the three thickest leaves was determined as the mesenteric fat thickness. Six apolipoprotein fasting serum concentrations were measured using a Luminex proteomics platform (xMAP Multiplex immunoassay: apolipoprotein A-I (apoAI, apolipoprotein A-II (apoAII, apolipoprotein B (apoB, apolipoprotein C-II (apoCII, apolipoprotein C-III (apoCIII and apolipoprotein E (apoE. Results MFT correlated with apoAII and apoB serum concentrations. The correlations with apoAII and apoB remained significant following correction for BMI. No correlations were noted between MFT and serum apoAI, apoCII, apoCIII or apoE levels before or after adjustment for BMI. Conclusions Our study indicates that MFT is significantly correlated with the concentration of atherogenic low density lipoproteins particles, as well as with apoAII, a determinant of free fatty acids levels. No

  20. Iloprost infusion in diabetic patients with peripheral arterial occlusive disease and foot ulcers.

    Science.gov (United States)

    Mirenda, Francesco; La Spada, Michele; Baccellieri, Domenico; Stilo, Francesco; Benedetto, Filippo; Spinelli, Francesco

    2005-01-01

    The aim of the study was to evaluate iloprost infusion as an alternative to open surgical revascularisation in diabetic patients with foot ulcers, also as a support measure in conjunction with endovascular procedures. We studied 244 patients with critical ischaemia of the lower limbs, 146 of whom (59.8%) affected by diabetes. A femoro-distal bypass was performed in 175 patients. In the 69 nonsurgical diabetic patients (47.3% of the diabetics) an iloprost infusion was started. These diabetics presented foot ulcers, a palpable or slightly hypo-sphygmic popliteal pulse and high distal arterial flow at the ankle. In 55 of these patients (79.7% of those not operated on and 37.6% of the diabetics) who were non-responders to medical therapy, an endovascular procedure was also performed. The results of the iloprost infusion (69 pts.) were evaluated after one week. In 14 responders treated only with iloprost infusion, complete healing of the lesions occurred during the 3 weeks following the end of the 4-week course of therapy. No severe ischaemia recurrences were reported in the follow-up of these 69 patients. In the 47.3% of subjects with diabetic arteriopathy presenting foot ulcers and high distal flow, it proved possible to avoid an open surgical revascularisation procedure and to resort to medical therapy with iloprost, completed in 79.7% of cases with endovascular procedures. Iloprost infusion improves limb perfusion and, in selected cases may be an important therapeutic tool for the care of ulcerative lesions of the diabetic foot, also as a support measure in conjunction with endovascular procedures.

  1. Ankle Brachial Index <0.9 Underestimates the Prevalence of Peripheral Artery Occlusive Disease Assessed with Whole-Body Magnetic Resonance Angiography in the Elderly

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    Wikstroem, J.; Hansen, T.; Johansson, L.; Lind, L.; Ahlstroem, H. [Dept. of Radiology and Dept. of Medical Sciences, Uppsala Univ. Hospital, Uppsala (Sweden)

    2008-03-15

    Background: Whole-body magnetic resonance angiography (WBMRA) permits noninvasive vascular assessment, which can be utilized in epidemiological studies. Purpose: To assess the relation between a low ankle brachial index (ABI) and high-grade stenoses in the pelvic and leg arteries in the elderly. Material and Methods: WBMRA was performed in a population sample of 306 subjects aged 70 years. The arteries below the aortic bifurcation were graded after the most severe stenosis according to one of three grades: 0-49% stenosis, 50-99% stenosis, or occlusion. ABI was calculated for each side. Results: There were assessable WBMRA and ABI examinations in 268 (right side), 265 (left side), and 258 cases (both sides). At least one {>=}50% stenosis was found in 19% (right side), 23% (left side), and 28% (on at least one side) of the cases. The corresponding prevalences for ABI <0.9 were 4.5%, 4.2%, and 6.6%. An ABI cut-off value of 0.9 resulted in a sensitivity, specificity, and positive and negative predictive value of 20%, 99%, 83%, and 84% on the right side, and 15%, 99%, 82%, and 80% on the left side, respectively, for the presence of a {>=} 50% stenosis in the pelvic or leg arteries. Conclusion: An ABI <0.9 underestimates the prevalence of peripheral arterial occlusive disease in the general elderly population.

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

    Directory of Open Access Journals (Sweden)

    Yasser S Nassar

    2013-01-01

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

  3. Transcriptomics and proteomics analyses of the PACAP38 influenced ischemic brain in permanent middle cerebral artery occlusion model mice

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    Hori Motohide

    2012-11-01

    Full Text Available Abstract Introduction The neuropeptide pituitary adenylate cyclase-activating polypeptide (PACAP is considered to be a potential therapeutic agent for prevention of cerebral ischemia. Ischemia is a most common cause of death after heart attack and cancer causing major negative social and economic consequences. This study was designed to investigate the effect of PACAP38 injection intracerebroventrically in a mouse model of permanent middle cerebral artery occlusion (PMCAO along with corresponding SHAM control that used 0.9% saline injection. Methods Ischemic and non-ischemic brain tissues were sampled at 6 and 24 hours post-treatment. Following behavioral analyses to confirm whether the ischemia has occurred, we investigated the genome-wide changes in gene and protein expression using DNA microarray chip (4x44K, Agilent and two-dimensional gel electrophoresis (2-DGE coupled with matrix assisted laser desorption/ionization-time of flight-mass spectrometry (MALDI-TOF-MS, respectively. Western blotting and immunofluorescent staining were also used to further examine the identified protein factor. Results Our results revealed numerous changes in the transcriptome of ischemic hemisphere (ipsilateral treated with PACAP38 compared to the saline-injected SHAM control hemisphere (contralateral. Previously known (such as the interleukin family and novel (Gabra6, Crtam genes were identified under PACAP influence. In parallel, 2-DGE analysis revealed a highly expressed protein spot in the ischemic hemisphere that was identified as dihydropyrimidinase-related protein 2 (DPYL2. The DPYL2, also known as Crmp2, is a marker for the axonal growth and nerve development. Interestingly, PACAP treatment slightly increased its abundance (by 2-DGE and immunostaining at 6 h but not at 24 h in the ischemic hemisphere, suggesting PACAP activates neuronal defense mechanism early on. Conclusions This study provides a detailed inventory of PACAP influenced gene expressions

  4. Biphasic functional regulation in hippocampus of rat with chronic cerebral hypoperfusion induced by permanent occlusion of bilateral common carotid artery.

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    Jihye Bang

    Full Text Available BACKGROUND: Chronic cerebral hypoperfusion induced by permanent occlusion of the bilateral common carotid artery (BCCAO in rats has been commonly used for the study of Alzheimer's disease and vascular dementia. Despite the apparent cognitive dysfunction in rats with BCCAO, the molecular markers or pathways involved in the pathological alternation have not been clearly identified. METHODS: Temporal changes (sham, 21, 35, 45, 55 and 70 days in gene expression in the hippocampus of rats after BCCAO were measured using time-course microarray analysis. Gene Ontology (GO and pathway analyses were performed to identify the functional involvement of temporally regulated genes in BCCAO. RESULTS: Two major gene expression patterns were observed in the hippocampus of rats after BCCAO. One pattern, which was composed of 341 early up-regulated genes after the surgical procedure, was dominantly involved in immune-related biological functions (false discovery rate [FDR]<0.01. Another pattern composed of 182 temporally delayed down-regulated genes was involved in sensory perception such as olfactory and cognition functions (FDR<0.01. In addition to the two gene expression patterns, the temporal change of GO and the pathway activities using all differentially expressed genes also confirmed that an immune response was the main early change, whereas sensory functions were delayed responses. Moreover, we identified FADD and SOCS3 as possible core genes in the sensory function loss process using text-based mining and interaction network analysis. CONCLUSIONS: The biphasic regulatory mechanism first reported here could provide molecular evidence of BCCAO-induced impaired memory in rats as well as mechanism of the development of vascular dementia.

  5. Low-speed treadmill running exercise improves memory function after transient middle cerebral artery occlusion in rats.

    Science.gov (United States)

    Shimada, Haruka; Hamakawa, Michiru; Ishida, Akimasa; Tamakoshi, Keigo; Nakashima, Hiroki; Ishida, Kazuto

    2013-04-15

    Physical exercise may enhance the recovery of impaired memory function in stroke rats. However the appropriate conditions of exercise and the mechanisms underlying these beneficial effects are not yet known. Therefore, the purpose of this study was to investigate the effect exercise intensity on memory function after cerebral infarction in rats. The animals were subjected to middle cerebral artery occlusion (MCAO) for 90 min to induce stroke and were randomly assigned to four groups; Low-Ex, High-Ex, Non-Ex and Sham. On the fourth day after surgery, rats in the Low-Ex and High-Ex groups were forced to exercise using a treadmill for 30 min every day for four weeks. Memory functions were examined during the last 5 days of the experiment (27-32 days after MCAO) by three types of tests: an object recognition test, an object location test and a passive avoidance test. After the final memory test, the infarct volume, number of neurons and microtubule-associated protein 2 (MAP2) immunoreactivity in the hippocampus were analyzed by histochemistry. Memory functions in the Low-Ex group were improved in all tests. In the High-Ex group, only the passive avoidance test improved, but not the object recognition or object location tests. Both the Low-Ex and High-Ex groups had reduced infarct volumes. Although the number of neurons in the hippocampal dentate gyrus of the Low-Ex and High-Ex groups was increased, the number for the Low-Ex group increased more than that for the High-Ex group. Moreover hippocampal MAP2 immunoreactivity in the High-Ex group was reduced compared to that in the Low-Ex group. These data suggest that the effects of exercise on memory impairment after cerebral infarction depend on exercise intensity.

  6. Asynchronization in Changes of Electrophysiology and Pathology of Spinal Cord Motor Neurons in Rats Following Middle Cerebral Artery Occlusion

    Institute of Scientific and Technical Information of China (English)

    Nan Lin; Ming-Sheng Liu; Si-Yuan Fan; Yu-Zhou Guan; Li-Ying Cui

    2015-01-01

    Background:Motor dysfunction is common in stroke patients.Clinical electrophysiological studies suggest that transsynaptic degeneration occurred in the lower motor neurons,while pathological evidence is lacked.This study aimed to combine the electrophysiological and pathological results to prove the existence of transsynaptic degeneration in the motor system after stroke.Methods:Modified neurologic severity score,electrophysiological,and pathological assessments were evaluated in rats before middle cerebral artery occlusion (MCAO),and at 24 hours,7 days,and 14 days after MCAO.Paired and independent-sample t-tests were applied to assess the changes of electrophysiological and pathological data.Results:Compound motor action potential amplitude in the paretic side was significantly lower than the nonparetic side at both 24 hours (61.9 ± 10.4 vs.66.6 ± 8.9,P < 0.05) and 7 days (60.9 ± 8.4 vs.67.3 ± 9.6,P < 0.05) after MCAO.Motor unit number estimation of the paretic side was significantly less than the nonparetic side (379.0 ± 84.6 vs.445.0 ± 89.5,P < 0.05) at 7 days after MCAO.Until 14 days after stroke,the pathological loss of motor neurons was detected.Motor neurons in 14-day MCAO group were significantly decreased,compared with control group (5.3 ± 0.7 vs.7.3 ± 1.8,P < 0.05).Conclusions:Both electrophysiological and pathological studies showed transsynaptic degeneration after stroke.This study identified the asynchronization in changes of electrophysiology and pathology.The abnormal physiological changes and function impairment can be detected in the early stage and recovered quickly,while the pathological loss of motor neuron can be detected only in a later stage.

  7. Optical inhibition of striatal neurons promotes focal neurogenesis and neurobehavioral recovery in mice after middle cerebral artery occlusion.

    Science.gov (United States)

    He, Xiaosong; Lu, Yifan; Lin, Xiaojie; Jiang, Lu; Tang, Yaohui; Tang, Guanghui; Chen, Xiaoyan; Zhang, Zhijun; Wang, Yongting; Yang, Guo-Yuan

    2017-03-01

    Striatal neurons regulate the activity of neural progenitor cells in the subventricular zone, but the effect of striatal neuronal activity on neurogenesis after ischemic stroke is unclear. In this study, we used optogenetic tools to investigate the impact of striatal neuronal activity on the neurogenesis and functional recovery after cerebral ischemia. We transfected striatal neurons with channelrhodopsin-2 or halorhodopsin from Natronomonas so that they can be excited by 473 nm laser or inhibited by 594 nm laser, respectively. Neural inhibition but not excitation at 4-7 days after middle cerebral artery occlusion resulted in reduced atrophy volume (6.8 ± 0.7 vs 8.5 ± 1.2 mm(3), p < 0.05) and better performance represented by longer sustaining time on rotarod (99.3 ± 9 vs 80.1 ± 11 s, p < 0.01) and faster moving speed (7.7 ± 2 vs 5.7 ± 1.1 cm/s, p < 0.05) in open field tests. Furthermore, neural inhibition increased the number of nestin(+), BrdU(+)/doublecortin(+) and BrdU(+)/NeuN(+) cells ( p < 0.001) in the subventricular zone and peri-focal region, and the expression level of axon guidance factor Netrin-1 (0.39 ± 0.16 vs 0.16 ± 0.02, p < 0.05) in the peri-focal region. These data suggest that striatal neuronal activity plays an important role in regulating neurogenesis and neural-behavioral outcomes, and that inhibiting striatal neurons by optogenetics promotes the recovery after ischemic stroke in mice.

  8. ChAT-positive neurons participate in subventricular zone neurogenesis after middle cerebral artery occlusion in mice.

    Science.gov (United States)

    Wang, Jianping; Fu, Xiaojie; Zhang, Di; Yu, Lie; Li, Nan; Lu, Zhengfang; Gao, Yufeng; Wang, Menghan; Liu, Xi; Zhou, Chenguang; Han, Wei; Yan, Bo; Wang, Jian

    2017-01-01

    The mechanisms of post-stroke neurogenesis in the subventricular zone (SVZ) are unclear. However, neural stem cell-intrinsic and neurogenic niche mechanisms, as well as neurotransmitters, have been shown to play important roles in SVZ neurogenesis. Recently, a previously unknown population of choline acetyltransferase (ChAT)(+) neurons residing in rodent SVZ were identified to have direct control over neural stem cell proliferation by indirectly activating fibroblast growth factor receptor (FGFR). This finding revealed possible neuronal control over SVZ neurogenesis. In this study, we assessed whether these ChAT(+) neurons also participate in stroke-induced neurogenesis. We used a permanent middle cerebral artery occlusion (MCAO) model produced by transcranial electrocoagulation in mice, atropine (muscarinic cholinergic receptor [mAchR] antagonist), and donepezil (acetylcholinesterase inhibitor) to investigate the role of ChAT(+) neurons in stroke-induced neurogenesis. We found that mAchRs, phosphorylated protein kinase C (p-PKC), and p-38 levels in the SVZ were upregulated in mice on day 7 after MCAO. MCAO also significantly increased the number of BrdU/doublecortin-positive cells and protein levels of phosphorylated-neural cell adhesion molecule and mammalian achaete scute homolog-1. FGFR was activated in the SVZ, and doublecortin-positive cells increased in the peri-infarction region. These post-stroke neurogenic effects were enhanced by donepezil and partially decreased by atropine. Neither atropine nor donepezil affected peri-infarct microglial activation or serum concentrations of TNF-α, IFN-γ, or TGF-β on day 7 after MCAO. We conclude that ChAT(+) neurons in the SVZ may participate in stroke-induced neurogenesis, suggesting a new mechanism for neurogenesis after stroke.

  9. Protective effects of quercetin on rat pial microvascular changes during transient bilateral common carotid artery occlusion and reperfusion.

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    Dominga eLapi

    2012-03-01

    Full Text Available The aim of this study was to assess the in vivo effects of quercetin on pial microvascular responses during transient bilateral common carotid artery occlusion (BCCAO and reperfusion. Rat pial microcirculation was visualized by fluorescence microscopy through a closed cranial window. Pial arterioles were classified in five orders of branchings. Capillaries were assigned order 0, the smallest arterioles order 1 and the largest ones order 5. In ischemic rats, 30 min BCCAO and 60 min reperfusion caused arteriolar diameter decrease (by 14.5 ± 3.3% of baseline in order 2, microvascular leakage (0.47 ± 0.04 NGL: Normalized Grey Levels, leukocyte adhesion in venules (9 ± 2/100 µm venular length, v.l./30s and reduction of capillary perfusion (by 40 ± 7% of baseline. Moreover, at the end of BCCAO and reperfusion there was a significant increase in reactive oxygen species formation (ROS when compared with baseline. Quercetin highest dose determined dilation in all arteriolar orders (by 40 ± 4 % of baseline in order 2 and prevented microvascular permeability (0.15 ± 0.02 NGL, leukocyte adhesion (3 ± 1/100 µm v.l./30s as well as ROS formation, while capillary perfusion was protected. Inhibition of endothelial Nitric Oxide Synthase (NOS prior to quercetin reduced arteriolar dilation (order 2 diameter increase by 10.3 ± 2.5% of baseline and caused permeability increase (0.29 ± 0.03 NGL; inhibition of neuronal NOS or inducible NOS did not affect quercetin-induced effects. Inhibition of guanylyl cyclase prior to quercetin reversed the quercetin’s effects on pial arteriolar diameter and leakage. In conclusion, quercetin was able to protect pial microcirculation from ischemia-reperfusion damage inducing arteriolar dilation likely by nitric oxide release. Moreover, quercetin scavenger activity blunted reactive oxygen species formation preserving the blood-brain barrier integrity.

  10. Impact of arterial occlusion during partial nephrectomy on residual renal function. An evaluation with {sup 99m}technetium-dimercaptosuccinic acid scintigraphy

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    Kondo, Tsunenori; Nakazawa, Hayakazu; Ito, Fumio; Onitsuka, Shiro; Ryoji, Osamu; Yago, Rie; Hashimoto, Yasunobu; Toma, Hiroshi [Tokyo Women' s Medical Coll. (Japan)

    2002-08-01

    Partial nephrectomy (PNx) has been performed with temporary renal arterial occlusion and in situ renal hypothermia (conventional PNx). However, the impact of temporary renal arterial occlusion on residual renal function has not been well assessed. To address this question, we performed renal scintigraphy with {sup 99m}technetium-dimercaptosuccinic acid (DMSA) for the quantitative measurement of postoperative residual renal function after conventional PNx and partial nephrectomy without arterial occlusion (non-clamping PNx). Thirty-four patients underwent postoperative DMSA scintigraphy after PNx for renal cell carcinoma. No obvious difference in preoperative renal function between the diseased kidney and the contralateral kidney was found in any of the patients. Of these patients, 24 underwent conventional PNx, and 10 underwent non-clamping PNx. Residual renal function was evaluated using the relative DMSA uptake of the operated kidney. The relative DMSA uptake of the operated kidney was 39.9{+-}7.3% (25.1-58.8) after conventional PNx compared to 34.8{+-}8.9% (13.5-45.5) after non-clamping PNx. This difference was not statistically significant (P=0.15). Total ischemic time during conventional PNx had no adverse influence on the residual renal function. In the analysis of the other determinant factors influencing residual renal function, tumor size was the only significant factor that inversely correlated with the relative DMSA uptake. Our results showed that arterial clamping during PNx has no negative impact on the functional residual capacity as long as in situ renal hypothermia is adequately performed. (author)

  11. The intervention effect of diammonium glycyrrhizinate on the formation of basilar artery aneurysm in rabbits%甘草酸二铵干预兔基底动脉瘤形成的实验研究

    Institute of Scientific and Technical Information of China (English)

    桂铮; 汪子文; 张鹏飞; 赵文可; 于耀宇

    2016-01-01

    Objective To explore the mechanism and intervention effects of diammonium glycyrrhizinate (DG) on the formation of intracranial aneurysm (IA) in rabbits. Methods Forty New Zealand rabbits were randomly divided into four groups: control group, IA group, normal saline (NS) group and DG group, 10 rabbits for each group. Except for the control group, rabbits in other three groups were operated with bilateral common carotid artery ligation to produce basilar artery aneurysm formation model. DG group was injected intravenously with DG[20 mg/(kg·d)]from the first day to the seventh day after operation, NS group was given same volume of normal saline, while IA group was injected nothing. The expressions of NF-κB and MMP-9 were detected by immunohistochemical staining, whileα-SMA was stained with immunofluorescence. Results The expressions of NF-κB and MMP-9 were significantly higher in IA group and NS group than those of control group, whileα-SMA expression was significantly lower than that of control group (P0.05). The expressions of NF-κB and MMP-9 were significantly lower in DG group than those of IA group and NS group (P<0.05). The expression of α-SMA was significantly higher in DG group than that of IA group and NS group (P<0.05). Conclusion DG can downregulate the expression levels of NF-κB and MMP-9 in intracranial aneurysm, suppress inflammatory in artery wall and reduce the pathological changes and have intervention effect on intracranial aneurysm formation.%目的:探讨甘草酸二铵(DG)干预兔基底动脉瘤发生的作用机制。方法新西兰白兔40只,按照随机数字表法分为对照组、动脉瘤(IA)组、生理盐水(NS)组、DG组,每组10只。其中对照组不做任何处理,其余各组结扎双侧颈总动脉建立基底动脉瘤形成模型。在造模后的第1~7天,IA组不做处理,DG组给予DG[20 mg/(kg·d)]静脉注射,NS组注入等剂量生理盐水。使用免疫组化染色方法检测基

  12. Diagnosis of intracranial occlusive vascular disease and evaluation of extracranial-intracranial (EC/IC) arterial bypass using three-dimensional magnetic resonance angiography

    Energy Technology Data Exchange (ETDEWEB)

    Aoki, Takashi; Houkin, Kiyohiro; Kamiyama, Hiroyasu; Iwasaki, Yoshinobu; Abe, Hiroshi (Hokkaido Univ., Sapporo (Japan). School of Medicine); Kawaguchi, Susumu; Kashiwabara, Takeshi; Koiwa, Mitsuyuki

    1993-01-01

    The three-dimensional time-of-flight (TOF) magnetic resonance angiograms (MRA) were studied to evaluate its accuracy in the assessment of the intracranial carotid occlusive lesions, collateral circulation and also the patency of extracranial-intracranial (EC/IC) arterial bypass surgery. All occlusive lesions of the intracranial major arteries seen in conventional angiograms were revealed clearly with MRA. However MRA had its practical limitation in the evaluation of the leptomeningeal anastomosis (collateral circulation) probably due to the deterioration of contrast in its slow flow and saturation effect of the magnetization. In addition to that, MRA often exaggerated the severity of the stenotic lesions, mostly in severe cases. The postoperative state of collateral flow and the patency of EC/IC bypass could be evaluated as properly with MRA as with conventional angiography, although MRA was limited in spatial resolution and evaluation of flow direction. In conclusion, MRA was considered to be a reliable non-invasive modality as a screening examination for the evaluation of the carotid occlusive disease and as the follow-up study of the post-operative patients with EC/IC bypass surgery. (author).

  13. The diagnosis of intracranial carotid occlusive disease and the evaluation of extracranial-intracranial arterial bypass using three-dimensional magnetic resonance angiography

    Energy Technology Data Exchange (ETDEWEB)

    Aoki, Takeshi; Houkin, Kiyohiro; Kamiyama, Hiroyasu; Iwasaki, Yoshinobu; Abe, Hiroshi (Hokkaido Univ., Sapporo (Japan). School of Medicine); Koiwa, Mitsuyuki; Kawaguchi, Susumu; Kashiwaba, Takeshi

    1993-02-01

    Three-dimensional time-of-flight (TOF) magnetic resonance angiograms (MRA) were studied in order to evaluate their accuracy in the assessment of intracranial carotid occlusive lesions, collateral circulation, and the usefulness of extracranial-intracranial (EC/IC) arterial bypass surgery. All occlusive lesions of the intracranial major arteries seen in conventional angiograms were clearly revealed with MRA. However, MRA had a practical limitation in the evaluation of leptomeningeal anastomosis (collateral circulation), probably because of the deterioration of the contrast in its slow flow and because of the saturation effect of the magnetization. In addition, MRA often exaggerated the severity of the stenotic lesions, mostly in severe cases. The post-operative state of the collateral flow and the usefulness of EC/IC bypass could be evaluated as properly with MRA as with conventional angiography, although MRA was limited in its spatial resolution and in its evaluation of the flow direction. In conclusion, MRA was considered to be a reliable, non-invasive modality for use as a screening examination for the evaluation of carotid occlusive disease and as a follow-up, post-operative study of patients who have received EC/IC bypass surgery. (author).

  14. A comparative study of perfusion CT and 99mTc-Hmpao spect measurement to assess cerebrovascular reserve capacity in patients with internal carotid artery occlusion

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    Eicker S

    2011-11-01

    Full Text Available Abstract Background and purpose Patients with internal carotid artery (ICA occlusion can demonstrate impaired cerebral vascular reserve (CVR. The detection of CVR using single photon emission CT (SPECT is nowadays widely accepted as a predictor in the diagnostic pathway in patients considered for cerebral revascularization. Recently perfusion CT (PCT gained widely acceptance in stroke imaging The present study was aimed at comparing the results of perfusion CT (PCT and 99mTc-HMPAO SPECT with acetazolamide challenge in patients with ICA occlusion. Methods 13 patients were included in the prospective evaluation. Both PCT and 99mTc-HMPAO SPECT were performed before and after the administration of acetazolamide. In detail, regional cerebral blood flow (rCBF, regional cerebral blood volume (rCBV, adapted time to peak (Tmax and mean transit times (MTT were compared with SPECT data. Results 99mTc-HMPAO SPECT demonstrated an impairment of CVR in six patients. A preserved CVR was present in seven patients. All patients with impaired CVR proven by SPECT had a delayed MTT (mean +2.98 s and a delayed Tmax (mean + 5.9 s, (both p Conclusion The prospective study demonstrated a highly significant correlation of perfusion parameters as' detected by 99mTc-HMPAO SPECT and the Tmax as detected by PCT in patients with ICA occlusion. Therefore this easy-to-perform technique seems to be an adequate method for the evaluation of cerebral perfusion in patients with ICA occlusion.

  15. Relaxant Effect of Daurinoline on Vascular Smooth Muscle of Isolated Rabbit Basilar Artery%蝙蝠葛诺林碱对家兔体外基底动脉血管平滑肌舒张作用的研究

    Institute of Scientific and Technical Information of China (English)

    陈密; 崔海东; 郝素芳; 卢云; 郭莲军

    2014-01-01

    Objective To investigate the effect of daurinoline on basilar artery vascular smooth muscle. Methods The tension of isolated basilar artery ring of rabbit was measured. The effects of daurinoline on the basilar artery contracted by methoxamine,5-hydroxytryptamine(5-HT),KCl and Histamine( His)were also examined. Dose-response curves of 5-HT and KCl were observed as well. Results Daurinoline exerted obvious relaxation effect on the basilar artery vascular ring contracted by methoxamine,5-HT,KCl and His in a concentration-dependent manner. IC50 of daurinoline in methoxamine,5-HT,KCl and His-treated rabbits was 8.67×10-5,1.78×10-6,6.79×10-7 and 4.98×10-4 mol·L-1,respectively. The change of concentration-response curves of methoxamine,5-HT,KCl and His showed that daurinoline was a non-competitive antagonist. Conclusion Daurinoline exerts marked relaxation effect on basilar artery of rabbits through non-competitive antagonism. The mechanism of relaxation action may be related to blockage of voltage-dependent or receptor-dependent calcium channels.%目的:探讨蝙蝠葛诺林碱对家兔基底动脉血管平滑肌的舒张作用。方法制备家兔基底动脉血管环,采用半对数摩尔浓度累积给药方法,观察给予蝙蝠葛诺林碱对家兔基底动脉血管平滑肌的舒张作用。结果蝙蝠葛诺林碱对甲氧胺、5-羟色胺、氯化钾和组胺所致的家兔基底动脉收缩均有明显的扩张作用,最大舒张50%( IC50)浓度分别为8.67×10-5,1.78×10-6,6.79×10-7,4.98×10-4 mol·L-1。同时对甲氧胺、5-羟色胺、氯化钾和组胺所致量效曲线的影响,均显示为非竞争性拮抗作用。结论蝙蝠葛诺林碱通过非竞争性拮抗作用,能有效舒张家兔基底动脉血管平滑肌,改善脑循环。

  16. Fatal outcome after brain stem infarction related to bilateral vertebral artery occlusion - case report of a detrimental complication of cervical spine trauma

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    Beauchamp Kathryn M

    2011-07-01

    Full Text Available Abstract Background Vertebral artery injury (VAI after blunt cervical trauma occurs more frequently than historically believed. The symptoms due to vertebral artery (VA occlusion usually manifest within the first 24 hours after trauma. Misdiagnosed VAI or delay in diagnosis has been reported to cause acute deterioration of previously conscious and neurologically intact patients. Case presentation A 67 year-old male was involved in a motor vehicle crash (MVC sustaining multiple injuries. Initial evaluation by the emergency medical response team revealed that he was alert, oriented, and neurologically intact. He was transferred to the local hospital where cervical spine computed tomography (CT revealed several abnormalities. Distraction and subluxation was present at C5-C6 and a comminuted fracture of the left lateral mass of C6 with violation of the transverse foramen was noted. Unavailability of a spine specialist prompted the patient's transfer to an area medical center equipped with spine care capabilities. After arrival, the patient became unresponsive and neurological deficits were noted. His continued deterioration prompted yet another transfer to our Level 1 regional trauma center. A repeat cervical spine CT at our institution revealed significantly worsened subluxation at C5-C6. CT angiogram also revealed complete occlusion of bilateral VA. The following day, a repeat CT of the head revealed brain stem infarction due to bilateral VA occlusion. Shortly following, the patient was diagnosed with brain death and care was withdrawn. Conclusion Brain stem infarction secondary to bilateral VA occlusion following cervical spine trauma resulted in fatal outcome. Prompt imaging evaluation is necessary to assess for VAI in cervical trauma cases with facet joint subluxation/dislocation or transverse foramen fracture so that treatment is not delayed. Additionally, multiple transportation events are risk factors for worsening when unstable cervical

  17. Preliminary findings of recanalization and stenting for symptomatic vertebrobasilar artery occlusion lasting more than 24 h: A retrospective analysis of 21 cases

    Energy Technology Data Exchange (ETDEWEB)

    He, Yingkun, E-mail: heyingkun@126.com [Cerebrovascular Center, Henan Provincial People' s Hospital, Zhengzhou University, Zhengzhou (China); Wang, Ziliang [Cerebrovascular Center, Henan Provincial People' s Hospital, Zhengzhou University, Zhengzhou (China); Li, Tianxiao, E-mail: dr.litianxiao@vip.163.com [Cerebrovascular Center, Henan Provincial People' s Hospital, Zhengzhou University, Zhengzhou (China); Jiang, Wei-Jian [Stroke Center, People' s Liberation Army Second Artillery Corps General Hospital, Beijing (China); Zhu, Liangfu; Xue, Jiangyu; Bai, Weixing [Cerebrovascular Center, Henan Provincial People' s Hospital, Zhengzhou University, Zhengzhou (China); Hui, Ferdinand [Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland, OH (United States)

    2013-09-15

    Purpose: To evaluate the technical feasibility, safety and short-term treatment effects of recanalization and stenting for intracranial symptomatic vertebrobasilar artery occlusion (VBAO) lasting more than 24 h. Methods and materials: Twenty-one consecutive patients with VBAO refractory to aggressive medical treatment were enrolled into this study and underwent recanalization and stenting. The rate of recanalization was evaluated radiographically and the functional outcome was examined using modified Rankin Scale (mRS) scores. Results: Median time between imaging-documented occlusion and endovascular recanalization was 10.5 days (IR, Interquartile Range: 6.5–18); technique success ratio of recanalization was 95.2%. There were 3 periprocedural complications. Median mRS score was 4 (IR, 2.5–5) prior to procedure and 4 (IR, 1–5) at discharge (P < 0.05). One stroke and one death occurred within 30 days after recanalization. Mean duration of clinical follow-up was 15.5 months. One transient ischemic attack, one stroke and one death occurred beyond 30-day window. Mean angiographic follow-up was 10.6 months in 10 patients. Four patients developed in-stent restenosis or occlusion, and two of them were symptomatic. Subgroup analyses revealed better functional recovery (lower mRS) in patients with vertebral artery occlusion (VAO) (P < 0.05). Conclusions: Endovascular recanalization and stenting for symptomatic VBAO lasting more than 24 h were technically feasible and patients with VAO benefited from the treatment with significant functional recovery. However, the complexity of the procedure and high risk of complication should prompt extreme caution.

  18. Short-Term Left Ventricular Remodeling After Revascularization in Subacute Total and Subtotal Occlusion With the Infarct-Related Left Anterior Descending Artery

    Science.gov (United States)

    Celik, Ahmet; Kalay, Nihat; Korkmaz, Hasan; Dogdu, Orhan; Sahin, Omer; Elcik, Deniz; Karacavus, Seyhan; Dogan, Ali; Inanc, Tugrul; Ozdogru, Ibrahim; Oguzhan, Abdurrahman; Topsakal, Ramazan

    2011-01-01

    Background Large randomized studies revealed that percutaneous coronary intervention has no clinical benefit in patients with total occlusion. The purpose of this study is to evaluate left ventricular remodelling after PCI for total and subtotal infarct-related left anterior desending artery in stable patients who have not received trombolytic theraphy. Methods Sixty stable patients with subacute anterior myocardial infarction who have total or subtotal occlusion in the infarct-related left anterior descending artery were enrolled the study (20 patient in the total-medical group, 20 patient in the total-PCI group and 20 patient in the subtotal-PCI group). All patients’ left ventricular diameters, volumes and ejection fractions measured at admission and after a month. Results The necrotic segment number in scintigraphy were similar in three groups. In the total-PCI group, there were significant increases in left ventricular diastolic diameter, left ventricular end-diastolic volume and left ventricular end-systolic volume at first month. A borderline significant increase was observed in LVEDV in the total-medical group at first month. No significant difference was seen in all echocardiographic parameters in the subtotal-PCI group at a month after discharge. The percentage of increase in LVEDV was significantly higher and the percentage of increase in LVESV was borderline significantly higher in the total-PCI group than the other groups. Conclusions In stable patients, PCI for total occlusion in the subacute phase of anterior MI causes an increase in LV remodeling. Nevertheless PCI for subtotal occlusion in the subacute phase of anterior MI may prevent LV remodeling.

  19. Acute embolic occlusion of the right common iliac artery after revision total hip arthroplasty treated with catheter-directed thrombolysis and balloon angioplasty: A case report

    Directory of Open Access Journals (Sweden)

    Hongqi Yang

    2015-07-01

    Full Text Available Methods: A 63-year-old woman with atrial fibrillation presented clinical symptoms and signs of acute ischemia in the right lower extremity on the 17th postoperative day after revision total hip arthroplasty of the left hip for aseptic loosening of femoral component. Aspirin was discontinued 7 days before surgery. Both computed tomography angiography and digital subtraction angiography demonstrated complete occlusion of the right common iliac artery. An emergency catheter-directed thrombolysis with urokinase combined with balloon angioplasty was performed to obtain complete patency of the right common iliac artery. Results: The patient received anticoagulation and antiplatelet therapy postoperatively and was fine at the 2-year follow-up. Conclusions: This case demonstrated that catheter-directed thrombolysis combined with balloon angioplasty could be an efficacious, minimally invasive approach for the treatment of acute embolic occlusion of the common iliac artery. Preoperative anticoagulation for patients undergoing total hip arthroplasty with long-term use of aspirin for atrial fibrillation needs further investigation.

  20. Near-infrared diffuse reflectance imaging of infarct core and peri-infarct depolarization in a rat middle cerebral artery occlusion model

    Science.gov (United States)

    Kawauchi, Satoko; Nishidate, Izumi; Nawashiro, Hiroshi; Sato, Shunichi

    2014-03-01

    To understand the pathophysiology of ischemic stroke, in vivo imaging of the brain tissue viability and related spreading depolarization is crucial. In the infarct core, impairment of energy metabolism causes anoxic depolarization (AD), which considerably increases energy consumption, accelerating irreversible neuronal damage. In the peri-infarct penumbra region, where tissue is still reversible despite limited blood flow, peri-infarct depolarization (PID) occurs, exacerbating energy deficit and hence expanding the infarct area. We previously showed that light-scattering signal, which is sensitive to cellular/subcellular structural integrity, was correlated with AD and brain tissue viability in a rat hypoxia-reoxygenation model. In the present study, we performed transcranial NIR diffuse reflectance imaging of the rat brain during middle cerebral artery (MCA) occlusion and examined whether the infarct core and PIDs can be detected. Immediately after occluding the left MCA, light scattering started to increase focally in the occlusion site and a bright region was generated near the occlusion site and spread over the left entire cortex, which was followed by a dark region, showing the occurrence of PID. The PID was generated repetitively and the number of times of occurrence in a rat ranged from four to ten within 1 hour after occlusion (n=4). The scattering increase in the occlusion site was irreversible and the area with increased scattering expanded with increasing the number of PIDs, indicating an expansion of the infarct core. These results suggest the usefulness of NIR diffuse reflectance signal to visualize spatiotemporal changes in the infarct area and PIDs.

  1. Sudden sensorineural hearing loss and vertigo associated with arterial occlusive disease: three case reports and literature review

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    Ney Penteado de Castro Junior

    Full Text Available Sudden sensorineural hearing loss and vertigo (SSNHLV has multifactorial causes, of which viral, autoimmune and vascular insufficiency are the most common. The therapeutic management for SSNHLV includes antiviral drugs, corticosteroids, vasodilators, normovolemic hemodilution therapy and hyperbaric oxygen therapy. Vertebrobasilar occlusive disease and carotid occlusive disease are seldom related to SSNHLV. Discussions concerning SSNHLV caused by occlusive vascular disease are important and necessary for both neurologists and otolaryngologists, since their therapeutic management and prognosis are very different from other causes of hearing loss and vertigo. Here, we present our experience with three cases managed with interventional treatment and conduct a review and discussion on the relevant literature. We conclude that investigation of vertebrobasilar and carotid occlusive diseases is necessary in patients over 50 years of age who present SSNHLV, mild neurological symptoms and a history of arteriosclerosis, high blood pressure or thrombosis.

  2. Multidisciplinary treatment for peripheral arterial occlusive disease and the role of eHealth and mHealth

    Directory of Open Access Journals (Sweden)

    Fokkenrood HJP

    2012-10-01

    Full Text Available Hugo JP Fokkenrood,1,2 Gert-Jan Lauret,1,2 Marc RM Scheltinga,4 Cor Spreeuwenberg,3 Rob A de Bie,2 Joep AW Teijink1,21Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; 2CAPHRI Research School, Department of Epidemiology, 3Department of Integrated Care, Maastricht University, Maastricht, The Netherlands; 4Department of Vascular Surgery, Maxima Medical Centre, Veldhoven, The NetherlandsAbstract: Increasingly unaffordable health care costs are forcing care providers to develop economically viable and efficient health care plans. Currently, only a minority of all newly diagnosed peripheral arterial occlusive disease (PAOD patients receive efficient and structured conservative treatment for their disease. The aim of this article is to introduce an innovative effective treatment model termed ClaudicatioNet. This concept was launched in The Netherlands as a means to combat treatment shortcomings and stimulate cohesion and collaboration between stakeholders. The overall goal of ClaudicatioNet is to stimulate quality and transparency of PAOD treatment by optimizing multidisciplinary health care chains on a national level. Improved quality is based on stimulating both a theoretical and practical knowledge base, while eHealth and mHealth technologies are used to create clear insights of provided care to enhance quality control management, in addition these technologies can be used to increase patient empowerment, thereby increasing efficacy of PAOD treatment. This online community consists of a web portal with public and personal information supplemented with a mobile application. By connecting to these tools, a social community is created where patients can meet and keep in touch with fellow patients, while useful information for supervising health care professionals is provided. The ClaudicatioNet concept will likely create more efficient and cost-effective PAOD treatment by improving the quality of supervised training

  3. Regulation of brain-derived neurotrophic factor gene expression after transient middle cerebral artery occlusion with and without brain damage.

    Science.gov (United States)

    Kokaia, Z; Zhao, Q; Kokaia, M; Elmér, E; Metsis, M; Smith, M L; Siesjö, B K; Lindvall, O

    1995-11-01

    Levels of mRNA for c-fos, nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), TrkB, and TrkC were studied using in situ hybridization in the rat brain at different reperfusion times after unilateral middle cerebral artery occlusion (MCAO). Short-term (15 min) MCAO, which does not cause neuronal death, induced elevated BDNF mRNA expression confined to ipsilateral frontal and cingulate cortices outside the ischemic area. With a longer duration of MCAO (2 h), which leads to cortical infarction, the increase was more marked and elevated BDNF mRNA levels were also detected bilaterally in dentate granule cells and CA1 and CA3 pyramidal neurons. Maximum expression was found after 2 h of reperfusion. At 24 h BDNF mRNA expression had returned to control values. In the ischemic core of the parietal cortex only scattered neurons were expressing high levels of BDNF mRNA after 15 min and 2 h of MCAO. Analysis of different BDNF transcripts showed that MCAO induced a marked increase of exon III mRNA but only small increases of exon I and II mRNAs in cortex and hippocampus. In contrast to BDNF mRNA, elevated expression of c-fos mRNA was observed in the entire ipsilateral cerebral cortex, including the ischemic core, after both 15 min and 2 h of MCAO. Two hours of MCAO also induced transient, bilateral increases of NGF and TrkB mRNA levels and a decrease of NT-3 mRNA expression, confined to dentate granule cells. The upregulation of BDNF mRNA expression in cortical neurons after MCAO is probably triggered by glutamate through a spreading depression-like mechanism. The lack of response of the BDNF gene in the ischemic core may be due to suppression of signal transduction or transcription factor synthesis caused by the ischemia. The observed pattern of gene expression after MCAO agrees well with a neuroprotective role of BDNF in cortical neurons. However, elevated levels of NGF and BDNF protein could also increase synaptic efficacy in the

  4. Occlusive Peripheral Arterial Disease

    Science.gov (United States)

    ... Commentary Recent News Scientists Working on Solar-Powered Prosthetic Limbs Exercise a Great Prescription to Help Older ... for too long, tissue may die, and the limb may need to be ... Such pain usually begins in the lower leg or front of the foot, is severe ...

  5. Retinal artery occlusion

    Science.gov (United States)

    ... eds. Duane's Clinical Ophthalmology . 2013 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:vol 3;chap 54E. Sanborn ... eds. Duane's Clinical Ophthalmology . 2013 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:vol 3;chap 14. Yanoff ...

  6. Doppler sonography to monitor flow in different cerebral arteries in the rabbit.

    Science.gov (United States)

    Roatta, S; Roncari, S; Micieli, G; Bosone, D; Passatore, M

    2000-07-01

    Most of the transcranial Doppler (TCD) experimental studies on cerebral haemodynamics have been performed in the rabbit because of the similarity between its Willis circle and that of the human, but these studies have mainly been limited to the basilar artery. The present study was aimed at extending the use of TCD sonography to all other large cerebral arteries. In anaesthetised rabbits, these arteries were insonated from three different recording sites, i.e. top-cranial, suboccipital and orbital, using a two-channel pulsed Doppler device equipped with 4 and 8 MHz probes. First, discrimination between intra- and extracranial arteries was achieved through a standard 'rebreathing' test (hypercapnic-hypoxic stimulation). The distinctive blood velocity response patterns, reflecting the different extents of metabolic reactivity in intra- and extracranial territories, are described and discussed. Intracranial arteries were then identified on the basis of their response to ipsi- and contralateral common carotid artery occlusion. This procedure allowed recording from the following arteries: anterior common trunk, anterior cerebral, internal carotid, middle cerebral and basilar; the latter could be simultaneously monitored with any of the others. This study provides an experimental model allowing investigation of regional differences in the haemodynamic response to neurogenic and pharmacological stimuli.

  7. Ruptured high flow gastric varices with an intratumoral arterioportal shunt treated with balloon-occluded retrograde transvenous obliteration during temporary balloon occlusion of a hepatic artery

    Institute of Scientific and Technical Information of China (English)

    Motoki Nakai; Morio Sato; Hirohiko Tanihata; Tetsuo Sonomura; Shinya Sahara; Nobuyuki Kawai; Masashi Kimura; Masaki Terada

    2006-01-01

    A patient presented with hematemesis due to gastric variceal bleeding with an intratumoral arterioportal shunt. Contrast-enhanced CT revealed gastric varices and hepatocellular carcinoma with tumor thrombi in the right portal vein. Angiography and angio-CT revealed a marked intratumoral arterioportal shunt accompanied with reflux into the main portal vein and gastric varices. Balloon-occluded retrograde venography from the gastro-renal shunt showed no visualization of gastric varices due to rapid blood flow through the intratumoral arterioportal shunt. The hepatic artery was temporarily occluded with a balloon catheter to reduce the blood flow through the arterioportal shunt, and then concurrent balloon-occluded retrograde transvenous obliteration (BRTO) was achieved. Vital signs stabilized immediately thereafter, and contrast-enhanced CT revealed thrombosed gastric varices. Worsening of hepatic function was not recognized. BRTO combined with temporary occlusion of the hepatic artery is a feasible interventional procedure for ruptured high flow gastric varices with an intratumoral arterioportal shunt.

  8. Preventive effect of yuzu and hesperidin on left ventricular remodeling and dysfunction in rat permanent left anterior descending coronary artery occlusion model.

    Directory of Open Access Journals (Sweden)

    Hye Yon Yu

    Full Text Available Left ventricular (LV remodeling, which includes ventricular dilatation and increased interstitial fibrosis after myocardial infarction (MI, is the critical process underlying the progression to heart failure. Therefore, a novel approach for preventing LV remodeling after MI is highly desirable. Yuzu is a citrus plant originating in East Asia, and has a number of cardioprotective properties such as hesperidin. However, no study has proved whether yuzu can prevent LV remodeling. The aim of this study was to determine the effects of yuzu on heart failure (HF and its potential impact on the LV remodeling process after MI. Our in vivo study using the permanent left anterior descending coronary artery (LAD occlusion model demonstrate that one week pre-treatment with yuzu or its major metabolite hesperidin before LAD occlusion significantly attenuated cardiac dysfunction, myocyte apoptosis and inflammation. Not only yuzu but also hesperidin inhibited caspase-3 activity, myeloperoxidase expression, α-smooth muscle actin expression, and matrix metalloproteinase-2 activity in a permanent LAD occlusion rat model. To our knowledge, our findings provide the first evidence that yuzu and hesperidin prevent MI-induced ventricular dysfunction and structural remodeling of myocardium.

  9. Preventive effect of yuzu and hesperidin on left ventricular remodeling and dysfunction in rat permanent left anterior descending coronary artery occlusion model.

    Science.gov (United States)

    Yu, Hye Yon; Ahn, Ji Hun; Park, Se Won; Jung, Yi-Sook

    2015-01-01

    Left ventricular (LV) remodeling, which includes ventricular dilatation and increased interstitial fibrosis after myocardial infarction (MI), is the critical process underlying the progression to heart failure. Therefore, a novel approach for preventing LV remodeling after MI is highly desirable. Yuzu is a citrus plant originating in East Asia, and has a number of cardioprotective properties such as hesperidin. However, no study has proved whether yuzu can prevent LV remodeling. The aim of this study was to determine the effects of yuzu on heart failure (HF) and its potential impact on the LV remodeling process after MI. Our in vivo study using the permanent left anterior descending coronary artery (LAD) occlusion model demonstrate that one week pre-treatment with yuzu or its major metabolite hesperidin before LAD occlusion significantly attenuated cardiac dysfunction, myocyte apoptosis and inflammation. Not only yuzu but also hesperidin inhibited caspase-3 activity, myeloperoxidase expression, α-smooth muscle actin expression, and matrix metalloproteinase-2 activity in a permanent LAD occlusion rat model. To our knowledge, our findings provide the first evidence that yuzu and hesperidin prevent MI-induced ventricular dysfunction and structural remodeling of myocardium.

  10. [Dolichoectatic intracranial arteries. Advances in images and therapeutics].

    Science.gov (United States)

    Casas Parera, I; Abruzzi, M; Lehkuniec, E; Schuster, G; Muchnik, S

    1995-01-01

    Dolichoectasia of intracranial arteries is an infrequent disease with an incidence less than 0.05% in general population. It represents 7% of all intracranial aneurysms. Commonly seen in middle age patients with severe atherosclerosis and hypertension, the affected arteries include the basilar artery, supraclinoid segment of the internal carotid artery, middle, anterior and posterior cerebral arteries; males are more frequently affected. The clinical features of these fusiform aneurysms are divided in three categories: ische-mic, cranial nerve compression and signs from mass effect. Hemorrhage may also occur. Nine patients with symptomatic cerebral blood vessel dolichoectasias are presented. Six of them were males with moderate or severe hypertension. Lesions were confined to the basilar artery in 3 cases, carotid arteries and the middle cerebral artery in 1 case, and both systems were affected in 4 patients. Middle cerebral arteries were affected in 5 cases and the anterior cerebral artery in one. An isolated fusiform aneurysm of the posterior cerebral artery is also presented (case 8) (Table 3). Motor or sensory deficits, ataxia, dementia, hemifacial spasm and parkinsonism were observed. One patient died from cerebro-meningeal hemorrhage (Table 2). All patients were studied with computerized axial tomography of the brain, 5 cases with four vessel cerebral angiography, 4 cases with magnetic resonance imaging (MRI) and case 5 with MRI angiography. Clinical symptoms depend on the affected vascular territory, size of the aneurysm and compression of adjacent structures. The histopathologic findings are atheromatous lesions, disruption of the internal elastic membrane and fibrosis of the muscular wall. The resultant is a diffuse deficiency of the muscular wall and the internal elastic membrane. Recent advances in neuroimaging such as better resolution of CT scan, magnetic resonance images (MRI) and MRI angiography increased the diagnosis of this pathology showing

  11. Development of radiolabelled compound using reactor producted RI - Evaluation of Ho-166 endovascular therapy to prevent restenosis after PTCA or stenting for occlusive coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Park, Chan Hee; Choi, Byung Il; Kim, Han Soo [Ajou University, Suwon (Korea)

    2000-04-01

    Occlusive coronary artery disease is managed successfully by percutaneous transfemoral coronary angioplasty (PTCA) or stenting with 95% success rate. However, restenosis after PTCA is not uncommon and the reported incidence of reocclusion is about 30 {approx} 40%. Therefore, the objective of the research was to develop endovascular brachytherapy using liquid form of Ho-166 in order to inhibit neointimal hyperplasia responsible for restenosis following PTCA or stenting. Our research was carried out in 3 stages: First stage - The effectiveness of radiation was confirmed by using animal model. Following over-sized balloon injury to rat carotid artery and porcine coronary artery, various external radiation doses were delivered. Second stage - For radiation dose distribution within the coronary artery and its surrounding tissues, Gafchromic film was used. In vitro dose distribution of Ho-166 utilizing water phantom and Gafchromic film was measured. Third stage - None uniform dose distribution from Ho-166 within the balloon caused by small air bubbles was eliminated by negative suction method. More accurate dose distribution was also possible using newly developed micrometer by our physicist. Limited number of human trial was performed without adverse effect. 40 refs. (Author)

  12. Improvement in Cerebral and Ocular Hemodynamics Early after Carotid Endarterectomy in Patients of Severe Carotid Artery Stenosis with or without Contralateral Carotid Occlusion

    Directory of Open Access Journals (Sweden)

    Jian Wang

    2016-01-01

    Full Text Available Purpose. To investigate the alternation in cerebral and ocular blood flow velocity (BFV in patients of carotid stenosis (CS with or without contralateral carotid occlusion (CO early after carotid endarterectomy (CEA. Patients and Methods. Nineteen patients underwent CEA for ≥50% CS. Fourteen patients had the unilateral CS, and five patients had the ipsilateral CS and the contralateral CO. Transcranial Doppler (TCD and Color Doppler Imaging (CDI were performed before and early after CEA. Results. In patients with unilateral CS, significant improvements in BFV were observed in anterior cerebral artery (ACA and middle cerebral artery (MCA on the ipsilateral side after CEA. In patients of ipsilateral CS and contralateral CO, significant improvements in BFV were observed in the ACA and MCA not only on the ipsilateral side but also on the contralateral side postoperatively. The ipsilateral ophthalmic artery (OA retrograde flows in two patients were recovered to anterograde direction following CEA. The BFV in short posterior ciliary artery (SPCA of the ipsilateral side significantly increased postoperatively irrespective of the presence of contralateral CO. Conclusions. CEA improved cerebral anterior circulation hemodynamics especially in patients of unilateral CS and contralateral CO, normalized the OA reverse flow, and increased the blood perfusion of SPCA.

  13. The effect of sumatriptan on cephalic arteries

    DEFF Research Database (Denmark)

    Amin, Faisal Mohammad; Asghar, Mohammad Sohail; Ravneberg, Julie W;

    2013-01-01

    AIM: To explore a possible differential effect of sumatriptan on extracerebral versus cerebral arteries, we examined the superficial temporal (STA), middle meningeal (MMA), extracranial internal carotid (ICAextra), intracranial internal carotid (ICAintra), middle cerebral (MCA) and basilar arteries...

  14. Temporary balloon occlusion as therapy for uncontrollable arterial hemorrhage in multiply injured patients; Temporaere Ballonokklusion als Therapie unkontrollierbarer arterieller Blutungen bei Polytraumapatienten

    Energy Technology Data Exchange (ETDEWEB)

    Rieger, J.; Linsenmaier, U.; Rock, C.; Pfeifer, K.J. [Abt. fuer Radiologie, Klinikum Innenstadt, Ludwig-Maximilian-Univ., Muenchen (Germany); Euler, E. [Chirurgische Klinik und Poliklinik, Klinikum Innenstadt, Ludwig-Maximilian-Univ., Muenchen (Germany)

    1999-01-01

    Purpose: Presentation of temporary balloon occlusion as an interventional radiological method for managing hemorrhage in multiply injured patients with uncontrollable loss of blood. Method: Temporary, non-selective arterial occlusion by introduction of a balloon catheter contralaterally to the source of bleeding has been performed since 1992 on 7 patients with multiple injuries, hemorrhagic shock requiring reanimation, and angiographic demonstration of an arterial hemorrhage in the supply region of the internal iliac artery with complex pelvic fracture. In each case a PTA balloon catheter was introduced transfemorally, non-selectively positioned proximal to the bleeding source, and left in place for 24-48 h under manometric control. Control angiographies were performed prior to catheter removal. Results: The bleeding was stopped immediately in all 7 patients. The hemodynamic stability made transport and thus further surgical management and/or a short-term treatment in the intensive-care station possible. Control angiographies confirmed that the bleeding had stopped in all patients. Conclusions: We recommend temporary balloon occlusion as a rapid and effective method for the management of bleeding in otherwise uncontrollable traumatic hemorrhages in the supply region of the internal iliac artery. (orig.) [Deutsch] Ziel: Vorstellung der temporaeren Ballonokklusion als interventionell-radiologischer Methode zur Blutungskontrolle bei Polytraumapatienten mit unkontrollierbarem Blutverlust. Methode: Temporaerer, nicht-selektiver arterieller Gefaessverschluss mit kontralateral der Blutungsquellen eingefuehrten PTA-Ballonkathetern bei seit 1992 insgesamt 7 Patienten mit Polytrauma, reanimationspflichtigem haemorrhagischem Schock und angiographischem Nachweis einer arteriellen Blutung im Versorgungsgebiet der A. iliaca interna im Rahmen einer komplexen Beckenfraktur. Transfemoral wurde jeweils ein PTA-Ballonkatheter eingefuehrt, nicht selektiv proximal der Blutungsquelle

  15. Generalised wavelet analysis of cutaneous flowmotion during post-occlusive reactive hyperaemia in patients with peripheral arterial obstructive disease.

    Science.gov (United States)

    Rossi, M; Bertuglia, S; Varanini, M; Giusti, A; Santoro, G; Carpi, A

    2005-06-01

    The purpose of the present study was to assess whether the generalised wavelet analysis (GWA) of the leg cutaneous laser Doppler (LD) flowmotion waves recorded during baseline (Bsl) and after skin post-occlusive hyperaemia (POH) can provide information on the leg cutaneous microcirculatory adaptation to stage II peripheral arterial obstructive disease (PAOD). With this aim the flowmotion was characterised in 20 healthy subjects (HS) and 20 stage II PAOD patients by GWA of LDF tracings during Bsl and POH test. The vascular endothelial and smooth muscle function was also evaluated exploring the arm skin vasodilatory response to iontophoretically delivered acetylcholine (Ach) and sodium nitroprusside (SNP) using LD. During Bsl there was no significant difference in leg skin perfusion between HS and PAOD patients (7.3+/-5.6 vs. 5.8+/-2.9 AU, respectively). PAOD patients revealed higher peak powers in the frequency interval of 0.007-0.02 Hz (120+/-82 vs. 85+/-62 AU(2)/Hz; P < 0.05), 0.02-0.06 Hz (116+/-128 vs. 63+/-48 AU(2)/Hz, respectively; P < 0.05) and 0.06-0.2 Hz (39+/-49 vs. 14+/-10 AU(2)/Hz; P < 0.05). These flowmotion frequencies are related to vascular endothelium activity, sympathetic activity and vessel wall myogenic activity, respectively. During POH the mean peak power of the flowmotion waves increased significantly (P < 0.05) in HS respect to Bsl with the only exception of the 0.02-0.06 Hz band. In the PAOD patients, compared to Bsl the amplitude of the flowmotion waves did not significantly change during POH. In addition, the PAOD patients presented an increased time from release to peak-flux (18.25+/-15.5 vs. 2.16+/-1.28 s, respectively; P < 0.05), an increased time from release to recovery of the basal perfusion (90.26+/-39.14 vs. 26.55+/-14.05 s, respectively; P < 0.05) and a lower slope of the POH curve (10+/-15 vs. 54+/-17 degrees , respectively; P < 0.05), compared with HS. The cutaneous arm vasodilatory response to Ach and to SNP was reduced in PAOD

  16. FLAIR vascular hyperintensities and dynamic 4D angiograms for the estimation of collateral blood flow in posterior circulation occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Foerster, Alex; Wenz, Holger; Kerl, Hans Ulrich; Al-Zghloul, Mansour; Habich, Sonia; Groden, Christoph [University of Heidelberg, Department of Neuroradiology, Universitaetsmedizin Mannheim, Mannheim (Germany)

    2014-09-15

    The objectives of this paper are to assess collateral blood flow in posterior circulation occlusion by MRI-based approaches (fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVHs), collateralization on dynamic 4D angiograms) and investigate its relation to ischemic lesion size and growth. In 28 patients with posterior cerebral artery (PCA) and 10 patients with basilar artery (BA) occlusion, MRI findings were analyzed, with emphasis on distal FVH and collateralization on dynamic 4D angiograms. In PCA occlusion, distal FVH was observed in 18/29 (62.1 %), in BA occlusion, in 8/10 (80 %) cases. Collateralization on dynamic 4D angiograms was graded 1 in 8 (27.6 %) patients, 2 in 1 (3.4 %) patient, 3 in 12 (41.4 %) patients, and 4 in 8 (27.6 %) patients with PCA occlusion and 0 in 1 (10 %) patient, 2 in 3 (30 %) patients, 3 in 1 (10 %) patient, and 4 in 5 (50 %) patients with BA occlusion. FVH grade showed neither correlation with initial or follow-up diffusion-weighted image (DWI) lesion size nor DWI-perfusion-weighted imaging (PWI) mismatch ratio. Collateralization on dynamic 4D angiograms correlated inversely with initial DWI lesion size and moderately with the DWI-(PWI) mismatch ratio. The combination of distal FVH and collateralization grade on dynamic 4D angiograms correlated inversely with initial as well as follow-up DWI lesion size and highly with the DWI-PWI mismatch ratio. In posterior circulation occlusion, FVH is a frequent finding, but its prognostic value is limited. Dynamic 4D angiograms are advantageous to examine and graduate collateral blood flow. The combination of both parameters results in an improved characterization of collateral blood flow and might have prognostic relevance. (orig.)

  17. Transcatheter intraarterial fibrinolysis for arterial occlusions%经导管血管内溶栓治疗急慢性动脉闭塞性疾患

    Institute of Scientific and Technical Information of China (English)

    印建国; 宋锦文; 杨艳; 贾雄; 郑曙光; 张亚琴; 杨炳飞

    2001-01-01

    目的:探讨经导管血管内溶栓治疗的疗效、价值和 方法。方法:6例患者经健侧股动脉穿刺置管,其中1例腹 主 动脉肾动脉平面以下广泛栓塞者,采用肱动脉置管。首先造影明确血栓部位与范围,用导丝或/与导管开辟血栓性“隧道”,充分抽吸血栓物与变性坏死血液后,采用微量泵注入国产 尿激酶50 万U加生理盐水50 ml/3~4 h。结果:腹主动 脉广泛血栓1例,股浅动脉和动脉各2例,外伤性腋动脉1例。除后者外溶通率达100%,平 均溶通时间21.4 h。结论:经导管血管内溶栓治疗,疗效 可靠,方便快捷,是治疗闭塞性血管疾患的首选方法。%Objective:To evaluate the curative effect,value and method of intravascular thrombolysis in the treatment of acute and chro nic arterial thrombotic lesions.Methods:The catheter izations were laid up through the femoral artery on the healthy side in 6 cases .1 case of diffuse thrombosis of the abdominal aorta below the orifice of renal artery,the catheterization through the humeral artery.The arteriography was empl oyed to denote the site and extent of thrombi firstly,then use the guidewire an d /or catheter to create a“tunnel”in the thrombi,and aspirate the blood clots and bloody materials thoroughly and inject urokinase (500 000 units in 50 ml sa line)slowly with micropump in 3-4 h.Results:1 case of diffuse abdominal aortic thrombosis,2 cases of thrombosis of femoral artery and 2 cases of thrombosis of popliteal artery(totally 5 cases)recanalized in 21.4 h (Average).Only 1 case of traumatic thrombosis of axillary artery failed becaus e of severe arterial trauma. Conclusion:Intravascula r thrombolysis might be a good method to treat arterial occlusive disease.

  18. Diagnóstico clínico diferencial entre oclusão da artéria carótida interna e da artéria cerebral média A comparative symptomatological study of internal carotid artery occlusion and middle cerebral artery occlusion

    Directory of Open Access Journals (Sweden)

    Roberto Melaragno

    1971-03-01

    Full Text Available Foi feito um estudo comparativo entre o quadro clínico inicial de 61 casos de oclusão da artéria carótida interna e o de 23 casos de oclusão da artéria cerebral média, diagnosticados pela angiografia cerebral e/ou pela necropsia em pacientes submetidos ou não à cirurgia vascular. Os autores comparam a idade dos pacientes, o sexo, o modo de início da afecção, a existência ou não de convulsões e/ou cefaléias, a ocorrência do acidente cerebral durante o sono ou em vigília, a existência de ictos prévios, os níveis de pressão arterial, o grau de consciência, a força muscular, os achados eletrencefalográficos, a palpação e ausculta das carótidas em nível cervical. Os resultados são demonstrados em índices percentuais, pelos quais os autores inferem que não há significância estatística nesses elementos com três exceções: a maior ocorrência de convulsões nas oclusões da artéria cerebral média em relação às da carótida, a oftalmodinamometria e a sintomatologia carotídea cervical. A oftalmodinamometria revela valores significantemente menores nas pressões da artéria central da retina, no mesmo lado da trombose da carótida em 70,0% dos casos, enquanto que medidas normais e simétricas verificaram-se em todos os casos de oclusão da artéria cerebral média em que o exame foi realizado. No que concerne a sinais arteriais no pescoço, havia anormalidades palpatórias e auscultatórias em 52,4% dos pacientes com trombose da carótida e em 8,6% dos casos com oclusão da cerebral média. Concluem os autores, portanto, que apenas a angiografia cerebral permite um diagnóstico seguro entre ambas as sedes da oclusão.A comparative study of the early clinical picture in 61 cases of internal carotid artery occlusion and 23 cases of middle cerebral artery occlusion, diagnosed by cerebral angiography and/or necropsy in patients who were either submitted to surgery or not operated upon is reported. The authors had

  19. Ischemic preconditioning at a distance: altered gene expression in mouse heart and other organs following brief occlusion of the mesenteric artery.

    Science.gov (United States)

    Huda, Ruksana; Chung, Dai H; Mathru, Mali

    2005-03-01

    Remote ischemic preconditionining (IPC) has been defined as a brief episode of ischemia/reperfusion in an organ that protects another remote organ from the damage induced by subsequent and prolonged ischemia. As yet, no study has been conducted with the purpose of elucidating a precise association between remote IPC and patterns of gene-transcription in cardiac tissue. In this study, using a cDNA microarray, we analyzed the gene expression profile in murine heart at 24h after brief cycles of occlusion of the superior mesenteric artery. The profile revealed that IPC induces significant levels of expression of many genes known to be associated with the stress response, redox regulation, growth and metabolism, DNA repair and other functions. The result of cDNA microarray profile from heart was also compared with those from other organs (lung, kidney and intestine). The genes identified in the expression profile may be associated with remote IPC induced late phase organ protection.

  20. The effects of Tanshinone IIA on blood-brain barrier and brain edema after transient middle cerebral artery occlusion in rats.

    Science.gov (United States)

    Tang, Chao; Xue, Hongli; Bai, Changlin; Fu, Rong; Wu, Anhua

    2010-12-01

    Disruption of blood-brain barrier (BBB) and edema formation play a key role in the development of neurological dysfunction after cerebral ischemia. In this study, the effects of Tanshinone IIA (Tan IIA), one of the active ingredients of Salvia miltiorrhiza root, on the BBB and brain edema after transient middle cerebral artery occlusion in rats were examined. Our study demonstrated that Tan IIA reduced brain infarct area, water content in the ischemic hemisphere. Furthermore, Tan IIA significantly decreased BBB permeability to Evans blue, suppressed the expression of intercellular adhesion molecule-1 (ICAM-1), matrix metalloproteinase-9 (MMP-9), inhibited the degradation of tight junction proteins zonula occludens-1 (ZO-1) and Occludin. These results demonstrated that Tan IIA was effective for attenuating the extent of brain edema formation in response to ischemia injury in rats, partly by Tan IIA's protective effect on the BBB. Our results may have implications in the treatment of brain edema in cerebral ischemia.

  1. Focal brain ischemia in the rat: methods for reproducible neocortical infarction using tandem occlusion of the distal middle cerebral and ipsilateral common carotid arteries.

    Science.gov (United States)

    Brint, S; Jacewicz, M; Kiessling, M; Tanabe, J; Pulsinelli, W

    1988-08-01

    This article describes a 3-year experience with focal neocortical ischemia in three rat strains. Multiple groups of adult Wistar (n = 50), Fisher 344 (n = 31), and spontaneously hypertensive (n = 72) rats were subjected to permanent occlusion of the distal middle cerebral (MCA) and ipsilateral common carotid arteries (CCA). Twenty-four hours later the animals were killed, and frozen brain sections were stained with hematoxylin and eosin to demarcate infarcted tissue. The infarct volume for each section was quantified with an image analyzer, and the total infarct volume was calculated with an iterative program that summed all interval volumes. Neocortical infarct volume was the largest and most reproducible in the spontaneously hypertensive rats (SHR). Statistical power analysis to project the numbers of animals necessary to detect a 25 or 50% change in infarct volume with alpha = 0.05 and beta = 0.2 revealed that only the SHR model was practical in terms of requisite animals: i.e., less than 10 animals per group. Tandem occlusion of the distal MCA and ipsilateral CCA in the SHR strain provides a surgically simple method for causing large neocortical infarcts with reproducible topography and volume. The interanimal variability in infarct volume that occurs even in the SHR strain dictates that randomized, concomitant controls are necessary in each study to ensure the accurate assessment of experimental manipulations or pharmacologic therapies.

  2. Heart ischemia-reperfusion induces local upregulation of vasoconstrictor endothelin receptor type B in rat coronary arteries downstream of occlusion

    DEFF Research Database (Denmark)

    Skovsted, Gry Freja; Kruse, L.S.; Larsen, R;

    2014-01-01

    . However, under pathophysiological conditions ETB receptors may also be expressed in vascular smooth muscle cells mediating vasoconstriction. We aimed to investigate whether vasoconstrictor ETB receptors are upregulated in coronary arteries after experimental myocardial ischemia in rats.......Endothelins act via two receptor subtypes, endothelin receptor type A (ETA ) and type B (ETB ). Under physiological conditions in coronary arteries ETA receptors expressed in smooth muscle cells mediate vasoconstriction whereas ETB receptors mainly found in endothelial cells mediate vasorelaxation...

  3. Earliest effects of sudden occlusions on pressure profiles in selected locations of the human systemic arterial system

    Science.gov (United States)

    Majka, Marcin; Gadda, Giacomo; Taibi, Angelo; Gałązka, Mirosław; Zieliński, Piotr

    2017-03-01

    We have developed a numerical simulation method for predicting the time dependence (wave form) of pressure at any location in the systemic arterial system in humans. The method uses the matlab-Simulink environment. The input data include explicitly the geometry of the arterial tree, treated up to an arbitrary bifurcation level, and the elastic properties of arteries as well as rheological parameters of blood. Thus, the impact of anatomic details of an individual subject can be studied. The method is applied here to reveal the earliest stages of mechanical reaction of the pressure profiles to sudden local blockages (thromboses or embolisms) of selected arteries. The results obtained with a purely passive model provide reference data indispensable for studies of longer-term effects due to neural and humoral mechanisms. The reliability of the results has been checked by comparison of two available sets of anatomic, elastic, and rheological data involving (i) 55 and (ii) 138 arterial segments. The remaining arteries have been replaced with the appropriate resistive elements. Both models are efficient in predicting an overall shift of pressure, whereas the accuracy of the 55-segment model in reproducing the detailed wave forms and stabilization times turns out dependent on the location of the blockage and the observation point.

  4. OCLUSIÓN TOTAL CRÓNICA DEL TRONCO CORONARIO IZQUIERDO Y ESTENOSIS DE LA CORONARIA DERECHA / Chronic total occlusion of the left main coronary artery and right coronary artery stenosis

    Directory of Open Access Journals (Sweden)

    Roberto Bermúdez Yera

    2012-01-01

    Full Text Available ResumenLa estenosis del tronco coronario izquierdo se encuentra entre el 3-5 % de los pacientes a los que se les realiza una coronariografía, pero su oclusión total es rara (0,05-0,1 %. En este artículo presentamos el caso de un paciente de 42 años con oclusión total de este vaso, que presentaba además, una estenosis de 85 % en la arteria coronaria derecha y fue revascularizado quirúrgicamente de forma exitosa. Se implantaron 3 injertos, mamaria a la descendente anterior, y vena safena a una obtusa marginal y a la descendente posterior. Se presentan las imágenes angiográficas y de la cirugía, y se comentan las alternativas terapéuticas, donde lo más importante es individualizar el tratamiento, con el objetivo de brindar la mejor opción a cada paciente en particular. Para lograrlo es imprescindible una excelente relación del equipo de trabajo donde, como en este caso, el cardiólogo intervencionista y el cirujano cardiovascular se complementen, para el bien del paciente. AbstractThe left main coronary artery stenosis is found in 3-5 % of patients who undergo coronary angiography, but total occlusion is rare (0,05-0,1 %. In this article, the case of a 42-year-old patient with chronic total occlusion of the left main coronary artery is presented. This patient, who also had 85 % stenosis of the right coronary artery, was surgically and successfully revascularized. 3 grafts were implanted: mammary artery to the anterior descending artery and saphenous vein to the obtuse marginal and posterior descending artery. The angiographic and surgery images are shown, and treatment options are discussed, where the most important thing is to individualize treatment in order to provide the best option for each patient. It order to achieve this, an excellent team work is essential, in which, as in this case, the interventional cardiologist and cardiovascular surgeon complement each other for the good of the patient.

  5. On the atrophy of the internal carotid artery in capybara.

    Science.gov (United States)

    Steele, Caroline; Fioretto, Emerson T; Sasahara, Tais H C; Guidi, Wanderley L; de Lima, Ana R; Ribeiro, Antonio A C M; Loesch, Andrzej

    2006-12-01

    Capybara might be a useful model for studying changes in cerebral circulation as the natural atrophy of the internal carotid artery (ICA) occurs in this animal at maturation. In this study, confocal and electron microscopy combined with immunohistochemical techniques were applied in order to reveal the changes in morphology and innervation to the proximal part of ICA in young (6-month-old) and mature (12-month-old) capybaras. Some features of the basilar artery (BA) were also revealed. The ICA of young animals degenerated to a ligamentous cord in mature animals. Immunolabelling positive for pan-neuronal marker protein gene product 9.5 but negative for tyrosine hydroxylase was observed in the proximal part of ICA at both ages examined. Axon varicosities positive for synaptophysin were present in the adventitia of ICA of young animals but were absent in the ligamentous cord of mature animals. In the ICA of young animals, adventitial connective tissue invaded the media suggesting that the process of regression of this artery began within the first 6 months of life. An increase in size of the BA was found in mature animals indicating increased blood flow in the vertebro-basilar system, possibly making capybara susceptible to cerebrovascular pathology (e.g. stroke). Capybara may therefore provide a natural model for studying adaptive responses to ICA regression/occlusion.

  6. Endovascular treatment for aorto-bi-iliac artery total occlusive disease%主-双髂动脉全闭塞的介入治疗

    Institute of Scientific and Technical Information of China (English)

    王雪平; 叶炜; 马亮亮; 赫建平; 刘昌伟

    2015-01-01

    Objective To investigate the feasibility, safety and efficiency of endovascular treatment for patients with aorto-bilateral-iliac artery total occlusive disease.Methods A total of 35 patients with aorto-bi-iliac artery total occlusive disease treated with endovascular therapy in Peking Union Medical College Hospital and the First Hospital of Shijiazhuang between Jan 2012 and Dec 2013 were retrospectively analyzed.Results There were 33 males and 2 females, mean age (67 ± 6) years treated during the study period.Technical success rate was 100%.129 bare stents and 4 covered stents were implanted.There were no peri-operative death.Postoperative leg ankle brachial index (ABI) improved significantly (0.86 vs.0.28, P < 0.28).Postoperative complications occurred in 2 patients (5.7%), including brachial artery thrombosis and rupture of external iliac artery post-dilation.The mean follow-up period was 16.5 months (2-28 months).Two patients (5.7%) were lost to follow up.Re-intervention was performed in 3 patients (8.6%) due to reocclusion of the stents.Primary patency was 91% (30/33) Conclusions Endovascular treatment is effective for aorto-bi-iliac artery total occlusive disease with low complications and acceptable mid-term patent rate.%目的 探讨介入治疗主-双髂动脉全闭塞性病变的可行性、安全性及疗效.方法 回顾性分析2012年1月至2013年12月北京协和医院和石家庄市第一医院采用介入治疗主-双髂动脉全闭塞性疾病35例患者的临床资料,评价其治疗的可行性、安全性及近中期疗效.结果 本组35例,男33例,女2例,平均年龄(67 ±6)岁.手术成功率100%,共置入裸支架129枚,覆膜支架4枚.无围手术期死亡,术后下肢踝肱指数(ABI)0.86 ±0.18,较术前0.28 ±0.17明显改善(P<0.001).围手术期并发症2例,肱动脉血栓和髂动脉扩张后破裂各1例,发生率为5.7%.术后随访2 ~ 28个月,平均随访(16.5±2.3)个月,2例(5.7%)失访,3例(8.6%)

  7. Posterior circulation revascularization to manage vertebrobasilar occlusion

    Directory of Open Access Journals (Sweden)

    SHANG Yan-guo

    2012-06-01

    Full Text Available Objective To discuss the technique and effect of posterior circulation revascularization to manage vertebrobasilar occlusion. Methods Nine patients with vertebrobasilar occlusion were treated by using occipital artery-posterior inferior cerebellar artery bypass, superficial temporal artery-superior cerebellar artery bypass, superficial temporal artery-posterior cerebral artery bypass and occipital artery-vertebral artery bypass with radial artery graft. Results Intraoperative indocyanine green angiography showed all the bypass arteries were patent. Postoperative DSA or CTA showed bypass arteries patent in 8 patients, among whom seven patients got obvious improvement on MR or CT perfusion. One patient died of heart failure on the 15th day postoperative. During the follow-up of eight patients, no stroke reoccurred, four patients got back to nearly normal life. Conclusion Most of the patients with vertebrobasilar occlusion could benefit from the posterior circulation revascularization, which should be confirmed by randomized controlled clinical trials in the future.

  8. Endovascular Management of a Combined Subclavian and Vertebral Artery Injury in an Unstable Polytrauma Patient: Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Christian David Weber

    2017-01-01

    Full Text Available While blunt trauma of the head and neck are a common pattern of injury, significant problems related to the prompt diagnosis and optimal management of traumatic artery injuries have been reported in the literature. While patients with major artery injuries might develop hemorrhagic shock very rapidly, patients with blunt cerebrovascular injuries (BCVI can present asymptomatic, but complications like basilar territory infarction, cortical blindness and death may occur. We report the life- and limb-saving management in a 57-year-old hemodynamically unstable trauma patient. The individual developed hemorrhagic shock, and other major complications, including cortical blindness, related to a posterior circulation stroke. Full recovery was achieved by immediate endovascular prosthesis for subclavian artery (SA rupture and stenting of a traumatic vertebral artery occlusion. Endovascular and alternative treatment options are discussed and the management of subsequent sequelae associated with aggressive anticoagulation in trauma patients is reviewed, including intracranial, abdominal and other sites of secondary hemorrhage.

  9. Technical nuances of subtemporal approach for the treatment of basilar tip aneurysm

    Science.gov (United States)

    Nakov, Vladimir S.; Spiriev, Toma Y.; Todorov, Ivan T.; Simeonov, Plamen

    2017-01-01

    Background: Basilar tip aneurysms are one of the most complex vascular lesions to treat surgically because of their location, depth of the approach, and close proximity of vital neurovascular structures such as the mesencephalon, cranial nerves, perforating arteries to the thalamus. There are different surgical approaches utilized to reach basilar tip aneurysms, namely, pterional, pretemporal, orbitozygomatic, subtemporal, and anterior petrosectomy. Each of them has its advantages and limitations. Methods: In this paper, we present our personal experience with the use of subtemporal approach. The technique is described in detail including its nuances and potential pitfalls. Results: The subtemporal approach is indicated for basilar tip aneurysms located at the level of the floor of the sella turcica to 1 cm above the dorsum sellae. Conclusion: Subtemporal approach offers good surgical corridor for the management of these complex vascular lesions. PMID:28217394

  10. Occlusal stability.

    Science.gov (United States)

    Wiens, Jonathan P; Priebe, Jennifer W

    2014-01-01

    Occlusion is the foundation for clinical success in fixed, removable, and implant prosthodontic treatment. Understanding those principles is critical when restoring a patient's occlusion. Many philosophies, devices, and theories of occlusion have evolved based on anecdotal clinical observations and applied geometric perceptions. The literature has reported these classic and contemporary occlusal concepts. As evidence-based dentistry emerged, it championed scrutiny of previously held beliefs, resulting in the abandonment of many pragmatic, yet beneficial occlusal procedures. The impetus toward scientific discovery, whereby factual information might be universally applied in dental education and clinical practice, has renewed interest in occlusal studies.

  11. Basilar invagination, Chiari malformation, syringomyelia: A review

    Directory of Open Access Journals (Sweden)

    Goel Atul

    2009-01-01

    Full Text Available Institute and personal experience (over 25 years of basilar invagination was reviewed. The database of the department included 3300 patients with craniovertebral junction pathology from the year 1951 till date. Patients with basilar invagination were categorized into two groups based on the presence (Group A or absence (Group B of clinical and radiological evidence of instability of the craniovertebral junction. Standard radiological parameters described by Chamberlain were used to assess the instability of the craniovertebral junction. The pathogenesis and clinical features in patients with Group A basilar invagination appeared to be related to mechanical instability, whereas it appeared to be secondary to embryonic dysgenesis in patients with Group B basilar invagination. Treatment by facetal distraction and direct lateral mass fixation can result in restoration of craniovertebral and cervical alignment in patients with Group A basilar invagination. Such a treatment can circumvent the need for transoral or posterior fossa decompression surgery. Foramen magnum bone decompression appears to be a rational surgical treatment for patients having Group B basilar invagination. The division of patients with basilar invagination on the basis of presence or absence of instability provides insight into the pathogenesis of the anomaly and a basis for rational surgical treatment.

  12. Skin perfusion pressure measured by isotope washout in legs with arterial occlusive disease. Evaluation of different tracers, comparison to segmental systolic pressure, angiography and transcutaneous oxygen tension and variations during changes in systemic blood pressure

    DEFF Research Database (Denmark)

    Holstein, P; Trap-Jensen, J; Bagger, H

    1983-01-01

    The skin perfusion pressure (SPP) measured as the isotope washout cessation external pressure is valuable in selection of major amputation level. Five methodological investigations important to clinical use were carried out: (1) In five normal legs and 10 legs with arterial occlusive disease (AOD...... in legs with arterial occlusions at two levels or more; (4) In 47 legs with AOD, the SPP on the calf or on the thigh was compared with transcutaneously measured pO2. The two different methods correlated statistically significant, but the scatter was great; (5) During induced variations in systemic blood...... pressure in seven patients (12 legs with AOD), the segmental SPP and the segmental systolic blood pressure were found on average to vary in proportion with intra-arterial mean and systolic pressure respectively; however, this proportional relationship was not valid for the individual leg. It is concluded...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1987-09-01

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

  14. Efficacy of extracranial-intracranial bypass for progressive middle cerebral artery occlusion associated with active Sjögren's syndrome: case report.

    Science.gov (United States)

    Sakata, Hiroyuki; Fujimura, Miki; Sato, Kenichi; Shimizu, Hiroaki; Tominaga, Teiji

    2014-09-01

    Sjögren syndrome affecting the major cerebral arteries is rare, and an optimal therapeutic strategy to counteract such a lesion has not yet been established. We herein report a case of a 39-year-old woman with a history of primary Sjögren syndrome, which had previously been treated with immunosuppressive therapy, manifesting with a crescendo transient ischemic attack because of left middle cerebral artery stenosis. Despite the administration of high doses of prednisolone and azathioprine for active Sjögren syndrome, the frequency of crescendo transient ischemic attacks increased with the progression of stenosis and magnetic resonance imaging showed the development of subacute cerebral infarction. Single-photon emission computed tomography with N-isopropyl[(123)I]-p-iodoamphetamine revealed apparent hemodynamic compromise in the affected cerebral hemisphere. In light of the increased risk of further progression of cerebral infarction, we decided to perform surgical revascularization in spite of her active inflammatory condition. The patient underwent extracranial-intracranial bypass without complications and was treated with intensive immunosuppressive therapy during the perioperative period. Based on our findings, we recommend surgical revascularization for occlusive cerebrovascular disease with hemodynamic compromise in combination with intensive immunosuppressive therapy, even in the active inflammatory state of autoimmune diseases, if ischemic symptoms are medically uncontrollable.

  15. Persistent trigeminal artery: in situ thrombosis and associated perforating vessel infarction.

    Science.gov (United States)

    Gaughen, John R; Starke, Robert M; Durst, Christopher R; Evans, Avery J; Jensen, Mary E

    2014-06-01

    We report a patient with progressive brainstem infarction despite medical therapy. The patient was transferred to our institution for potential angioplasty of basilar stenosis. Imaging review demonstrated persistent trigeminal artery in situ thrombosis and associated perforating vessel infarction. Persistent trigeminal arteries are commonly associated with an atretic basilar artery and interventional treatment can result in significant morbidity and mortality.

  16. Clinical and imaging characteristics of internal carotid artery occlusion%症状性颈内动脉闭塞的临床及影像学特点

    Institute of Scientific and Technical Information of China (English)

    尚慧; 王雁; 侯桂英

    2013-01-01

    目的 分析颈内动脉闭塞(internal carotid artery occlusion,ICAO)后的临床和影像学特点.方法 分析85例ICAO患者的临床表现与合并其它脑血管狭窄及是否建立侧支循环的关系;比较经颅多普勒超声(transcranial doppler,TCD)、磁共振血管造影(magnetic resonance angiography,MRA)与数字减影血管造影(digital subtractive angiography,DSA)对侧支循环动脉的显示率.结果 ICAO后最常见的临床表现是肢体无力,重症患者多合并其他脑血管狭窄或闭塞,侧支循环建立不完善.后交通动脉(posterior communicating artery,PCoA)显示率MRA高于TCD(P <0.05);眼动脉(ophthalmic artery,OA)显示率TCD高于MRA(P<0.01);TCD联合MRA对侧支动脉的显示率与DSA比较无统计学差异(P>0.05).结论 ICAO患者的临床症状转归与是否合并其它脑血管狭窄及是否建立侧支循环有密切的关系.TCD与MRA能够很好地显示ICAO后颅内脑血管血流动力学变化和侧支循环状态,可替代或减少有创性DSA的使用.

  17. Comparison of drug eluting stent implantation with coronary artery bypass surgery in the treatment of patients with chronic total occlusion and multiple vessel disease

    Institute of Scientific and Technical Information of China (English)

    LIU Wei; ZHU Xiao-Ling; MA Chang-sheng; KANG Jun-ping; DU Xin; CHEN Fang; ZHOU Yu-jie; L(U) Shu-zheng; HUANG Fang-jiong; GU Cheng-xiong

    2011-01-01

    Background In patients with chronic total occlusion (CTO) and multivessel coronary artery disease, the comparison of surgical and the percutaneous revascularization strategies has rarely been conducted. The aim of this study was to compare long term clinical outcomes of drug eluting stent (DES) implantation with coronary artery bypass surgery (CABG)in the patients with CTO and multivessel disease.Methods From a prospective registry of 6000 patients in our institution, we included patients with CTO and multivessel coronary artery disease who underwent either CABG (n=679) or DES (n=267) treatment. Their propensity risk score was used for adjusting baseline differences.Results At a median follow-up of three years, propensity score adjusted Cox regression analysis showed that the rate of major adverse cardiac cerebrovascular events (MACCE) was lower in CABG group (12.7% vs. 24.3%, hazard ratio (HR) 1.969, 95% Cl 1.219-3.179, P=0.006) mainly due to lower rate of target vessel revascularization in CABG group than in DES group (3.1% vs. 17.2%, HR 16.14, 95% CI 5.739-45.391, P <0.001). The incidence of cardiac death or myocardial infarction (composite end point) was not significantly different between these two groups. On multivariate analysis, the significant predictors of MACCE were only the type of revascularization. Age, left ventricular ejection fraction (LVEF), and complete revascularization were identified as significant predictors of composite end points.Conclusions Our study shows that in patients with CTO and multivessel coronary disease, DES can offer comparable long term outcomes in cardiac death and myocardial infraction free survival in comparison with CABG. However, there is an increased rate of MACCE which results from more repeat revascularizations. Obtaining a complete revascularization is crucial for decreasing adverse cardiac events.

  18. Alternative Techniques for Treatment of Complex Below-the Knee Arterial Occlusions in Diabetic Patients With Critical Limb Ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Gandini, Roberto [IRCCS Policlinico di Tor Vergata, Department of Diagnostic Imaging, Interventional Radiology, Radiotherapy, and Nuclear Medicine (Italy); Uccioli, Luigi [IRCCS Policlinico di Tor Vergata, Department of Internal Medicine (Italy); Spinelli, Alessio; Del Giudice, Costantino, E-mail: costantino.delgiudice@yahoo.it; Ros, Valerio Da; Volpi, Tommaso [IRCCS Policlinico di Tor Vergata, Department of Diagnostic Imaging, Interventional Radiology, Radiotherapy, and Nuclear Medicine (Italy); Meloni, Marco [IRCCS Policlinico di Tor Vergata, Department of Internal Medicine (Italy); Simonetti, Giovanni [IRCCS Policlinico di Tor Vergata, Department of Diagnostic Imaging, Interventional Radiology, Radiotherapy, and Nuclear Medicine (Italy)

    2013-02-15

    The purpose of this study was to describe alternative endovascular (EV) techniques and assess their feasibility and efficacy in minimizing failure rates in limb salvage for the treatment of complex below-the knee (BTK) occlusions that could not be crossed with a conventional antegrade access. Between December 2007 and November 2010, 1,035 patients (557 male) underwent EV treatment for critical limb ischemia in our institution. In 124 (12% [83 male], mean age 68.2 {+-} 0.5 years) patients, transfemoral antegrade revascularization attempt failed, and an alternative approach was used. Follow-up was performed at 1 and 6 months. Results were compared with 56 patients treated between November 2002 and November 2007, in whom conventional technique was unsuccessful and unconventional techniques were not adopted. Technical success was achieved in 119 (96%) patients. The limb-salvage rates were 96.8% and 83% at 1- and 6-month follow-up, respectively. Sixteen (12.9%) and 33 (26.6%) patients underwent reintervention at 1- and 6-month follow-up, respectively. Transcutaneous oxygen tension increased at 1 month (44.7 {+-} 1.1 vs. 15.7 {+-} 0.8 mmHg; p < 0.001) and remained stable at follow-up. Twenty (16.1%) patients required major amputation. Thirteen (10.4%) patients died during follow-up. In our previous experience, percutaneous transluminal angioplasty failure, amputation, and death rates were 10.9, 39.2, and 23.2%, respectively. Alternative techniques allowed a significant decrease of major amputation and death rates (p = 0.0001 and p = 0.02, respectively). The use of alternative techniques seems feasible in case of a failed antegrade BTK revascularization attempt and could minimize failure rates in the treatment of complex occlusions while providing satisfying clinical success rates at 6 months.

  19. Effects of coronary artery occlusion and reperfusion on cardiac cycle-dependent variation of myocardial ultrasonic backscatter

    Energy Technology Data Exchange (ETDEWEB)

    Glueck, R.M.; Mottley, J.G.; Miller, J.G.; Sobel, B.E.; Perez, J.E.

    1985-05-01

    We have recently reported a systematic variation in integrated ultrasonic backscatter throughout the cardiac cycle in canine hearts. This study was performed to determine whether the pattern of such variation is modified systematically by ischemia. Measurements of integrated ultrasonic backscatter in selected regions of normal, ischemic, and reperfused hearts were compared in view of known differences in systolic function of myocardium in each of these regions. Integrated ultrasonic backscatter (3-7 MHz) gated to the first derivative of left ventricular pressure was measured at the apex, midwall, and base in 10 dogs and at the apex before and during transient ischemia and reperfusion in four dogs. Quantitative integrated ultrasonic backscatter was referenced to a steel reflector. Cyclic variation of integrated ultrasonic backscatter was greatest at the apex (peak to trough variation 5.5 +/- 0.9 dB (mean +/- SE)) with the maximum near end diastole (-52.9 +/- 0.9 dB) and minimum near end systole (-58.4 +/- 1.0 dB). Variation at the apex (5.5 +/- 0.9 dB) and the midwall (4.3 +/- 0.8 dB) was greater than at the base (0.5 +/- 1.0 dB) (P less than 0.01 for either region compared with base). Left anterior descending coronary occlusion for 10 minutes in four of 10 dogs reduced variation at the apex to 0.4 +/- 1.5 dB (P less than 0.02 compared with preocclusion). Reperfusion for 2 hours restored apical cyclic variation to 3.9 +/- 1.7 dB, i.e., to values not significantly different from those before occlusion.

  20. Altered expression of connexin43 and its possible role in endothelin - 1 - induced contraction in rabbit basilar artery%缝隙连接蛋白43在内皮素诱导的脑基底动脉收缩中的表达变化

    Institute of Scientific and Technical Information of China (English)

    赵万巨; 王海涛; 洪涛

    2011-01-01

    目的 探讨Cx43在内皮素诱导的脑基底动脉收缩中的表达变化及其可能的作用.方法 血管环张力实验检测内皮素诱导的脑基底动脉的收缩变化并应用Western blot检测基底动脉Cx43蛋白的表达变化,染料传输实验用来检测脑基底动脉收缩过程中平滑肌细胞间缝隙连接的功能变化.结果 浓度递增的内皮素导致脑基底动脉呈显著浓度依赖性的收缩,一定浓度缝隙连接阻断剂苷珀酸显著缓解该收缩;收缩过程中,Cx43的蛋白表达呈显著时间依赖性的升高,苷珀酸减弱该表达的升高;内皮素刺激下,血管平滑肌细胞间的染料传输呈时间依赖性的升高,苷珀酸显著减少染料在细胞间的传输.结论 脑血管痉挛过程中,通过增加Cx43的表达,血管细胞间缝隙连接的功能被内皮素激活并在血管痉挛病理过程中发挥重要作用;抑制缝隙连接的功能是有效缓解蛛网膜下腔出血后脑血管痉挛的新途径.%Objective To investigate the role of connexin43 in ET- 1 -induced contraction in rabbit basilar artery.Methods The ET - 1 - induced contraction without or with carbenoxolone was studied with an isometric tension system.The expression of connexin43 protein in ET - t stimulated basilar arteries was studied with Western blot.Scrape/scratch method was used to analyze the function of gap junction in cultured rabbit cerebrovascular smooth muscle ceils.Results ET - 1 produced a concentration - dependent contraction.Carbenoxolone inhibited ET- 1 induced contraction.The connexin43 protein level was increased in ET- 1stimulated basilar arteries.Carbenoxolone decreased the connexin43 protein level increased by ET - 1.Cells treated with ET - 1 appeared positive communication and the dye transfer was increased in a time - dependent fashion.Carbenoxolone suppressed the ET - 1 - induced increasement of dye transfer.Conclusions The enhancement of gap junction intercellular communication is

  1. Exploration of the relationship between the enhanecment degree and location of basilar artery plaque and infar ction with MRI3D-SPACE%MRI3D-SPACE探讨基底动脉斑块位置和增强度与梗死的关系

    Institute of Scientific and Technical Information of China (English)

    张红梅; 孙雪园; 陈新; 牛琰鑫

    2016-01-01

    目的 应用3T MRI(3T magnetic resonance imaging, MRI),三维快速自旋回波(3D sampling perfection with ap-plication-optimized contrasts using different flip angle evolutions , 3D-SPACE)序列显示症状性动脉粥样硬化患者基底动脉管壁硬化斑块,通过斑块形态学特征及增强度,评估其与梗死的关系. 方法 103例症状性后循环缺血患者行3D-SPACE序列扫描,测量基底动脉斑块及邻近正常脑灰质信号强度,二者得出基底动脉斑块相对增强度,且划分为:轻度强化(1%~10%)、中度强化(10%~100%)、明显强化(100%以上);研究急性联合亚急性梗死(A组)、慢性及无梗死(B组)与基底动脉斑块相对增强度的关系. DWI图像评估有无近期梗死灶. 结果 100例有症状患者纳入统计,急性梗死46例、亚急性梗死26例 、慢性期梗死15 例、无梗死13 例. 梗死部位包括脑干、桥臂、小脑半球、枕叶、中脑、丘脑及延髓. 3 D-SPACE序列能多角度显示基底动脉斑块,偏心性斑块70例,且斑块位于基底动脉腹侧壁更易发生梗死;斑块相对增强度>100%更易发生梗死;急性联合亚急性梗死( A组)、慢性及无梗死( B组)两组之间斑块增强度比较存在差异;在脑梗死分期时斑块明显强化与轻度强化、中度强化之间有统计学意义( P值100%).Then, the relationship between both acute joint subacute infarction (group A), chronic and no infarction (group B) with basilar artery plaque enhancement degree was studied .DWI image was used to assess whether the recent infarcts occurred or not .Results Of those 100 patients who were included in the statistics , 46 were suffered from acute infarction , 26 from subacute infarction , and 15 from chronic infarction , and 13had no infarction .The infarct parts included the brain stem , bridge arm, cerebellum, occipital lobe, the midbrain and hypothalamus and medulla oblon -gata.3 D-SPACE sequence can display the basal artery plaque with multi

  2. What is the optimal duration of middle-cerebral artery occlusion consistently resulting in isolated cortical selective neuronal loss in the spontaneously hypertensive rat?

    Directory of Open Access Journals (Sweden)

    Sohail eEjaz

    2015-03-01

    Full Text Available Introduction and Objectives: Selective neuronal loss (SNL in the reperfused penumbra may impact clinical recovery and is thus important to investigate. Brief proximal middle cerebral artery occlusion (MCAo results in predominantly striatal SNL, yet cortical damage is more relevant given its behavioral implications and that thrombolytic therapy mainly rescues the cortex. Distal temporary MCAo (tMCAo does target the cortex, but the optimal occlusion duration that results in isolated SNL has not been determined. In the present study we assessed different distal tMCAo durations looking for consistently pure SNL.Methods: Microclip distal tMCAo (md-tMCAo was performed in ~6-month old male spontaneously hypertensive rats (SHRs. We previously reported that 45min md-tMCAo in SHRs results in pan-necrosis in the majority of subjects. Accordingly, three shorter MCAo durations were investigated here in decremental succession, namely 30, 22 and 15mins (n=3, 3 and 7 subjects, respectively. Recanalization was confirmed by MR angiography just prior to brain collection at 28 days and T2-weighted MRI was obtained for characterization of ischemic lesions. NeuN, OX42 and GFAP immunohistochemistry appraised changes in neurons, microglia and astrocytes, respectively. Ischemic lesions were categorized into three main types: 1 pan-necrosis; 2 partial infarction; and 3 SNL. Results: Pan-necrosis or partial infarction was present in all 30min and 22min subjects, but not in the 15min group (p < 0.001, in which isolated cortical SNL was consistently present. MRI revealed characteristic hyperintense abnormalities in all rats with pan-necrosis or partial infarction, but no change in any 15min subject. Conclusions: We found that 15min distal MCAo consistently resulted in pure cortical SNL, whereas durations equal or longer than 22min consistently resulted in infarcts. This model may be of use to study the pathophysiology of cortical SNL and its prevention by appropriate

  3. Stent placement for chronic iliac arterial occlusive disease: the results of 10 years experience in a single institution

    Energy Technology Data Exchange (ETDEWEB)

    Park, Kwang Bo; Do, Young Soo; Kim, Dong Ik; Kim, Duk Kyung; Kim, Young Wook; Shin, Sung Wook; Cho, Sung Ki; Choo, Sung Wook; Choe, Yeon Heyon; Choo, In Wook [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, Jae Hyung; Han, Yoon Hee [Inje Univ., Kimhae (Korea, Republic of)

    2005-12-15

    We wanted to retrospectively evaluate the long-term therapeutic results of iliac arterial stent placement that was done in a single institution for 10 years. From May 1994 to April 2004, 206 patients who underwent iliac arterial stent placement (mean age; 64 {+-} 8.8) were followed up for evaluating the long term stent patency. Combined or subsequent bypass surgery was performed in 72 patients. The follow up period ranged from one month to 120 months (mean; 31 {+-} 25.2 months). The factors that were analyzed for their effect on the patency of stents were age, the stent type and diameter, the lesion site, lesion shape, lesion length, the Societ