Management of Extracranial Carotid Artery Aneurysm

NARCIS (Netherlands)

Welleweerd, J. C.; den Ruijter, H. M.; Nelissen, B. G. L.; Bots, M. L.; Kappelle, L. J.; Rinkel, G. J. E.; Moll, F. L.; de Borst, G. J.

Introduction: Aneurysms of the extracranial carotid artery (ECAA) are rare. Several treatments have been developed over the last 20 years, yet the preferred method to treat ECAA remains unknown. This paper is a review of all available literature on the risk of complications and long-term outcome

Craniocervical artery dissection: MR imaging and MR angiographic findings

International Nuclear Information System (INIS)

Oelerich, M.; Schuierer, G.; Stoegbauer, F.; Kurlemann, G.; Schul, C.

1999-01-01

Dissection of the carotid and vertebral arteries is a not so uncommon cause of stroke and has to be considered as a differential diagnosis especially in younger patients. Therapeutic and prognostic implications are different from those in extracranial atherosclerotic disease. Dissection results from hemorrhage into the vessel wall usually between the layers of the media. Digital subtraction angiography (DSA) depicts the resulting luminal compromise that may reveal some typical, but not specific, findings. The same is true for non-invasive angiographic techniques such as time-of-flight magnetic resonance angiography (MRA) and computed tomography angiography (CTA), which have shown accurate results compared with DSA. The main advantage of these techniques is the direct visualization of the vessel wall confirming the intramural hematoma. This is achieved best with MR imaging due to the high signal of blood degradation products on T1- and T2-weighted images. Therefore, MRI in combination with MRA is presently the method of choice for initial diagnosis and follow-up of craniocervical artery dissection (CCAD). In some questionable cases, CTA is a non-invasive alternative that is independent of flow phenomena. (orig.)

Craniocervical artery dissection: MR imaging and MR angiographic findings

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Oelerich, M.; Schuierer, G. [Institute of Clinical Radiology, University of Muenster (Germany); Stoegbauer, F. [Department of Neurology, University of Muenster (Germany); Kurlemann, G. [Department of Pediatric Neurology, University of Muenster (Germany); Schul, C. [Department of Neurosurgery, University of Muenster (Germany)

1999-09-01

Dissection of the carotid and vertebral arteries is a not so uncommon cause of stroke and has to be considered as a differential diagnosis especially in younger patients. Therapeutic and prognostic implications are different from those in extracranial atherosclerotic disease. Dissection results from hemorrhage into the vessel wall usually between the layers of the media. Digital subtraction angiography (DSA) depicts the resulting luminal compromise that may reveal some typical, but not specific, findings. The same is true for non-invasive angiographic techniques such as time-of-flight magnetic resonance angiography (MRA) and computed tomography angiography (CTA), which have shown accurate results compared with DSA. The main advantage of these techniques is the direct visualization of the vessel wall confirming the intramural hematoma. This is achieved best with MR imaging due to the high signal of blood degradation products on T1- and T2-weighted images. Therefore, MRI in combination with MRA is presently the method of choice for initial diagnosis and follow-up of craniocervical artery dissection (CCAD). In some questionable cases, CTA is a non-invasive alternative that is independent of flow phenomena. (orig.) With 6 figs., 2 tabs., 33 refs.

Magnetic resonance angiography of the extracranial carotid and vertebral arteries

International Nuclear Information System (INIS)

Akimura, Tatsuo; Saito, Kenichi; Nakayama, Hisato; Kashiwagi, Shiro; Kato, Shoichi; Ito, Haruhide.

1994-01-01

To evaluate the contribution of magnetic resonance angiography (MRA) in the screening study of the extracranial carotid and vertebral arteries using the conventional head and neck coils, 500 consecutive MRAs of the cervical vessels were performed using 1.5 tesla magnetic resonance unit with circularly polarized head coil. The 5 cm-thick imaging plane was placed in coronal fashion including both carotid and vertebral arteries. The imaging sequence was three-dimensional (3D) fast imaging with steady precession (FISP). In 10 patients with failed head coil examination, 10 patients with possible carotid and vertebral diseases and 10 volunteers, the extracranial carotid and vertebral arteries were examined with the Helmholtz neck coil. Both 3D- and 2D-FISP were performed in each case. The imaging plane was placed in oblique sagittal fashion. In 458 out of 500 cases (91.6%), the extracranial carotid and vertebral arteries were successfully depicted using head coil. In 20 patients with high shoulders, the carotid bifurcations were out of range of the head coil. In these cases, carotid bifurcations and the origins of the carotid and vertebral arteries were successfully revealed using a neck coil. To evaluate the stenotic lesions and tortuous vessels, 2D-FISP sequence seemed to be more suitable than 3D-FISP. Compared with conventional angiography, MRA caused overestimation of the degree of stenotic lesions. For screening examination of the extracranial carotid and vertebral arteries, most cases can be evaluated only with the conventional head coil. If depiction of the carotid bifurcation fails and the examination of carotids or vertebrals down to the aortic arch is needed, neck coil examination is required. (author)

Magnetic resonance angiography of intracranial and extracranial arteries in patients with spontaneous migraine without aura

DEFF Research Database (Denmark)

Amin, Faisal Mohammad; Asghar, Mohammad Sohail; Hougaard, Anders

2013-01-01

Extracranial arterial dilatation has been hypothesised to be the cause of pain in patients who have migraine without aura. To test that hypothesis, we aimed to measure extracranial and intracranial arteries during attacks of migraine without aura....

Classical surgical approach and treatment with clips of extracranial internal carotid artery berry aneurysm

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Haris Vukas

2016-06-01

Full Text Available Introduction: We can define extracranial carotid artery aneurysm (ECAA as bulb dilatation greater than 200% of the diameter of the internal carotid artery (ICA or in a case of common carotid artery (CCA greater than 150% of the diameter. Surgical intervention is required for the treatment of this disease.Case report: This study presents an open vascular surgical procedure to resolve ECAA. We report a case of 61 years old woman with an extracranial internal carotid artery berry aneurysm, presented with a headache and dizziness when turning the head aside. Classic open surgery was performed and the lumen of berry aneurysm was separated with three clips from the lumen of ICA.Conclusions: The open surgical approach is the method of choice for the treatment of extracranial internal carotid artery pathological conditions.

MDCT angiography of the major congenital anomalies of the extracranial arteries: pictorial review

International Nuclear Information System (INIS)

Saade, Charbel; Bourne, Roger; Brennan, Patrick C.; Wilkinson, Mark

2013-01-01

Multidetector computed tomographic angiography is becoming the modality of choice for evaluation of the supra-aortic circulation in acute stroke imaging. Variations of the supra-aortic circulation, in particular of the extracranial arteries, are common. This article aims to provide a pictorial description of the variant anatomy of the aortic arch and extracranial arteries. Knowledge of the presence and clinical relevance of normal variants such as anomalies, duplications and embryological persistence plays a clinically relevant role in the diagnosis and management of neurological and surgical conditions, particularly as we enter an era of increasing extracranial intervention.

Doppler changes of extracranial cerebral and peripheral arteries in cardiovascular diseases

International Nuclear Information System (INIS)

Dichev, P.

1995-01-01

In recent years Doppler sonography has been approved as a valuable noninvasive method for identification of the extracranial vascular obturations. On the other hand obturational pathology of the extracranial arteries have often been associated with different cardiovascular diseases, and this requires perfect awareness of blood flow changes in the latter. The current study considers the specific flow changes in extracranial cerebral arteries in patients with ischemic heart disease (III-IV) (functional grade - FG - NYHA), and those with concomitant congestive heart failure (III-IV FG), as compared to healthy subjects. In the patients with ischemic heart disease without heart failure the changes are not as significant as compared to healthy subjects (p<0.1). Congestive heart failure is related to significant changes in some of the Doppler parameters. In the last stage of congestive heart failure spectral waveform of the internal carotid arteries also changes. Additionally the changes of spectral waveform of the carotid arteries in different heart diseases are represented: Idiopathic Subvalvular Aortic Stenosis, Valvular Aortic Stenosis and Regurgitation, Supravalvular Aortic Stenosis, Aortic Coarctation, Patent Ductus Botalli, Orthostatismus, Tamponade. Some of the changes are very specific and the Doppler technique would be useful for diagnosis of these diseases. 7 refs., 12 figs. (author)

Intracranial cerebral artery stenosis with associated coronary artery and extracranial carotid artery stenosis in Turkish patients

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Alkan, Ozlem [Department of Radiology, Baskent University, Faculty of Medicine, Ankara (Turkey)], E-mail: yalinozlem@hotmail.com; Kizilkilic, Osman; Yildirim, Tulin [Department of Radiology, Baskent University, Faculty of Medicine, Ankara (Turkey); Atalay, Hakan [Department of Cardiovascular Surgery, Baskent University, Faculty of Medicine, Ankara (Turkey)

2009-09-15

Purpose: Although it has been demonstrated that there is a high prevalence of extracranial carotid artery stenosis (ECAS) in patients with severe coronary artery disease, intracranial cerebral artery stenosis (ICAS) is rarely mentioned. We evaluated the prevalence of ICAS in patients with ECAS having elective coronary artery bypass grafting (CABG) surgery to determine the relations between ICAS, ECAS and atherosclerotic risk factors. Methods: We retrospectively reviewed the digital subtraction angiography findings of 183 patients with ECAS {>=} 50% preparing for CABG surgery. The analyses focused on the intracranial or extracranial location and degree of the stenosis. The degree of extracranial stenoses were categorized as normal, <50%, 50-69%, 70-89%, and 90-99% stenosis and occluded. The degree of intracranial stenosis was classified as normal or {<=}25%, 25-49%, and {>=}50% stenosis and occluded. Traditional atherosclerotic risk factors were recorded. Results: ECAS < 70% in 42 patients and ECAS {>=} 70% in 141 patients. ICAS was found in 51 patients and ICAS {>=} 50% in 30 patients. Regarding risk factors, we found hypertension in 135 patients, diabetes mellitus in 91 patients, hyperlipidemia in 84 patients, and smoking in 81 patients. No risk factor was significant predictors of intracranial atherosclerosis. The severity of ICAS was not significantly associated with that of the ECAS. Conclusions: We found ICAS in 27.8% of the patients with ECAS > 50% on digital subtraction angiography preparing for CABG. Therefore a complete evaluation of the neck vessels with magnetic resonance or catheter angiography seems to be indicated as well as intracranial circulation for the risk assessment of CABG.

Atheromatous extracranial carotid arteries: CT evaluation correlated with arteriography and pathologic examination

International Nuclear Information System (INIS)

Leeson, M.D.; Cacayorin, E.D.; Iliya, A.R.; Hodge, C.J.; Culebras, A.; Collins, G.H.; Kieffer, S.A.

1985-01-01

Dynamic, rapid sequence, axial computed tomography (CT) was employed to evaluate the extracranial common and internal carotid arteries in 17 patients with clinical histories suggesting recent or remote ischemia in the territory supplied by the internal carotid artery. The CT findings were correlated with arteriographic observations and with gross and histologic evaluations of endarterectomy specimens. Areas of arterial wall thickening were evaluated on CT scans with regard to both degree of thickening and radiographic density (attenuation). The degree of vessel wall thickening secondary to atheromatous plaque demonstrated on CT scans corresponded closely to the severity of luminal compromise seen on arteriograms. While arteriography provides information regarding the status of the arterial lumen, CT offers the potential of accurate characterization of pathologic changes in the wall of the extracranial carotid arteries in patients with symptoms of cerebral ischemia

Treatment of a spontaneous intracranial dissecting aneurysm with stent-assisted coil embolization

International Nuclear Information System (INIS)

Irie, Keiko; Negoro, Makoto; Hayakawa, Motoharu; Hayashi, Junichi; Kanno, Tetsuo

2003-01-01

Arterial dissection is now recognized as an important cause of stroke. Most reported dissections involve the extracranial portion of the internal carotid artery (ICA) and vertebral arteries. Spontaneous dissecting aneurysms of the intracranial ICA are uncommon. Endovascular treatment for cerebral aneurysms has become widespread; however, the dissecting aneurysm is still difficult to treat if the parent artery has to be preserved. More recently, stenting has been advocated for use with endosaccular coiling, with the coils held in place by the stent. We herein report a spontaneous intracranial ICA dissecting aneurysm in a 51-year-old woman who was treated using a new technique of combined stent and coils. (orig.)

Headache characteristics of uncomplicated intracranial vertebral artery dissection and validation of ICHD-3 beta diagnostic criteria for headache attributed to intracranial artery dissection.

Science.gov (United States)

Kim, Jae-Gyum; Choi, Jeong-Yoon; Kim, Sung Un; Jung, Jin-Man; Kwon, Do-Young; Park, Moon Ho; Oh, Kyungmi

2015-05-01

Headache may be a warning sign of subsequent stroke in patients with vertebral artery dissection (VAD). Even though the headache characteristics of VAD have been described predominantly in patients with extracranial VAD and neurological complications, headache semiology is not well known in patients with uncomplicated intracranial vertebral artery dissection (ICVAD). In the present study, we attempt to identify the headache semiology that characterizes ICVAD and validate the revised version of the International Classification of Headache Disorders (ICHD-3 beta) criteria for headache attributed to intracranial artery dissection. Six patients with neurologically uncomplicated ICVAD presented at a participating medical center, and eight similar patients were reviewed in the literature. Combining these data, we analyzed headache characteristics of patients with uncomplicated ICVAD according to their pain onset and duration, nature, intensity, location, aggravating and relieving factors, associated symptoms, response to medication, and prognosis. Headache in uncomplicated ICVAD usually has an acute mode of onset (11/14) and persistent (10/14) temporal feature. Pain that has a throbbing quality (nine of 14) and severe intensity (13/14) on the ipsilesional (10/14) and occipitonuchal area (12/14) is a headache prototype in ICVAD. Additionally, headache was intensified by head flexion and rotation (three of six), and relieved by head extension and supine positioning (five of six). Headache of all patients in the present study fulfilled the ICHD-3 beta criteria. Headache semiology of uncomplicated ICVAD is mostly homogenous in the present study. These characteristics may be helpful in the diagnosis of uncomplicated ICVAD. © International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Stroke prevention by endovascular treatment of carotid and vertebral artery dissections.

Science.gov (United States)

Moon, Karam; Albuquerque, Felipe C; Cole, Tyler; Gross, Bradley A; McDougall, Cameron G

2017-10-01

Endovascular intervention for cervical carotid artery dissection (CAD) and vertebral artery dissection (VAD) may be indicated in specific circumstances. To review our institutional experience with endovascular treatment of cervical dissections over the past 20 years to examine indications for treatment, interventional methods, and outcomes. Retrospective review of a prospectively maintained database to identify patients with extracranial dissection who underwent endovascular intervention between January 1996 and January 2016. Demographic data and details of procedures, outcomes, and complications were extracted. Of 116 patients [93 CAD, 23 VAD; mean age 44.9 years (range 5-76 years)], 104 underwent stent placement; 11, coil occlusion of the parent artery; and 1, stenting with contralateral vessel occlusion. The cohorts were well matched for age, sex, dissection etiology, and admission and follow-up modified Rankin Scale (mRS) scores. Patients with CAD had significantly more stent placements (p<0.001), failure of medical therapy (p=0.004), and interventions for enlarging pseudoaneurysms (p=0.01) or thromboembolic events (p=0.004). Patients with VAD had significantly more interventions for traumatic occlusion with recanalization (p<0.001). Dissections were spontaneous (n=67), traumatic (n=36), or iatrogenic (n=13). Traumatic dissections in patients with CAD were associated with poor admission mRS scores (p=0.01). Six of 67 (9.0%) patients with spontaneous dissection reported recent chiropractic manipulation. Mean follow-up was 3.5 years (range 1-146 months). Permanent morbidity/mortality was 3.4%, including two deaths. Over a follow-up period of 364 patient-years, 1 stroke occurred (0.27% per year). At last follow-up, 41 previously disabled patients [CAD, 31/93 (33.3%); VAD, 10/23 (43.5%)] were no longer disabled; no patient reported worsened disability. Patients with CAD and VAD differ significantly in presentation, indications for treatment, and treatment

A case of carotid dissection having significant benefit from thrombolytic treatment

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Sibel Güler

2016-01-01

Full Text Available Ischemic stroke due to carotid artery dissection is more common among young people and it accounts about 2-5% of all strokes. A 56 year old left landed male patient was evaluated for left-sided hemiparesis and aphasia in the emergency department. His cranial CT was assessed normal and NIH score was assessed 24 then he undergone thrombolytic therapy. His NIH score was decreased to 14 after 24 hours. At extracranial dupplex USG, cranial MRI and MR-Angiography, done the same day there were findings for carotid dissection. At MR-anjio repeated 5 days later, partial recanalization were seen. At control cranial CT only striocapsüler infarct was seen. There was no any evidence of bleeding as complication. Here we present a rare case of extracranial carotid artery dissection case undergone IV thrombolytic therapy and want to take attention that in carotid dissection IV thrombolytic therapy is quiet safe and there is no difference of complication such as hemorrhage and the prognosis is no different then those with no carotid dissection.

Cervicocephalic arterial dissection

International Nuclear Information System (INIS)

Suyama, Kazuhiko; Hayashi, Kentaro; Nagata, Izumi

2008-01-01

The authors review the clinical and neuroradiological features of cervicocephalic arterial dissection, which is occasionally seen in young adults, with special reference to the differences in the region of occurrence of these lesions between patients in Western countries and Japan. In Western countries, the cervical internal carotid artery is the most common site of occurrence of these lesions; however, in Japan, these lesions have been frequently reported to occure in the intracranial vertebral artery. Most clinical manifestations of cervical arterial dissection are non-hemorrhagic events such as headaches associated with arterial dissection or cerebral ischemia caused by a distal embolism following thrombus formation in the cervical lesion. On the other hand, a subarachnoid hemorrhage and cerebral infarction are frequently observed in intracranial arterial dissections. Non-invasive procedures, including MR imaging, are useful for demonstrating characteristic features of this condition such as the presence of an intimal flap or a double lumen, and for monitoring the chronological changes in the lesions, which may regress spontaneously. Since the pathological mechanisms underlying the progression and/or the regression of this condition are still unknown, the clinical evidence indicating the optimal therapeutic strategies has not yet been reported. Nevertheless, conservative therapy, including antithrombotic treatment, is widely used for the treatment of non-hemorrhagic lesions, which generally results in good clinical outcomes. Further, surgical intervention is essential for the treatment of lesions with a subarachnoid hemorrhage to prevent fatal rebleeding, and it is also required for the treatment of certain non-hemorrhagic lesions. Recent advancements in surgical procedures, especially endovascular treatments, may therefore be helpful in the management of similar complicated vascular conditions. (author)

Vascular Pathology in the Extracranial Vertebral Arteries in Patients with Acute Ischemic Stroke

DEFF Research Database (Denmark)

Bentsen, L; Nygård, A; Ovesen, C

2014-01-01

INTRODUCTION: Vascular pathology in the extracranial vertebral arteries remains among the possible causes in cryptogenic stroke. However, the diagnosis is challenged by the great variety in the anatomy of the vertebral arteries, clinical symptoms and difficulties in the radiological assessments....... The aim of this study was to assess the prevalence of CT angiography (CTA)-detected pathological findings in the extracranial vertebral arteries in an acute stroke population and secondly to determine the frequency of posterior pathology as probable cause in patients with otherwise cryptogenic stroke....... METHOD: The analysis was based on 657 consecutive patients with symptoms of acute stroke and a final diagnosis of ischemic stroke or transient ischemic attack. On admission, a noncontrast CT cerebrum and CTA were performed. A senior consultant neuroradiologist, blinded to clinical data, reviewed all CTA...

Arterial occlusion to treat basilar artery dissecting aneurysm

NARCIS (Netherlands)

Cui, Qing Ke; Liu, Wei Dong; Liu, Peng; Li, Xue Yuan; Zhang, Lian Qun; Ma, Long Jia; Ren, Yun Fei; Wu, Ya Ping; Wang, Zhi Gang

2015-01-01

Object: To explore the clinical feasibility of employing occlusion to treat basilar artery dissecting aneurysm. Methods: One patient, male and 46 years old, suffered transient numbness and weakness on the right limbs. Cerebral angiography indicated basilar artery dissecting aneurysm. The patient

Vertebrocarotid collateral in extracranial carotid artery occlusions: digital subtraction angiography findings

International Nuclear Information System (INIS)

Oguzkurt, Levent; Kizilkilic, Osman; Tercan, Fahri; Tuerkoez, Riza; Yildirim, Tuelin

2005-01-01

The internal and external carotid arteries are usually considered occluded distal to a common carotid artery occlusion but some collateral vessels may provide blood keeping the internal and external carotid arteries patent distal to the occlusion. Most common communication in such a case is diversion of blood from muscular branches of the vertebral artery to occipital branch of the external carotid artery which in turn could maintain blood flow into the internal carotid artery, a condition called carotid steal. We encountered vertebrocarotid anastomoses maintaining the patency of carotid circulation in six patients. Patients were four females and two males, ages ranging from 40 to 67 (mean age: 56) years. Five of the patients had ischemic cerebral symptoms. The origin of the external carotid artery was occluded in two and the whole common carotid artery in the remaining four patients. Two patients had double steal, carotid and subclavian at the same time. There was also severe stenosis or occlusion of at least one other major extracranial cerebral artery in all the cases. This concomitant involvement of the second extracranial cerebral artery was thought to be the main reason for the development of vertebrocarotid collateral. In contrast to most of the previously published reports claiming the inadequacy of angiography when compared with colour Doppler ultrasonography, angiography finely depicted the distal patency of the carotid circulation and all the collaterals in detail in every case. Selective injection of the vertebral artery ipsilateral to the occlusion, is the key to demonstrate distal patency of the carotid circulation in cases of proximal carotid occlusion. Demonstration of patency of the distal circulation is very important because some of the patients might get benefit from a reconstructive surgery

Vertebrocarotid collateral in extracranial carotid artery occlusions: digital subtraction angiography findings

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Oguzkurt, Levent; Kizilkilic, Osman; Tercan, Fahri; Tuerkoez, Riza; Yildirim, Tuelin

2005-02-01

The internal and external carotid arteries are usually considered occluded distal to a common carotid artery occlusion but some collateral vessels may provide blood keeping the internal and external carotid arteries patent distal to the occlusion. Most common communication in such a case is diversion of blood from muscular branches of the vertebral artery to occipital branch of the external carotid artery which in turn could maintain blood flow into the internal carotid artery, a condition called carotid steal. We encountered vertebrocarotid anastomoses maintaining the patency of carotid circulation in six patients. Patients were four females and two males, ages ranging from 40 to 67 (mean age: 56) years. Five of the patients had ischemic cerebral symptoms. The origin of the external carotid artery was occluded in two and the whole common carotid artery in the remaining four patients. Two patients had double steal, carotid and subclavian at the same time. There was also severe stenosis or occlusion of at least one other major extracranial cerebral artery in all the cases. This concomitant involvement of the second extracranial cerebral artery was thought to be the main reason for the development of vertebrocarotid collateral. In contrast to most of the previously published reports claiming the inadequacy of angiography when compared with colour Doppler ultrasonography, angiography finely depicted the distal patency of the carotid circulation and all the collaterals in detail in every case. Selective injection of the vertebral artery ipsilateral to the occlusion, is the key to demonstrate distal patency of the carotid circulation in cases of proximal carotid occlusion. Demonstration of patency of the distal circulation is very important because some of the patients might get benefit from a reconstructive surgery.

Acute headache and persistent headache attributed to cervical artery dissection

DEFF Research Database (Denmark)

Schytz, Henrik W; Ashina, Messoud; Magyari, Melinda

2014-01-01

for Headache or facial or neck pain attributed to cervical carotid or vertebral artery dissection or Headache attributed to intracranial arterial dissection. Six months after dissection five of 19 patients still reported persistent headache attributed to dissection. The study demonstrates that the ICHD......The criteria for headache attributed to cervical artery dissection have been changed in the new third edition of the International Classification of Headache Disorders (ICHD-III beta). We have retrospectively investigated 19 patients diagnosed from 2001 to 2006 with cervical artery dissection......-III beta criteria for cervical artery dissection are useful for classifying patients at the first encounter. We show for the first time that persistent headache attributed to arterial dissection is frequent....

Cervical artery dissection following a turbulent flight.

LENUS (Irish Health Repository)

Quinn, Colin

2012-01-31

BACKGROUND: Cervical artery dissection is a common cause of stroke in young patients without vascular risk factors and may affect the carotid or vertebral arteries. The risk of spontaneous dissection is higher in those with genetic predisposing factors while other cases may be precipitated by an event involving head or neck movement or associated with direct neck trauma. CASE REPORT: We present the case of a previously well young woman with a history of migraine who developed internal carotid artery dissection following a turbulent short-haul commercial flight while restrained using a seatbelt. DISCUSSION: We propose that repetitive flexion-hyperextension neck movements encountered during the flight were the most likely precipitant of carotid artery dissection in this case and review the therapeutic options available.

Recurrent post-partum coronary artery dissection

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Resnic Frederic S

2010-10-01

Full Text Available Abstract Coronary artery dissection is a rare but well-described cause for myocardial infarction during the post-partum period. Dissection of multiple coronary arteries is even less frequent. Here we present a case of recurrent post-partum coronary artery dissections. This unusual presentation poses unique problems for management. A 35 year-old female, gravida 3 para 2, presented with myocardial infarction 9 weeks and 3 days post-partum. Cardiac catheterization demonstrated left anterior descending (LAD dissection but an otherwise normal coronary anatomy. The lesion was treated with four everolimus eluting stents. Initially the patient made an unremarkable recovery until ventricular fibrillation arrest occurred on the following day. Unsynchronized cardioversion restored a normal sinus rhythm and repeat catheterization revealed new right coronary artery (RCA dissection. A wire was passed distally, but it was unclear whether this was through the true or false lumen and no stents could be placed. However, improvement of distal RCA perfusion was noted on angiogram. Despite failure of interventional therapy the patient was therefore treated conservatively. Early operation after myocardial infarction has a significantly elevated risk of mortality and the initial dissection had occurred within 24 hours. This strategy proved successful as follow-up transthoracic echocardiography after four months demonstrated a preserved left ventricular ejection fraction of 55-60% without regional wall motion abnormalities. The patient remained asymptomatic from a cardiac point of view.

Extracranial internal carotid artery aneurysm: case illustration

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Zenteno Marco

2017-12-01

Full Text Available Extracranial internal carotid artery aneurysms (EICAA are uncommon lesion. These aneurysms can be classified as true or false aneurysms, atherosclerotic, dysplastic, infectious, posttraumatic and iatrogenic aneurysms. The most common presentation is central neurologic dysfunction, either a stroke or a transient ischemic attack. The rupture of these aneurysms can lead to severely impairment and can affect the quality of life of the patients or even may lead to death. Management of these lesions is required in most cases to prevent complications, however there is no treatment guideline or expert consensus for the management. We present a case of an unusual EICAA, associated with kinking of the affected vessel and review the literature.

Hybrid endovascular and surgical approach for mycotic pseudoaneurysms of the extracranial internal carotid artery

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Daniela Mazzaccaro

2014-11-01

Full Text Available Objectives: Mycotic pseudoaneurysms of the extracranial internal carotid artery are rare, and their management often represents a challenge, but treatment is necessary due to the high risk of rupture and distal brain embolization. Systemic antibiotics associated with open surgical excision of the infected tissues and carotid reconstruction using autologous grafts are the treatment of choice. The use of endovascular techniques still remains controversial in infective fields; however, it can be an attractive alternative in high-risk patients or more often as a “temporary” solution to achieve immediate bleeding control for a safe surgical reconstruction. Methods: We discuss the unusual case of an extracranial right internal carotid artery mycotic pseudoaneurysm following methicillin-resistant Staphylococcus aureus infection, in a patient with poor general conditions. Results and Conclusion: The lesion was successfully treated using a hybrid endovascular and surgical procedure.

Rare Presentation of Left Lower Lobe Pulmonary Artery Dissection

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René Hako

2017-01-01

Full Text Available Background. Pulmonary arterial dissection with chronic pulmonary arterial hypertension as its major cause is a very rare but life-threatening condition. In most cases the main pulmonary trunk is the affected site usually without involvement of its branches. Segmental or lobar pulmonary artery dissection is extremely rare. Case Presentation. We report a unique case of left lower lobe pulmonary artery dissection in a 70-year-old male, with confirmed chronic pulmonary hypertension. To confirm dissection MDCT pulmonary angiography was used. Multiplanar reformation (MPR images in sagittal, coronal, oblique sagittal, and curved projections were generated. This case report presents morphologic CT features of rare chronic left lobar pulmonary artery dissection associated with chronic pulmonary hypertension at a place of localised pulmonary artery calcification. CT pulmonary angiography excluded signs of thromboembolism and potential motion or flow artefacts. Conclusion. To the best of our knowledge, no case of lower lobe pulmonary artery dissection with flap calcification has been reported yet. CT imaging of the chest is a key diagnostic tool that is able to detect an intimal flap and a false lumen within the pulmonary arterial tree and is preferred in differential diagnosis of rare complications of sustained pulmonary arterial hypertension.

Late sequelae of whiplash injury with dissection of cervical arteries.

Science.gov (United States)

Hauser, Vital; Zangger, Peter; Winter, Yaroslav; Oertel, Wolfgang; Kesselring, Jürg

2010-01-01

The objective of our study was to estimate the incidence of posttraumatic dissections of cervical arteries in patients with whiplash injury acquired in a car accident. We performed a retrospective analysis of medical records of 500 patients with whiplash injury acquired in car accidents between 1996 and 2005 and searched for dissections of cervical arteries occurring within 12 months after injury. Eight cases of cervical arterial dissection occurred within 12 months following whiplash injury. In 7 cases (87.5%), the dissection was complicated by brain infarction. The incidence of posttraumatic dissections after whiplash injuries was much higher than the overall incidence of cervical arterial dissections in the general population (1.6 vs. 0.0041%). The risk of cerebrovascular events was still increased 4-12 months after whiplash injury (0.6 vs. 0.003075% in the general population). There is an increased risk of posttraumatic dissection and cerebrovascular events within 12 months after whiplash injury. Car accident is an important risk factor for arterial dissections. The victims of car accidents should be screened for arterial dissections. The results of this study should be more thoroughly investigated in a prospective trial of car accident victims as a risk factor for arterial dissections. Copyright © 2010 S. Karger AG, Basel.

Association between internal carotid artery dissection and arterial tortuosity

International Nuclear Information System (INIS)

Saba, Luca; Piga, Mario; Argiolas, Giovanni Maria; Siotto, Paolo; Sumer, Suna; Wintermark, Max; Raz, Eytan; Sanfilippo, Roberto; Montisci, Roberto

2015-01-01

Carotid artery dissection is an important cause of ischemic stroke in all age groups, particularly in young patients. The purpose of this work was to assess whether there is an association between the presence of an internal carotid artery dissection (ICAD) and the arterial tortuosity. This study considered 124 patients (72 males and 52 females; median age 57 years) with CT/MR diagnosis of ICAD of the internal carotid artery were considered in this multi-centric retrospective study. The arterial tortuosity was evaluated and, when present, was categorized as elongation, kinking, or coiling. For each patient, both the right and left sides were considered for a total number of 248 arteries in order to have the same number of cases and controls. Fisher's exact test was applied to test the association between elongation, kinking, coiling, dissection, and the side affected by CAD. Fisher's exact test showed a statistically significant association between the ICAD and kinking (p = 0.0089) and coiling (p = 0.0251) whereas no statistically significant difference was found with arterial vessel elongation (p = 0.444). ICAD was more often seen on the left side compared to the right (p = 0.0001). These results were confirmed using both carotid arteries of the same patient as dependent parameter with p = 0.0012, 0.0129, and 0.3323 for kinking, coiling, and elongation, respectively. The presence of kinking and coiling is associated with ICAD. (orig.)

Association between internal carotid artery dissection and arterial tortuosity

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Saba, Luca; Piga, Mario [Azienda Ospedaliero Universitaria (A.O.U.), Department of Radiology, Monserrato, Cagliari (Italy); Argiolas, Giovanni Maria; Siotto, Paolo [Azienda Ospedaliero Brotzu (A.O.B.), Department of Radiology, di Cagliari (Italy); Sumer, Suna; Wintermark, Max [Neuroradiology Division, Neuroradiology, UVA Department of Radiology, Charlottesville, VA (United States); Raz, Eytan [New York University School of Medicine, Department of Radiology, New York, NY (United States); Sapienza University of Rome, Department of Neurology and Psychiatry, Rome (Italy); Sanfilippo, Roberto; Montisci, Roberto [Azienda Ospedaliero Universitaria (A.O.U.), Department of Vascular Surgery, di Cagliari (Italy)

2014-10-18

Carotid artery dissection is an important cause of ischemic stroke in all age groups, particularly in young patients. The purpose of this work was to assess whether there is an association between the presence of an internal carotid artery dissection (ICAD) and the arterial tortuosity. This study considered 124 patients (72 males and 52 females; median age 57 years) with CT/MR diagnosis of ICAD of the internal carotid artery were considered in this multi-centric retrospective study. The arterial tortuosity was evaluated and, when present, was categorized as elongation, kinking, or coiling. For each patient, both the right and left sides were considered for a total number of 248 arteries in order to have the same number of cases and controls. Fisher's exact test was applied to test the association between elongation, kinking, coiling, dissection, and the side affected by CAD. Fisher's exact test showed a statistically significant association between the ICAD and kinking (p = 0.0089) and coiling (p = 0.0251) whereas no statistically significant difference was found with arterial vessel elongation (p = 0.444). ICAD was more often seen on the left side compared to the right (p = 0.0001). These results were confirmed using both carotid arteries of the same patient as dependent parameter with p = 0.0012, 0.0129, and 0.3323 for kinking, coiling, and elongation, respectively. The presence of kinking and coiling is associated with ICAD. (orig.)

Self-limiting Spontaneous Isolated Celiac Artery Dissection: A Case Report

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A.D. Morzycki

Full Text Available : Introduction: Isolated dissection of the celiac artery is rare, with less then 100 cases reported to date. Although some patients present with epigastric pain and tenderness, many cases are asymptomatic and found incidentally on CT. The appropriate management of isolated celiac artery dissections is unclear. This report illustrates an observational approach to a symptomatic case of isolated celiac artery dissection. Report: A 55-year-old Caucassian male presented to the emergency department with epigastric pain. His Initial CT revealed possible celiac artery dissection with associated intramural hematoma. Due to continued pain, a subsequent CTA was ordered. This scan showed progression of the intramural hematoma to near occlusion of the hepatic artery. Despite this, there were no signs of ischemic hepatitis as indicated by normal levels of liver transaminases. There was also no evidence to suggest propagation of the dissection or pseudo-aneurysm formation. We therefore choose a conservative and observational approach to this isolated celiac artery dissection. His dissection was managed with ASA and metoprolol, and he was discharged after 1 week of observation. 3 week follow-up CTA showed spontaneous resolution of the intramural hematoma and improved patency of the hepatic artery. There was no change at 3 months follow-up. Conclusion: This case highlights that an observational approach to cases of isolated celiac artery dissection may be indicated if there is no evident end organ disease or malperfusion. Keywords: Celiac artery, Dissection, Management

Reconstruction of Traumatic External Iliac Artery Dissection Due to Vascular Clamping.

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Kırnap, Mahir; Özçelik, Ümit; Akdur, Aydıncan; Ayvazoğlu Soy, Ebru H; Işıklar, İclal; Yarbuğ Karakayalı, Feza; Moray, Gökhan; Haberal, Mehmet

2017-10-31

Traumatic external iliac artery dissection after renal transplant is a rare complication, but it should be urgently managed due to its devastating effects on graft and lower limb circulation. External iliac artery dissection is seen more in recipients with diabetes mellitus and comorbid disease. Recipients with external iliac artery dissection should be treated immediately by percutaneus angioplasty or surgical reconstruction. In this study, we reported the management of 2 kidney transplant cases with external iliac artery dissection due to vascular clamping of the artery. External iliac artery dissection was diagnosed by ultrasonography in both cases. After failed percutaneous interventional angioplasty, we reconstructed the external iliac artery dissection surgically and replaced the external iliac artery with polytetra-fluoroethylene grafts in both patients. Both patients were discharged with normal functioning grafts showing 0.9 and 0.8 mg/dL serum creatinine levels at month 3 posttransplant. Close monitoring of recipients after transplant is mandatory for early diagnosis and early management of external iliac artery dissection to prevent graft loss and preserve lower limb circulation. Routine Doppler ultrasonography is an inexpensive and useful tool for early diagnosis in cases of sudden cessation or decrease in urine. In cases of failed percutaneous interventional angioplasty, reconstruction with synthetic vascular grafts can be safely applied in external iliac artery dissection.

CrossFit-related cervical internal carotid artery dissection.

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Lu, Albert; Shen, Peter; Lee, Paul; Dahlin, Brian; Waldau, Ben; Nidecker, Anna E; Nundkumar, Anoop; Bobinski, Matthew

2015-08-01

CrossFit is a high-intensity strength and conditioning program that has gained popularity over the past decade. Potential injuries associated with CrossFit training have been suggested in past reports. We report three cases of cervical carotid dissection that are associated with CrossFit workouts. Patient 1 suffered a distal cervical internal carotid artery (ICA) dissection near the skull base and a small infarct in Wernicke's area. He was placed on anticoagulation and on follow-up has near complete recovery. Patient 2 suffered a proximal cervical ICA dissection that led to arterial occlusion and recurrent middle cerebral artery territory infarcts and significant neurological sequelae. Patient 3 had a skull base ICA dissection that led to a partial Horner's syndrome but no cerebral infarct. While direct causality cannot be proven, intense CrossFit workouts may have led to the ICA dissections in these patients.

Warfarin-induced Primary Dissection of Lower Peripheral Arteries: A Case Report

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Lee, Jae A; You, He Chul; Han, Young Min; Kwak, Hyo Sung [Chonbuk National University Hospital and Medical School, Jeonju (Korea, Republic of)

2010-12-15

Primary dissection of a peripheral artery without involvement of the aorta is a rare entity. Warfarin is currently used as the standard oral anticoagulant in a variety of clinical settings. We report here on a case of focal dissection of the common iliac artery and the superficial femoral artery following prophylactic treatment with warfarin for a prosthetic heart valve. The patient's laboratory results showed a high international normalized ratio and prolongation of the activated partial thromboplastin time. Angiography showed a dissection of the left common iliac artery and the right superficial femoral artery. His symptoms immediately disappeared after deploying stents to the arterial dissections

Warfarin-induced Primary Dissection of Lower Peripheral Arteries: A Case Report

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Lee, Jae A; You, He Chul; Han, Young Min; Kwak, Hyo Sung

2010-01-01

Primary dissection of a peripheral artery without involvement of the aorta is a rare entity. Warfarin is currently used as the standard oral anticoagulant in a variety of clinical settings. We report here on a case of focal dissection of the common iliac artery and the superficial femoral artery following prophylactic treatment with warfarin for a prosthetic heart valve. The patient's laboratory results showed a high international normalized ratio and prolongation of the activated partial thromboplastin time. Angiography showed a dissection of the left common iliac artery and the right superficial femoral artery. His symptoms immediately disappeared after deploying stents to the arterial dissections

Long term outcome of ruptured vertebrobasilar artery dissection treated non-surgically

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Nakano, Takahiro; Ohkuma, Hiroki; Shimamura, Norihito; Munakata, Akira; Kikkawa, Tomoshige

2010-01-01

Vertebrobasilar artery dissection began to attract attention as a cause of subarachnoid hemorrhage (SAH) in the late 1970s. Although reports on this disease have gradually increased, the natural history of vertebrobasilar artery dissection remains obscure, and long-term follow-up of patients without surgical treatment is necessary to determine appropriate treatment. We describe the long-term clinical course of ruptured vertebrobasilar artery dissection treated non-surgically. Fourteen subjects with ruptured vertebrobasilar artery dissection were treated conservatively in 7 neurosurgical departments. We reviewed their clinical outcomes, image findings and the chronological changes at the dissection site from their charts. The modified Rankin Scale was Grade 0 in 13 of 14 cases, and Grade 2 in 1 case. The configuration of dissection did not change during the follow-up period in 12 of 14 cases, but occlusion and restoration were recognized in a single case each. Good prognosis was common in the patients with ruptured vertebrobasilar artery dissection who were treated non-surgically. It is essential to accumulate more data on the clinical course and changes in image findings of long-term survival cases to establish a definite strategy for ruptured vertebrobasilar artery dissection. (author)

Clinical and radiological evaluation in vertebral artery dissections

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Murat Çabalar

2013-04-01

Full Text Available In recent years, vertebral artery dissection (VAD is reported more frequently as a cause of young cerebrovascular accidents. It can occur spontaneously or following a neck manipulation and trauma. The patients were 3 females (mean age: 35±26 years and 7 males (mean age: 37.71±4.96 years. Only 2 patients described neck trauma. Cerebellar findings were prominent in all cases. On radiological investigation, vascular changes of vertebral arteries were detected bilaterally in 2 cases, right in 5 and left in 3 cases. All the cases were treated with anticoagulant therapy and cured but 1 with sequela. Prognosis of vertebral artery dissection is generally good by early diagnosis and treatment. In this article, we reported clinical and radiological properties of 10 vertebral artery dissection cases.

Pulmonary Artery Dissection: A Fatal Complication of Pulmonary Hypertension

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Chuanchen Zhang

2016-01-01

Full Text Available Pulmonary artery dissection is extremely rare but it is a really life-threatening condition when it happens. Most patients die suddenly from major bleeding or tamponade caused by direct rupture into mediastinum or retrograde into the pericardial sac. What we are reporting is a rare case of a 46-year-old female patient whose pulmonary artery dissection involves both the pulmonary valve and right pulmonary artery. The patient had acute chest pain and severe dyspnea, and the diagnosis of pulmonary artery dissection was confirmed by ultrasonography and CT angiography. Moreover, its etiology, clinical manifestations, and management are also discussed in this article.

Asymptomatic Extracranial Artery Stenosis and the Risk of Cardiovascular and Cerebrovascular Diseases

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Wang, Dandan; Wang, Jing; Jin, Cheng; Ji, Ruijun; Wang, Anxin; Li, Xin; Gao, Xiang; Wu, Shouling; Zhou, Yong; Zhao, Xingquan

2016-01-01

Asymptomatic extracranial artery stenosis (ECAS) is a well-known risk factor for stroke events, but it remains unclear whether it has the same role in predicting cardiovascular and cerebrovascular diseases, especially in China. We investigated the potential associations between ECAS, carotid plaque and carotid intima-media thickness and the new occurrence of cardiovascular and cerebrovascular diseases in the study. Out of 5440 study participants, 364 showed an asymptomatic ECAS at baseline, a...

Sharp Dissection versus Electrocautery for Radial Artery Harvesting

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Marzban, Mehrab; Arya, Reza; Mandegar, Mohammad Hossein; Karimi, Abbas Ali; Abbasi, Kiomars; Movahed, Namvar; Abbasi, Seyed Hesameddin

2006-01-01

Radial arteries have been increasingly used during the last decade as conduits for coronary artery revascularization. Although various harvesting techniques have been described, there has been little comparative study of arterial damage and patency. A radial artery graft was used in 44 consecutive patients, who were randomly divided into 2 groups. In the 1st group, the radial artery was harvested by sharp dissection and in the 2nd, by electrocautery. These groups were compared with regard to radial artery free flow, harvest time, number of clips used, complications, and endothelial damage. Radial artery free flow before and after intraluminal administration of papaverine was significantly greater in the electrocautery group (84.3 ± 50.7 mL/min and 109.7 ± 68.5 mL/min) than in the sharp-dissection group (52.9 ± 18.3 mL/min and 69.6 ± 28.2 mL/ min) (P =0.003). Harvesting time by electrocautery was significantly shorter (25.4 ± 4.3 min vs 34.4 ± 5.9 min) (P =0.0001). Electrocautery consumed an average of 9.76 clips, versus 22.45 clips consumed by sharp dissection. The 2 groups were not different regarding postoperative complications, except for 3 cases of temporary paresthesia of the thumb in the electrocautery group; histopathologic examination found no endothelial damage. We conclude that radial artery harvesting by electrocautery is faster and more economical than harvesting by sharp dissection and is associated with better intraoperative flow and good preservation of endothelial integrity. PMID:16572861

Individualized management for intracranial vertebral artery dissecting aneurysms

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SHANG Yan-guo

2012-02-01

Full Text Available Objective To discuss the individualized management strategy for intracranial vertebral artery dissecting aneurysms. Methods Eighteen patients with intracranial vertebral artery dissecting aneurysms were treated with different surgical methods. Results Eighteen patients underwent different surgical treatment. Five patients underwent complete occlusion of the aneurysm and parent artery by coiling, 5 were treated by stent -assisted coiling (3 densely packed coiling and 2 non-densely packed coiling, 4 underwent stent-only therapy and 3 of them presented hemodynamic improvement after surgery, 3 were treated by direct surgical clipping, and 1 underwent occipital artery-posterior inferior cerebellar artery bypass. Two aneurysms ruptured immaturely, in which one patient died on the third day after operation and one patient occurred moderate disablity. Only 1 patient who underwent complete occlusion of aneurysm and parent artery presented temporarily ischemic symptoms. No adverse effects were seen in other patients. Seventeen patients were followed up for 1 month to 3 years, and all the aneurysms were stable. Conclusion There are many kinds of therapeutic methods for intracranial vertebral artery dissecting aneurysms. The patients should be treated according to several factors such as the clinical manifestations, aneurysm configuration, and relationship with the posterior inferior cerebellar artery. The treatment should be individualized.

Vertebral basilar artery dissections

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Zimmerman, R.A.; Bilaniuk, L.T.; Hackney, D.B.; Grossman, R.I.; Goldberg, H.I.; Atlas, S.W.

1988-01-01

Eleven patients (ten male, one female; range, 2-56 years) presented with posterior circulation ischemic symptoms and were evaluated with computed tomography (CT) (eta=11), arteriography (eta=11), and magnetic resonance (MR) imaging (eta=6). Angiography showed dissection of a vertebral artery (eta=8), a basilar artery (eta=1), or a combination of both (eta=2). On CT and/or MR images, infarctions were demonstrated in ten of 11 cases. Most frequently involved were the thalmus (eta=7), cerebellum (eta=6), occipital lobes (eta=4), and pons (eta=3). The site of infarction did not correlate with the side or site of angiographic abnormality. In six cases evaluated by all modalities, MR imaging showed more extensive and widespread infarction than did CT and also showed whether or not the infarcts were hemorrhagic. MR imaging was able to demonstrate the presence of intramural dissecting hematoma prior to angiography and to indicate whether or not flow was reconstituted on follow-up examination

Vertebral Artery Dissection Causing Stroke After Trampoline Use.

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Casserly, Courtney S; Lim, Rodrick K; Prasad, Asuri Narayan

2015-11-01

The aim of this study was to report a case of a 4-year-old boy who had been playing on the trampoline and presented to the emergency department (ED) with vomiting and ataxia, and had a vertebral artery dissection with subsequent posterior circulation infarcts. This study is a chart review. The patient presented to the emergency department with a 4-day history of vomiting and gait unsteadiness. A computed tomography scan of his head revealed multiple left cerebellar infarcts. Subsequent magnetic resonance imaging/magnetic resonance angiogram of his head and neck demonstrated multiple infarcts involving the left cerebellum, bilateral thalami, and left occipital lobe. A computed tomography angiogram confirmed the presence of a left vertebral artery dissection. Vertebral artery dissection is a relatively common cause of stroke in the pediatric age group. Trampoline use has been associated with significant risk of injury to the head and neck. Patients who are small and/or young are most at risk. In this case, minor trauma secondary to trampoline use could be a possible mechanism for vertebral artery dissection and subsequent strokes. The association in this case warrants careful consideration because trampoline use could pose a significant risk to pediatric users.

Spontaneous Dissection of the Superior Mesenteric Artery

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Sheldon, Patrick J.; Esther, James B.; Sheldon, Elana L.; Sparks, Steven R.; Brophy, David P.; Oglevie, Steven B.

2001-01-01

Spontaneous dissection of the superior mesenteric artery (SMA) is a rare occurrence, especially when not associated with aortic dissection. Currently, only 28 cases appear to have been reported. Due to the scarcity of cases in the literature, the natural history of isolated, spontaneous SMA dissection is unclear. CT has been reported to be useful for the initial diagnosis of SMA dissection [2-5]. We present two recent cases of spontaneous SMA dissection in which enhanced spiral CT was instrumental in following the disease process and guiding clinical decision making

Acute and chronic dissection of pulmonary artery: new challenges in pulmonary arterial hypertension?

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Florczyk, Michał; Wieteska, Maria; Kurzyna, Marcin; Gościniak, Piotr; Pepke-Żaba, Joanna; Biederman, Andrzej; Torbicki, Adam

2018-01-01

Right ventricular failure is a leading cause of mortality in patients with pulmonary arterial hypertension (PAH). However, up to 25% of such patients die unexpectedly, without warning signs of hemodynamical decompensation. We previously documented that pulmonary artery (PA) dilatation significantly increases the risk of those deaths. Some of them may be due to dissection of PA resulting in cardiac tamponade. However, direct confirmation of this mechanism is difficult as most of such deaths occur outside hospitals. We present 4 patients with severe PAH and PA dilatation in whom PA dissection has been confirmed. Three patients had IPAH, one had PAH associated with congenital heart disease. All patients had mean pulmonary artery pressure (PAP) > 50 mmHg at diagnosis and dissection occurred late in the course of apparently well controlled disease (6 to 14 years). Several clinical elements were common to our patients - high systolic PAP, long lasting PH, progressive dilatation of PA to more than 50 mm with chest pain prior to dissection. However, clinical course followed three different patterns: sudden death due to cardiac tamponade, hemopericarditis caused by blood leaking from dissected aneurysm with imminent but not immediate cardiac tamponade, or chronic asymptomatic PA dissection. Indeed, two of our patients are alive and on lung transplantation waiting list for more than 2 years now. Further research is needed to suggest optimal management strategies for patients with stable PAH but significantly dilated proximal pulmonary arteries or confirmed PA dissection depending on the clinical presentation and expected outcome.

Fatal Intraventricular Hemorrhage After the Extracranial Carotid Artery Angioplasty and Stent Placement

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Krajickova, Dagmar; Krajina, Antonin; Nova, Marketa; Raupach, Jan

2005-01-01

We report on a 72-year-old female with an unusual intracranial bleeding complication after an extracranial carotid artery stenting procedure performed for a tight left ICA stenosis associated with contralateral carotid occlusion. Two hours after the procedure, the initial signs of intracranial bleeding appeared that led to the patient's demise 5 days later. A brain CT showed and autopsy proved massive intraventricular bleeding. To our knowledge, our case is only the second report of isolated reperfusion intraventricular hemorrhage post-CAS

Juvenile Stroke: Cervical Artery Dissection in a Patient after a Polytrauma

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Nicole Marschner-Preuth

2013-01-01

Full Text Available Dissections of the cervical arteries cause about 20% of total juvenile strokes. Approximately 4% of the carotid artery dissections are due to a (polytrauma such as car accidents. Despite improved diagnostic facilities, traumatic dissections are often underdiagnosed or diagnosed too late due to a lack of awareness of potential initial signs and symptoms.We report here a case of a delayed embolic stroke after a car accident caused by a dissection of the carotid artery and subsequent pseudoaneurysm.To reduce the long-term morbidity or mortality of multiple trauma patients, an early detection of cervical carotid and vertebral dissections is strictly necessary.

Cervical artery dissection: early recognition and stroke prevention [digest].

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Cadena, Rhonda; Kim, Jeremy

2016-07-22

Cervical artery dissections involve the carotid or vertebral arteries. Although the overall incidence is low, they remain a common cause of stroke in children, young adults, and trauma patients. Symptoms such as headache, neck pain, and dizziness are commonly seen in the emergency department, but may not be apparent in the obtunded trauma patient. A missed diagnosis of cervical artery dissection can result in devastating neurological sequelae, so emergency clinicians must act quickly to recognize this event and begin treatment as soon as possible while neurological consultation is obtained. This issue reviews the evidence in applying advanced screening criteria and choosing imaging and antithrombotic treatment strategies for patients with cervical artery dissections to reduce the occurrence of ischemic stroke. [Points & Pearls is a digest of Emergency Medicine Practice].

Cervical Artery Dissection and Choosing Appropriate Therapy.

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Lau, Jonathan T; Hunt, John S; Bruner, David I; Austin, Andrea L

2017-08-01

Cervical artery dissection is a common cause of stroke in young adults. This may result from head and neck trauma; it can also occur spontaneously or secondary to genetic connective tissue or vascular disorders. Neurologic symptoms arise as a result of thromboembolism and hypoperfusion causing cerebral ischemia. We present a case of a previously healthy male who was found to have a cervical internal carotid artery dissection and the decision to use antiplatelet therapy instead of anticoagulation to prevent stroke. Data is lacking regarding the efficacy of one therapy over the other.

Cervical Artery Dissection and Choosing Appropriate Therapy

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Jonathan T. Lau

2017-07-01

Full Text Available Cervical artery dissection is a common cause of stroke in young adults. This may result from head and neck trauma; it can also occur spontaneously or secondary to genetic connective tissue or vascular disorders. Neurologic symptoms arise as a result of thromboembolism and hypoperfusion causing cerebral ischemia. We present a case of a previously healthy male who was found to have a cervical internal carotid artery dissection and the decision to use antiplatelet therapy instead of anticoagulation to prevent stroke. Data is lacking regarding the efficacy of one therapy over the other.

Dolichoectasia and dissection of the intracranial vertebrobasilar artery

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Stoyanov, D.; Boshnjakovich, P.; Zivkovic, M.

2001-01-01

The purpose is to determine the clinical neuro-radiological features of dolichoectatic intracranial vertebrobasilar artery dissection. The clinical features native and post-contrast CT scans of five patients (4 men and 1 woman; age ranged from 25 to 68 years) with dolichoectatic intracranial vertebrobasilar artery dissection were analysed retrospectively for a period of 3 years. Diagnosis was confirmed by vertebral angiography. Clinical symptoms due to ischemic cerebellar and/or brain stem lesion were present in 4 patient, 2 of them had Wallenberg syndrome. Occipital and/or posterior neck pains were found in 4 patients. Subarachnoid hemorrhage was shown in 1 patient. The incidence of previously documented hypertension was 60% (3 of 5 patients). The prognosis was relatively good. Dolichoectasia was detected by native, post-contrast CT scans and reconstructions in all patients. Intimal flap was visualized with post contrast CT scans in 1 patients. Extension of the basilar artery tip into the third ventricle was detected in 3 patients. Ischemic low-density lesions were detected in 3 patients and subarachnoid hemorrhage in 1 patient. Vertebral angiography disclosed elongation and dilatation of the vertebral and basilar arteries, double lumen sign - the presence of a true and false lumen and an intimal flap, double density and retention of contrast medium. Ischemic symptoms and head and/or neck pain were the most common clinical findings. The double lumen sign considered as the only pathognomonic angiographic finding of arterial dissection, was found in all patients. Angiography is still considered the 'gold standard' for diagnosis of intracranial vertebrobasilar artery dissection. (author)

Spontaneous Coronary Artery Dissection following Topical Hormone Replacement Therapy

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Alexander L. Pan

2012-01-01

Full Text Available Spontaneous coronary artery dissection is a rare condition, usually presenting as an acute coronary syndrome, and is often seen in states associated with high systemic estrogen levels such as pregnancy or oral contraceptive use. While topical hormonal replacement therapy may result in increased estrogen levels similar to those documented with oral contraceptive use, there are no reported cases of spontaneous coronary dissection with topical hormonal replacement therapy. We describe a 53-year-old female who developed two spontaneous coronary dissections while on topical hormonal replacement therapy. The patient had no other risk factors for coronary dissection. After withdrawal from topical hormonal therapy, our patient has done well and has not had recurrent coronary artery dissections over a one-year follow-up period. The potential contributory role of topical hormonal therapy as a cause of spontaneous coronary dissection should be recognized.

Endovascular stent-assisted thrombolysis in acute occlusive carotid artery dissection

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Mourand, Isabelle [Hopital Gui de Chauliac, Department of Neurology, CHU Montpellier, Montpellier, Cedex 5 (France); Hopital Gui de Chauliac, Department of Neurology, Service de Neurologie, Montpellier, Cedex 5 (France); Brunel, Herve; Vendrell, Jean-Francois; Bonafe, Alain [Hopital Gui de Chauliac, Department of Neuroradiology, CHU Montpellier, Montpellier, Cedex 5 (France); Thouvenot, Eric [Hopital Gui de Chauliac, Department of Neurology, CHU Montpellier, Montpellier, Cedex 5 (France)

2010-02-15

Internal carotid artery dissection with tandem internal carotid and middle cerebral artery occlusion may be responsible for large cerebral infarction that carries a general poor prognosis. Recanalization of internal carotid artery (ICA) dissection by stent-assisted thrombolysis has been recently proposed. We report two cases of acute symptomatic ICA dissection with tandem occlusion successfully treated with emergent endovascular stent-assisted thrombolysis using new self-expandable intracranial stents. A 37-year-old woman and a 59-year-old man were admitted in our hospital after acute severe symptoms of right-hemispheric stroke with National Institutes of Health Stroke Scale (NIHSS) scores of 15 and 18, respectively. In both cases, magnetic resonance angiography showed tandem occlusion and angiography confirmed tandem occlusion with ICA dissection. An extensive mismatch region was diagnosed by Perfusion-diffusion MRI of the brain within 3 h after symptoms onset. Treatment was initiated 4 h after symptom onset by implantation of self-expandable intracranial stents into the dissected ICA and administration of intra-arterial recombinant tissue plasminogen activator. Recanalization of the ICA and middle cerebral artery (MCA) was accomplished within 6 h after symptoms onset. In both cases, no periprocedural complication was observed and follow-up CT scan showed only a mild brain infarct in the MCA territory. After, respectively, 12 and 10 months follow-up, patients had a favorable outcome with NIHSS 0 and mRS {<=}1. Endovascular stent-assisted thrombolysis appears to be a promising treatment in tandem occlusion due to ICA dissection. Our work underline the potential use of self-expandable intracranial stents in symptomatic acute ICA dissection. (orig.)

Pulmonary artery dissection in eight dogs with patent ductus arteriosus.

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Scansen, Brian A; Simpson, Elaine M; López-Alvarez, Jordi; Thomas, William P; Bright, Janice M; Eason, Bryan D; Rush, John E; Dukes-McEwan, Joanna; Green, Henry W; Cunningham, Suzanne M; Visser, Lance C; Kent, Agnieszka M; Schober, Karsten E

2015-06-01

To describe a series of dogs with pulmonary artery dissection and patent ductus arteriosus (PDA). Eight dogs. Retrospective case series. Pulmonary artery dissection was diagnosed in 8 dogs, 3 were Weimaraners. Four dogs presented in left-sided congestive heart failure, 4 presented for murmur evaluation and without clinical signs, and 1 presented in right-sided congestive heart failure. In 7 dogs the dissection was first documented concurrent with a diagnosis of uncorrected PDA. In the other dog, with pulmonary valve stenosis and PDA, the dissection was observed on autopsy examination 17 months after balloon pulmonary valvuloplasty and ductal closure. Median age at presentation for the 7 dogs with antemortem diagnosis of pulmonary artery dissection was 3.5 years (range, 1.5-4 years). Three dogs had the PDA surgically ligated, 2 dogs did not undergo PDA closure, 1 dog failed transcatheter occlusion of the PDA with subsequent surgical ligation, 1 dog underwent successful transcatheter device occlusion of the PDA, and 1 dog had the PDA closed by transcatheter coil delivery 17 months prior to the diagnosis of pulmonary artery dissection. The 2 dogs that did not have the PDA closed died 1 and 3 years after diagnosis due to heart failure. Pulmonary artery dissection is a potential complication of PDA in dogs, the Weimaraner breed may be at increased risk, presentation is often in mature dogs, and closure of the PDA can be performed and appears to improve outcome. Copyright © 2014 Elsevier B.V. All rights reserved.

Dissection of internal carotid artery presenting as isolated ischaemic optic neuropathy

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Serdar Oruc

2016-08-01

Full Text Available Carotid artery dissections are one of the important reasons of cerebrovascular events that are observed before the age of 45. Besides the local findings such as head, neck and face pains, Horner syndrome findings, pulsatile tinnitus and cranial nerve involvements, some other symptoms such as ischemic stroke, transient ischemic attacks and amaurosis fugax can also be observed in the approximately three quarters of patients. Ischemic optic neuropathy may be seen as %4 in the carotid artery dissections and it mostly accompanies other ischemic local symptoms. It is rare to observe the ischemic optic neuropathy as the first and unique finding in the carotid artery dissections. In this study, a 55 year old male patient with carotid artery dissection was represented. He did not have any other complaint, except the sudden unilateral visual loss and he was sent to our clinics from the opthalmology clinics in order to search for the etiology of ischemic optic neuropathy. It should be kept in mind that there can be a possibility to have carotid artery dissections in patients with unilateral visual loss.

Case of radiation induced aneurysm of extracranial carotid artery

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

1988-08-01

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

Friable but treatable: coronary artery dissections in Ehlers-Danlos syndrome.

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Zago, Alexandre C; Matte, Bruno S

2013-01-01

Vascular Ehlers-Danlos syndrome is a rare connective tissue disorder associated with arterial dissection or rupture. Percutaneous coronary intervention (PCI) is often critical in patients with this syndrome because their coronary arteries are prone to dissection, enhancing the risk of stent borders dissection when conventional stent deployment pressures are used. Coronary artery bypass graft (CABG) treatment for these patients may also raise concerns because the left internal mammary artery is probably friable. Therefore, coronary artery revascularization in vascular Ehlers-Danlos syndrome either using PCI or CABG is challenging due to the arteries friability. A small number of cases have been published describing the friability of the vessels and associated complications; nevertheless, the optimum treatment remains unclear. We report the case of a 54-year-old woman treated successfully with PCI and CABG in two different acute coronary syndrome episodes, in which specific technical issues related to both procedures were decisive. Copyright © 2011 Wiley Periodicals, Inc.

Endovascular stent-assisted thrombolysis in acute occlusive carotid artery dissection

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Mourand, Isabelle; Brunel, Herve; Vendrell, Jean-Francois; Bonafe, Alain; Thouvenot, Eric

2010-01-01

Internal carotid artery dissection with tandem internal carotid and middle cerebral artery occlusion may be responsible for large cerebral infarction that carries a general poor prognosis. Recanalization of internal carotid artery (ICA) dissection by stent-assisted thrombolysis has been recently proposed. We report two cases of acute symptomatic ICA dissection with tandem occlusion successfully treated with emergent endovascular stent-assisted thrombolysis using new self-expandable intracranial stents. A 37-year-old woman and a 59-year-old man were admitted in our hospital after acute severe symptoms of right-hemispheric stroke with National Institutes of Health Stroke Scale (NIHSS) scores of 15 and 18, respectively. In both cases, magnetic resonance angiography showed tandem occlusion and angiography confirmed tandem occlusion with ICA dissection. An extensive mismatch region was diagnosed by Perfusion-diffusion MRI of the brain within 3 h after symptoms onset. Treatment was initiated 4 h after symptom onset by implantation of self-expandable intracranial stents into the dissected ICA and administration of intra-arterial recombinant tissue plasminogen activator. Recanalization of the ICA and middle cerebral artery (MCA) was accomplished within 6 h after symptoms onset. In both cases, no periprocedural complication was observed and follow-up CT scan showed only a mild brain infarct in the MCA territory. After, respectively, 12 and 10 months follow-up, patients had a favorable outcome with NIHSS 0 and mRS ≤1. Endovascular stent-assisted thrombolysis appears to be a promising treatment in tandem occlusion due to ICA dissection. Our work underline the potential use of self-expandable intracranial stents in symptomatic acute ICA dissection. (orig.)

Vertebral artery dissection in hypertensive disorders of pregnancy: a case series and literature review.

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Shanmugalingam, Renuka; Reza Pour, Nina; Chuah, Siang Chye; Vo, Thi Mong; Beran, Roy; Hennessy, Annemarie; Makris, Angela

2016-07-16

Arterial dissection is a rare complication of pregnancy and puerperium. There have been reports of aortic, coronary and cervical artery dissection in association with preeclampsia, however, vertebral artery dissection is rarely reported particularly in the antenatal setting in the presence of a Hypertensive Disorder of Pregnancy (HDP).The general annual incidence of symptomatic spontaneous cervicocephalic arterial dissection is 0.0026 % and a data registry reported that 2.4 % of these occurred in the post-partum period. The actual incidence of vertebral artery dissection in HDP is unknown as the current literature consists of case series and reports only with most documenting adverse outcomes. Given the presence of collateral circulation, unilateral vertebral artery dissections may go unrecognised and may be more common than suspected. We present a case series of four patients with vertebral artery dissection in association with HDP, two of which occurred in the antenatal setting and two in the post-partum setting. All our patients had favourable outcome with no maternal neurological deficit and live infants. Our discussion covers the proposed pathophysiology of vertebral artery dissection in HDP and the management of it. Our case series highlights the need to consider VAD an important differential diagnosis when assessing pregnant women with headache and neck pain particularly in the context of HDP.

Diagnosing extracranial atherosclerotic diseases with spiral CT

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Moran, C.J.; Vannier, M.W.; Erickson, K.K.; Broderick, D.F.; Kido, D.K.; Yoffie, R.L.

1991-01-01

This paper reports that this discovery study was performed to determine whether extracranial carotid artery plaques could be diagnosed with a new CT technique (spiral CT) that allows nondistorted three-dimensional (3D) reconstructions in the z axis. Twenty carotid arteries were examined with spiral CT in normal volunteers and in patients suspected of having atherosclerotic plaques in the extracranial carotid arteries. The Somatom Plus CT table was advanced at a constant rate, the x-ray tube was continuously rotated, and 3D data were continuously acquired. Sixty milliliters of nonionic contrast medium was injected intravenously previous to and during the acquisition of data. The carotid bifurcations were identified in all patients. Planar images, similar to conventional intraarterial angiograms, were routinely produced from the volumetric CT data

Anatomical characteristics of the styloid process in internal carotid artery dissection: Case-control study.

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Amorim, José M; Pereira, Daniela; Rodrigues, Marta G; Beato-Coelho, José; Lopes, Margarida; Cunha, André; Figueiredo, Sofia; Mendes-Pinto, Mafalda; Ferreira, Carla; Sargento-Freitas, João; Castro, Sérgio; Pinho, João

2018-06-01

Introduction Pathophysiology of cervical artery dissection is complex and poorly understood. In addition to well-known causative and predisposing factors, including major trauma and monogenic connective tissue disorders, morphological characteristics of the styloid process have been recently recognized as a possible risk factor for cervical internal carotid artery dissection. Aims To study the association of the anatomical characteristics of styloid process with internal carotid artery dissection. Methods Retrospective, multicenter, case-control study of patients with internal carotid artery dissection and age- and sex-matched controls. Consecutive patients with internal carotid artery dissection and controls with ischemic stroke or transient ischemic attack of any etiology excluding internal carotid artery dissection, who had performed computed tomography angiography, diagnosed between January 2010 and September 2016. Two independent observers measured styloid process length and styloid process distance to internal carotid artery. Results Sixty-two patients with internal carotid artery dissection and 70 controls were included. Interobserver agreement was good for styloid process length and styloid process-internal carotid artery distance (interclass correlation coefficient = 0.89 and 0.76, respectively). Styloid process ipsilateral to dissection was longer than left and right styloid process in controls (35.8 ± 14.4 mm versus 30.4 ± 8.9 mm and 30.3 ± 8.2 mm, p = 0.011 and p = 0.008, respectively). Styloid process-internal carotid artery distance ipsilateral to dissection was shorter than left and right distance in controls (6.3 ± 1.9 mm versus 7.2 ± 2.1 mm and 7.0 ± 2.3 mm, p = 0.003 and p = 0.026, respectively). Internal carotid artery dissection was associated with styloid process length (odds ratio = 1.04 mm -1 , 95% confidence interval = 1.01-1.08, p = 0.015) and styloid process

Clinical characteristics of unruptured vertebral artery dissections presenting with headaches

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Nakamura, Homare; Mizuniwa, Yoshitaka; Kouno, Takao; Nakayama, Hirofumi; Furuya, Yu; Taguchi, Yoshio

2011-01-01

We reviewed 13 cases of patients with unruptured dissections of the vertebral artery who were treated at our hospital after presenting with headaches. We identified 13 patients who had headache alone at the time of onset and who were diagnosed as having vertebral artery dissection using three-dimensional CT, MRI, MR angiography (MRA), or angiography from November 2007 to October 2009. Primary radiographic investigations showed the 'pearl and string' sign in two cases, dilatation in eight, and the string sign alone in three cases. Following initial conservative treatment, 11 cases exhibited radiographic improvement, but two cases underwent surgical treatment because of progressive vertebral artery dissection. A definitive diagnosis was made using primary investigations in nine cases and dynamic changes on radiographic investigations in four cases. The headache was located posteriorly in all cases, but some patients had mild headaches. Clinicians need to be aware of the possibility of vertebral artery dissection even if the headache is mild at onset. Radiographic investigations are important for a definitive diagnosis and in deciding whether to intervene surgically. (author)

Cerebral Ischemia Due to Traumatic Carotid Artery Dissection: Case Report

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Deniz Kamacı Şener; Özlem Taşkapılıoğlu; Nermin Kelebek Girgin; Bahattin Hakyemez; Mustafa Bakar; Yakup Tomak

2012-01-01

Blunt injury to the neck region may lead to carotid artery dissection and cerebral ischemia. Blunt injury to carotid artery is not frequent but determination of the presence of trauma in the history of stroke patients will provide early diagnosis and treatment of them. In this article, a case with cerebral ischemia resulting from traumatic carotid artery dissection is presented and clinical findings, diagnostic procedures and choice of treatment are discussed in the light of the literature.

The subpetrous carotid wall hematoma. A sign of spontaneous dissection of the internal carotid artery on non-enhanced computed tomography. A retrospective study

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Jensen-Kondering, U.; Univ. Hospital Schleswig-Holstein, Kiel; Huhndorf, M.; Madjidyar, J.; Jansen, O.

2015-01-01

Spontaneous dissection of the internal carotid artery (CAD) is an increasingly recognized cause for stroke especially in young and middle-aged patients. We hypothesized that non-enhanced cranial computed tomography (NECCT) can visualize the subpetrous carotid wall hematoma and thus enable identification of patients with CAD. We retrospectively reviewed patients with confirmed CAD (n=21) and a control group with ischemic symptoms but without CAD (n=42) who received NECCT at admission. Two independent neuroradiologists rated the presence and shape of SPH, density and diameter of the subpetrous internal carotid artery. Additionally, we correlated the shape of the subpetrous carotid wall hematoma with the grade of stenosis on subsequent angiographic imaging. The subpetrous carotid wall hematoma was present in 14 of 21 patients (Cohen's k = 0.67). Mean diameter was 6.95 ± 1.05 mm in dissected vessels and 5.71 ± 1.52 mm in the contralateral vessel (p<0.05). Mean difference in vessel density was 15.05 ± 8.01 HU (p<0.01). Median grade of stenosis was significantly higher in patients with a full moon- shaped (n=11) than crescent-shaped (n=3) subpetrous carotid wall hematoma (21% vs. 80%, p<0.05). Two-thirds of patients with CAD were correctly identified on NECCT. The extracranial carotid artery should be evaluated in patients with symptoms of cerebral ischemia.

The subpetrous carotid wall hematoma. A sign of spontaneous dissection of the internal carotid artery on non-enhanced computed tomography. A retrospective study

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Jensen-Kondering, U. [Univ. Hospital Schleswig-Holstein, Kiel (Germany). Dept. of Radiology and Neuroradiology; Univ. Hospital Schleswig-Holstein, Kiel (Germany). Dept. of Neurology; Huhndorf, M.; Madjidyar, J.; Jansen, O. [Univ. Hospital Schleswig-Holstein, Kiel (Germany). Dept. of Radiology and Neuroradiology

2015-03-15

Spontaneous dissection of the internal carotid artery (CAD) is an increasingly recognized cause for stroke especially in young and middle-aged patients. We hypothesized that non-enhanced cranial computed tomography (NECCT) can visualize the subpetrous carotid wall hematoma and thus enable identification of patients with CAD. We retrospectively reviewed patients with confirmed CAD (n=21) and a control group with ischemic symptoms but without CAD (n=42) who received NECCT at admission. Two independent neuroradiologists rated the presence and shape of SPH, density and diameter of the subpetrous internal carotid artery. Additionally, we correlated the shape of the subpetrous carotid wall hematoma with the grade of stenosis on subsequent angiographic imaging. The subpetrous carotid wall hematoma was present in 14 of 21 patients (Cohen's k = 0.67). Mean diameter was 6.95 ± 1.05 mm in dissected vessels and 5.71 ± 1.52 mm in the contralateral vessel (p<0.05). Mean difference in vessel density was 15.05 ± 8.01 HU (p<0.01). Median grade of stenosis was significantly higher in patients with a full moon- shaped (n=11) than crescent-shaped (n=3) subpetrous carotid wall hematoma (21% vs. 80%, p<0.05). Two-thirds of patients with CAD were correctly identified on NECCT. The extracranial carotid artery should be evaluated in patients with symptoms of cerebral ischemia.

Cerebral Ischemia Due to Traumatic Carotid Artery Dissection: Case Report

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Deniz Kamacı Şener

2012-12-01

Full Text Available Blunt injury to the neck region may lead to carotid artery dissection and cerebral ischemia. Blunt injury to carotid artery is not frequent but determination of the presence of trauma in the history of stroke patients will provide early diagnosis and treatment of them. In this article, a case with cerebral ischemia resulting from traumatic carotid artery dissection is presented and clinical findings, diagnostic procedures and choice of treatment are discussed in the light of the literature.

Timing of Incident Stroke Risk After Cervical Artery Dissection Presenting Without Ischemia.

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Morris, Nicholas A; Merkler, Alexander E; Gialdini, Gino; Kamel, Hooman

2017-03-01

Cervical artery dissection is a common cause of stroke in young people. The temporal profile of stroke risk after cervical artery dissection presenting without ischemia remains uncertain. We performed a crossover cohort study using administrative claims data on all emergency department visits and acute care hospitalizations from 2005 to 2011 in CA, 2006 to 2013 in NY, and 2005 to 2013 in FL. Using previously validated International Classification of Diseases, Ninth Revision, Clinical Modification codes, we identified patients with a cervical artery dissection and no previous or concurrent stroke or transient ischemic attack diagnosis. We compared the risk of stroke in successive 2-week periods during the 12 weeks after dissection versus the corresponding 2-week period 1 year later. Absolute risk increases were calculated using McNemar test for matched data. In a sensitivity analysis, we limited our population to patients presenting with typical symptoms of cervical artery dissection. We identified 2791 patients with dissection without ischemia. The absolute increase in stroke risk was 1.25% (95% confidence interval, 0.84-1.67%) in the first 2 weeks after dissection compared with the same time period 1 year later. The absolute risk increase was 0.18% (95% confidence interval, 0.02-0.34%) during weeks 3 to 4 and was no longer significant during the remainder of the 12-week postdissection period. Our findings were similar in a sensitivity analysis identifying patients who presented with typical symptoms of acute dissection. The risk of stroke after cervical artery dissection unaccompanied by ischemia at time of diagnosis seems to be limited to the first 2 weeks. © 2017 American Heart Association, Inc.

Dissecting aneurysm of the cervical internal carotid artery

International Nuclear Information System (INIS)

Itoh, Yoshihiro; Itoyama, Youichi; Fukumura, Akinobu; Matsukado, Yasuhiko; Kodama, Takafumi.

1987-01-01

On lifting a heavy case, a 51-year-old male experienced a sudden onset of headache with giddiness and clouded vision. A week later, vertigo and right hand numbness were added to his symptoms. The next day anisocoria (right > left) and dilation of the left retinal veins were noted. Cranial computed tomography (CT) scan appeared normal and there were no other remarkable neurological findings. The patient was treated conservatively for cerebral infarction, however, the headache worsened and diplopia occurred. Neurological examination on admission revealed nothing unusual except for left Horner's syndrome. Physical examination showed a palpable sausage-like painless tumor on the left side of the neck. Angiography showed a narrowing of the internal carotid artery in the cervical region with a small dissecting aneurysm at the C3 level. Cervical CT scan at the upper C3 level showed a low density lunar defect in the high density section of the enlarged left internal carotid artery. The patient was operated on by superficial temporal artery-middle cerebral artery anastomosis to increase the intracranial blood flow. Postoperatively the symptoms were quickly relieved. Angiography 1 month later showed less narrowing of the carotid artery, though the dissecting aneurysm still remained. Postoperative cervical CT scan showed the left internal carotid artery to be of normal size. The patient returned to his work in normal condition 2 months later. It is emphasized that cervical CT scan may be useful in the diagnosis of this unusual type of cervical dissecting aneurysm. (author)

Extracranial Internal Carotid Artery Aneurysms: Report of a Ruptured Case and Review of the Literature

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Siablis, Dimitrios; Karnabatidis, Dimitrios; Katsanos, Konstantinos; Mastronikolis, Nikos; Zabakis, Peter; Kraniotis, Pantelis

2004-01-01

Aneurysms of the extracranial carotid arteries (ECAA) are extremely rare. Schechter et al. documented 835 cases in the literature up to 1977. One hundred and sixteen cases of ECAA have been documented in the Chinese literature since 1981, suggesting a higher prevalence of carotid aneurysmal disease in China than in the West. Four percent of all peripheral artery aneurysms are reported to be ECAA. Those arising from the internal carotid artery (EICAA) are even more rare. Two recent reviews reported 24 and 25 cases of EICAA during 21 and 17 years, respectively, the majority of them is treated surgically. Our literature review revealed only a few true EICAA managed endovascularly, but none of them with a covered stent. We describe a rare such case of ruptured atherosclerotic EICAA which was treated percutaneously

Propagation of aortic dissection and visceral artery compromise. Three-dimensional analysis on CT angiography

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Minamiguchi, Hiroki

2003-01-01

The purpose of this study was to clarify the patterns of the propagation of aortic dissection with quantitative data from CT angiography and to verify the relationship between the propagation of aortic dissection and visceral artery compromise. The subjects were 67 cases (48 men, 19 women) with acute and subacute aortic dissection extending from the descending thoracic aorta to the aortic bifurcation. The mean age is 56.5±12.3 years old (range 34 to 80 years). Eight axial levels of the trunk of right pulmonary artery, left inferior pulmonary vein, coronary sinus, celiac axis, the orifice of superior mesenteric artery (SMA), the orifice of right real artery, the orifice of left renal artery and the orifice of inferior mesenteric artery were submitted to investigate the propagation of aortic dissection. The true lumen central angle was calculated in each level. The axial distance, branch angle difference and true distance between SMA and bilateral renal arteries were calculated. The trajectory of aortic dissection propagation from descending thoracic aorta to aortic bifurcation could be divided into two types of linear dissection type (n=41) and spiral dissection type (n=26). The latter were further subdivided into clockwise rotation type (n=14) and counter-clockwise rotation type (n=12). Younger age was significantly associated with the spiral dissection type as compared to older age (p=0.030). The spiral dissection type propagation pattern was found predominantly from the descending thoracic aorta to celiac axis, while at more distal levels linear type dissection was more common. The blood flow of SMA and celiac axis came from the true lumen or both lumens in all cases but single case from false lumen. The incidence (19.4%) of the right renal blood flow supplied from false lumen was lower than that (37.3%) of the left one supplied from false lumen. The shorter distance and the less angle difference between SMA and right renal artery than between SMA and left renal

Imaging findings and management of isolated dissection of the visceral arteries

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Tokue, Hiroyuki; Tsushima, Yoshito; Endo, Keigo

2009-01-01

The purpose of this study was to describe clinical and computed tomography (CT) findings of isolated dissection of the visceral arteries (IDVA). We retrospectively analyzed clinical presentation and abdominal CT findings of 38 patients who were diagnosed as having an IDVA. IDVA were classified into three types based on CT findings: patent false lumen with re-entry (type I), patent false lumen without re-entry (type II), and completely thrombosed false lumen (type III). The dissection was located in the superior mesenteric artery (SMA) in 27 patients, celiac artery (CA) in 6, CA to splenic artery in 2, and common hepatic artery (CHA), CA to CHA, and inferior mesenteric artery (IMA) in 1 patient each. The dissection was classified into type I in 8 patients, type II in 12, and type III in 18. Surgical treatment was performed in 1 patient with type II SMA dissection because of bowel ischemia, although the remaining 37 patients were managed conservatively. Two cases with type II showed a progressive enlargement of the false lumen in follow-up CT. Increased density of the fat tissue around the affected visceral artery was more commonly seen in symptomatic patients compared to asymptomatic ones (P<0.01). Based on our observation, patients with IDVA can be managed conservatively when there are no signs indicating organ ischemia. (author)

Efficacy of a Self-Expandable Porous Stent as the Sole Curative Treatment for Extracranial Carotid Pseudoaneurysms.

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Chen, Peng Roc; Edwards, Nancy J; Sanzgiri, Aditya; Day, Arthur L

2016-04-01

Extracranial carotid pseudoaneurysms are uncommon vascular lesions. Even with conservative management complications can happen, such as delayed cerebral embolization or symptoms due to flow limitation. Although endovascular therapy can be curative, literature demonstrating a preferred technique is scant. Our goal was to evaluate the use of 1 technique only-the deployment of overlapping self-expandable porous stents-to treat a series of extracranial carotid pseudoaneurysms. From 2008 to 2014, 14 consecutive cases of symptomatic extracranial carotid pseudoaneurysms were managed with single or multilayer porous stents at our institution. Each patient underwent a standardized angiographic follow-up at 6 months. Twelve patients also received a follow-up computed tomography angiogram at 12 months, and yearly thereafter (median radiographic follow-up, 38 months). The total clinical follow-up period ranged between 6 and 69 months (median, 46 months). In our series, each of the extracranial carotid pseudoaneurysms appeared to be the result of carotid artery dissection with associated carotid stenosis at the origin of every pseudoaneurysm. Endovascular treatment consisted of 1-3 layers of self-expandable porous stents placed without balloon angioplasty. Immediately after stenting angiographic images were notable for stagnant opacification of the pseudoaneurysm through the stent(s). All pseudoaneurysms were completely obliterated by the 6-month follow-up angiogram and remained so throughout the radiographic follow-up period. Complications were minimal, consisting of 1 patient developing a mild Horner's syndrome after treatment that resolved during clinical follow-up. Extracranial carotid pseudoaneurysms can be successfully obliterated with the use of porous, self-expandable stents. Copyright © 2016 Elsevier Inc. All rights reserved.

A case of radiation induced aneurysm of extracranial carotid artery

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

1988-01-01

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

Mycotic aneurysm of the extracranial internal carotid artery - report of a case and review of the literature

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Nascimento, Edilene Cristina do; Silva, Ivone Martins da

1998-01-01

The authors report a case of mycotic aneurysm of the extracranial internal carotid artery in a 4-year-old- male child, resulting from tonsillar infection. The authors relate the difficulties to initially suggest the diagnosis, stress the importance of the differential diagnosis particularly in children and describe the findings on conventional films, US colour-Doppler, CT and carotid digital subtraction angiography. (author)

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

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

2014-01-01

The left anterior descending (LAD) coronary artery is the most frequently involved vessel in coronary artery dissection, a cause of acute coronary syndrome or sudden cardiac death. The biomechanical mechanisms underlying arterial dissection are not well understood. This study investigated the dissection properties of LAD specimens harvested from explanted hearts at the time of cardiac transplantation, from patients with primary dilated cardiomyopathy (n=12). Using a previously validated approach uniquely modified for these human LAD specimens, we quantified the local energy release rate, G, within different arterial layers during experimental dissection events (tissue tearing). Results show that the mean values of G during arterial dissection within the intima and within the media in human LADs are 20.7±16.5 J/m2 and 10.3±5.0 J/m2, respectively. The difference in dissection resistance between tearing events occurring within the intima and within the media is statistically significant. Our data fall in the same order of magnitude as most previous measurements of adhesive strength in other human arteries, with the differences in measured values of G within the layers most likely due to histologically observed differences in the structure and composition of arterial layers. PMID:24729631

Rotastenting in an anomalously arising right coronary artery after an ugly dissection

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Ashwin B. Mehta

2013-07-01

Full Text Available Rotational atherectomy is contraindicated in dissected coronary arteries since it can lead to progression of the dissection or perforation. In our case, the right coronary artery (RCA arose anomalously from the left coronary sinus. The lesion in the RCA was an undilatable calcified one. There was a dissection in the RCA due to high pressure balloon dilatation. Since the patient was hemodynamically unstable and there were no options besides rotablation, we proceeded with caution. Rotablation and stenting were successfully done. Our case report highlights the importance of the need for good guide catheter support even in the presence of anomalously arising arteries and the rotablation option for unyielding calcified coronary lesions, even in the setting of a dissection.

Dissection of internal carotid and vertebral arteries: clinical presentation, diagnosis, and treatment

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Lyudmila Andreevna Kalashnikova

2013-01-01

Full Text Available The paper gives the data available in the literature and the author’s results of an examination of almost 140 patients with dissection of the internal carotid and vertebral arteries (ICA and VA. Dissection is blood penetration through an intimal tear from the lumen of an artery into its wall to develop intramural hematoma (IMH. The cause of dissection is the weakness of the arterial wall presumably due to mitochondrial cytopathy. IMH narrows/occludes the arterial lumen or is a source of arterioarterial embolism, which in turn leads to ischemic stroke. Stroke as a result of dissection generally develops in young patients, who are not prone to traditional vascular risk factors, frequently after the influence of provocative factors (mild head/neck injury, head jerks, physical strain, contraceptives, etc.. The characteristics of stroke are head/neck pain on the side of dissection that appears a few days prior to stroke or simultaneously with the latter; quite often a good recovery of impaired functions; and low recurrence rates. Another major manifestation, isolated cervicocephalic pain, is encountered in PA dissection more frequently (in almost a third of cases and in ICA dissection less frequently (about 5%. Magnetic resonance (MR angiography and fat-saturated T1-weighted MR imaging play a leading role in the verification of dissection. Dissection should be treated with anticoagulants/antiaggregants in its acute phase, as well as with trophic drugs, primarily actovegin, in both acute and chronic phases.

Surgical anatomy of the styloid muscles and the extracranial glossopharyngeal nerve.

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Prades, J M; Gavid, M; Asanau, A; Timoshenko, A P; Richard, C; Martin, C H

2014-03-01

The purpose of the study was to determine the relationships between the extracranial glossopharyngeal (IX) nerve and the muscles of the styloid diaphragm. In humans, the IX nerve is a hidden retrostyloid nerve which plays a critical role notably in swallowing and has to be preserved during infratemporal fossa and parapharyngeal spaces surgical procedures. In ten adult heads from cadavers (20 sides) fixed in formalin, dissection of the extracranial IX nerve was performed under operating microscope with special attention given to the relationships between this nerve and the styloid muscles of the styloid diaphragm. The three styloid muscles delimit three triangular intermuscular intervals which were each thoroughly explored. Different osseous landmarks were investigated for easy nerve location. The styloid process (SP) is the main superior osseous landmark for the three muscles of the styloid diaphragm. The stylohyoid muscle (SHM) is anteromedially located to the posterior belly of the digastric muscle. The styloglossus muscle (SGM) is medial and anterior to the SHM. The stylopharyngeal muscle (SPM) is the most vertical and medial of the three styloid muscles. It courses from the medial surface of the SP in a deep plane hidden between the SHM and the SGM. The extracranial IX nerve turns around the SPM superiorly with a vertical segment posterior to the SPM and inferiorly with a horizontal segment lateral to the SPM. The meeting point of the two segments of the IX nerve is about 10 mm anteriorly located from the transverse process of the atlas. The external carotid artery and some of its branches lie in contact with the lateral side of the IX nerve. Such relationships between the extracranial IX nerve, the styloid muscles and the transverse process of the atlas should be appreciated by clinician who treats patients with stylohyoid complex syndromes and by the surgeon for the parapharyngeal spaces approach.

Effective imaging of carotid artery dissection

International Nuclear Information System (INIS)

Obradovis, G.

1997-01-01

Angiography has been the gold standard in the diagnosis of arterial dissection for many years. With recent advances in techniques, particularly in MRI it may be worthy to re-evaluate the imaging methods available in obtaining the most information to maxims the patients' level of management. Assessing the imaging methods used in four patients with clinically suspected carotid artery dissection may reveal the most appropriate clinical pathway in managing these types of patients. In today's economic environment, we are striving for the most cost-effective imaging methods combined with the least invasive and safest. We must also review the cost benefit analysis of CT, angiography (DSA), Doppler Ultrasound and MRI/MRA. It is not within the scope of this paper to argue the merits of each imaging method, but purely to present some of the benefits in using non-invasive techniques if the clinical indications warrant them and they are available. (author)

Patient- and lesion-tailored algorithm of endovascular treatment for arterial occlusive disease of extracranial arteries supplying the brain: safety of the treatment at 30-day follow-up.

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Latacz, Paweł; Simka, Marian; Brzegowy, Paweł; Janas, Piotr; Kazibudzki, Marek; Pieniążek, Piotr; Ochała, Andrzej; Popiela, Tadeusz; Mrowiecki, Tomasz

2017-01-01

Although surgical endarterectomy remains the treatment of choice for carotid artery stenosis, stenting plays an important role as an alternative treatment modality, especially in high-risk patients. The actual safety profile associated with stenting procedures is probably better than that reported by randomized controlled trials. To assess the safety of stent implantations in extracranial arteries supplying the brain, and also to identify risk factors associated with this procedure. This was a post hoc analysis, with 30-day follow-up. We analyzed the results of treatment of 372 patients who underwent 408 procedures, 197 such procedures in asymptomatic, and 211 in symptomatic individuals. Stenting procedures were performed using a technique and armamentarium which were tailored to the type and anatomy of lesions. There were 6 (1.5%) strokes, including 2 (0.5%) major strokes, 1 ipsi- and 1 contralateral, and 4 (1.0%) minor strokes. In asymptomatic patients there was 1 (0.3%) minor stroke. Transient ischemic attacks occurred in 5 (1.2%) patients. There were 2 (0.5%) non-STEMI myocardial infarctions and 2 (0.5%) non-stroke related fatalities. Risk factors of these adverse events were diabetes mellitus, lesions localized in a tortuous segment of the artery, embolic material in the filter and bilateral stenoses of carotid arteries. Additional risk factors in asymptomatic patients were renal impairment and advanced coronary artery disease; and in symptomatic patients, grade 3 arterial hypertension, dislipidemia, cigarette smoking and lesions requiring predilatation. Stenting procedures of extracranial arteries supplying the brain, which are tailored to the type and anatomy of lesions, seem to be relatively safe.

Coronary artery dissection following chest trauma

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Manoj K Agarwala

2016-01-01

Full Text Available Chest trauma has a high rate of mortality. Coronary dissection causing myocardial infarction (MI following blunt chest trauma is rare. We describe the case of an anterior MI following blunt chest trauma. A 39-year-old male was received in our hospital following a motorcycle accident. The patient was asymptomatic before the accident. The patient underwent craniotomy for evacuation of hematoma. He developed severe chest pain and an electrocardiogram (ECG revealed anterior ST segment elevation following surgery. Acute coronary event was medically managed; subsequently, coronary angiogram was performed that showed dissection in the left anterior coronary artery, which was stented.

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

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

2013-01-01

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

Subclavian artery dissection during diagnostic cardiac catheterization: the role of conservative management.

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Frohwein, S; Ververis, J J; Marshall, J J

1995-04-01

Dissection of the subclavian artery during routine cardiac catheterization while obtaining cannulation to the left internal mammary artery is an unusual complication and to our knowledge has never been reported. Conservative management of this vascular injury can avoid the sequelae of high-risk surgical repairs made difficult by a complex operative exposure. We describe a case in which dissection of the left subclavian artery was treated conservatively with an excellent outcome.

Spontaneous intracranial arterial dissection in the young: diagnosis by CT angiography

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Given Curtis A

2006-04-01

Full Text Available Abstract Background Spontaneous carotid artery dissections have been rarely reported in children. Diagnosis has traditionally been confirmed by catheter arteriography. More recently diagnosis has been made by magnetic resonance imaging and magnetic resonance angiography; however the sensitivity of these techniques has yet to be determined. The authors are unaware of reports of carotid dissection confirmed by dynamic computed tomography (computerized tomographic arteriography in the young. Case presentation We recently evaluated a fourteen year-old male following the development of transient neurologic symptoms. There was no antecedent illness or trauma. Dynamic computed tomography revealed an intracranial dissection involving the supraclinoid segment of the left internal carotid artery (confirmed by catheter arteriography. Studies for vasculitis, pro-thrombotic states, and defects of collagen were negative. Conclusion Spontaneous carotid artery dissection is a potential cause of transient neurological symptoms and ischemic stroke in the pediatric population. Dynamic computed tomography appears to be a reliable diagnostic tool which can lead to early diagnosis.

Non invasive techniques for the study of the extracranial carotid arterial system

International Nuclear Information System (INIS)

Ameneiro Perez, Santiago; Alvarez Sanchez, Jose Antonio; Aldama Figueroa, Alfredo

2000-01-01

A review of the noninvasive diagnostic techniques that have been historically used to detect the stenoocclussive lesions of the extracranial carotid arterial system is made. The technological development and the new therapeutic criteria to prevent strokes caused by these lesions have encouraged research in this field. A review of the most used techniques at present: mode B ultrasound, duplex ultrasound and color duplex ultrasound, as well as of the advantages and disadvantages of each one is made. Nowadays, there are hemodynamic criteria together with these techniques that evaluate the stenosis degrees and the characteristics of the lesions with accuracy enough to substitute in most of the cases the invasive and more expensive diagnostic angiographic methods

Spontaneous coronary artery dissection associated with apical hypertrophic cardiomyopathy

International Nuclear Information System (INIS)

Tuncer, M.; Gumrukcuoglu, H.A.; Ekim, H.; Gunes, Y.; Simsek, H.

2010-01-01

Apical hypertrophic cardiomyopathy (HCM) is a relatively uncommon inherited disease. Spontaneous coronary artery dissection (SCAD) is also uncommonly observed, which often occurs in pregnant or post partum women but is rare in men. This report describes a 38 years old man with apical hypertrophic cardiomyopathy who developed SCAD leading to acute inferior myocardial infarction. After emergent appendectomy operation at another hospital, he was immediately transferred to the Cardiology Department of our hospital due to acute myocardial infarction. He emergently underwent coronary angiography which showed a long dissection involving the right coronary. He underwent an emergent CABG with cardiopulmonary bypass. Postoperative recovery was uneventful and he was discharged. According to our knowledge, no case of spontaneous coronary artery dissection associated with apical hypertrophic cardiomyopathy unrelated to postpartum period or oral contraceptive use has been reported so far. (author)

Patient- and lesion-tailored algorithm of endovascular treatment for arterial occlusive disease of extracranial arteries supplying the brain: safety of the treatment at 30-day follow-up

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Paweł Latacz

2017-03-01

Full Text Available Introduction: Although surgical endarterectomy remains the treatment of choice for carotid artery stenosis, stenting plays an important role as an alternative treatment modality, especially in high-risk patients. The actual safety profile associated with stenting procedures is probably better than that reported by randomized controlled trials. Aim : To assess the safety of stent implantations in extracranial arteries supplying the brain, and also to identify risk factors associated with this procedure. Material and methods: This was a post hoc analysis, with 30-day follow-up. We analyzed the results of treatment of 372 patients who underwent 408 procedures, 197 such procedures in asymptomatic, and 211 in symptomatic individuals. Stenting procedures were performed using a technique and armamentarium which were tailored to the type and anatomy of lesions. Results : There were 6 (1.5% strokes, including 2 (0.5% major strokes, 1 ipsi- and 1 contralateral, and 4 (1.0% minor strokes. In asymptomatic patients there was 1 (0.3% minor stroke. Transient ischemic attacks occurred in 5 (1.2% patients. There were 2 (0.5% non-STEMI myocardial infarctions and 2 (0.5% non-stroke related fatalities. Risk factors of these adverse events were diabetes mellitus, lesions localized in a tortuous segment of the artery, embolic material in the filter and bilateral stenoses of carotid arteries. Additional risk factors in asymptomatic patients were renal impairment and advanced coronary artery disease; and in symptomatic patients, grade 3 arterial hypertension, dislipidemia, cigarette smoking and lesions requiring predilatation. Conclusions : Stenting procedures of extracranial arteries supplying the brain, which are tailored to the type and anatomy of lesions, seem to be relatively safe.

Patient- and lesion-tailored algorithm of endovascular treatment for arterial occlusive disease of extracranial arteries supplying the brain: safety of the treatment at 30-day follow-up

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Simka, Marian; Brzegowy, Paweł; Janas, Piotr; Kazibudzki, Marek; Pieniążek, Piotr; Ochała, Andrzej; Popiela, Tadeusz; Mrowiecki, Tomasz

2017-01-01

Introduction Although surgical endarterectomy remains the treatment of choice for carotid artery stenosis, stenting plays an important role as an alternative treatment modality, especially in high-risk patients. The actual safety profile associated with stenting procedures is probably better than that reported by randomized controlled trials. Aim To assess the safety of stent implantations in extracranial arteries supplying the brain, and also to identify risk factors associated with this procedure. Material and methods This was a post hoc analysis, with 30-day follow-up. We analyzed the results of treatment of 372 patients who underwent 408 procedures, 197 such procedures in asymptomatic, and 211 in symptomatic individuals. Stenting procedures were performed using a technique and armamentarium which were tailored to the type and anatomy of lesions. Results There were 6 (1.5%) strokes, including 2 (0.5%) major strokes, 1 ipsi- and 1 contralateral, and 4 (1.0%) minor strokes. In asymptomatic patients there was 1 (0.3%) minor stroke. Transient ischemic attacks occurred in 5 (1.2%) patients. There were 2 (0.5%) non-STEMI myocardial infarctions and 2 (0.5%) non-stroke related fatalities. Risk factors of these adverse events were diabetes mellitus, lesions localized in a tortuous segment of the artery, embolic material in the filter and bilateral stenoses of carotid arteries. Additional risk factors in asymptomatic patients were renal impairment and advanced coronary artery disease; and in symptomatic patients, grade 3 arterial hypertension, dislipidemia, cigarette smoking and lesions requiring predilatation. Conclusions Stenting procedures of extracranial arteries supplying the brain, which are tailored to the type and anatomy of lesions, seem to be relatively safe. PMID:28344618

Aortic dissection presenting with secondary pulmonary hypertension caused by compression of the pulmonary artery by dissecting hematoma: a case report

International Nuclear Information System (INIS)

Kim, Dong Hun; Ryu, Sang Wan; Choi, Yong Sun; Ahn, Byoung Hee

2004-01-01

The rupture of an acute dissection of the ascending aorta into the space surrounding the pulmonary artery is an uncommon occurrence. No previous cases of transient pulmonary hypertension caused by a hematoma surrounding the pulmonary artery have been documented in the literature. Herein, we report a case of acute aortic dissection presenting as secondary pulmonary hypertension

Surgical Treatment of A Dissecting Aneurysm of the Superior Cerebellar Artery: Case Report

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Stefanescu Florin

2014-10-01

Full Text Available Dissecting aneurysm located in the peripheral region of the superior cerebellar artery is very rare. There is little experience regarding their surgical or endovascular treatment. We present the case of a peripheral dissecting superior cerebellar artery aneurysm treated by surgical clipping.

Clinical Significance of the Champagne Bottle Neck Sign in the Extracranial Carotid Arteries of Patients with Moyamoya Disease.

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Yasuda, C; Arakawa, S; Shimogawa, T; Kanazawa, Y; Sayama, T; Haga, S; Morioka, T

2016-05-26

The champagne bottle neck sign represents a rapid reduction in the extracranial ICA diameters and is a characteristic feature of Moyamoya disease. However, the clinical significance of the champagne bottle neck sign is unclear. We investigated the relationship between the champagne bottle neck sign and the clinical and hemodynamic stages of Moyamoya disease. We analyzed 14 patients with Moyamoya disease before revascularization (5 men, 9 women; age, 43.2 ± 19.3 years). The ratio of the extracranial ICA and common carotid artery diameters was determined using carotid ultrasonography or cerebral angiography; a ratio of champagne bottle neck sign-positive. The clinical disease stage was determined using the Suzuki angiographic grading system. CBF and cerebral vasoreactivity also were measured. The ICA/common carotid artery ratio (expressed as median [interquartile range]) decreased as the clinical stage advanced (stages I-II, 0.71 [0.60-0.77]; stages III-IV, 0.49 [0.45-0.57]; stages V-VI, 0.38 [0.34-0.47]; P champagne bottle neck sign-positive arteries were classified as Suzuki stage ≥III, 73% were symptomatic, and 89% exhibited reduced cerebral vasoreactivity. In contrast, all champagne bottle neck sign-negative arteries were Suzuki stage ≤III, 67% were asymptomatic, and all showed preserved cerebral vasoreactivity. The champagne bottle neck sign was related to advanced clinical stage, clinical symptoms, and impaired cerebral vasoreactivity. Thus, detection of the champagne bottle neck sign might be useful in determining the clinical and hemodynamic stages of Moyamoya disease. © 2016 American Society of Neuroradiology.

Extracranial-intracranial bypass in medial sphenoid ridge meningioma associated with severe stenosis of the intracranial segments of the internal carotid artery: A case report.

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Huang, Yabo; Wang, Zhong; Han, Qingdong

2018-06-01

Tumor resection and extracranial-intracranial bypass concerning medial sphenoid ridge meningioma associated with severe stenosis of the internal carotid artery (ICA) of intracranial segments has been rarely presented. Effective treatment as to the complex lesions may be complicated. Tumor resection and cerebrovascular protection should be both taken into consideration. We presented one case of medial sphenoid ridge meningioma associated with severe stenosis of the internal carotid artery of intracranial segments. The patient suffered hyperthyroidism, mirror-image dextrocardia and congenital heart disease atrial septal defect simultaneously. Before the neurosurgical treatment , the colleagues of department of cardiac surgery, anesthesiology and respiratory medicine agreed on our plan of resecting the tumor following the comprehensive evaluation of basal clinical conditions in the patient. For reducing the bleeding intraoperatively, the interventional branch performed digital subtraction angiography(DSA) and found collateral anastomosis between the supplying vessels of left middle meningeal arteries and anterior choroid arteries. No preoperative interventional embolization was determined considering the risk of cerebral ischemia. The following subtotal resection of medial sphenoid ridge meningioma and left extracranial-intracranial bypass were carried out. Additionally, ipsilateral decompressive craniectomy was done. Post-operative imaging Computed tomography (CT), Computed tomography angiography (CTA) and Transcranial Doppler (TCD) indicated subtotal resection of tumor and bypass patency. The patient was discharged with the right limbs of muscle strength of grade IV. The muscle strength of the patient returned to grade V after 6 months of follow-up. Comprehensive treatment of tumor resection and extracranial-intracranial bypass concerning medial sphenoid ridge meningioma associated with severe stenosis of the internal carotid artery of intracranial segments is

Clinical features of 10 patients with spontaneous cervical internal carotid artery dissection

International Nuclear Information System (INIS)

Nagoya, Harumitsu; Takeda, Hidetaka; Dembo, Tomohisa; Kato, Yuzi; Deguchi, Ichiro; Fukuoka, Takuya; Maruyama, Hazime; Horiuchi, Yohsuke; Tanahashi, Norio

2011-01-01

We clinically investigated 10 patients with spontaneous cervical internal carotid artery dissections (age range 36-70, mean 52±12 years; 8 male and 2 female) who were admitted to our university hospital between August 2002 and 2009. Cervical internal carotid artery dissection was diagnosed using findings from MRI, MR angiography (MRA), 3D-CTA, cerebral angiography, and carotid artery ultrasonography according to the diagnostic criteria of brain artery dissociation defined by the brain artery dissociation working group of the Strategies Against Stroke Study for Young Adults in Japan. The initial symptoms were stroke in eight patients, only neck pain in another, and no symptoms in the last. Four patients (40%) had neck pain or headache at onset. Five of the 10 patients had radiological improvements within three months after onset. The outcomes at three months were relatively good, with seven and three patients scoring 1 and 2, respectively, on the modified Rankin Scale. Disease did not recur in any patients during an average of 17.2 months of follow up. Spontaneous cervical internal carotid artery dissection is not rare in Japan. This condition should be considered when patients present with internal carotid artery occlusion or stenosis. (author)

Spontaneous carotid artery dissection causing a juvenile cerebral infarction

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Trattnig, S.; Huebsch, P.; Schindler, E.

1988-11-01

The case of a 19-year-old patient is presented who was admitted with aphasia and hemiparesis due to basal ganglia infarction as a result of spontaneous dissection of the internal carotid artery. The difficulties in diagnosing this disease with CT and MRI in the acute stage are demonstrated. Angiography is still imperative in order to ascertain that a carotid dissection has occurred.

Subclavian artery dissection during catheterization in a patient after irradiation

International Nuclear Information System (INIS)

Kanazawa, Susumu; Hiraki, Yoshio; Fujie, Shunji; Sato, Nobuo.

1997-01-01

A 47-year-old woman with right breast cancer underwent partial mastectomy and had irradiations to the primary and metastatic sites, including the left supraclavicular region. During catheterization of the left internal mammary artery for arterial infusion therapy, the patient developed an iatrogenic dissection and subsequent occlusion of the left subclavian artery. Arterial infusion of tissue plasminogen activator into the artery resulted in recanalization and improvement of clinical signs and symptoms. (author)

[Neurological deterioration within 30 days of ischemic stroke with spontaneous cervicocranial artery dissection].

Science.gov (United States)

Mori, Mayumi; Wakugawa, Yoshiyuki; Yasaka, Masahiro; Yasumori, Kotaro; Nagata, Shinji; Okada, Yasushi

2014-01-01

The objective of this study was to identify the clinical features associated with neurological deterioration within 30 days of ischemic stroke patients with spontaneous cevicocranial dissection (SCCD) and clarify the effect on outcomes. We retrospectively identified 18 patients with SCCD (1.6%, 3 women, 52 ± 16 years old) among 1,112 patients with acute ischemic stroke within 7 days after onset. Of the 18 patients, 13 (72%) had vertebrobasilar arterial dissection. Neurological deterioration was present in 4 patients (22%), and 2 patients (11%) died. All of them became worse within 3 days after onset. Their initial blood pressures were high. All of them had dominant side vertebral artery or basilar artery dissection. Subarachnoid hemorrahage (SAH) were not seen although the agressive anticoagulant therapy were performed except for a case who had aneurysmal change. The patients with neurological deterioration had poor outcome, but the patients without neurological deterioration had good outcome. Recurrent ischemic event or SAH did not occurred in 3 months if they had not neurological deterioration. When we see acute stroke patients with dissection at the dominant side vertebral artery or the basilar artery, we should observe carefully for neurological deterioration especially within three days of onset.

Reversal of end-stage renal disease after aortic dissection using renal artery stent: a case report

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Parikh Chirag R

2004-05-01

Full Text Available Abstract Background Medical management is the conventional treatment for Stanford Type B aortic dissections as surgery is associated with significant morbidity and mortality. The advent of endovascular interventional techniques has revived interest in treating end-organ complications of Type B aortic dissection. We describe a patient who benefited from endovascular repair of renal artery stenosis caused by a dissection flap, which resulted in reversal of his end-stage renal disease (ESRD. Case presentation A 69 y/o male with a Type B aortic dissection diagnosed two months earlier was found to have a serum creatinine of 15.2 mg/dL (1343.7 μmol/L on routine visit to his primary care physician. An MRA demonstrated a rightward spiraling aortic dissection flap involving the origins of the celiac artery, superior mesenteric artery, and both renal arteries. The right renal artery arose from the false lumen with lack of blood flow to the right kidney. The left renal artery arose from the true lumen, but an intimal dissection flap appeared to be causing an intermittent stenosis of the left renal artery with compromised blood flow to the left kidney. Endovascular reconstruction with of the left renal artery with stent placement was performed. Hemodialysis was successfully discontinued six weeks after stent placement. Conclusion Percutaneous intervention provides a promising alternative for patients with Type B aortic dissections when medical treatment will not improve the likelihood of meaningful recovery and surgery entails too great a risk. Nephrologists should therefore be aggressive in the workup of ischemic renal failure associated with aortic dissection as percutaneous intervention may reverse the effects of renal failure in this population.

Spontaneous carotid artery dissection causing a juvenile cerebral infarction

International Nuclear Information System (INIS)

Trattnig, S.; Huebsch, P.; Schindler, E.

1988-01-01

The case of a 19-year-old patient is presented who was admitted with aphasia and hemiparesis due to basal ganglia infarction as a result of spontaneous dissection of the internal carotid artery. The difficulties in diagnosing this disease with CT and MRI in the acute stage are demonstrated. Angiography is still imperative in order to ascertain that a carotid dissection has occurred. (orig.) [de

Spontaneous Arterial Dissection.

Science.gov (United States)

Brandt, Tobias; Caplan, Louis

2001-09-01

There is no controlled study for the best treatment or management of cervico-cerebral artery dissection (CAD). Rationale initial empiric treatment in acute CAD to prevent secondary embolism is partial thromboplastin time (PTT)-guided anticoagulation by intravenous heparin followed by anticoagulation with warfarin. Carotid surgery for treatment of CAD is not recommended anymore with the possible exception of persisting severe stenosis of the proximal internal carotid artery (ICA). There could be use of carotid angioplasty by balloon dilatation and stenting in selected cases of severe cerebral hemodynamic impairment by bilateral CAD. Duration of secondary prophylaxis by anticoagulation is best guided by Doppler sonography follow-up, and should be continued until normalization of blood flow or until at least 1 year after the vessel is occluded. There is no evidence that pseudoaneurysms increase the risk for embolic complication, and there is no evidence for surgery or continuation of anticoagulation in patients with pseudoaneurysms. Caution should be recommended for exercises that involve excessive head movements (eg, bungee jumping, trampoline jumping, and chiropractic maneuvers). The patient should be informed that recurrent rate is low in nonfamilial cases. Doppler sonography is a low-cost and high-sensitivity method for patients at risk.

Bilateral Internal Carotid Artery Occlusion Associated with the Antiphospholipid Antibody Syndrome

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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.

Arterial embolizations with microvascular plug in extracranial and intracranial districts: technical results.

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Giurazza, Francesco; Corvino, Fabio; Cavaglià, Errico; Cangiano, Gianluca; Amodio, Francesco; De Magistris, Giuseppe; Frauenfelder, Giulia; Guarnieri, Gianluigi; Muto, Mario; Niola, Raffaella

2018-03-01

A new detachable microvascular plug (MVP, Reverse Medical ® , Irvine, CA, USA) has been recently developed; three models are available according to the size (MVP3-MVP5-MVP7). MVP3 and MVP5 are released through a 0.027″ microcatheter, MVP7 through a 4 Fr catheter. This series aims to describe an initial single-center experience examining intraprocedural safety and technical success of MVP. Ten patients (mean age 55.1 years) have been treated for arterial embolization using MVP; eight extracranial and two intracranial arterial embolizations have been performed. The embolizations were because of: four bleedings, three aneurysms, two pseudoaneurysms, and one presurgical nephrectomy. MVP3 was used in five cases, MVP5 in four cases, and MVP 7 once. In all cases, the MVP was successfully released in MVP was the sole embolizing agent employed, while in four subjects, it was positioned complementary after coils. The technical and clinical success was obtained in 100%; hemorrhages were interrupted and aneurysms and pseudoaneurysms did not show recanalization at follow-up. MVP seems to be a safe embolizing device that interventional radiologists should consider when facing arterial embolization of both body and neuroarterial districts; the main advantage is related to MVP3 and MVP5 models that can be adopted for distal embolization thanks to the precise release through 0.027″ microcatheter.

Stent assisted coil embolization of a dissecting aneurysm of the vertebral artery: a case involving a patient with hypoplasia of the contralateral vertebral artery

International Nuclear Information System (INIS)

Kim, Hyun Jin; Jeong, Hae Woong; Cho, Jae Kwoeng; Park, Jeong Hoon; Koo, Yong Woon; Baik, Seung Kug

2002-01-01

A dissecting aneurysm of the vertebral artery may be treated conservatively, surgically, or using an endovascular approach. Proximal clipping, wrapping or trapping are surgical treatment methods, and endovascular treatment with coils and balloons is performed where a dissecting aneurysm is located near the midline or the appropriate surgical manipulation is difficult. As the contralateral vertebral artery of this patient was hypoplastic, the stent-assisted coil embolization technique was employed to preserve the ipsilateral vertebral artery. We describe a clinical case of dissecting aneurysm of the vertebral artery occurring in a patient in whom a hypoplastic contralateral vertebral artery was successfully treated

The emerging role of multidetector row CT angiography in the diagnosis of cervical arterial dissection: preliminary study

International Nuclear Information System (INIS)

Elijovich, Lucas; Kazmi, Khuram; Gauvrit, Jean Y.; Law, Meng

2006-01-01

Cervical artery dissection is an important cause of ischemic stroke, particularly in young patients. The diagnosis can be made with invasive catheter angiography or non-invasive imaging, either with MRI in conjunction with MR angiography (MRA) or CT angiography (CTA). Both modalities have been shown to have a high specificity and sensitivity. New developments such as multi-slice CTA (MSCTA) are emerging as an alternative methods for imaging the cervical and intracranial arteries. However, the contribution of modern MSCTA to carotid artery dissection has not been reported. We present a retrospective series of seven patients in whom both MSCTA and cervical axial T1 MRI and MRA were performed in the acute to subacute setting of internal carotid artery dissection. Carotid artery dissection was identified in all seven patients by MSCTA. The combination of MRI and MRA identified dissection in five of the seven patients. Additionally, a pseudoaneurysm was identified by MSCTA that was missed by MRI and MRA. Our findings confirm that MSCTA is a complementary technique in comparison to cervical axial T1 MRI and cervical MRA for diagnosing carotid artery dissection, and at times may provide additional information that can impact patient management. (orig.)

Iatrogenic dissection of the celiac artery and its branches during TAE for HCC: results of follow-up in 30 cases

International Nuclear Information System (INIS)

Yoon, Dae Young; Park, Jae Hyung; Chung, Jin Wook; Han, Joon Koo; Han, Man Chung; Suh, Chang Hae

1993-01-01

The authors analyzed 30 patients whose celiac artery or its branches were dissected during the procedure of transcatheter arterial embolization (TAE) for hepatocellular carcinoma (HCC) and were followed up angiographically. The incidence of arterial dissection was 1.25%. The dissection occurred most frequently in the celiac artery (40% 12/30) and the proper hepatic artery (28% 7/30). The frequency of arterial dissection was affected by the status of the vessel and the experience of the operator. The follow-up angiography revealed complete recanalization in 40% (12/30), irregularity and narrowing of the lumen in 23% (7/30), pseudoaneurysm formation in 23% (7/30), and complete obstruction in 13% (4/30) of the cases. The rate of recanalization in the celiac artery was lower than that of any other arteries in our series. Recanalization to a certain degree without therapeutic intervention was observed in 72% of the dissected arteries enabling and contributing to subsequent successful TAE within 2 months in 78% of the patients with the dissection

Superior Mesenteric Artery Dissection after Extracorporeal Shockwave Lithotripsy

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Christos Bakoyiannis

2012-01-01

Full Text Available The use of shockwave lithotripsy is currently the mainstay of treatment in renal calculosis. Several complications including vessel injuries have been implied to extracorporeal shockwave lithotripsy. We report an isolated dissection of the superior mesenteric artery in a 60-year-old male presenting with abdominal pain which occurred three days after extracorporeal shockwave lithotripsy. The patient was treated conservatively and the abdominal pain subsided 24 hours later. The patient's history, the course of his disease, and the timing may suggest a correlation between the dissection and the ESWL.

Distribution of ischemic infarction and stenosis of intra- and extracranial arteries in young Chinese patients with ischemic stroke.

Science.gov (United States)

Ojha, Rajeev; Huang, Dongya; An, Hedi; Liu, Rong; Du, Cui; Shen, Nan; Tu, Zhilan; Li, Ying

2015-11-23

The distribution of cerebral ischemic infarction and stenosis in ischemic stroke may vary with age-group, race and gender. This study was conducted to understand the risk factors and characteristics of cerebral infarction and stenosis of vessels in young Chinese patients with ischemic stroke. This was a retrospective study, from January 2007 to July 2012, of 123 patients ≤50 years diagnosed with acute ischemic stroke. Patient characteristics were compared according to sex (98 males and 25 females) and age group (51 patients were ≤45 years and 72 patients were 46-50 years). Characteristics of acute ischemic infarction were studied by diffusion weighted imaging. Stenosis of intra- and extracranial arteries was diagnosed by duplex sonography, head magnetic resonance angiography (MRA) or cervical MRA. Common risk factors were hypertension (72.4 %), dyslipidemia (55.3 %), smoking (54.4 %) and diabetes (33.3 %). Lacunar Infarction was most common in our patients (41.5 %). Partial anterior circulation infarction was predominant in females (52.0 vs 32.7 %; P = 0.073) and posterior circulation infarction in males (19.8 vs 4 %; P = 0.073). Multiple brain infarctions were found in 38 patients (30.9 %). Small artery atherosclerosis was found in 54 patients (43.9 %), with higher prevalence in patients of the 46-50 years age-group. Intracranial stenosis was more common than extracranial stenosis, and middle cerebral artery stenosis was most prevalent (27.3 %). Stenosis in the anterior circulation was more frequent than in the posterior circulation (P young patients, hypertension, smoking, dyslipidemia and diabetes were common risk factors. Intracranial stenosis was most common. The middle cerebral artery was highly vulnerable.

Dissecting Vertebral Artery Aneurysm Presenting Regrowth After Stent-Assisted Coil Embolization in Acute Stage.

Science.gov (United States)

Hijikata, Takamichi; Baba, Eiichi; Shirokane, Kazutaka; Tsuchiya, Atsushi; Nomura, Motohiro

2018-06-01

For a case of dissecting vertebral artery aneurysm (DVAA) in a dominant vertebral artery (VA) or posterior inferior cerebellar artery (PICA)-involving lesion, stent-assisted coil embolization (SACE) is an effective technique to preserve blood flow of the VA. A 41-year-old man presented with subarachnoid hemorrhage. Angiography demonstrated DVAA on the left VA just distal to the PICA, and the right VA was thinner than the left. For this case, SACE was performed to preserve the left VA and PICA. On the 10th day, angiography showed recurrence of the dissection. The dissected portion had thickened and extended to both distal and proximal sides involving the PICA origin and proximal portion to the PICA. A second endovascular embolization was performed and the recurrent dissecting aneurysm was embolized including the main VA cavity. In cases of DVAA, there is a possibility of recurrence after SACE, if a dissecting cavity remains unembolized. Therefore, total embolization is necessary under close observation from multiple angles, including the down-the-barrel view.

[Ehlers Danlos type IV syndrome presenting with simultaneous dissection of both internal carotid and both vertebral arteries].

Science.gov (United States)

Mondon, K; de Toffol, B; Georgesco, G; Cassarini, J-F; Machet, M-C; Cottier, J-P; Arbeille, B; Autret, A

2004-04-01

Dissection of cervical arteries is a frequent cause of stroke in young subjects. We report the case of a 34-year-old patient who experienced simultaneous dissection of both internal carotid arteries and both vertebral arteries leading to repeated motor deficit of the right half-body associated with persistent otalgia. Search for an etiology led to the diagnosis of Ehlers-Danlos syndrome type IV. Search for the cause of cervical artery dissection must consider connective tIssue disease, particularly vascular forms of Ehler-Danlos syndrome. Diagnostic, therapeutic as well as prognostic aspects are discussed.

CT versus MR Techniques in the Detection of Cervical Artery Dissection.

Science.gov (United States)

Hanning, Uta; Sporns, Peter B; Schmiedel, Meilin; Ringelstein, Erich B; Heindel, Walter; Wiendl, Heinz; Niederstadt, Thomas; Dittrich, Ralf

2017-11-01

Spontaneous cervical artery dissection (sCAD) is an important etiology of juvenile stroke. The gold standard for the diagnosis of sCAD is convential angiography. However, magnetic resonance imaging (MRI)/MR angiography (MRA) and computed tomography (CT)/CT angiography (CTA) are frequently used alternatives. New developments such as multislice CT/CTA have enabled routine acquisition of thinner sections with rapid imaging times. The goal of this study was to compare the capability of recent developed 128-slice CT/CTA to MRI/MRA to detect radiologic features of sCAD. Retrospective review of patients with suspected sCAD (n = 188) in a database of our Stroke center (2008-2014), who underwent CT/CTA and MRI/MRA on initial clinical work-up. A control group of 26 patients was added. All Images were evaluated concerning specific and sensitive radiological features for dissection by two experienced neuroradiologists. Imaging features were compared between the two modalities. Forty patients with 43 dissected arteries received both modalities (29 internal carotid arteries [ICAs] and 14 vertebral arteries [VAs]). All CADs were identified in CT/CTA and MRI/MRA. The features intimal flap, stenosis, and lumen irregularity appeared in both modalities. One high-grade stenosis was identified by CT/CTA that was expected occluded on MRI/MRA. Two MRI/MRA-confirmed pseudoaneurysms were missed by CT/CTA. None of the controls evidenced specific imaging signs for dissection. CT/CTA is a reliable and better available alternative to MRI/MRA for diagnosis of sCAD. CT/CTA should be used to complement MRI/MRA in cases where MRI/MRA suggests occlusion. Copyright © 2017 by the American Society of Neuroimaging.

Diagnosis of vertebral artery dissection with basiparallel anatomical scanning magnetic resonance imaging

International Nuclear Information System (INIS)

Katsuno, Makoto; Kobayashi, Shiro

2011-01-01

There is no consensus regarding the optimal method for diagnosing the dissection of intracranial arteries. We have developed a rapid and accurate examination method to diagnose vertebral artery dissection in the acute stage of cerebral infarction. Twenty-two patients with severe headache and neck pain and/or symptoms of brain stem or cerebellar ischemia underwent magnetic resonance imaging (MRI) with a 1.5-T scanner. Our protocol generated 3 contrast-weighted scans (T2-weighted, diffusion-weighted, and basi-parallel anatomical scanning [BPAS]-MRI) and conventional angiographs within 3 hours of the onset of symptoms. Then, we retrospectively analyzed the findings to identify the most reliable imaging method for diagnosing vertebral artery dissection in the acute stage of cerebral infarction. Based on the symptoms and the findings of T2-weighted imaging and conventional angiography, the initial diagnosis was dissection in 17 patients, lacunar infarction in 3 patients, and atherothrombosis in 2 patients. After follow-up studies the diagnosis was changed in 7 patients. The diagnosis based on symptoms and the findings of T2-weighted MRI and BPAS-MRI was dissection in 13 patients, atherothrombosis in 6 patients, and lacunar infarction in 3 patients. In 3 patients the diagnosis was changed during the follow-up phase. The diagnostic accuracy rate was higher with T2-weighted MRI and BPAS-MRI than with T2-weighted MRI and conventional angiography. We suggest that when intracranial vascular dissection is suspected, both the inner and outer contours of vessels must be inspected and that BPAS-MRI should be performed instead of conventional angiography to establish the definite diagnosis. (author)

Stroke from cercocephalic arterial dissecting in Saudi children

International Nuclear Information System (INIS)

Salih, Mustafa A.; Al-Jarallah, Ahmed A.; Al-Salman, Mussaad M.; Alorainy, Ibrahim A.; Hassan, Hamdy H.

2006-01-01

Cercocephalic arterial dissecting (CCAD) is an important, but rarely recognized, cause of stroke in children. We describe 3 cases of CCAD who were diagnosed during a study on childhood stroke which included 104 patients. A high index of suspicion and targeted investigations are needed for the diagnosis and management of CCAD in childhood. (author)

Spontaneous coronary artery dissection. Case report and literature review

DEFF Research Database (Denmark)

Elming, H; Køber, L

1999-01-01

to patient characteristics, patient treatment, and prognosis. Primary spontaneous coronary artery dissection is a rare condition but one that must be considered when young people, especially post partum women, present an acute ischaemic syndrome. Thrombolytic therapy may be a two-edged sword and therefore...

Simultaneous Onset of Ischemic and Hemorrhagic Stroke Due To Intracranial Artery Dissection

OpenAIRE

Kim, Jong-Hoon; Jung, Young-Jin; Chang, Chul-Hoon

2017-01-01

Intracranial dissections commonly present as ischemic stroke and as hemorrhagic stroke. In general, while either ischemic stroke or hemorrhagic stroke may develop, the simultaneous onset of both may also occasionally occur. In this report, we present a case of simultaneous development of ischemic stroke and hemorrhagic stroke due to an intracranial artery dissection.

Dynamic changes of intramural hematoma in patients with acute spontaneous internal carotid artery dissection.

Science.gov (United States)

Heldner, Mirjam R; Nedelcheva, Mila; Yan, Xin; Slotboom, Johannes; Mathier, Etienne; Hulliger, Justine; Verma, Rajeev K; Sturzenegger, Matthias; Jung, Simon; Bernasconi, Corrado; Arnold, Marcel; Wiest, Roland; Fischer, Urs

2015-08-01

We prospectively investigated temporal and spatial evolution of intramural hematomas in patients with acute spontaneous internal carotid artery dissection using repeated magnetic resonance imaging over six-months. The aim of the present study was to assess dynamic changes of intramural hematoma in patients with acute spontaneous internal carotid artery dissection at multiple follow-up time-points with T1w, PD/T2w, and magnetic resonance angiography. We performed serial multiparametric magnetic resonance imaging in 10 patients with spontaneous internal carotid artery dissection on admission, at days 1, 3, 7-14 and at months 1·5, 3, and 6. We calculated the volume and extension of the hyperintense intramural hematoma using T1w and PD/T2w fat suppressed sequences and assessed the degree of stenosis due to the hematoma using magnetic resonance angiography. Mean interval from symptom onset to first magnetic resonance imaging was two-days (SD 2·7). Two patients presented with ischemic stroke, three with transient ischemic attacks, and five with pain and local symptoms only. Nine patients had a transient increase of the intramural hematoma volume, mainly up to day 10 after symptom onset. Fifty percent had a transient increase in the degree of the internal carotid artery stenosis on MRA, one resulting in a temporary occlusion. Lesions older than one-week were predominantly characterized by a shift from iso- to hyperintese signal on T2w images. At three-month follow-up, intramural hematoma was no longer detectable in 80% of patients and had completely resolved in all patients after six-months. Spatial and temporal dynamics of intramural hematomas after spontaneous internal carotid artery dissection showed an early volume increase with concomitant progression of the internal carotid artery stenosis in 5 of 10 patients. Although spontaneous internal carotid artery dissection overall carries a good prognosis with spontaneous hematoma resorption in all our patients, early

An interesting case report of vertebral artery dissection following polytrauma

Directory of Open Access Journals (Sweden)

Vikas Acharya

2016-01-01

Conclusion: Our report displays select images related to this case report and emphasizes the consideration of routine imaging in head and neck traumatic injuries to diagnose internal carotid and/or vertebral artery dissections much earlier.

Spontaneous Coronary Artery Dissection in a Male Patient with Takayasu’s Arteritis and Antiphospholipid Antibody Syndrome

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Demet Menekşe Gerede

2013-01-01

Full Text Available We present a case of a 34-year-old male who presented to the emergency ward with fever and abdominal pain. The diagnosis of Takayasu’s arteritis and also antiphospholipid syndrome was made during an imaging workup of deep-vein thrombosis. A spontaneous coronary artery dissection was revealed in coronary CT angiography requested for chest pain and dyspnea. The patient was treated medically and discharged on close followup. The concurrence of spontaneous coronary artery dissection with antiphospholipid syndrome and Takayasu’s arteritis has not been reported in the previous literature. The possibility of a spontaneous coronary artery dissection should be considered in patients presenting with both diseases.

Acute Myocardial Infarction Due to Spontaneous Dissection of the Right Coronary Artery in a Young Male

International Nuclear Information System (INIS)

Papadopoulos, Dimitris P.; Moyssakis, Ioannis; Perakis, Alexandros; Athanasiou, Andreas; Anagnostopoulou, Sophia; Benos, Ioannis; Votteas, Vassilios E.

2004-01-01

Spontaneous coronary artery dissection is a rare cause of acute myocardial infarction. We report a case of a 33-year-old male who presented with an acute inferior myocardial infarction. Coronary arteriography performed 3 hours after the episode revealed a dissection involving the middle segment of right coronary artery. Because of a spiral form of dissection and the TIMI 3 flow grade, our patient was treated medically and repeat coronary angiography 6 months later was decided

Delayed presentation of carotid artery dissection following major orthopaedic trauma resulting in dense hemiparesis.

LENUS (Irish Health Repository)

Edmundson, S P

2012-01-31

We report a 30-year-old patient who was involved in a high-velocity road traffic accident and developed a left-sided hemiparesis, which was noted in the post-operative period following bilateral femoral intramedullary nailing. CT scanning of the brain revealed infarcts in the right frontal and parietal lobes in the distribution of the right middle cerebral artery. CT angiography showed occlusion of the right internal carotid artery consistent with internal carotid artery dissection. He was anticoagulated and nine months later was able to walk independently. An awareness of this injury is needed to diagnose blunt trauma to the internal carotid artery. Even in the absence of obvious neck trauma, carotid artery dissection should be suspected in patients with a neurological deficit in the peri-operative period.

Spontaneous coronary artery dissection: complete angiographic resolution without stenting

Directory of Open Access Journals (Sweden)

Alexandre Abizaid

2007-09-01

Full Text Available A case of spontaneous coronary artery dissection in a 49-year-oldwoman is presented. She did not present the classical cardiovascular riskfactors. Etiology and treatment are discussed. She underwent primarypercutaneous coronary intervention of the left anterior descendingartery with no stenting and had complete angiographic resolution.

Pulmonary arterial dissection in a post-partum patient with patent ductus arteriosus: Case report and review of the literature.

Science.gov (United States)

Yaman, Mehmet; Arslan, Uğur; Ateş, Ahmet Hakan; Aksakal, Aytekin

2015-02-26

Pulmonary arterial dissection is an uncommon but usually a deadly complication of chronic pulmonary hypertension. A 26-year-old female patient was admitted to our clinics with sudden dyspnea and chest discomfort one hour after giving birth to twins by vaginal delivery. An echocardiography was performed with a pre-diagnosis of pulmonary embolism. However, echocardiographic examination revealed a dilated main pulmonary artery and a dissection flap extending from main pulmonary artery to left pulmonary artery. In summary, in this report, we described a very rare case of pulmonary artery dissection in a pregnant patient with a previously un-diagnosed patent ductus arteriosus without an obvious rise in pulmonary artery pressure and reviewed the relevant literature.

Spontaneous healing of cervical pseudoaneurysm in vertebral artery dissection under anticoagulant therapy

International Nuclear Information System (INIS)

Sommer, A.; Neff, W.; Schwartz, A.

1998-01-01

We report a 41-year-old woman with embolic stroke of the mid-pons attributed to embolism from vertebral artery dissection. Angiography revealed an occluded artery on one side and an incidental pseudoaneurysm of the midcervical portion of the vertebral artery on the other. After 3 months of warfarin therapy control angiography showed complete occlusion of the pseudoaneurysm. We discuss therapeutic choices and review the literature. (orig.)

Spontaneous coronary artery dissection in a young woman with polycystic ovarian syndrome.

Science.gov (United States)

Mirra, Marco; Kola, Nertil; Mattiello, Giacomo; Morisco, Carmine; Spinelli, Letizia

2017-06-01

Polycystic ovarian syndrome (PCOS) affects 4% to 12% of women in reproductive age, representing a clinical condition that could predispose to cardiovascular diseases. We report a case of a 34-year-old woman with PCOS, presenting with chest pain, onset two days before, and ST segment-elevation myocardial infarction. She was not pregnant or in a postpartum state. Subsequent cardiac angiography revealed spontaneous left anterior descending coronary artery dissections, managed by conservative approach. The patient was discharged in medical therapy after 5days. This is the first observation of spontaneous coronary artery dissection occurring in a PCOS patient. Copyright © 2016 Elsevier Inc. All rights reserved.

Bilateral Carotid Artery Dissection after High Impact Road Traffic Accident

OpenAIRE

Michael Kelly; Marcus Bradley; Ankur Srivastava

2008-01-01

A 58 year old man was involved in a high impact road traffic incident and was admitted for observation. Asymptomatic for the first 24 hours, he collapsed with symptoms and signs consistent with a cerebrovascular accident. Computed tomography angiogram (CTA) and Magnetic resonance angiogram (MRA) demonstrated bilateral internal carotid artery dissections and a left middle cerebral artery infarct. It was not considered appropriate to attempt stenting or other revascularistation. The patient was...

Postoperative peri-axillary seroma following axillary artery cannulation for surgical treatment of acute type A aortic dissection

Directory of Open Access Journals (Sweden)

Katsanos Konstantinos

2010-05-01

Full Text Available Abstract The arterial cannulation site for optimal tissue perfusion and cerebral protection during cardiopulmonary bypass (CPB for surgical treatment of acute type A aortic dissection remains controversial. Right axillary artery cannulation confers significant advantages, because it provides antegrade arterial perfusion during cardiopulmonary bypass, and allows continuous antegrade cerebral perfusion during hypothermic circulatory arrest, thereby minimizing global cerebral ischemia. However, right axillary artery cannulation has been associated with serious complications, including problems with systemic perfusion during cardiopulmonary bypass, problems with postoperative patency of the artery due to stenosis, thrombosis or dissection, and brachial plexus injury. We herein present the case of a 36-year-old Caucasian man with known Marfan syndrome and acute type A aortic dissection, who had direct right axillary artery cannulation for surgery of the ascending aorta. Postoperatively, the patient developed an axillary perigraft seroma. As this complication has, not, to our knowledge, been reported before in cardiothoracic surgery, we describe this unusual complication and discuss conservative and surgical treatment options.

MR diagnosis of cerebellar infarction due to vertebral artery dissection in children

International Nuclear Information System (INIS)

Cheon, J.E.; Kim, I.O.; Kim, W.S.; Yeon, K.M.; Hwang, Y.S.; Wang, K.C.

2001-01-01

Posterior circulation infarction is uncommon in children. We describe the clinical presentation and radiological findings in two children with cerebellar infarction resulting from dissection of the vertebral artery. We emphasize that vertebral artery injury should be considered in a child with acute symptoms and signs of ischaemia in the posterior circulation. MRI and MRA may be helpful in the diagnosis of cerebellar infarction and vertebral artery abnormality. (orig.)

Bilateral Carotid Artery Dissection after High Impact Road Traffic Accident

Directory of Open Access Journals (Sweden)

Michael Kelly

2008-11-01

Full Text Available A 58 year old man was involved in a high impact road traffic incident and was admitted for observation. Asymptomatic for the first 24 hours, he collapsed with symptoms and signs consistent with a cerebrovascular accident. Computed tomography angiogram (CTA and Magnetic resonance angiogram (MRA demonstrated bilateral internal carotid artery dissections and a left middle cerebral artery infarct. It was not considered appropriate to attempt stenting or other revascularistation. The patient was treated with heparin prior to starting warfarin. He made a partial recovery and was discharged to a rehabilitation facility. This case is a reminder of carotid dissection as an uncommon but serious complication of high speed motor vehicle accident, which may be silent initially. Literature Review suggests risk stratification before relevant radiological screening at risk patients. Significant advances in CTA have made it the diagnostic tool of choice, but ultrasound is an important screening tool.

Association between plasma homocysteine concentrations and extracranial carotid stenosis

International Nuclear Information System (INIS)

Mousavi, Seyed Ali; Ghasemi, M.; Hoseini, T.

2006-01-01

Increasing epidemiologic data support a relationship between elevated plasma total homocysteine levels and an increased risk for vascular disease. Higher plasma total homocysteine (tHcy) levels have been associated with extracranial carotid atherosclerosis and cerebral infarction in whites. However, data regarding such associations are limited for Asians. This study examined the association between tHcy level and carotid stenosis in Iranian subjects. In this retrospective study, the subjects were 158 patients with ischemic stroke, including 105 with a normal tHcy level and 53 with a high tHcy level. We investigated the extracranial carotid arteries by ultrasonography and measured serum tHcy by ELISA method in these two groups. We found no meaningful association between a high tHcy level and carotid stenosis. The lack of any meaningful difference in carotid stenosis between patients with normal and elevated tHcy levels is probably due to the low frequency of extracranial diseases in the Asian population and to the nature of homocysteine atherosclerosis. (author)

Effects of neck radiation therapy on extra-cranial carotid arteries atherosclerosis disease prevalence: systematic review and a meta-analysis.

Directory of Open Access Journals (Sweden)

Khalid Bashar

Full Text Available Radiation arteritis following neck irradiation as a treatment for head and neck malignancy has been well documented. The long-term sequelae of radiation exposure of the carotid arteries may take years to manifest clinically, and extra-cranial carotid artery (ECCA stenosis is a well-recognised vascular complication. These carotid lesions should not be regarded as benign and should be treated in the same manner as standard carotid stenosis. Previous studies have noted increased cerebrovascular events such as stroke in this cohort of patients because of high-grade symptomatic carotid stenosis resulting in emboli.To evaluate the effect of radiation therapy on ECCA atherosclerosis progression.Online search for case-control studies and randomised clinical trials that reported on stenosis in extra-cranial carotid arteries in patients with neck malignancies who received radiation therapy (RT comparing them to patients with neck malignancies who did not receive RT.Eight studies were included in the final analysis with total of 1070 patients - 596 received RT compared to 474 in the control group. There was statistically significant difference in overall stenosis rate (Pooled risk ratio  =  4.38 [2.98, 6.45], P  =  0.00001 and severe stenosis (Pooled risk ratio  =  7.51 [2.78, 20.32], P <0.0001, both being higher in the RT group. Pooled analysis of the five studies that reported on mild stenosis also showed significant difference (Pooled risk ratio  =  2.74 [1.75, 4.30], 95% CI, P  =  0.0001.The incidence of severe ECCA stenosis is higher among patients who received RT for neck malignancies. Those patients should be closely monitored and screening programs should be considered in all patients who receive neck RT.

Dissections of the cervical brain supplying arteries; Dissektionen der zervikalen hirnversorgenden Gefaesse

Energy Technology Data Exchange (ETDEWEB)

Jensen-Kondering, U. [Universitaetsklinikum Schleswig-Holstein, Kiel (Germany). Klinik fuer Radiologie und Neuroradiologie

2015-12-15

Dissections of the cervical brain supplying arteries are rare but are an important cause of stroke in young and middle aged patients. Furthermore, recognition of dissections is crucial to prevent recurring embolic events by adequate choice of therapy. In this article the anatomical and pathophysiological basics, diagnostic and treatment options will be discussed with an emphasis on cross sectional imaging and typical imaging findings.

[Aortic dissection spread to the renal arteries: role of renal volumetry after angioplasty].

Science.gov (United States)

Vautrin, E; Thony, F; Chavanon, O; Hannachi, I; Barone-Rochette, G; Pierre, H; Baguet, J-P

2012-06-01

Type A or B aortic dissection can extend to renal arteries, causing a renal ischemia which treatment is usually endovascular. The aim of our study is to show the interest of the renal volumetry in the follow-up of these patients. Twenty-two patients (16 men, mean age 63.4±11.8years, BMI 25.2±3.4kg/m(2)) with a type A or B aortic dissection spread to one or to both renal arteries and followed at Grenoble university hospital were consecutively included. All patients underwent renal angiography with aorto-renal pressure gradients measurements and follow-up by renal volumetry (scanner Siemens(®)). A renal ischemia was defined by a decrease of 20% or more of the volumetry. Sixteen patients (73%) were hypertensive before the aortic dissection among which ten (62%) were treated. Eight patients (36%) have a significant renal pressure gradient among which five (62%) underwent renal endovascular therapy. The renal volumetry of these five patients remained unchanged while six of 17 patients (36%) without angioplasty have a decreasing volumetry. Renal volumetry appeared an effective and attractive option for the follow-up of the patients with aortic dissection spread to the renal arteries. These results should be taken into account to put the indication of an endovascular treatment. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Spontaneous healing of cervical pseudoaneurysm in vertebral artery dissection under anticoagulant therapy

Energy Technology Data Exchange (ETDEWEB)

Sommer, A.; Neff, W.; Schwartz, A. [Department of Neurology, Klinikum Mannheim, Medical Faculty, University of Heidelberg, Theodor-Kutzer-Ufer 1, D-68132 Mannheim (Germany)

1998-04-01

We report a 41-year-old woman with embolic stroke of the mid-pons attributed to embolism from vertebral artery dissection. Angiography revealed an occluded artery on one side and an incidental pseudoaneurysm of the midcervical portion of the vertebral artery on the other. After 3 months of warfarin therapy control angiography showed complete occlusion of the pseudoaneurysm. We discuss therapeutic choices and review the literature. (orig.) With 4 figs., 8 refs.

Common variation in PHACTR1 is associated with susceptibility to cervical artery dissection

NARCIS (Netherlands)

Debette, S.; Kamatani, Y.; Metso, T.M.; Kloss, M.; Chauhan, G.; Engelter, S.T.; Pezzini, S; Thijs, V.; Markus, H.S.; Dichgans, M.; Wolf, C.; Dittrich, R.; Touze, E.; Southerland, A.M.; Samson, Y.; Abboud, S.; Bejot, Y.; Caso, V.; Bersano, A.; Gschwendtner, A.; Sessa, M.; Cole, J.; Lamy, C.; Medeiros, E.; Beretta, S.; Bonati, L.H.; Grau, A.J.; Michel, P.; Majersik, J.J.; Sharma, P.; Kalashnikova, L.; Nazarova, M.; Dobrynina, L.; Bartels, E.; Guillon, B.; Herik, E.G. van den; Fernandez-Cadenas, I.; Jood, K.; Nalls, M.A.; Leeuw, H.F. de; Jern, C.; Cheng, Y.C.; Werner, I.; Metso, A.J.; Lichy, C.; Lyrer, P.A.; Brandt, T.; Boncoraglio, G.B.; Wichmann, H.E.; Gieger, C.; Johnson, A.D.; Bottcher, T.; Castellano, M.; Arveiler, D.; Ikram, M.A.; Breteler, M.M.; Padovani, A.; Meschia, J.F.; Kuhlenbaumer, G.; Rolfs, A.; Worrall, B.B.; Ringelstein, E.B.; Zelenika, D.; Tatlisumak, T.; Lathrop, M.; Leys, D.; Amouyel, P.; Dallongeville, J.

2015-01-01

Cervical artery dissection (CeAD), a mural hematoma in a carotid or vertebral artery, is a major cause of ischemic stroke in young adults although relatively uncommon in the general population (incidence of 2.6/100,000 per year). Minor cervical traumas, infection, migraine and hypertension are

Renal Infarction Caused by Spontaneous Renal Artery Dissection: Treatment with Catheter-Directed Thrombolysis and Stenting

International Nuclear Information System (INIS)

Jeon, Yong Sun; Cho, Soon Gu; Hong, Ki Cheon

2009-01-01

Spontaneous renal artery dissection (SRAD) is rare and presents a diagnostic and therapeutic challenge. We report a case of a 36-year-old man who had an SRAD-complicated renal infarction. The patient experienced severe unilateral flank pain. Enhanced abdominal computed axial tomography scan showed renal infarction, and urinalysis showed no hematuria. Selective renal angiography was essential to evaluate the extent of dissection and suitability for repair. The patient was treated with catheter-directed thrombolysis and frenal artery stenting.

Brainstem ischemic stroke without permanent sequelae during the course of spontaneous internal carotid artery dissection – case report

International Nuclear Information System (INIS)

Nesteruk, Tomasz; Nesteruk, Marta; Bulik-Pasińska, Marta; Boroszko, Dariusz; Ostrowska, Monika

2012-01-01

Internal carotid artery dissection (ICAD) is a frequent cause of a stroke in young patients. Risk factors which can lead to dissection include neck injury and diseases of the inner wall of the artery. Common symptoms in ICAD are cervical pain and headache, Horner’s syndrome, paralysis of the cranial nerves and subsequently cerebral and retinal ischemia. MR angiography in TOF technique and brain MRI in T1- and T2-weighted images, FLAIR and DWI sequences are the method of choice in patients with ICAD but contrast-enhanced multislice computed tomography remains the fastest and the most available diagnostic method. A 39-year old woman, previously healthy, presented to the Hospital Emergency Department because of increasing neck pain on the right side and difficulty in swallowing. The neurological examination revealed: drooping of the right eyelid with narrow palpebral fissure, dysarthria, anisocoria (narrower pupil on the right side), unilateral hypoesthesia on the left side, weak palatal and pharyngeal reflexes on both sides, paresthesia within the left half of the body. Seven days before, the patient felt a sudden, severe neck pain radiating to the temporal apophysis. CT angiography revealed a defect in contrast filling within the left internal carotid artery and right vertebral artery. MRI of the head with MR angiography showed internal carotid artery dissection on the left side and dissection of the right vertebral artery and no ischemic changes within the brain. CT and MR angiography are methods characterized by high sensitivity in detecting dissection of the cervical arteries

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

Science.gov (United States)

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

2017-08-01

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

Symptomatic isolated middle cerebral artery dissection: High resolution MR findings

Energy Technology Data Exchange (ETDEWEB)

Byon, Jung Hee; Kwak, Hyo Sung; Chung, Gyung Ho; Hwang, Seung Bae [Dept. of Radiology, Chonbuk National University Medical School, Jeonju (Korea, Republic of)

2015-11-15

To perform high-resolution magnetic resonance imaging (HRMRI) and determine clinical features of patients with acute symptomatic middle cerebral artery (MCA) dissection. Thirteen patients with acute symptomatic MCA dissection underwent HRMRI within 3 days after initial clinical onset. They also underwent routine brain MR imaging. HRMRI examinations included time-of-flight MR angiography (MRA), T2-weighted, T1-weighted, proton-density-weighted, and three-dimensional magnetization-prepared rapid acquisition gradient-echo (MPRAGE) sequences. Conventional angiography and MRA were used as reference standard to establish the diagnosis of MCA dissection. The angiographic findings and HRMRI findings such as intimal flap, double lumen, and intramural hematoma were analyzed in this study. All patients presented cerebral ischemia (median National Institutes of Health Stroke Scale score = 4, range = 0-18). String sign was seen on MRA in seven patients. However, double lumen was seen in all patients on HRMRI by intimal flap. High signal lesion on MPRAGE sequences around the dissection lumen due to intramural hematoma was seen in three patients. HRMRI can be used to easily detect the wall structure of MCA such as the intimal flap and double lumen in patients with acute symptomatic MCA dissection. MPRAGE can detect hemorrhage in false lumen of MCA dissection.

Assessment of extracranial ICA stenosis with color ultrasound and CEMRA

International Nuclear Information System (INIS)

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

2003-01-01

Objective: To evaluate the color ultrasound and CEMRA in assessment of extracranial ICA stenosis. Methods: The preoperation assessment of color ultrasound and CEMRA were reviewed in 93 cases who underwent interventional treatment for severe extracranial ICA stenosis. Results: Ultrasonic examination could reveal the nature and severity of the stenosis, while CEMRA could explore full length of carotid artery and find tandem stenosis. They both possessed a trend for overestimating the stenosis and could hardly show plaque ulceration. Conclusions: Up to the moment, neither color ultrasound nor CEMRA can substitute DSA. A combination of DSA, color ultrasound, and CEMRA could provide details of the stenotic ICA drawing an appropriate operation plan

Chronic dissection of the superior mesenteric artery: case report

International Nuclear Information System (INIS)

Common, A.A.; Pressacco, J.

1999-01-01

Acute dissection of the thoracic aorta is a well-recognized, often fatal condition that frequently extends to involve the abdominal aorta and iliac vessels. The ostia of the renal and mesenteric vessels may be compromised, and the resulting visceral ischemia may necessitate surgical intervention. However, visceral perfusion may be restored if blood flow from true to false lumen is re-established or if the false lumen is obliterated, either spontaneously or by surgical or interventional techniques. Isolated dissections of mesenteric, renal, and carotid vessels are rarely reported. These may be spontaneous, related to high blood pressure and underlying disease of the vessel wall, or caused by abdominal trauma or medical intervention, including angiographic procedures. They are usually associated with pain and other signs and symptoms of ischemia in the appropriate territory. We present a case of chronic superior mesenteric artery (SMA) dissection, an incidental angiographic finding, in an asymptomatic patient being evaluated for resection of an abdominal aortic aneurysm (AAA). (author)

Chronic dissection of the superior mesenteric artery: case report

Energy Technology Data Exchange (ETDEWEB)

Common, A.A.; Pressacco, J. [Univ. of Toronto, St. Michael' s Hospital, Dept. of Medical Imaging, Toronto, Ontario (Canada)

1999-02-01

Acute dissection of the thoracic aorta is a well-recognized, often fatal condition that frequently extends to involve the abdominal aorta and iliac vessels. The ostia of the renal and mesenteric vessels may be compromised, and the resulting visceral ischemia may necessitate surgical intervention. However, visceral perfusion may be restored if blood flow from true to false lumen is re-established or if the false lumen is obliterated, either spontaneously or by surgical or interventional techniques. Isolated dissections of mesenteric, renal, and carotid vessels are rarely reported. These may be spontaneous, related to high blood pressure and underlying disease of the vessel wall, or caused by abdominal trauma or medical intervention, including angiographic procedures. They are usually associated with pain and other signs and symptoms of ischemia in the appropriate territory. We present a case of chronic superior mesenteric artery (SMA) dissection, an incidental angiographic finding, in an asymptomatic patient being evaluated for resection of an abdominal aortic aneurysm (AAA). (author)

The Use of Tissue Plasminogen Activator in the Treatment of Wallenberg Syndrome Caused by Vertebral Artery Dissection.

Science.gov (United States)

Salerno, Alexis; Cotter, Bradford V; Winters, Michael E

2017-05-01

Acute cerebrovascular accident (CVA) is a devastating cause of patient morbidity and mortality. Up to 10% of acute CVAs in young patients are caused by dissection of the vertebral or carotid artery. Wallenberg syndrome results from a CVA in the vertebral or posterior inferior artery of the cerebellum and manifests as various degrees of cerebellar dysfunction. The administration of a thrombolytic medication has been recommended in the treatment of patients with stroke caused by cervical artery dissection. Surprisingly, there is scant literature on the use of this medication in the treatment of this condition. We describe a 42-year-old man with the sudden onset of headache, left-sided neck pain, vomiting, nystagmus, and ataxia 1 h after completing a weightlifting routine. Computed tomography angiography revealed a grade IV left vertebral artery injury with a dissection flap extending distally and resulting in complete occlusion. Subsequent magnetic resonance imaging and angiography demonstrated acute left cerebellar and lateral medullary infarcts, consistent with Wallenberg syndrome. The patient was treated with tissue plasminogen activator, which failed to resolve his symptoms. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians frequently manage patients with acute CVAs. For select patients, the administration of tissue plasminogen activator can improve outcomes. However, the risk of major hemorrhage with this medication is significant. Cervical artery dissection is an important cause of acute stroke in young patients and is often missed on initial presentation. It is imperative for the emergency physician to consider acute cervical artery dissection as a cause of stroke and to be knowledgeable regarding the efficacy of thrombolytic medications for this condition. Copyright © 2017 Elsevier Inc. All rights reserved.

Spontaneous coronary artery dissection causing acute coronary syndrome in a young patient without risk factors

Directory of Open Access Journals (Sweden)

Parag Chevli

2014-09-01

Full Text Available Spontaneous coronary artery dissection (SCAD is a rare cause of acute myocardial infarction that is more common in younger patients (under age 50 and in women. Although the etiology is not known, some predisposing conditions to SCAD are well known and include Marfan syndrome, pregnancy and peripartum state, drug abuse, and some anatomical abnormalities of the coronary arteries such as aneurysms and severe kinking. We describe a case of SCAD in a young woman who presented with sudden onset of chest pain and was admitted for the treatment of acute coronary syndrome. The coronary angiography showed dissection of the left anterior descending artery. The patient underwent successful percutaneous transluminal coronary angioplasty and stent placement.

Pulmonary artery dissection following balloon valvuloplasty in a dog with pulmonic stenosis.

Science.gov (United States)

Grint, K A; Kellihan, H B

2017-04-01

A 3-month-old, 9.9 kg, male pit bull cross was referred for evaluation of collapse. A left basilar systolic heart murmur graded V/VI and a grade IV/VI right basilar systolic heart murmur were ausculted. Echocardiography showed severe pulmonic stenosis characterized by annular hypoplasia, leaflet thickening, and leaflet fusion. After 1 month of atenolol therapy, a pulmonic valve balloon valvuloplasty procedure was performed, and the intra-operative right ventricular pressure was reduced by 43%. Echocardiography, performed the following day, showed apparent rupture of a pulmonary valve leaflet and a membranous structure within the pulmonary artery consistent with a dissecting membrane. Short-term follow-up has shown no apparent progression of the pulmonary artery dissection and the patient remains free of clinical signs. Copyright © 2016 Elsevier B.V. All rights reserved.

A Limb-Threatening Long Arterial Dissection Caused by Humerus Neck Fracture: A Case Report

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Kurnaz R

2018-03-01

Full Text Available Proximal humerus fracture is a common arm trauma and rarely occurs with vascular injury which however is a serious complication. In this case report, we present a long segment dissection of the axillary and brachial arteries as a rare complication due to fragmented proximal humerus fracture and shoulder dislocation. An 80-year old female patient was seen at the emergency department. Radiograph examination has revealed a fragmented proximal humerus fracture besides dislocation of the head of humerus towards the axillary area. On vascular examination, acute arterial occlusion such as absence of radial and ulnar pulses were observed in her left hand. The patient was immediately taken to the operating room. The dissection included the entire segment approximately 20cm between the distal subclavian artery and the distal brachial artery. This injured segment was removed and a 6mm Polytetrafluroethylene (PTFE graft with rings was interpositoned between subclavian and brachial arteries. This case is a rarity because of such a significant complication after a small injury. Axillary artery injuries caused by humeral neck fractures are rare but should not be missed by the physician.

Imaging of Spontaneous and Traumatic Cervical Artery Dissection : Comparison of Typical CT Angiographic Features.

Science.gov (United States)

Sporns, Peter B; Niederstadt, Thomas; Heindel, Walter; Raschke, Michael J; Hartensuer, René; Dittrich, Ralf; Hanning, Uta

2018-01-26

Cervical artery dissection (CAD) is an important etiology of ischemic stroke and early recognition is vital to protect patients from the major complication of cerebral embolization by administration of anticoagulants. The etiology of arterial dissections differ and can be either spontaneous or traumatic. Even though the historical gold standard is still catheter angiography, recent studies suggest a good performance of computed tomography angiography (CTA) for detection of CAD. We conducted this research to evaluate the variety and frequency of possible imaging signs of spontaneous and traumatic CAD and to guide neuroradiologists' decision making. Retrospective review of the database of our multiple injured patients admitted to the Department of Trauma, Hand, and Reconstructive Surgery of the University Hospital Münster in Germany (a level 1 trauma center) for patients with traumatic CAD (tCAD) and of our stroke database (2008-2015) for patients with spontaneous CAD (sCAD) and CT/CTA on initial clinical work-up. All images were evaluated concerning specific and sensitive radiological features for dissection by two experienced neuroradiologists. Imaging features were compared between the two etiologies. This study included 145 patients (99 male, 46 female; 45 ± 18.8 years of age), consisting of 126 dissected arteries with a traumatic and 43 with spontaneous etiology. Intimal flaps were more frequently observed after traumatic etiology (58.1% tCADs, 6.9% sCADs; p < 0.001); additionally, multivessel dissections were much more frequent in trauma patients (3 sCADs, 21 tCADs) and only less than half (42%) of the patients with traumatic dissections showed cervical spine fractures. Neuroradiologists should be aware that intimal flaps and multivessel dissections are more common after a traumatic etiology. In addition, it seems important to conduct a CTA in a trauma setting, even if no cervical spine fracture is detected.

Early post transplantation renal allograft perfusion failure due to intimal dissection of the renal artery

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Khattab Omar

2009-01-01

Full Text Available Transplant renal artery stenosis (TRAS is a recognized and potentially curable cause of post transplant arterial hypertension, allograft dysfunction, and graft loss. It usually occurs 3 months to 2 years after transplantation, but early or later presentations are not uncommon. We present a case of renal artery narrowing due to intimal dissection that was managed medically.

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

Science.gov (United States)

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

2013-09-01

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

Dissecting aneurysm of the cervical internal carotid artery. Cervical CT scan findings and treatment - case report

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Itoh, Yoshihiro; Itoyama, Youichi; Fukumura, Akinobu; Matsukado, Yasuhiko; Kodama, Takafumi

1987-06-01

On lifting a heavy case, a 51-year-old male experienced a sudden onset of headache with giddiness and clouded vision. A week later, vertigo and right hand numbness were added to his symptoms. The next day anisocoria (right > left) and dilation of the left retinal veins were noted. Cranial computed tomography (CT) scan appeared normal and there were no other remarkable neurological findings. The patient was treated conservatively for cerebral infarction, however, the headache worsened and diplopia occurred. Neurological examination on admission revealed nothing unusual except for left Horner's syndrome. Physical examination showed a palpable sausage-like painless tumor on the left side of the neck. Angiography showed a narrowing of the internal carotid artery in the cervical region with a small dissecting aneurysm at the C3 level. Cervical CT scan at the upper C3 level showed a low density lunar defect in the high density section of the enlarged left internal carotid artery. The patient was operated on by superficial temporal artery-middle cerebral artery anastomosis to increase the intracranial blood flow. Postoperatively the symptoms were quickly relieved. Angiography 1 month later showed less narrowing of the carotid artery, though the dissecting aneurysm still remained. Postoperative cervical CT scan showed the left internal carotid artery to be of normal size. The patient returned to his work in normal condition 2 months later. It is emphasized that cervical CT scan may be useful in the diagnosis of this unusual type of cervical dissecting aneurysm.

Vertebral artery dissecting aneurysms: report of 3 cases and review of the literature

International Nuclear Information System (INIS)

Li Zequn; Zhong Ming; Tan Xianxi; Zhen Weiming; Lu Xianghe; Lin Chen

2005-01-01

Objective: To investigate the features, diagnosis and the ideal therapy of vertebral dissecting aneurysms. Methods: Three vertebral dissecting aneurysms were performed endovascular treatment, 2 with stents implantation and embolization, one parental artery and aneurysm occlusion. The course of the diagnosis and treatment were analyzed correlating with the literature. Results: One male, two female, 56-66 years old. 2 presented SAH, one complained of vertigo. The features on DSA: 2 showed pearl and string sign, that was, aneurismal dilation accompanied by proximal and/or distal narrowing; one demonstrated fusiform aneurysm. Two cases recovered well, one died after procedure. Conclusions: Endovascular treatment is the ideal choice to treat the vertebral dissecting aneurysms. (authors)

Dissecting aneurysm of the cervical internal carotid artery. Cervical CT scan findings and treatment - case report

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Itoh, Yoshihiro; Itoyama, Youichi; Fukumura, Akinobu; Matsukado, Yasuhiko; Kodama, Takafumi

1987-06-01

On lifting a heavy case, a 51-year-old male experienced a sudden onset of headache with giddiness and clouded vision. A week later, vertigo and right hand numbness were added to his symptoms. The next day anisocoria (right > left) and dilation of the left retinal veins were noted. Cranial computed tomography (CT) scan appeared normal and there were no other remarkable neurological findings. The patient was treated conservatively for cerebral infarction, however, the headache worsened and diplopia occurred. Neurological examination on admission revealed nothing unusual except for left Horner's syndrome. Physical examination showed a palpable sausage-like painless tumor on the left side of the neck. Angiography showed a narrowing of the internal carotid artery in the cervical region with a small dissecting aneurysm at the C3 level. Cervical CT scan at the upper C3 level showed a low density lunar defect in the high density section of the enlarged left internal carotid artery. The patient was operated on by superficial temporal artery-middle cerebral artery anastomosis to increase the intracranial blood flow. Postoperatively the symptoms were quickly relieved. Angiography 1 month later showed less narrowing of the carotid artery, though the dissecting aneurysm still remained. Postoperative cervical CT scan showed the left internal carotid artery to be of normal size. The patient returned to his work in normal condition 2 months later. It is emphasized that cervical CT scan may be useful in the diagnosis of this unusual type of cervical dissecting aneurysm.

Dissection of the V4 segment of the vertebral artery: clinicoradiologic manifestations and endovascular treatment

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Yoon, Woong; Seo, Jeong Jin [Chonnam National University Medical School, Department of Radiology, Chonnam National University Hospital, 501-757Dong-gu, Gwangju (Korea); Kim, Tae Sun [Chonnam National University Medical School, Department of Neurosurgery, Chonnam National University Hospital, Dong-gu, Gwangju (Korea); Do, Huy M.; Jayaraman, Mahesh V.; Marks, Michael P. [Stanford University Medical Center, Department of Radiology, Stanford, California (United States)

2007-04-15

Intracranial vertebral artery (VA) dissection has three clinical presentations: ischemia, hemorrhage, and mass effect. Imaging findings of intracranial VA dissections vary according to clinical presentation. Irregular stenosis or occlusion of the VA is the most common finding in patients with posterior fossa infarction, whereas a dissecting aneurysm is the main feature in those with acute subarachnoid hemorrhage. A chronic, giant, dissecting aneurysm can cause mass effect on the brain stem or cranial nerves, as well as distal embolism. Magnetic resonance imaging is useful for detection of intramural hematomas and intimal flaps, both of which are diagnostic of VA dissection. Multidetector computed tomography angiography is increasingly used for diagnosis of VA dissection. Catheter angiography is still beneficial for evaluation of precise endoluminal morphology of the dissection before surgical or endovascular intervention. Endovascular treatment is now considered a major therapeutic option for patients with a ruptured dissecting aneurysm or a chronic dissecting aneurysm. Anticoagulation therapy is currently considered the initial treatment of choice in patients with posterior circulation ischemic symptoms. Endovascular treatment, such as stent-assisted angioplasty or coil occlusion at the dissection site, can be performed in selected patients with posterior fossa ischemic symptoms. (orig.)

Dissection of the V4 segment of the vertebral artery: clinicoradiologic manifestations and endovascular treatment

International Nuclear Information System (INIS)

Yoon, Woong; Seo, Jeong Jin; Kim, Tae Sun; Do, Huy M.; Jayaraman, Mahesh V.; Marks, Michael P.

2007-01-01

Intracranial vertebral artery (VA) dissection has three clinical presentations: ischemia, hemorrhage, and mass effect. Imaging findings of intracranial VA dissections vary according to clinical presentation. Irregular stenosis or occlusion of the VA is the most common finding in patients with posterior fossa infarction, whereas a dissecting aneurysm is the main feature in those with acute subarachnoid hemorrhage. A chronic, giant, dissecting aneurysm can cause mass effect on the brain stem or cranial nerves, as well as distal embolism. Magnetic resonance imaging is useful for detection of intramural hematomas and intimal flaps, both of which are diagnostic of VA dissection. Multidetector computed tomography angiography is increasingly used for diagnosis of VA dissection. Catheter angiography is still beneficial for evaluation of precise endoluminal morphology of the dissection before surgical or endovascular intervention. Endovascular treatment is now considered a major therapeutic option for patients with a ruptured dissecting aneurysm or a chronic dissecting aneurysm. Anticoagulation therapy is currently considered the initial treatment of choice in patients with posterior circulation ischemic symptoms. Endovascular treatment, such as stent-assisted angioplasty or coil occlusion at the dissection site, can be performed in selected patients with posterior fossa ischemic symptoms. (orig.)

Coronary interventionism for dissection of the artery brachial right

International Nuclear Information System (INIS)

Conde Cerdeira, Hector; Obregon Santos, Angel Gaspar; Aroche Aportela, Ronald; Dominguez Perez, Reyber Jesus

2007-01-01

A prospective, no controlled study was conducted from march 1 to December 31 of 2004. 23 patients were enrolled who made outpatients coronariography and were implanted coronary stents (25 lesions) by angioplasty with optimal results. Found 73,9% of male, stable angina 52,2%, mean age 55.1 + 8.9 years. Hypertension associates to smoke habits were most frequent risk factors. 80% receive 300 mg of clopidogrel during or immediately after procedure. Left anterior descending artery was most frequently treated (44%) and B2 type lessons (64%). The mid time procedure was 48 minutes. Reference diameter 2,87 + 0.42 mm, stenosis diameter 71,6 + 15.1 mm; minimal lumen diameter 0,97 + 0.64 mm; length lesson 14,72 + 5.6 mm; stent diameter 2,9 + 0.42 mm; stent length 16,8 + 5.44 mm; insufflation's time 36,4 + 7.3 seconds; atmospheres 13,56 + 1.7; acute gain 1,96 + 0.61 mm. Two patients had minor bleeding at dissection site (8.7%) and one a little haematoma (4,3%). The radial pulse from the arm's dissection was present in all patients event 24 hours after. We conclude brachial dissection ambulatory angioplasty stent in selected patients with optimal angiography results is feasible and safe

Intracranial vertebral artery dissection with subarachnoid hemorrhage following child abuse

International Nuclear Information System (INIS)

Nguyen, Pamela H.; Burrowes, Delilah M.; Ali, Saad; Shaibani, Ali; Bowman, Robin M.

2007-01-01

Child abuse is often suspected based on particular patterns of injury. We report a case of intracranial vertebral artery dissection with subarachnoid hemorrhage (SAH) in a 3-month-old boy following child abuse. The mechanisms of injury and the clinical and imaging findings are discussed. This particular pattern of injury has rarely been reported in association with child abuse. We hope to raise physician awareness of child abuse when faced with these imaging findings. (orig.)

Vertebral artery dissection in weightlifter with performance enhancing drug use

OpenAIRE

Low, Andrew; Dovey, Julie; Ash-Miles, Janice

2011-01-01

This case report describes a transient ischaemic attack secondary to vertebral artery dissection (VAD) in a young male body builder. This occurred following weight training with weights across the back and shoulders. The patient was also known to take multiple performance enhancing agents including anabolic steroids, slimming agents, stimulants and human growth hormone. Cases of VAD have been described with cervical manipulation in the past and an association between the use of anabolic stero...

Intracranial vertebral artery dissection with subarachnoid hemorrhage following child abuse

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Nguyen, Pamela H.; Burrowes, Delilah M.; Ali, Saad; Shaibani, Ali [Feinberg School of Medicine of Northwestern University, Department of Radiology, Chicago, IL (United States); Bowman, Robin M. [Feinberg School of Medicine of Northwestern University, Department of Neurological Surgery, Chicago, IL (United States)

2007-06-15

Child abuse is often suspected based on particular patterns of injury. We report a case of intracranial vertebral artery dissection with subarachnoid hemorrhage (SAH) in a 3-month-old boy following child abuse. The mechanisms of injury and the clinical and imaging findings are discussed. This particular pattern of injury has rarely been reported in association with child abuse. We hope to raise physician awareness of child abuse when faced with these imaging findings. (orig.)

Visualization of the Adamkiewicz artery in patients with acute Stanford A dissections. A prospective 64-row multi-detector CT study

International Nuclear Information System (INIS)

Kovacs, Attila; Willinek, W.A.; Schild, H.; Urbach, H.; Schiller, W.; Gerhards, H.M.; Welz, A.; Flacke, S.

2009-01-01

Purpose: to evaluate the detectability of the Adamkiewicz artery (AA) in patients with acute Stanford type A aortic dissections with multi-detector computed tomography (MDCT). Materials and Methods: 51 patients with Stanford type A dissection underwent contrast-enhanced 64-row MDCT of the entire aorta (collimation 64 x 0.625 mm; rotation time 0.4sec; 120kV; 300 mAs). The visualization of the AA, its origin, and whether it originated from the true or false lumen were analyzed using source and multiplanar reformation images. Results: a single anterior radicular artery that formed a hairpin turn constituting the anterior spinal artery was visualized in 36 (70%) patients. Thirty (83%) of these arteries originated from the left side, and 35 (97%) originated between the level T7 and L2. Twenty-three (64%) arteries originated from the true and 13 (36%) from the false lumen. Two AAs in the same patient were not observed. Conclusion: MDCT depicts the AA in a high percentage of patients with acute Stanford type A aortic dissection. (orig.)

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.

Internal carotid artery dissection in a patient with Ehlers-Danlos syndrome type IV: diagnosis and management

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Michel Nasser

2013-06-01

Full Text Available Ehlers-Danlos syndrome (EDS type IV, also known as vascular EDS, is an inherited connective tissue disorder with an estimated prevalence of 1/100,000 to 1/250,000. In EDS type IV, vascular complications may affect all anatomical areas, with a preference for large- and medium-sized arteries. Dissections of the vertebral and carotid arteries in their extra- and intra-cranial segments are typical. The authors report the case of a patient with EDS type IV for whom the diagnosis was established based on clinical signs and who developed internal carotid artery dissection at the age of 44 years. In the absence of a specific treatment for EDS type IV, medical interventions should focus on symptomatic relief, prophylactic measures, and genetic counseling. Invasive imaging techniques are contraindicated, and a conservative approach to vascular complications is usually recommended.

Dissecting aneurysms of the middle cerebral artery: neuroradiological and clinical features

International Nuclear Information System (INIS)

Ohkuma, H.; Suzuki, S.; Shimamura, N.; Nakano, T.

2003-01-01

There are few reported cases of nontraumatic dissecting aneurysms of the middle cerebral artery (MCA), and their neuroradiological and clinical features have not been analysed. We looked at these aspects in a collaborative study. We reviewed 13 patients diagnosed as having a dissecting aneurysm of the MCA based on clinical signs and neuroradiological findings in 46 stroke centres between 1995 and 1999. There were four patients who presented with cerebral ischaemia, and nine who presented with bleeding. Of the former group, three were aged less than 15 years. Cerebral angiography showed extensive stenosis and a double lumen of the M1 portion in all four patients. High signal on T1-weighted images around the arterial flow void, due to intramural haematoma, was often seen in the second week. MR angiography showed findings corresponding those of intra-arterial angiography in all four cases. We saw an infarct on CT or MRI in territory of the perforating branches of the M1 segment in all four patients. In the patients presenting with bleeding, pure subarachnoid haemorrhage or a sylvian fissure haematoma was seen on initial CT, and the predominant angiographic finding was dilatation with stenosis, but the site of the lesions was not uniform. A double lumen or intimal flap was seen in about half the cases. Rebleeding occurred within 14 days of the onset in five of the nine patients, with a poor prognosis. (orig.)

Medical and Interventional Therapy for Spontaneous Vertebral Artery Dissection in the Craniocervical Segment

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Guiyun Zhang

2017-01-01

Full Text Available Background and Purpose. Spontaneous vertebral artery dissection (SVAD is an important reason for posterior-circulation-ischemic stroke in the young and middle-aged population. Although some previous reports reveal a favorable outcome with conservative therapy, it is still controversial in the treatment of SVAD in some specific patients. Herein, we present our 10 years of clinical experience for SVAD at this location. Material and Methods. 20 patients with 20 SVADs in V2 and V3 segments were retrospectively studied. Clinical manifestations and imageology materials were collected and analyzed. All the patients underwent anticoagulation except for one patient because of contraindication. 14 patients underwent Wingspan stents implantation with general anesthesia. Results. In our sample, ischemia (infarction or transient ischemic attack, TIA was found in all the patients. Angiographic stenosis and dissection aneurysm were the most common findings in the segments mentioned above. 19 of the patients (95% got the excellent imageological and clinical outcomes. Conclusions. According to our experience in this group, although anticoagulation is effective in vertebral artery dissection, interventional therapy for SVADs in V2 and/or V3 segments is preferred in some specific patients. Stent with higher radial supporting and flexibility, such as Wingspan stent, is suggested.

Endovascular stent graft for treatment of complicated spontaneous dissection of celiac artery: Report of two cases

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Kang, Ung Rae; Lee, Young Hwan [Dept. of Diagnostic Radiology, Catholic University of Daegu School of Medicine, Daegu (Korea, Republic of); Kim, Young Hwan [Dept. of Diagnostic Radiology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of)

2013-06-15

We report 2 cases of complicated spontaneous dissection of the celiac artery, which were successfully treated by a stent graft. The first patient was a 47-year-old man who presented with acute abdominal pain. CT scan showed ruptured saccular aneurysm with surrounding retroperitoneal hematoma. The second patient was a 57-year-old man with progressive dissecting aneurysm. Endovascular stent graft was placed in the celiac trunk to control bleeding, and to prevent rupture in each patient. Follow-up CT scans showed complete obliteration of a dissecting aneurysm.

Glomus jugulare tumor with intra- and extracranial extension

International Nuclear Information System (INIS)

Morisako, Toshitaka; Goya, Tomokazu; Wakisaka, Shinichiro; Kinoshita, Kazuo

1987-01-01

A case of glomus jugulare tumor with intra- and extracranial extension is described. The patient was a 63-year-old woman who complained of gait and memory disturbances. On admission neurological examination revealed recent memory disturbance, left deafness, left XI, XIIth cranial nerve palsies, and slight ataxic gait. Roentgenogram of the skull showed an enlarged left jugular foramen with bone erosion. Plain X-ray computerized tomography scan (X-CT) indicated obstructive hydrocephalus and X-CT with contrast enhancement revealed a mass lesion in the left posterior cranial fossa extending through enlarged left jugular foramen to the extracranial space toward the level of C 2 . Cerebral angiography demonstrated a large mass with blood supply from branches of left external carotid and vertebral arteries. The tumor stain was not remarkable. Left internal jugular vein was completely obstructed at the level of the second cervical vertebral body. Magnetic resonance imaging (MRI) clearly showed the tumor extending from the anterolateral portion to the second cervical vertebral body through the enlarged jugular foramen to the posterior cranial fossa. Brain stem and cerebellar hemisphere which were markedly compressed by the mass were clearly visualized. At first a ventriculo-peritoneal shunt was made and four weeks later subtotal removal of the tumor was undertaken. Histopathology of tumor specimen showed typical glomus jugulare tumor. MRI was considered to be very useful for the diagnosis and treatment of the glomus jugulare tumor with intra- and extracranial extension. (author)

An Extensive Stanford Type A Aortic Dissection Involving Bilateral Carotid and Iliac Arteries

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E. W. Lee

2013-01-01

Full Text Available We present a rare case of continuous, extensive aortic dissection (AD involving the bilateral common carotid arteries, the ascending, thoracic, and abdominal aorta, and bifurcation of the right common iliac artery. A 61-year-old man with history of chronic hypertension presented with a one-day history of chest pain, vertigo, left facial drooping, and left hemiparesis. Despite the presence of bilateral carotid bruits, doppler ultrasound of the neck was postponed, and the patient was treated with thrombolytic therapy for a presumed ischemic stroke. The patient's symptoms began to resolve within an hour of treatment, at which time treatment was withheld. Ultrasound performed the following day showed dissection of bilateral common carotid arteries, and CT angiography demonstrated extensive AD as described earlier. The patient subsequently underwent cardiovascular surgery and has been doing clinically well since then. AD has a myriad of manifestations depending on the involvement of aortic branches. Our paper illustrates the importance of having a high index of suspicion for AD when a patient presents with a picture of ischemic stroke, since overlapping signs and symptoms exist between AD and stroke. Differentiating between the two conditions is central to patient care as thrombolytic therapy can be helpful in stroke, but detrimental in AD.

Fatal subarachnoid hemorrhage associated with internal carotid artery dissection resulting from whiplash trauma.

Science.gov (United States)

Uhrenholt, Lars; Freeman, Michael D; Webb, Alexandra L; Pedersen, Michael; Boel, Lene Warner Thorup

2015-12-01

Spinal injury following inertial loading of the head and neck (whiplash) is a common sequel of low speed traffic crashes. A variety of non-musculoskeletal injuries have been described in association with injury to the spine following whiplash trauma, including traumatic brain injury, vestibular derangement, and cranial nerve injury, among others. Vascular injuries in the head and neck have, however, only rarely been described. We present the case of a middle-aged male who sustained an ultimately fatal injury that resulted from injury to the internal carotid artery (ICA) and intracerebral vascular structures following a hard braking maneuver, with no direct head- or neck contact with the vehicular interior. Based on this unusual mechanism of injury we reviewed hospital data from the United States nationwide inpatient database (NIS) to assess the frequency of similar injuries reportedly resulting from traffic crashes. The post-mortem examination revealed a left internal carotid artery dissection associated with subarachnoid hemorrhage (SAH). Based on the close temporal association, the absent prior history, and the plausibility of the injury mechanism, the injury was attributed to the braking maneuver. An analysis of NIS data demonstrated that the prevalence of subarachnoid hemorrhage is significantly higher when there is a traumatic etiology, and higher yet when the trauma is a traffic crash (odds ratio 3.3 and 4.3, respectively). The presented case, together with the hospital inpatient data analysis, indicate that although SAH in combination with ICA dissection is relatively rare, it is substantially more probable following a traffic crash. In a clinical or forensic setting the inference that magnitude of a trauma was low should not serve as a basis for either excluding a cervical artery dissection from a differential diagnosis, or for excluding the trauma as a cause of a diagnosed dissection. This case report illustrates a rare fatal outcome of inertial load to

Spontaneous Dissection of the Renal Artery in Vascular Ehlers-Danlos Syndrome

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Filipa Pereira

2015-01-01

Full Text Available Ehlers-Danlos syndrome (EDS is a rare heterogeneous group of connective tissue disorders. The vascular type (vEDS is an autosomal dominant disorder caused by heterozygous mutations in the COL3A1 gene predisposing to premature arterial, intestinal, or uterine rupture. We report a case of a 38-year-old woman with a recent diagnosis of vEDS admitted in the Emergency Department with a suspicion of a pyelonephritis that evolved to a cardiopulmonary arrest. A fatal retroperitoneal hematoma related with a haemorrhagic dissection of the right renal artery was found after emergency surgery. This case highlights the need to be aware of the particular characteristics of vEDS, such as a severe vascular complication that can lead to a fatal outcome.

Operative and endovascular management of extracranial vertebral artery aneurysm in Ehlers-Danlos syndrome:a clinical dilemma--case report and literature review.

LENUS (Irish Health Repository)

Sultan, Sherif

2002-01-01

The most prevalent lesion of the vertebral artery is an atheromatous plaque located at its origin from the subclavian artery. A case of successful management of a symptomatic vertebral artery aneurysm due to Ehlers-Danlos syndrome is reported. The patient had asymptomatic posterior intracerebral artery dissection on the contralateral side. A common carotid artery to V-3 segment bypass using reversed saphenous vein graft was carried out. Avulsion of the V-2 segment occurred peroperatively and endovascular coil embolization of the vertebral artery aneurysm was performed. Endovascular equipment and training must be in the armamentarium of vascular surgeons as more complex cases are being treated, which demands new approaches for ultimate clinical success. This unique case outlines what might unexpectedly occur. Endovascular intervention as an adjuvant procedure provides a satisfactory outcome in what could have been a catastrophe.

Mycotic aneurysm of the extracranial internal carotid artery - report of a case and review of the literature; Aneurisma micotico da arteria carotida interna extracraniana - relato de um caso e revisao da literatura

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Nascimento, Edilene Cristina do; Silva, Ivone Martins da [Pernambuco Univ., Recife, PE (Brazil). Hospital das Clinicas. Servico de Radiologia; Albuquerque, Silvio Cavalcanti de [Instituto Materno Infantil de Pernambuco, Recife, PE (Brazil). Servico de Radiologia; Abath, Carlos [Angiorad, Recife, PE (Brazil)

1998-08-01

The authors report a case of mycotic aneurysm of the extracranial internal carotid artery in a 4-year-old- male child, resulting from tonsillar infection. The authors relate the difficulties to initially suggest the diagnosis, stress the importance of the differential diagnosis particularly in children and describe the findings on conventional films, US colour-Doppler, CT and carotid digital subtraction angiography. (author)

Association of Inter-arm Blood Pressure Difference with Asymptomatic Intracranial and Extracranial Arterial Stenosis in Hypertension Patients.

Science.gov (United States)

Wang, Yan; Zhang, Jin; Qian, Yuesheng; Tang, Xiaofeng; Ling, Huawei; Chen, Kemin; Li, Yan; Gao, Pingjin; Zhu, Dingliang

2016-07-14

Inter-arm blood pressure (BP) difference has been associated with ischemic stroke. Local atherosclerosis of stroke differ among vulnerable individuals, whereas intracranial arterial stenosis (ICAS) is more frequently affected Asians, and extracranial arterial stenosis (ECAS) is more prevalent among whites. We hereby sought to explore the association of inter-arm BP difference with ICAS and ECAS in stroke-free hypertensive patients in Chinese population. All the 885 subjects were evaluated of ICAS and ECAS through computerized tomographic angiography. Both arm BP was measured simultaneously by Vascular Profiler-1000 device. In the continuous study, ICAS was significantly associated with age, male, average brachial SBP, diabetes, anti-hypertensive treatment and inter-arm DBP difference. ECAS was associated with age, inter-arm SBP and LDL. In the categorical study, subjects with the top quartile of inter-arm DBP difference (≥4 mmHg) showed significantly higher risk of ICAS (OR = 2.109; 95% CI, 1.24-3.587). And the participants with the top quartile of inter-arm SBP difference (≥6 mmHg) showed significantly higher risk of ECAS (OR = 2.288; 95% CI, 1.309-3.998). In conclusion, we reported a diverse association of inter-arm SBP/DBP difference with the ICAS/ECAS. Inter-arm DBP difference might be the early symbol of ICAS in Chinese population, which need further verification in long-term cohort study.

Magnetic resonance angiography and tomography of vertebrobasilar dissections; Magnetresonanzangiographie und Magnetresonanztomographie bei Dissektionen der A. vertebralis

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Felber, S. [Inst. fuer Magnetresonanztomographie und Spektroskopie, Universitaetskliniken Innsbruck (Austria)]|[Universitaetsklinik fuer Radiologie, Klinische Abt. 2, Universitaetskliniken Innsbruck (Austria); Auer, A. [Inst. fuer Magnetresonanztomographie und Spektroskopie, Universitaetskliniken Innsbruck (Austria); Schmidauer, C. [Universitaetsklinik fuer Neurologie, Universitaetskliniken Innsbruck (Austria); Waldenberger, P. [Universitaetsklinik fuer Radiologie, Klinische Abt. 1, Universitaetskliniken Innsbruck (Austria); Aichner, F. [Inst. fuer Magnetresonanztomographie und Spektroskopie, Universitaetskliniken Innsbruck (Austria)

1996-11-01

We retrospectively analyzed the role of MRT and MR angiography (MRA) in the detection of dissections of the vertebral artery. Between 1989 and 1995 we identified 24 patients with a vertebral artery dissection and 1 patient with a basilar artery dissection. The diagnosis of VAD was established by specific arteriographical findings (DSA) or clinical and neuroradiological course. All patients underwent a combined MRT/MRA examination protocol at 1.5 T that consisted of spin-echo imaging and time of flight MRA of the intra- and extracranial arteries using 2D Flash and 3D Fisp sequences. The MRT/MRA findings were correlated to DSA and ultrasound results. During the acute and subacute stage, MRT/MRA revealed abnormal findings in 21 of 22 dissected vessels (95.5%). There was one false-negative MRT/MRA in a patient with a V1 dissection. In 7/22 VAD the MRT/MRA findings were rated specific. DAS was sensitivie in 100% and ultrasound in 77.3%. Specific results were obtained by DSA in 8/22 VAD (36.4%) and in 7/22 VAD (30.4%) by MRT/MRA. When MRT/MRA and DSA results were combined, the specific findings increased to 43.5%. Follow-up examinations revealed recanalization in 52% of initially stenosed or occluded vertebral arteries. With this retrospective approach, we were able to show a high sensitivity of MRT/MRA for the presence of disturbed flow in the dissected vertebral artery. The MRA projections tended to overestimate stenosis and were inferior to DSA in the appreciation of irregularities of the vessel wall. Identification of high-grade stenosis, especially in the presence of distal occlusion, was improved on the MRA source images. The differentiation between luminal thrombus and mural hematoma requires interpretation of MRA source images, together with flow compensated spinecho images. There is a complementary role of MRT/MRA and DSA for an improved overall specificity for vertebral artery dissection. (orig./MG) [Deutsch] Dissektionen der hirnversorgenden Arterien sind eine

The MDCT and MRI Findings of a Pancreatic Arteriovenous Malformation Combined with Isolated Dissection of the Superior Mesenteric Artery: A Case Report

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Kim, Yong Soo; Jeong, Woo Kyoung [Hanyang University Guri Hospital, Seoul (Korea, Republic of); Kim, Jin Oo [Naval Pohang Hospital, Pohang (Korea, Republic of); Oh, Ji Young; Song, Soon Young [Hanyang University Medical College, Seoul (Korea, Republic of)

2010-03-15

Pancreatic arteriovenous malformation and isolated spontaneous dissection of the superior mesenteric artery are both rare maladies, and now they can be easily diagnosed due to the development of such noninvasive modalities as multi-detector computed tomography and magnetic resonance imaging. We report here on the multi-detector computed tomography and magnetic resonance imaging findings of a rare case of pancreatic arteriovenous malformation combined with isolated dissection of the superior mesenteric artery.

The MDCT and MRI Findings of a Pancreatic Arteriovenous Malformation Combined with Isolated Dissection of the Superior Mesenteric Artery: A Case Report

International Nuclear Information System (INIS)

Kim, Yong Soo; Jeong, Woo Kyoung; Kim, Jin Oo; Oh, Ji Young; Song, Soon Young

2010-01-01

Pancreatic arteriovenous malformation and isolated spontaneous dissection of the superior mesenteric artery are both rare maladies, and now they can be easily diagnosed due to the development of such noninvasive modalities as multi-detector computed tomography and magnetic resonance imaging. We report here on the multi-detector computed tomography and magnetic resonance imaging findings of a rare case of pancreatic arteriovenous malformation combined with isolated dissection of the superior mesenteric artery

Therapeutic strategy for the treatment of isolated spontaneous dissection of superior mesenteric arteries

International Nuclear Information System (INIS)

Xu Yongle; Xiong Jiang; Guo Wei; Liu Xiaoping; Liu Meng

2010-01-01

Objective: To summarize the treatment strategies of isolated superior mesenteric artery (SMA) dissection and to discuss the selection of therapeutic methods. Methods: The clinical data of ten patients, who were encountered during the period from Jan. 2007 to Feb. 2010 in General Hospital of Chinese PLA and diagnosed as isolated SMA dissection,were retrospectively analyzed. According to the presence or absence of intestinal ischemic necrosis and SMA rupture, the patients were divided into simple group (n = 9) and complicated group(n = 1). The treatments for different type of SMA dissection were discussed and the results and prognosis were analyzed. Results: Nine patients were divided into simple group and received conservative treatment, of which anticoagulation was not employed in 5. One patient was divided into complicated group and had to receive an iliomesenteric bypass surgery after the patient had failed to respond to conservative treatment. After the treatment the abdominal pain was relieved in all ten patients. Conclusion: With the wide use of computer tomography angiography and digital subtraction angiography, more and more isolated SMA dissections have been confirmed. For most patients with SMA dissection, especially for simple ones (i.e. without bowel ischemia or SMA rupture), excellent short-term results can be achieved by pure conservative treatment, even no anticoagulation needed. However, for the complicated isolated SMA dissections, vascular reconstruction procedure with various techniques, including open surgery, is necessary in order to obtain satisfactory short-term results. (authors)

Assessment of long-term effects of aneurysms trapping and extracranial-intracranial bypass surgery in patients with complex cerebral aneurysms

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MAO Zhi-qi

2012-02-01

Full Text Available Objective To study the long-term effects of extracranial-intracranial (EC-IC bypass and aneurysms trapping in patients with complex cerebral aneurysms. Methods Seventeen patients with complex aneurysms, who underwent EC-IC bypass and aneurysms trapping from 2008 to 2009, were followed up. Clinical records were reviewed, modified Rankin Scale (mRS was recorded at admission, discharging, and follow-up point, and activities of daily living (ADL scale (Barthel Index at admission and follow-up point. Results Seventeen patients (11 males and 6 females were followed up. At admission mRS scores were 1.06 ± 0.87, Barthel index 91.10 ± 10.30. Superficial temporal artery-middle cerebral artery (STA-MCA was performed in 8 cases, extracarotid artery-great saphenous vein-middle cerebral artery (ECA-GSV-MCA in 5 cases, extracarotid artery-radial artery-middle cerebral artery (ECA-RA-MCA in 3 cases, occipital artery-posterior inferior cerebellar artery (OA-PICA in 1 case. Patients were followed up for 19-39 months (mean 28.67 months. At follow-up point, 2 patients (11.76% died, operation-related mortality was 5.88% (1/17, operation-related morbidity 5.88% (1/17, mRS scores 1.07 ± 1.16, Barthel index 96.40 ± 10.30. Conclusion Patients with complex aneurysms who were impossible to be treated with surgical clipping or endovascular intervention could be cured with extracranial-intracranial bypass and aneurysms trapping, and good follow-up results were acquired.

Delayed Presentation of an Extracranial Internal Carotid Artery Pseudoaneurysm and Massive Epistaxis Secondary to a Nasal Foreign Body: Case Report and Review of the Literature.

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Katsevman, Gennadiy A; Braca, John A; Welch, Kevin C; Ashley, William W

2016-08-01

Epistaxis is a very common medical condition and can often be controlled with conservative measures. Rarely, uncontrolled and life-threatening epistaxis can occur. We present the case of a 58-year-old man who developed delayed, massive epistaxis caused by an extracranial left internal carotid artery pseudoaneurysm caused by an intranasal foreign object without apparent recent trauma. The patient was successfully treated with endovascular stenting of the affected vessel segment. Massive epistaxis is a potentially lethal condition. Although the source uncommonly originates from the internal carotid artery, pseudoaneurysm rupture needs to be considered on the differential diagnosis in selected patients. This case illustrates the need for vigilance for the presence of foreign objects and/or vessel injuries in the setting of acute, massive epistaxis. Additionally, we describe treatment options and review the literature. Copyright © 2016 Elsevier Inc. All rights reserved.

The Diagnosis of Spontaneous Coronary Artery Dissection by Optical Coherence Tomography.

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Kanda, Takahiro; Tawarahara, Kei; Matsukura, Gaku; Matsunari, Masayoshi; Takabayashi, Rumi; Tamura, Jun; Ozeki, Mariko; Ukigai, Hiroshi

2018-02-15

Spontaneous coronary artery dissection (SCAD) is rare, but it frequently presents as acute myocardial infarction. It is frequently fatal and most cases are diagnosed at autopsy. We herein present the case of a 65-year-old woman with ST-elevation and myocardial infarction due to SCAD. Optical coherence tomography (OCT) helped us to confirm the diagnosis. The information on the intravascular morphology provided by OCT imaging is much more detailed in comparison to that provided by coronary angiography (CAG) and intravascular ultrasound (IVUS).

Low arterial pressure on admission as a predictor of mortality in operated patients with type A aortic dissection

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Pavlović Katica

2011-01-01

Full Text Available Background/Aim. Hypertension is a known predictor of proximal aortic dissection, but it is not commonly present in these patients on presentation. The associations between ascending aorta with left ventricular hypertrophy, cardiovascular risk factors and coronary atherosclerosis, and outcome of these patients are not fully elucidated. Methods. This retrospective study included 55 consecutive patients with acute type A aortic dissection treated surgically in our institution during the last 2 years. The diagnosis was based on imaging studies. Diameter of ascending aorta was measured with echocardiography. Results. The mean age of the patients was 55.4 ± 12.19 years, and 72.7% were men. A history of arterial hypertension was present in 76.4% of the patients. Maximal ascending aorta diameter was 4.09 ± 0.59 cm, while patients with frank aneurysm accounted for 5.5%. Systolic blood pressure on admission was < 150 mmHg in 58.2% of the patients. Diastolic blood pressure on admission was < 90 mmHg in 54.5% of the patients. Mean arterial pressure on admission was 104.9 ± 24.6 mmHg. No correlations were demonstrated between maximal ascending aorta diameter and diameter of the left ventricular wall, any obtained risk factor and with coronary artery atherosclerosis (p > 0.05. After six months 11 (20% patients died, while intrahospital mortality was 72%. According to logistic regression analysis which included traditional risk factors, echo parameters, coronary artery disease and logistic euro scor, mean arterial blood pressure was the independent predictor of a six-month mortality [RR 0.956; CI (0.918-0.994 ; p = 0.024]. Conclusion. In our population the acute type A aortic dissection occurred rarely in the setting of frank ascending aortic aneurysms > 5.0 cm. The majority of patients had a history of arterial hypertension. A history of arterial hypertension was not associated with maximal ascending aorta diameter. Mean arterial blood pressure was the

Managing practical issues with percutaneous treatment of spontaneous coronary artery dissection in the cardiac catheterization laboratory: An interesting case report

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T G Varghese

2017-01-01

Full Text Available Spontaneous coronary artery dissection (SCAD is a rare condition and uncommon cause of acute coronary syndrome which is associated with high acute phase mortality with an estimated prevalence of approximately 0.7%. SCAD is known to occur more commonly in young women during pregnancy or postpartum period, and in most cases, it involves a single coronary artery. It has also been reported in patients with atherosclerosis. SCAD is generally treated by percutaneous intervention and stenting. While stenting a segment of the right coronary artery (RCA with dissection, opening the balloon in the false lumen or placing a stent in the false plane can lead to abrupt closure of the RCA leading to on table catastrophe, thereby confirming that we are in the true lumen is of pivotal importance. Simple maneuvers to prevent this error can be lifesaving. In this article, we have presented a few practical measures to deal with this dilemma in the background of a patient who was found to have spontaneous spiral dissection of the RCA while being evaluated for angina.

Clomiphene Associated Inferior STEMI in a Young Female due to Right Coronary Artery Dissection

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Feras Husain Abuzeyad

2017-01-01

Full Text Available Nonatherosclerotic spontaneous coronary artery dissection (NA-SCAD is an uncommon cause of myocardial infarction. It most commonly affects females in the perimenopausal age. NA-SCAD has been associated with many predisposing factors including pregnancy and hormonal therapy for both contraception and ovulation induction. The presented case is a previously healthy 41-year-old woman diagnosed with inferior ST-elevation myocardial infarction due to right descending coronary artery dissection associated with recent use of clomiphene monotherapy for ovulation induction (a previously fertile woman, which was not previously reported. Learning Objectives. Emergency physicians (EPs should be aware about NA-SCAD as a cause of acute coronary syndrome (ACS especially in perimenopausal women even with no risk factors. NA-SCAD occurs more commonly in the postpartum period and in females following hormonal therapy. Here, clomiphene monotherapy was reported as a possible contributing factor to NA-SCAD. Guidelines for NA-SCAD management are not up to date, and EPs should avoid some interference before the final diagnosis of the cause of myocardial infarction.

Stenting of the cervical internal carotid artery in acute stroke management: The Karolinska experience.

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Mpotsaris, Anastasios; Kabbasch, Christoph; Borggrefe, Jan; Gontu, Vamsi; Soderman, Michael

2017-04-01

Background Emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy is a routine procedure. Yet, precise indications and clinical safety in this setting remains controversial. Present data for mechanical thrombectomy include few studies with acute stenting of tandem occlusions. We evaluated the feasibility, safety and clinical outcome of this endovascular treatment in a retrospective analysis of all consecutive cases at a comprehensive stroke centre. Methods This was a retrospective analysis of all consecutive patients with acute extracranial carotid artery occlusion including acute dissection or high-grade stenosis and concomitant intracranial large-vessel occlusion treated with emergency carotid stenting and intracranial mechanical thrombectomy between November 2007 and May 2015. Results A total of 63 patients with a median age of 67 years (range 33-84 years) were treated. Of these, 33 (52%) patients had concomitant intravenous thrombolysis with recombinant tissue-type plasminogen activator initially. Median admission National Institutes of Health Stroke Scale was 14 (range 1-29). Median time from stroke onset to recanalization was 408 minutes (range 165-1846 minutes). Procedure time was significantly shorter after intravenous thrombolysis (110 minutes [range 15-202 minutes] vs. 130 minutes [range 60-280 minutes]; p = 0.02). Three (5%) patients experienced post-procedural symptomatic intracerebral haemorrhage. In 55/63 (87%) patients, a score of ≥2b on the Thrombolysis in Cerebral Infarction scale could be achieved. Eight (13%) patients died, five (8%) during the acute phase. A total of 29/63 (46%) patients showed a favourable outcome (modified Rankin Scale score of 0-2) after three months. Conclusions Our single-centre retrospective analysis of emergency stent placement in the extracranial internal carotid artery in combination with anterior circulation thrombectomy demonstrated high

Aneurisma da artéria carótida interna extracraniana: relato de caso Aneurysm of the extracranial internal carotid artery: a case report

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Marcio Ricardo Taveira Garcia

2004-08-01

Full Text Available Os aneurismas verdadeiros da artéria carótida interna extracraniana são raros, ao contrário dos supraclinóideos, somando menos de 4% dos aneurismas periféricos. Eles se apresentam clinicamente como massas palpáveis cervicais, junto à margem inferior do ângulo da mandíbula, causando rouquidão, disfagia e dor por compressão nervosa. Há freqüente associação desta doença com outros aneurismas periféricos devido à sua etiologia principal (aterosclerose. Os aneurismas periféricos são comumente identificados à ultra-sonografia Doppler, quando na vigência de janela acústica adequada. Nesta situação, os aneurismas podem ser avaliados tanto morfológica como hemodinamicamente. Sua identificação e estudo são importantes para prevenir graves complicações, como tromboses, infartos maciços ou embólicos da área correspondente no sistema nervoso central, ruptura e dissecção, além de auxiliar na indicação da melhor conduta terapêutica.Unlike supraclinoid aneurysms, true aneurysms of the extracranial internal carotid artery are extremely rare (less than 4% of the peripheral aneurysms. The commonest presentation is a pulsatile neck swelling below the angle of the jaw associated with hoarseness, dysphagia and pain (neural compression. Concomitance with other peripherical aneurysms is frequent and caused by atherosclerosis. The morphological and hemodynamic features are very well evaluated by Doppler ultrasound, when the acoustic window is satisfactory. Identification and evaluation of these aneurysms are very important to prevent thrombosis, rupture, dissections, massive strokes and embolic brain infarcts, besides helping in the decision of the best treatment.

Spontaneous Renal Artery Dissection in a Patient with Neurofibromatosis Type I

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Nicolas W. Shammas

2016-01-01

Full Text Available We present a case of spontaneous renal artery dissection (SRAD in a 28-year-old female with history of neurofibromatosis type I (NF-1 treated successfully with endovascular stenting. The clinical presentation, diagnostic testing, and treatment options are discussed. An endovascular approach with stenting was successfully performed after failure of medical treatment with subcutaneous low molecular weight heparin. Patient’s blood pressure and symptoms improved significantly. This may be the first reported case of SRAD in a patient with NF-1 successfully treated with endovascular stenting.

CT and MR angiographic findings in dissection of cervical vessels

International Nuclear Information System (INIS)

Link, J.; Brinkmann, G.; Heuser, K.; Heller, M.

1996-01-01

Purpose: To determine the usefulness of CT angiography (CTA) and MR angiography (MRA) for evaluation of dissection in cervical vessels. Material and methods: Dissection of cervical vessels was revealed by conventional angiography in 4 patients (two female, two male) of 30-62 years of age. Dissection was located in the carotid artery (n=3) and in the vertebral artery (n=1). In two patients CTA and in two patients MRA was performed. Results: Diagnosis of dissection was possible by CTA (internal carotid artery: n=2) and by MRA (internal carotid artery and vertebral artery). Imaging of the dissection membrane of the vessel wall was possible in one case with MRA. Conclusion: CT and MR angiography was successful for detection of typical morphology of dissection in all cases. If results in a greater number can be obtained it seems to be conceivable that both methods can be used in primary diagnosis. (orig.) [de

Multi-slice CT angiography in evaluation of extracranial-intracranial bypass

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Teksam, Mehmet E-mail: mehmetteksam@yahoo.com; McKinney, Alexander; Truwit, Charles L

2004-12-01

Multi-slice CT (MSCT) scanners provided significant improvement in vascular applications. In this study, our purpose was to determine the clinical utility of MSCTA in evaluation of extracranial-intracranial (EC-IC) bypass patency. Eleven (4 men and 7 women; mean age, 46 years; age range, 19-68 years) consecutive patients who underwent MSCTA and DSA after EC-IC bypass surgery were evaluated retrospectively. All patients underwent DSA within 3 weeks of MSCTA. The indications for EC-IC bypass were severe stenosis or occlusion of intracranial arteries in seven patients and therapeutic occlusion of intracranial artery for unclippable giant aneurysm in four patients. Ten patients underwent superficial temporal artery (STA)-middle cerebral artery (MCA) bypass and one patient underwent occipital artery-posterior cerebral artery (PCA) bypass. Eight STA-MCA bypasses in six patients were patent on MSCTA which were confirmed on DSA. Two MSCTA bypasses and one occipital artery-posterior cerebral artery (PCA) bypass were occluded in three patients on MSCTA and DSA. In one patient, minimal stenosis of the STA-MCA bypass was identified on MSCTA and DSA. In 1 patient, STA-MCA bypass was not well seen on MSCTA and suspected for occlusion. DSA identified the occlusion of bypass on this patient. MSCTA seems to be a very promising noninvasive technique in evaluation of EC-IC bypass.

Multi-slice CT angiography in evaluation of extracranial-intracranial bypass

International Nuclear Information System (INIS)

Teksam, Mehmet; McKinney, Alexander; Truwit, Charles L.

2004-01-01

Multi-slice CT (MSCT) scanners provided significant improvement in vascular applications. In this study, our purpose was to determine the clinical utility of MSCTA in evaluation of extracranial-intracranial (EC-IC) bypass patency. Eleven (4 men and 7 women; mean age, 46 years; age range, 19-68 years) consecutive patients who underwent MSCTA and DSA after EC-IC bypass surgery were evaluated retrospectively. All patients underwent DSA within 3 weeks of MSCTA. The indications for EC-IC bypass were severe stenosis or occlusion of intracranial arteries in seven patients and therapeutic occlusion of intracranial artery for unclippable giant aneurysm in four patients. Ten patients underwent superficial temporal artery (STA)-middle cerebral artery (MCA) bypass and one patient underwent occipital artery-posterior cerebral artery (PCA) bypass. Eight STA-MCA bypasses in six patients were patent on MSCTA which were confirmed on DSA. Two MSCTA bypasses and one occipital artery-posterior cerebral artery (PCA) bypass were occluded in three patients on MSCTA and DSA. In one patient, minimal stenosis of the STA-MCA bypass was identified on MSCTA and DSA. In 1 patient, STA-MCA bypass was not well seen on MSCTA and suspected for occlusion. DSA identified the occlusion of bypass on this patient. MSCTA seems to be a very promising noninvasive technique in evaluation of EC-IC bypass

Giant-cell Arteritis of the Ovarian Arteries: A Rare Manifestation of a Common Disease

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Prisca Theunissen

2018-02-01

Full Text Available We describe a 58-year-old woman presenting with headache and an elevated erythrocyte sedimentation rate (ESR, who was diagnosed with and successfully treated for giant-cell arteritis (GCA. Seven months after the end of treatment, ovarian GCA was incidentally found after ovariectomy for a simple cyst. GCA of extracranial vessels like the ovarian arteries is rare. Nevertheless, we stress that extracranial GCA should be considered in patients older than 50 years with an elevated ESR, even if a temporal artery biopsy is negative or specific symptoms are absent. Moreover, we discuss the importance of imaging techniques when GCA of the extracranial large vessels is suspected.

Outcomes of emergent carotid artery stenting within 6 hours of symptom onset in patients with acute ischemic stroke

International Nuclear Information System (INIS)

Jeong, Won Gi; Yoon, Woong; Yim, Nam Yeol; Jung, Min Young; Jung, Se Hee; Kang, Heoung Keun

2013-01-01

To investigate clinical outcomes following the emergent carotid artery stenting for treatment of acute ischemic stroke. Twenty-eight consecutive patients with acute stroke due to atherosclerotic steno-occlusive diseases of extracranial internal carotid artery underwent emergent carotid artery stenting. Of these, 23 patients had tandem intracranial arterial occlusions. Extracranial carotid stenting was successful in all patients. From the 13 patients who underwent intracranial recanalization procedures, successful recanalization occurred in 84.6% (11/13). 57% of patients (16/28) had a good clinical outcome (modified Rankin Scale 0-2) after 3 months. Patients with successful intracranial/extracranial recanalization had a significantly higher rate of good outcome than those without recanalization after 3 months (75% vs. 33%, p = 0.027). Patients without intracranial tandem occlusions had a more favorable clinical outcome than those with intracranial tandem occlusions (100% vs. 48%, p = 0.033). Symptomatic intracerebral hemorrhage occurred in one patient (3.6%). Mortality rate was 0% (0/28) after 3 months. Emergent carotid artery stenting in setting of acute stroke was a safe and effective treatment modality. Successful recanalization (extracranial and intracranial) and absence of intracranial tandem occlusion are significantly associated with a good outcome for our cohort of patients whom undergone emergent carotid artery stenting.

A new contrast agent for radiological and dissection studies of the arterial network of anatomic specimens.

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Bulla, A; Casoli, C; Farace, F; Mazzarello, V; De Luca, L; Rubino, C; Montella, A

2014-01-01

The aim of the present study is to propose a new contrast agent that can be easily applied both to CT and dissection studies to replace lead oxide based formulas for comparative anatomical analyses of the vascularisation of cadaveric specimens. The infusion material was an epoxy resin, especially modified by the addition of barium sulphate to enhance its radiopacity. The final copolymer was toxicologically safe. To test the properties of the new material, several cadaveric limb injections were performed. The injected specimens were both CT scanned to perform 3D vascular reconstructions and dissected by anatomical planes. There was a perfect correspondence between the image studies and the dissections: even the smallest arteries on CT scan can be identified on the specimen and vice versa. The properties of the epoxy allowed an easy dissection of the vessels. The new imaging techniques available today, such as CT scan, can evaluate the vascular anatomy in high detail and 3D. This new contrast agent may help realising detailed vascular studies comparing CT scan results with anatomical dissections. Moreover, it may be useful for teaching surgical skills in the field of plastic surgery.

Recanalisation of spontaneously occluded vertebral artery dissection after subarachnoid haemorrhage.

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Akiyama, Takenori; Onozuka, Satoshi; Horiguchi, Takashi; Yoshida, Kazunari

2012-10-01

Spontaneous occlusion is a rare manifestation of ruptured vertebral artery dissection (VAD). Its natural history and treatment strategy have yet to be established due to its rarity. Here, we report five lesions involving spontaneous occlusion of VAD after subarachnoid haemorrhage, among which three lesions showed recanalisation. Based on our experience and previous reports, spontaneous occlusion of ruptured VAD can be classified into two groups-one group with occlusion in the acute stage with a high incidence of recanalisation and another group with occlusion in the chronic stage with a relatively low incidence of recanalisation. The underlying mechanism is likely different in each group, and treatment strategies should also be tailored depending on the pathophysiology.

Treatment Challenges of a Primary Vertebral Artery Aneurysm Causing Recurrent Ischemic Strokes

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Davide Strambo

2017-01-01

Full Text Available Background. Extracranial vertebral artery aneurysms are a rare cause of embolic stroke; surgical and endovascular therapy options are debated and long-term complication may occur. Case Report. A 53-year-old man affected by neurofibromatosis type 1 (NF1 came to our attention for recurrent vertebrobasilar embolic strokes, caused by a primary giant, partially thrombosed, fusiform aneurysm of the left extracranial vertebral artery. The aneurysm was treated by endovascular approach through deposition of Guglielmi Detachable Coils in the proximal segment of the left vertebral artery. Six years later the patient presented stroke recurrence. Cerebral angiography and Color Doppler Ultrasound well characterized the unique hemodynamic condition developed over the years responsible for the new embolic event: the aneurysm had been revascularized from its distal portion by reverse blood flow coming from the patent vertebrobasilar axis. A biphasic Doppler signal in the left vertebral artery revealed a peculiar behavior of the blood flow, alternately directed to the aneurysm and backwards to the basilar artery. Surgical ligation of the distal left vertebral artery and excision of the aneurysm were thus performed. Conclusion. This is the first described case of NF1-associated extracranial vertebral artery aneurysm presenting with recurrent embolic stroke. Complete exclusion of the aneurysm from the blood circulation is advisable to achieve full resolution of the embolic source.

Correlation between intra- and extracranial background EEG

DEFF Research Database (Denmark)

Duun-Henriksen, Jonas; Kjaer, Troels W.; Madsen, Rasmus E.

2012-01-01

Scalp EEG is the most widely used modality to record the electrical signals of the brain. It is well known that the volume conduction of these brain waves through the brain, cerebrospinal fluid, skull and scalp reduces the spatial resolution and the signal amplitude. So far the volume conduction...... has primarily been investigated by realistic head models or interictal spike analysis. We have set up a novel and more realistic experiment that made it possible to compare the information in the intra- and extracranial EEG. We found that intracranial EEG channels contained correlated patterns when...... placed less than 30 mm apart, that intra- and extracranial channels were partly correlated when placed less than 40 mm apart, and that extracranial channels probably were correlated over larger distances. The underlying cortical area that influences the extracranial EEG is found to be up to 45 cm2...

Vertebral Artery Dissection Associated with Generalized Convulsive Seizures: A Case Report

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Faisal Mohammad Amin

2013-07-01

Full Text Available A 46-year-old male with juvenile myoclonic epilepsy was admitted to the neurological department for convulsive seizures just after lamotrigine was discontinued. On admission he was awake but had a right-sided hemiparesis with Babinski sign and ataxic finger-nose test on the left side. An MR scan showed a left-sided pontine infarction, an infarct in the left cerebellar hemisphere and a right vertebral artery dissection (VAD. The patient was treated with heparin and an oral anticoagulant for 6 months. Recovery of neurologic function was excellent. In patients with symptoms of disturbances of posterior circulation after epileptic seizures, VAD should be considered.

Intra-arterial high signals on arterial spin labeling perfusion images predict the occluded internal carotid artery segment

International Nuclear Information System (INIS)

Sogabe, Shu; Satomi, Junichiro; Tada, Yoshiteru; Kanematsu, Yasuhisa; Kuwayama, Kazuyuki; Yagi, Kenji; Yoshioka, Shotaro; Mizobuchi, Yoshifumi; Mure, Hideo; Yamaguchi, Izumi; Kitazato, Keiko T.; Nagahiro, Shinji; Abe, Takashi; Harada, Masafumi; Yamamoto, Nobuaki; Kaji, Ryuji

2017-01-01

Arterial spin labeling (ASL) involves perfusion imaging using the inverted magnetization of arterial water. If the arterial arrival times are longer than the post-labeling delay, labeled spins are visible on ASL images as bright, high intra-arterial signals (IASs); such signals were found within occluded vessels of patients with acute ischemic stroke. The identification of the occluded segment in the internal carotid artery (ICA) is crucial for endovascular treatment. We tested our hypothesis that high IASs on ASL images can predict the occluded segment. Our study included 13 patients with acute ICA occlusion who had undergone angiographic and ASL studies within 48 h of onset. We retrospectively identified the high IAS on ASL images and angiograms and recorded the occluded segment and the number of high IAS-positive slices on ASL images. The ICA segments were classified as cervical (C1), petrous (C2), cavernous (C3), and supraclinoid (C4). Of seven patients with intracranial ICA occlusion, five demonstrated high IASs at C1-C2, suggesting that high IASs could identify stagnant flow proximal to the occluded segment. Among six patients with extracranial ICA occlusion, five presented with high IASs at C3-C4, suggesting that signals could identify the collateral flow via the ophthalmic artery. None had high IASs at C1-C2. The mean number of high IAS-positive slices was significantly higher in patients with intra- than extracranial ICA occlusion. High IASs on ASL images can identify slow stagnant and collateral flow through the ophthalmic artery in patients with acute ICA occlusion and help to predict the occlusion site. (orig.)

Intra-arterial high signals on arterial spin labeling perfusion images predict the occluded internal carotid artery segment

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Sogabe, Shu; Satomi, Junichiro; Tada, Yoshiteru; Kanematsu, Yasuhisa; Kuwayama, Kazuyuki; Yagi, Kenji; Yoshioka, Shotaro; Mizobuchi, Yoshifumi; Mure, Hideo; Yamaguchi, Izumi; Kitazato, Keiko T.; Nagahiro, Shinji [Tokushima University Graduate School, Department of Neurosurgery, Tokushima (Japan); Abe, Takashi; Harada, Masafumi [Tokushima University Graduate School, Department of Radiology, Tokushima (Japan); Yamamoto, Nobuaki; Kaji, Ryuji [Tokushima University Graduate School, Department of Clinical Neurosciences, Institute of Biomedical Biosciences, Tokushima (Japan)

2017-06-15

Arterial spin labeling (ASL) involves perfusion imaging using the inverted magnetization of arterial water. If the arterial arrival times are longer than the post-labeling delay, labeled spins are visible on ASL images as bright, high intra-arterial signals (IASs); such signals were found within occluded vessels of patients with acute ischemic stroke. The identification of the occluded segment in the internal carotid artery (ICA) is crucial for endovascular treatment. We tested our hypothesis that high IASs on ASL images can predict the occluded segment. Our study included 13 patients with acute ICA occlusion who had undergone angiographic and ASL studies within 48 h of onset. We retrospectively identified the high IAS on ASL images and angiograms and recorded the occluded segment and the number of high IAS-positive slices on ASL images. The ICA segments were classified as cervical (C1), petrous (C2), cavernous (C3), and supraclinoid (C4). Of seven patients with intracranial ICA occlusion, five demonstrated high IASs at C1-C2, suggesting that high IASs could identify stagnant flow proximal to the occluded segment. Among six patients with extracranial ICA occlusion, five presented with high IASs at C3-C4, suggesting that signals could identify the collateral flow via the ophthalmic artery. None had high IASs at C1-C2. The mean number of high IAS-positive slices was significantly higher in patients with intra- than extracranial ICA occlusion. High IASs on ASL images can identify slow stagnant and collateral flow through the ophthalmic artery in patients with acute ICA occlusion and help to predict the occlusion site. (orig.)

Multiple contemporary arterial dissection in Ehlers-Danlos syndrome type IV

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Anna Rocci

2015-03-01

Full Text Available We report a case of multiple spontaneous arteries dissection in a 52-year-old female; the patient had a relevant family history of vascular complications and typical features so we hypothesized vascular Ehlers-Danlos syndrome (EDS that was confirmed by genetic analysis of COL3A1 gene. We adopted a conservative approach: the patient was treated with heparin in the acute phase followed by aspirin and then celiprolol was started on the basis of a recent trial that demonstrates a reduction in arterial events in EDS patient treated. A careful follow-up was done with Doppler ultrasound and computed tomography scan, as non-invasive diagnostic techniques are preferred in these patients, and no other vascular symptomatic events have occurred. We tested all living relatives: half of them had COL3A1 mutation, they were referred to another center specialized in rare diseases and EDS for long-term follow-up and genetic counseling. This case demonstrates as a careful evaluation of clinical signs, clinical history of the patient and his family has allowed a definitive diagnosis, proper management of the patient during the acute event and in terms of prophylaxis of recurrence.

Radiographically occult perforation and dissection of the common carotid artery following stab injury to the neck

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Sebastian Gamba

2017-06-01

Full Text Available In recent years, many diagnostic algorithms have been devised to reduce the rate of negative explorations associated with indiscriminate surgical management of penetrating neck injuries. In hemodynamically stable patients, the need for surgical intervention is usually determined by integrating both clinical signs and radiological findings; if such investigations remain unremarkable, recommended treatment consists in close observation and sequential physical examinations. We report on a 29-year-old male who was admitted to a Swiss tertiary care hospital after sustaining a penetrating injury to his left neck following a knife attack. Disregarding a pre-hospital account of hemorrhage from the wound and slight dysphagia, no manifest symptoms or signs of internal organ damage were present on primary survey. Moreover, there was no evidence of vascular or aerodigestive tract injury on initial CT angiography. We nonetheless proceeded with immediate surgical exploration, exposing a significant perforation of the left common carotid artery with concomitant dissection of the said vessel. Surgical repair was successfully performed and the patient suffered no long-term sequelae. We thus recommend that a high level of suspicion be upheld in both asymptomatic and oligosymptomatic patients with PNI and that clinical practitioners remain cautious in the face of deceptively reassuring radiologic findings. Keywords: Penetrating neck injury, Carotid artery perforation, Carotid artery dissection, CT angiography

Clinical features and treatment strategy in intracranial arterial dissection of ischemic onset

International Nuclear Information System (INIS)

Ono, Jun-ichi; Matsuda, Shinji; Higuchi, Yoshinori

2011-01-01

The natural history of intracranial arterial dissection (ICAD) is not known precisely, so that treatment strategy is hard to determine in some cases. We examined the clinical features, treatment and long-term outcomes in the ICAD of ischemic onset. Among 214 consecutive patients with ICAD [199 in the vertebrobasilar system (VBs) and 15 in the internal carotid system (ICs)], 76 presented with brain ischemia. Those were classified into 2 groups: 53 in the VBs and 13 in the ICs. We analyzed age, site of dissection, progression or recurrence of ischemia, medical and surgical treatment, and long-term outcomes. The outcomes were evaluated by modified Rankin disability scale (mRS). Good outcome was defined as mRS 0 to 2. The patients were younger in the ICs (mean: 44.8 years) than in the VBs (mean: 53.0 years). The vertebral artery was mostly affected in both arterial systems. The acute stage progression or recurrence of ischemia was observed in 37% of the VBs and 54% of the ICs. The progression or recurrence is more frequent in the patients of the VBs with antithrombotic therapy (p=0.0224). Treatment: Medical treatment was performed in 94% of the VBs and in all of the ICs. In addition, antithrombotic agents were prescribed in 38% of the VBs and in 85% of the ICs. Four patients (6%) of the VBs were surgically treated because of enlargement of the aneurismal dilatation on follow-up study of MRI/MRA or 3D-CT angiography. Long-term outcomes: In the medical group, good outcomes were achieved in 77% of the VBs and all of the ICs. In the VBs, the patients with antithrombotic therapy had poorer outcomes than those without the therapy (P=0.0399). All the patients in the surgical group had good outcomes in the VBs. These results suggest that antithrombotic therapy might lead to the progression or recurrence of ICAD and a poorer outcome. This therapy should be selected prudently in the ICAD of ischemic onset, especially in the VBs. (author)

Traumatic Arteriovenous Fistula of the Scalp in the Left Temporoparietal Region with Intra- and Extracranial Blood Supply

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Feng Zheng

2016-01-01

Full Text Available Traumatic AVF of the scalp is a rare abnormal vascular disease. It is defined as a communication between the high flow arterial system and the low flow venous network, which directly connects the arterial feeding vessels of the scalp and the draining veins without an intervening capillary bed. The superficial temporal artery (STA was involved in 90% of the cases, and 71% of the patients only had one dominant feeding STA. Here, we report the case of a rare large traumatic arteriovenous fistula (AVF of the scalp that is fed by intra- and extracranial blood supply. The clinical and radiological features are presented, and the possible pathogenesis and surgical technique are discussed.

Usefulness of R2* maps generated by iterative decomposition of water and fat with echo asymmetry and least-squares estimation quantitation sequence for cerebral artery dissection

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Kato, Ayumi; Shinohara, Yuki; Fujii, Shinya; Miyoshi, Fuminori; Kuya, Keita; Ogawa, Toshihide [Tottori University, Division of Radiology, Department of Pathophysiological, and Therapeutic Science, Faculty of Medicine, Yonago (Japan); Yamashita, Eijiro [Tottori University Hospital, Division of Clinical Radiology, Yonago (Japan)

2015-09-15

Acute intramural hematoma resulting from cerebral artery dissection is usually visualized as a region of intermediate signal intensity on T1-weighted images (WI). This often causes problems with distinguishing acute atheromatous lesions from surrounding parenchyma and dissection. The present study aimed to determine whether or not R2* maps generated by the iterative decomposition of water and fat with echo asymmetry and least-squares estimation quantitation sequence (IDEAL IQ) can distinguish cerebral artery dissection more effectively than three-dimensional variable refocusing flip angle TSE T1WI (T1-CUBE) and T2*WI. We reviewed data from nine patients with arterial dissection who were assessed by MR images including R2* maps, T2*WI, T1-CUBE, and 3D time-of-flight (TOF)-MRA. We visually assessed intramural hematomas in each patient as positive (clearly visible susceptibility effect reflecting intramural hematoma as hyperintensity on R2* map and hypointensity on T2*WI), negative (absent intramural hematoma), equivocal (difficult to distinguish between intramural hematoma and other paramagnetic substances such as veins, vessel wall calcification, or hemorrhage) and not evaluable (difficult to determine intramural hematoma due to susceptibility artifacts arising from skull base). Eight of nine patients were assessed during the acute phase. Lesions in all eight patients were positive for intramural hematoma corresponding to dissection sites on R2* maps, while two lesions were positive on T2*WI and three lesions showed high-intensity on T1-CUBE reflected intramural hematoma during the acute phase. R2* maps generated using IDEAL IQ can detect acute intramural hematoma associated with cerebral artery dissection more effectively than T2*WI and earlier than T1-CUBE. (orig.)

Dangerous extracranial-intracranial anastomoses and supply to the cranial nerves: vessels the neurointerventionalist needs to know.

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Geibprasert, S; Pongpech, S; Armstrong, D; Krings, T

2009-09-01

Transarterial embolization in the external carotid artery (ECA) territory has a major role in the endovascular management of epistaxis, skull base tumors, and dural arteriovenous fistulas. Knowledge of the potential anastomotic routes, identification of the cranial nerve supply from the ECA, and the proper choice of embolic material are crucial to help the interventionalist avoid neurologic complications during the procedure. Three regions along the skull base constitute potential anastomotic routes between the extracranial and intracranial arteries: the orbital, the petrocavernous, and the upper cervical regions. Branches of the internal maxillary artery have anastomoses with the ophthalmic artery and petrocavernous internal carotid artery (ICA), whereas the branches of the ascending pharyngeal artery are connected to the petrocavernous ICA. Branches of both the ascending pharyngeal artery and the occipital artery have anastomoses with the vertebral artery. To avoid cranial nerve palsy, one must have knowledge of the supply to the lower cranial nerves: The petrous branch of the middle meningeal artery and the stylomastoid branch of the posterior auricular artery form the facial arcade as the major supply to the facial nerve, and the neuromeningeal trunk of the ascending pharyngeal artery supplies the lower cranial nerves (CN IX-XII).

Dissection of the internal carotid artery and stroke after mandibular fractures: a case report and review of the literature.

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Tveita, Ingrid Aune; Madsen, Martin Ragnar Skjerve; Nielsen, Erik Waage

2017-06-02

We present a report of a patient with blunt trauma and mandibular fractures who developed a significant cerebral infarction due to an initially unrecognized injury of her left internal carotid artery. We believe that increased knowledge of this association will facilitate early recognition and hence prevention of a devastating outcome. A 41-year-old ethnic Norwegian woman presented to our Emergency Room after a bicycle accident that had caused a direct blow to her chin. At admittance, her Glasgow Coma Scale was 15. Initial trauma computed tomography showed triple fractures of her mandible, but no further pathology. She was placed in our Intensive Care Unit awaiting open reduction of her mandibular fractures. During the following 9 hours, she showed recurrent episodes of confusion and a progressive right-sided hemiparesis. Repeated cerebral computed tomography revealed no further pathology compared to the initial scan. She had magnetic resonance angiography 17 hours after admittance, which showed dissection and thrombus formation in her left internal carotid artery, total occlusion of her left medial cerebral artery, and left middle cerebral artery infarction was detected. Carotid artery dissection is a rare but life-threatening condition that can develop after trauma to the head and neck. There should be a high index of suspicion in patients with a mechanism of injury that places the internal carotid artery at risk because blunt vascular injury may show delayed onset with no initial symptoms of vascular damage. By implementing an algorithm for early detection and treatment of these injuries, serious brain damage may be avoided.

Magnetic resonance diagnosis of aortic dissection

International Nuclear Information System (INIS)

Mukohara, Nobuhiko; Yoshida, Yutaka; Nakamura, Kazuo

1986-01-01

Magnetic resonance imaging (MRI) was performed in thirty-one patients with aortic dissection to evaluate its usefulness in diagnosing the site of communicating orifice between the true and false lumens and the presence of retrograde dissection. 1. MRI revealed the site of the entry as a defect in the intimal flap in the images of 12 of 15 patients (80 %). 2. The site of the communicating orifice between the true and false lumens in the abdominal aorta could be determined in six of eight patients (75 %). 3. MRI diagnosis of retrograde dissection was successful in three patients. 4. Cross-sectional analysis of the abdominal aorta based on the location of the true lumen revealed that the celiac and superior mesenteric arteries tended to arise from the true lumen when the latter was situated in the anterior part of the abdominal aorta. The right and left renal arteries arose from the true lumen when it was positioned anterolaterally. In conclusion, MRI was a useful diagnostic method for aortic dissection, especially for determining the site of entry in the thoracic aorta. The changes in signal intensity in the false lumen provided useful information for locating the communicating orifice between the true and false lumens and for diagnosis of retrograde dissection. Cross-sectional analysis of dissection in the abdominal aorta was useful for predicting the branching of the main arteries from the true or false lumen. (author)

[Pregnancy and coronary artery dissection].

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Martínez-Quintana, Efrén; Rodríguez-González, Fayna

2015-01-01

Acute myocardial infarction during pregnancy is associated with high maternal and fetal mortality. Coronary atherosclerosis is the most common cause due to an increase in the age of the patients and the association with cardiovascular risk factors such as smoking, hypertension, diabetes mellitus, preeclampsia, and the existence of family history of coronary disease. However, thrombosis, coronary dissection or coronary vasospasms are other causes that may justify it. We report the case of a 33 weeks pregnant first-time mother, without cardiovascular risk factors, who presented an acute coronary event in the context of atherosclerotic disease and coronary dissection after percutaneous coronary intervention. Copyright © 2014 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

Dynamic CT brain scanning in the haemodynamic evaluation of cerebral arterial occlusive disease

International Nuclear Information System (INIS)

Davis, S.M.; Melbourne Univ.; Tress, B.M.; Hopper, J.L.; Rossiter, S.C.; Kaye, A.H.

1987-01-01

Dynamic cerebral CT scanning (DCT) was used to quantitatively analyse the haemodynamic effects of extracranial and intracranial arterial occlusive lesions in 17 patients with TIA's or minor cerebral infarcts. Using DCT and gamma variate curve fitting, mean transit times were determined for the terminal internal carotid arteries, middle cerebral arteries and middle cerebral-supplied Sylvian cortex at the level of the Circle of Willis. Six patients were studied sequentially, four before and after transcranial bypass surgery. No arterial or tissue delays were found in patients without haemodynamic arterial lesions or cortical infarcts. Seven of nine patients with haemodynamic, extracranial carotid lesions showed ipsilateral delays in arterial or tissue transit times. Tissue delays usually correlated with CT or clinical evidence of infarction. Improved haemodynamics in patients re-studied correlated with the effects of surgery or clinical recovery. DCT has several important limitations but has the potential to provide additional haemodynamic information about the cerebral circulation in selected patients with cerebral arterial occlusive disease. (orig.)

Incidence of traumatic carotid and vertebral artery dissections: results of cervical vessel computed tomography angiogram as a mandatory scan component in severely injured patients

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Schicho A

2018-01-01

Full Text Available Andreas Schicho,1 Lukas Luerken,1 Ramona Meier,1 Antonio Ernstberger,2 Christian Stroszczynski,1 Andreas Schreyer,1 Lena-Marie Dendl,1 Stephan Schleder1 1Department of Radiology, 2Department of Trauma Surgery, University Medical Center, Regensburg, Germany Purpose: The aim of this study was to evaluate the true incidence of cervical artery dissections (CeADs in trauma patients with an Injury Severity Score (ISS of ≥16, since head-and-neck computed tomography angiogram (CTA is not a compulsory component of whole-body trauma computed tomography (CT protocols. Patients and methods: A total of 230 consecutive trauma patients with an ISS of ≥16 admitted to our Level I trauma center during a 24-month period were prospectively included. Standardized whole-body CT in a 256-detector row scanner included a head-and-neck CTA. Incidence, mortality, patient and trauma characteristics, and concomitant injuries were recorded and analyzed retrospectively in patients with carotid artery dissection (CAD and vertebral artery dissection (VAD. Results: Of the 230 patients included, 6.5% had a CeAD, 5.2% had a CAD, and 1.7% had a VAD. One patient had both CAD and VAD. For both, CAD and VAD, mortality is 25%. One death was caused by fatal cerebral ischemia due to high-grade CAD. A total of 41.6% of the patients with traumatic CAD and 25% of the patients with VAD had neurological sequelae. Conclusion: Mandatory head-and-neck CTA yields higher CeAD incidence than reported before. We highly recommend the compulsory inclusion of a head-and-neck CTA to whole-body CT routines for severely injured patients. Keywords: polytrauma, carotid artery, vertebral artery, dissection, blunt trauma, computed tomography angiogram

Spontaneous coronary artery dissection presenting as an ischaemic stroke in a middle-aged man with anti-cardiolipin antibodies: a case report

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Lim F

2010-03-01

Full Text Available Abstract Introduction Cerebrovascular disease is a major cause of mortality and morbidity worldwide. Ischemic stroke is the most common manifestation, encompassing a wide variety of causative mechanisms. We present the case of a middle-aged male patient with spontaneous coronary artery dissection in the presence of anti-cardiolipin antibodies, leading to left ventricular thrombus and presenting with stroke. Case presentation A 56-year-old Caucasian man presented with dysarthria and right-sided weakness. There was a history of chest pain with autonomic symptoms four days earlier. Examination revealed right-sided hemiparesis. Electrocardiogram showed sinus rhythm with anterior Q waves. Magnetic resonance imaging of the brain showed large left parietal and smaller multiple cerebral infarcts. Echocardiogram showed anterior wall and apical akinesis with a large mural thrombus. Anti-cardiolipin antibodies immunoglobulin G and immunoglobulin M were strongly positive. Coronary angiography showed dissection of the mid left anterior descending artery with normal flow down the distal vessel. He was treated conservatively with anticoagulation and secondary prevention. He was in good health when seen in clinic four months later. Conclusion We highlight the importance of a comprehensive approach at obtaining the correct diagnosis, input of different specialities and the fact that the presence of anti-cardiolipin antibodies is associated with coronary artery dissection in a middle-aged male patient whose presentation was stroke.

CT and radiographic appearance of extracranial Onyx® embolization

International Nuclear Information System (INIS)

Jia, J.B.; Green, C.S.; Cohen, A.J.; Helmy, M.

2015-01-01

Onyx ® (ev3, Irvine, CA, USA) is a liquid embolic agent composed of ethylene vinyl alcohol copolymer dissolved in dimethyl sulphoxide used for the treatment of intracranial arteriovenous malformations. Onyx is a preferred embolizing agent due to its unique properties, non-adhesive nature, and durability. In addition to its approved intracranial application, Onyx is also being used successfully in extracranial embolization in areas including extracranial aneurisms and vascular malformations, trauma, gastrointestinal bleeding, and neoplasms. Because of its increasing utilization, it is important for reporting radiologists to be able to recognize its extracranial appearance across different imaging techniques and to be familiar with its uses. The goal of this review is to describe the extracranial uses of Onyx and its appearance in various extracranial locations at radiography and CT, while providing didactic examples. Onyx appears radiodense at CT and plain radiography and has a curvilinear pattern following the expected path of the vessel embolized. At CT, Onyx creates streak artefact that may obstruct the view of surrounding tissues consistent with descriptions of other tantalum devices

Treatment of Cervical Internal Carotid Artery Spontaneous Dissection with Pseudoaneurysm and Unilateral Lower Cranial Nerves Palsy by Two Silk Flow Diverters

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Zelenak, Kamil, E-mail: zelenak@unm.sk [University Hospital, Department of Radiology (Slovakia); Zelenakova, Jana [University Hospital, Department of Neurology (Slovakia); DeRiggo, Julius [University Hospital, Department of Neurosurgery (Slovakia); Kurca, Egon; Kantorova, Ema [University Hospital, Department of Neurology (Slovakia); Polacek, Hubert [University Hospital, Department of Radiology (Slovakia)

2013-08-01

Internal carotid artery (ICA) lesions in the parapharyngeal space (a dissection and a pseudoaneurysm) may present as isolated lower cranial nerves (IX, X, XI, and XII) palsy (Collet-Sicard syndrome). Some arteriopathies such as fibromuscular dysplasia and tortuosity make a vessel predisposed to dissection. Extreme vessel tortuosity makes the treatment by a stent graft impossible. Two Silk stents were used in a 46 year-old man with left lower cranial nerves (IX-XII) palsy for the treatment of left ICA spontaneous dissection with pseudoaneurysm. A follow-up angiogram 5 months later confirmed pseudoaneurysm thrombosis and patency of the left ICA. The patient recovered completely from the deficits.

Treatment of Cervical Internal Carotid Artery Spontaneous Dissection with Pseudoaneurysm and Unilateral Lower Cranial Nerves Palsy by Two Silk Flow Diverters

International Nuclear Information System (INIS)

Zeleňák, Kamil; Zeleňáková, Jana; DeRiggo, Július; Kurča, Egon; Kantorová, Ema; Poláček, Hubert

2013-01-01

Internal carotid artery (ICA) lesions in the parapharyngeal space (a dissection and a pseudoaneurysm) may present as isolated lower cranial nerves (IX, X, XI, and XII) palsy (Collet–Sicard syndrome). Some arteriopathies such as fibromuscular dysplasia and tortuosity make a vessel predisposed to dissection. Extreme vessel tortuosity makes the treatment by a stent graft impossible. Two Silk stents were used in a 46 year-old man with left lower cranial nerves (IX–XII) palsy for the treatment of left ICA spontaneous dissection with pseudoaneurysm. A follow-up angiogram 5 months later confirmed pseudoaneurysm thrombosis and patency of the left ICA. The patient recovered completely from the deficits

Three-dimensional stereotactic atlas of the extracranial vasculature correlated with the intracranial vasculature, cranial nerves, skull and muscles.

Science.gov (United States)

Nowinski, Wieslaw L; Shoon Let Thaung, Thant; Choon Chua, Beng; Hnin Wut Yi, Su; Yang, Yili; Urbanik, Andrzej

2015-04-01

Our objective was to construct a 3D, interactive, and reference atlas of the extracranial vasculature spatially correlated with the intracranial blood vessels, cranial nerves, skull, glands, and head muscles.The atlas has been constructed from multiple 3T and 7T magnetic resonance angiogram (MRA) brain scans, and 3T phase contrast and inflow MRA neck scans of the same specimen in the following steps: vessel extraction from the scans, building 3D tubular models of the vessels, spatial registration of the extra- and intracranial vessels, vessel editing, vessel naming and color-coding, vessel simplification, and atlas validation.This new atlas contains 48 names of the extracranial vessels (25 arterial and 23 venous) and it has been integrated with the existing brain atlas.The atlas is valuable for medical students and residents to easily get familiarized with the extracranial vasculature with a few clicks; is useful for educators to prepare teaching materials; and potentially can serve as a reference in the diagnosis of vascular disease and treatment, including craniomaxillofacial surgeries and radiologic interventions of the face and neck. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

MRI in giant cell (temporal) arteritis; Magnetresonanztomografie der Arteriitis temporalis Horton

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Bley, T.A.; Uhl, M.; Frydrychowicz, A.; Langer, M. [Uniklinik Freiburg (Germany). Roentgendiagnostik; Markl, M. [Uniklinik Freiburg (Germany). Roentgendiagnostik - Medizinische Physik

2007-07-15

Giant cell (temporal) arteritis is a diagnostic challenge. Blindness is a dreaded complication, especially if high-dose steroid treatment is delayed. With an optimized MR protocol, noninvasive diagnosis of giant cell arteritis is facilitated. Submillimeter in-plane resolution makes it possible to distinguish healthy segments from inflamed segments. The lumen and arterial wall can be depicted in high detail. Post-contrast high-resolution MRI visualizes the superficial cranial arteries bilaterally and simultaneously, allowing assessment of the cranial involvement pattern. In combination with MR angiography of the aortic arch and supra-aortic arteries, the extracranial involvement pattern can be demonstrated in a single comprehensive MR examination assessing the cranial, cervical and thoracic vasculature. Good diagnostic image quality can be achieved at 1.5 Tesla and at 3 Tesla. However, due to higher signal-to-noise ratios, image quality seems to be superior at 3 Tesla. Over the course of successful long-term treatment, MR signs of mural inflammation decrease significantly and eventually vanish entirely. In contrast to color-coded Duplex sonography, which is a comparatively cost-efficient imaging modality, acquisition of high-resolution MRI is almost independent of the investigator's expertise. Compared to positron emission tomography with 18F-fluoro-2-deoxy-D-glucose, which is a very sensitive whole-body screening tool for detecting extracranial involvement of large vessel vasculitis, MRI allows visualization and assessment of both the superficial cranial arteries in high detail and the extracranial large artery involvement in the same investigation. (orig.)

Evaluation of Contrast MR Angiography in the Study of Internal Carotid Artery Stenosis. Systematic Review of the Literature

International Nuclear Information System (INIS)

Rodriguez Perez, P.; Martinez Cantarero, J.; Ruiz Diaz, M.; Blazquez Morera, J. A.; Llano Senaris, J. E. de

2004-01-01

To evaluate the diagnostic benefit of using contrast MR Angiography (MRA) in the study of extracranial internal carotid artery stenosis as opposed to intraarterial digital subtraction arteriography (LADSA). A search for relevant articles from 1990 to 2000 using MDLINE and EMBASE databases. Initial selection criteria: 1. articles which compare MRA and IADSA in the study of extracranial internal carotid artery stenosis; and 2, sample size of 10 or more subjects. Studies employing contrast MRA were subsequently selected. Contrast MRA diagnostic results were studied, as were those of non-contrast MRA (TOF) if included. Roc curves and 95% confidence intervals were calculated. In the studies, 324 patients and 648 extracranial internal carotid arteries were evaluated (12 articles). The diagnostic results in carotid artery stenosis discrimination using contrast MRA as opposed to IADSA were sensitivity and specificity=97.28% and 96.08%. With regard to contrast MRA vs. non-contrast MRA (TOF), significant differences favoring contrast MRA in both sensitivity and specificity were observed. (p=0.08 and p<0.001, respectively). MRA techniques demonstrate very high diagnostic capabilities in the detection of carotid stenosis, with contrast MRA being more effective than non-contrast. MRA. In spite of not being superior to IADSA, given the morbimortality risk which the latter is associated (0.7-1.2%). many authors defend contrast MRA (in association with Doppler echography) having become the method of choice for presurgical study of extracranial internal carotid artery stenosis. (Author) 53 refs

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

Science.gov (United States)

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

2015-02-01

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 angiography (CTA) of the intracranial VAs was available. In 72 patients an additional CTA of the extracranial VAs was available. Adjusted risk ratios (aRRs) for death and poor outcome, defined as a modified Rankin Scale score ≥4, were calculated with Poisson regression in relation to VA occlusion, VA occlusion or stenosis ≥50 %, and bilateral VA occlusion. Sixty-six of 141 (47 %) patients had uni- or bilateral intracranial VA occlusion or stenosis ≥50 %. Of the 72 patients with intra- and extracranial CTA, 46 (64 %) had uni- or bilateral VA occlusion or stenosis ≥50 % and 9 (12 %) had bilateral VA occlusion. Overall, VA occlusion or stenosis ≥50 % was not associated with the risk of poor outcome. Patients with intra- and extracranial CTA and bilateral VA occlusion had a higher risk of poor outcome than patients without bilateral VA occlusion (aRR, 1.23; 95 % CI 1.02-1.50). The risk of death did not depend on the presence of unilateral or bilateral VA occlusion or stenosis ≥50 %. In conclusion, in patients with acute BAO, unilateral VA occlusion or stenosis ≥50 % is frequent, but not associated with an increased risk of poor outcome or death. Patients with BAO and bilateral VA occlusion have a slightly increased risk of poor outcome.

Fibromuscular dysplasia: an update for the headache clinician.

Science.gov (United States)

O'Connor, Sarah C; Poria, Neil; Gornik, Heather L

2015-05-01

Fibromuscular dysplasia (FMD) is an uncommon vascular disease that presents with stenosis, aneurysm, dissection, beading, and tortuosity of medium-sized arteries. It primarily manifests in the renal and extracranial carotid and vertebral arteries, and is associated with major vascular events such as carotid artery dissection, renal artery dissection, ruptured aneurysm, transient ischemic attack, stroke, and myocardial infarction (due to coronary artery dissection). There is a wide spectrum of disease severity among FMD patients. Symptoms of FMD are related to the vascular beds involved and the severity of arterial stenoses. Headache is an extremely common and important symptom reported by patients with FMD, although the precise mechanism of headache in this population is not yet known. This review summarizes the most recent literature regarding FMD, including epidemiology, clinical manifestations, imaging practices, and treatment. Special attention will be paid to the association of headaches and FMD. Correct diagnosis, optimal medical management, and appropriate referral for vascular intervention are vital elements of the treatment of patients with FMD. There is a great need for more clinical research regarding the epidemiology, pathophysiology, and optimal treatment of headache in the FMD patient population. © 2015 American Headache Society.

Congenital extracranial meningioma

International Nuclear Information System (INIS)

Wong, H.F.; Ng, S.H.; Wai, Y.Y.; Wan, Y.L.; Kong, M.S.

1995-01-01

The authors report a case of congenital meningioma in a newborn. This tumour is extremely rare and only six cases have been reported in the literature. Those reported cases were mainly intracranial. This is the first case of a neonatal extracranial meningioma that was evaluated preoperatively by computed tomography and magnetic resonance imaging. (orig.)

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

Energy Technology Data Exchange (ETDEWEB)

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

2016-10-15

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

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

International Nuclear Information System (INIS)

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

2016-01-01

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

Clinical significance of intraluminal contrast enhancement in patients with spontaneous cervical artery dissection. A black-blood MRI study

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Coppenrath, Eva; Lenz, Olga; Sommer, Nora; Treitl, Karla; Reiser, Maximilian [Munich Univ. (Germany). Inst. of Clinical Radiology; Lummel, Nina [Univ. Hospital Klinikum rechts der Isar Munich, Munich (Germany). Inst. of Neuroradiology and Interventional Neuroradiology; Linn, Jennifer [Univ. Hospital Dresden (Germany). Inst. of Neuroradiology; Bamberg, Fabian [Tuebingen Univ. (Germany). Diagnostical and Interventional Radiology; Pfefferkorn, Thomas [Munich Univ. (Germany). Interdisciplinary Stroke Center Munich; Saam, Tobias [Radiology Center Rosenheim (Germany)

2017-07-15

Recent studies have suggested that intraluminal thrombi show contrast enhancement on carotid black-blood T1w MRI. The aim of this study was to evaluate the significance of intraluminal contrast enhancement (iCE) regarding symptom status in patients with spontaneous cervical artery dissection (sCAD). 33 consecutive patients (19 men) with sCAD received a brain MRI (DIFF, T2w, T2{sup *}w, FLAIR) and a multi-sequence 3T-MRI with fat-saturated high-resolution black-blood T1w-sequences pre- and post-contrast, contrast-enhanced MR angiography and TOF images of carotid and vertebral arteries. Presence/absence of iCE, vessel occlusion and vessel wall hematoma (hyperintense in T1w pre-contrast) were analysed by two radiologists in consensus decision. 44 of 132 analysed vessels had a vessel wall hematoma, consistent with sCAD. In 17 of 44 dissected vessels an acute ischemic stroke was found. 16 of 17 (94.1 %) vessels ipsilateral to ischemic stroke demonstrated iCE, compared to 9 of 44 (20.4 %) dissected vessels without stroke (P< 0.001). The presence/absence of iCE resulted in a sensitivity, specificity, positive and negative predictive value and accuracy for ischemic stroke of 0.94, 0.67, 0.64, 0.95, and 0.77, respectively, and an odds ratio of 32.0. iCE, which is suggestive of intraluminal thrombus formation, is strongly correlated with ischemic symptoms in patients with sCAD.

Clinical significance of intraluminal contrast enhancement in patients with spontaneous cervical artery dissection. A black-blood MRI study

International Nuclear Information System (INIS)

Coppenrath, Eva; Lenz, Olga; Sommer, Nora; Treitl, Karla; Reiser, Maximilian

2017-01-01

Recent studies have suggested that intraluminal thrombi show contrast enhancement on carotid black-blood T1w MRI. The aim of this study was to evaluate the significance of intraluminal contrast enhancement (iCE) regarding symptom status in patients with spontaneous cervical artery dissection (sCAD). 33 consecutive patients (19 men) with sCAD received a brain MRI (DIFF, T2w, T2"*w, FLAIR) and a multi-sequence 3T-MRI with fat-saturated high-resolution black-blood T1w-sequences pre- and post-contrast, contrast-enhanced MR angiography and TOF images of carotid and vertebral arteries. Presence/absence of iCE, vessel occlusion and vessel wall hematoma (hyperintense in T1w pre-contrast) were analysed by two radiologists in consensus decision. 44 of 132 analysed vessels had a vessel wall hematoma, consistent with sCAD. In 17 of 44 dissected vessels an acute ischemic stroke was found. 16 of 17 (94.1 %) vessels ipsilateral to ischemic stroke demonstrated iCE, compared to 9 of 44 (20.4 %) dissected vessels without stroke (P< 0.001). The presence/absence of iCE resulted in a sensitivity, specificity, positive and negative predictive value and accuracy for ischemic stroke of 0.94, 0.67, 0.64, 0.95, and 0.77, respectively, and an odds ratio of 32.0. iCE, which is suggestive of intraluminal thrombus formation, is strongly correlated with ischemic symptoms in patients with sCAD.

Spontaneous vertebral dissection: Clinical, conventional angiographic, CT, and MR findings

Energy Technology Data Exchange (ETDEWEB)

Provenzale, J.M.; Morgenlander, J.C. [Duke Univ. Medical Center, Durham, NC (United States); Gress, D. [Univ. of California, San Francisco, CA (United States)

1996-03-01

The purpose of this study was to determine if typical clinical and neuroradiologic patterns exist in patients with spontaneous vertebral artery (VA) dissection. The medical records and neuroradiologic examinations of 14 patients with spontaneous VA dissection were reviewed. The medical records were examined to exclude patients with a history of trauma and to record evidence of a nontratimatic precipitating event ({open_quotes}trivial trauma{close_quotes}) and presence of possible risk factors such as hypertension. All patients under-went conventional angiography, 13 either CT or MRI (II both CT and MRI), and 3 MRA. Conventional arteriograrris were evaluated for dissection site, evidence of fibromuscular dysplasia, luminal stenosis or occlusion, and pseudoaneurysm formation, CT examinations for the presence of infarction or subarachnoid hemorrhage, MR examinations for the presence of infarction or arterial signal abnormality, and MR angiograms for abnormality of the arterial signal column. Seven patients had precipitating events within 24 h of onset of symptoms that may have been causative of dissection and five had hypertension. At catheter angiography, two patients had dissections in two arteries (both VAs in one patient, VA and internal carotid artery in one patient), giving a total of 15 VAs with dissection. Dissection sites included V1 in four patients, V2 in one patient, V3 in three patients, V4 in six patients, and both V3 and V4 in one patient. Luminal stenosis was present in 13 VAs, occlusion in 2, pseudoaneurysm in 1, and evidence of fibromuscular dysplasia in 1. Posterior circulation infarcts were found on CT or MR in five patients. Subarachnoid hemorrhage was found on CT in two patients and by lumbar puncture alone in two patients. Abnormal periarterial signal on MRI was seen in three patients. MRA demonstrated absent VA signal in one patient, pseudoaneurysm in one, and a false-negative examination in one.

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

Science.gov (United States)

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

2018-01-01

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

Stroke in Ehlers-Danlos Syndrome Kyphoscoliotic Type: Dissection or Vasculitis?

Science.gov (United States)

Quade, Annegret; Wiesmann, Martin; Weis, Joachim; Kurth, Ingo; Jalaie, Houman; Rohrbach, Marianne; Häusler, Martin

2017-09-01

Patients with the kyphoscoliotic type of Ehlers-Danlos syndrome have an increased risk of vascular complications such as aortic dissection and perforation. Cerebral ischemia has only rarely been documented. This 13-year-old girl with the kyphoscoliotic type of Ehlers-Danlos syndrome experienced a large right middle cerebral artery distribution infarction. Full intravenous heparinization was started in response to presumed arterial dissection. Magnetic resonance imaging studies including magnetic resonance angiography and digital subtraction angiography, however, did not confirm dissection but suggested with cerebral vasculitis extending from the intradural right internal carotid artery to the M2 branches of the middle cerebral artery. Combined steroid and cyclophosphamide therapy was associated with clinical improvement. Two months later she died from hemorrhagic shock caused by a two-sided spontaneous rupture of the aortic artery. Cerebral vasculitis should be included in the differential diagnosis of vascular complications in kyphoscoliotic type of Ehlers-Danlos syndrome. Copyright © 2017 Elsevier Inc. All rights reserved.

An exceedingly rare cause of secondary hypertension: bilateral renal artery dissection possibly secondary to extracorporeal shock-wave lithotripsy (ESWL).

Science.gov (United States)

Orhan, Ozbek; Kultigin, Turkmen; Osman, Koc; Yalcin, Solak; Melih, Anil; Niyazi, Gormus

2011-01-01

Extracorporeal shock-wave lithotripsy (ESWL) is an effective and relatively non-invasive treatment modality for ureteral or renal calculi. Although it has been accepted as a safe procedure, minor and major complications have been reported after ESWL. Spontaneous renal artery dissection (SRAD) is a rare and usually misdiagnosed condition because of non-specific presentation of the patients. Depending on the severity of the extent of the dissection non-operative or surgical treatment modalities could be performed. We represent a patient with complaints of bilateral flank pain, hematuria and hypertensive urgency who was diagnosed as having bilateral SRAD possibly secondary to ESWL and chronic hypertension.

Inner-ear circulation in humans is disrupted by extracranial venous outflow strictures: Implications for Ménière’s disease

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Eleuterio F. Toro

2018-02-01

Full Text Available Ménière’s disease (MD is a pathology of the inner ear, the symptoms of which include tinnitus, vertigo attacks, fluctuating hearing loss, and nausea. Neither cause nor cure are currently known, though animal experiments suggest that disruption of the inner ear circulation, including venous hypertension and endolymphatic hydrops, to be hallmarks of the disease. Recent evidence for humans suggests a potential link to strictures in the extracranial venous outflow routes. The purpose of the present work is to demonstrate that the inner-ear circulation in humans is disrupted by extracranial venous outflow stricture and to discuss the implications of this finding for MD. The hypothesis linking extracranial venous outflow strictures to the altered dynamics of central nervous system (CNS fluid compartments is investigated theoretically via a global, closed-loop, multiscale mathematical model for the entire human circulation, interacting with the brain parenchyma and cerebrospinal fluid (CSF. The fluid dynamics model for the full human body includes submodels for the heart, pulmonary circulation, arterial system, microvasculature, venous system and the CSF, with a specially refined description of the inner ear vasculature. We demonstrate that extracranial venous outflow strictures disrupt inner ear circulation, and more generally, alter the dynamics of fluid compartments in the whole CNS. Specifically, as compared to a healthy control, the computational results from our model show that subjects with extracranial outflow venous strictures exhibit: altered inner ear circulation, redirection of flow to collaterals, increased intracranial venous pressure and increased intracranial pressure. Our findings are consistent with recent clinical evidence in humans that links extracranial outflow venous strictures to MD, aid the mechanistic understanding of the underlying features of the disease and lend support to recently proposed biophysically motivated

Thrombin Injection Failure with Subsequent Successful Stent-Graft Placement for the Treatment of an Extracranial Internal Carotid Pseudoaneurysm in a 5-Year-Old Child

International Nuclear Information System (INIS)

Garcia-Monaco, R. D.; Kohan, A. A.; Martinez-Corvalan, M. P.; Cacchiarelli, N.; Peralta, O.; Wahren, C. G.

2012-01-01

Internal carotid artery pseudoaneurysm is a rare life-threatening condition that may develop in different clinical situations. We report the case of an extracranial internal carotid artery pseudoaneurysm secondary to a throat infection in a pediatric patient that was initially treated with percutaneous thrombin injection under ultrasound guidance. However, recanalization occurred at 48 h, and definitive treatment was then performed by endovascular stent-graft placement. We briefly review the clinical characteristics of this uncommon clinical condition as well as the treatment options.

Brain Stem Infarction Due to Basilar Artery Dissection in a Patient with Moyamoya Disease Four Years after Successful Bilateral Revascularization Surgeries.

Science.gov (United States)

Abe, Takatsugu; Fujimura, Miki; Mugikura, Shunji; Endo, Hidenori; Tominaga, Teiji

2016-06-01

Moyamoya disease (MMD) is a rare cerebrovascular disease with an unknown etiology and is characterized by intrinsic fragility in the intracranial vascular walls such as the affected internal elastic lamina and thinning medial layer. The association of MMD with intracranial arterial dissection is extremely rare, whereas that with basilar artery dissection (BAD) has not been reported previously. A 46-year-old woman developed brain stem infarction due to BAD 4 years after successful bilateral superficial temporal artery-middle cerebral artery anastomosis with indirect pial synangiosis for ischemic-onset MMD. She presented with sudden occipitalgia and subsequently developed transient dysarthria and mild hemiparesis. Although a transient ischemic attack was initially suspected, her condition deteriorated in a manner that was consistent with left hemiplegia with severe dysarthria. Magnetic resonance (MR) imaging revealed brain stem infarction, and MR angiography delineated a double-lumen sign in the basilar artery, indicating BAD. She was treated conservatively and brain stem infarction did not expand. One year after the onset of brain stem infarction, her activity of daily living is still dependent (modified Rankin Scale of 4), and there were no morphological changes associated with BAD or recurrent cerebrovascular events during the follow-up period. The association of MMD with BAD is extremely rare. While considering the common underlying pathology such as an affected internal elastic lamina and fragile medial layer, the occurrence of BAD in a patient with MMD in a stable hemodynamic state is apparently unique. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

[Thoracic aortic dissection revealed by systemic cholesterol embolism].

Science.gov (United States)

Braem, L; Paule, P; Héno, P; Morand, J J; Mafart, B; La Folie, T; Varlet, P; Mioulet, D; Fourcade, L

2006-10-01

Systemic cholesterol embolism is a rare complication of atherosclerosis, and has various presentations. Arterial catheterisms are a common cause. However, the association with an aortic dissection has been exceptionally reported. We report the observation of a 70 year-old man, with coronary artery disease, hypertension, diabetes and dyslipidemia. Six months before hospitalization, a coronary angioplasty was performed due to recurrent angina. The association of purpuric lesions on the feet, with acute renal failure confirmed cholesterol embolism syndrome. Transoesophageal echocardiography showed a dissection of the descending thoracic aorta associated with complex atheroma. The evolution was marked by the pulpar necrosis of a toe and by a worsening of the renal failure, requiring definitive hemodialysis. Further echographic control highlighted the rupture of the intimal veil of the dissection. Cholesterol embolism syndrome may reveal an aortic dissection in patients without thoracic symptoms. In such cases, transoesophageal echocardiography is a useful and non-invasive examination.

Paediatric dissecting posterior cerebral aneurysms: report of two cases and review of the literature

International Nuclear Information System (INIS)

Vilela, Pedro; Goulao, Augusto

2006-01-01

Intracranial aneurysms in the paediatric population are uncommon, accounting for 2% to 6% of all aneurysms, and spontaneous arterial dissection is rarely reported as the cause of aneurysms in children, especially in the posterior cerebral artery. Two cases of paediatric spontaneous posterior cerebral artery dissecting aneurysms are reported, one in a 33-month-old male child presenting with aneurysmal rupture and subarachnoid haemorrhage and the other in a 9-year-old boy with an unruptured aneurysm. The first child was successfully treated by endovascular parent vessel occlusion without neurological deficit and in the second a spontaneous thrombosis of the aneurysm and its parent artery occurred associated with hydrocephalus and a favourable outcome. Dissecting aneurysms are dynamic lesions with variable and unpredictable evolution and close follow-up and/or early treatment is warranted. Spontaneous arterial dissection is a rare, probably still under-recognized, cause of intracranial aneurysms that may be responsible for a significant number of aneurysms and spontaneous aneurysmal thromboses in children. (orig.)

Paediatric dissecting posterior cerebral aneurysms: report of two cases and review of the literature

Energy Technology Data Exchange (ETDEWEB)

Vilela, Pedro; Goulao, Augusto [Garcia de Orta Hospital, Neuroradiology Department, Almada (Portugal)

2006-08-15

Intracranial aneurysms in the paediatric population are uncommon, accounting for 2% to 6% of all aneurysms, and spontaneous arterial dissection is rarely reported as the cause of aneurysms in children, especially in the posterior cerebral artery. Two cases of paediatric spontaneous posterior cerebral artery dissecting aneurysms are reported, one in a 33-month-old male child presenting with aneurysmal rupture and subarachnoid haemorrhage and the other in a 9-year-old boy with an unruptured aneurysm. The first child was successfully treated by endovascular parent vessel occlusion without neurological deficit and in the second a spontaneous thrombosis of the aneurysm and its parent artery occurred associated with hydrocephalus and a favourable outcome. Dissecting aneurysms are dynamic lesions with variable and unpredictable evolution and close follow-up and/or early treatment is warranted. Spontaneous arterial dissection is a rare, probably still under-recognized, cause of intracranial aneurysms that may be responsible for a significant number of aneurysms and spontaneous aneurysmal thromboses in children. (orig.)

Influência do etanol das bebidas alcoólicas na aterosclerose em artérias carótidas extracranianas The influence of the ethanol in alcoholic beverages in the extracranial carotid arteries atherosclerosis

Directory of Open Access Journals (Sweden)

Ibsen Thadeo Damiani

2004-12-01

Full Text Available Existem fortes evidências de menor incidência de doença cerebrovascular oclusiva, de aterosclerose coronariana e de outros vasos em indivíduos com consumo leve ou moderado de álcool. Este estudo procura analisar o efeito do etanol, em diferentes doses no comportamento da aterosclerose carotídea extracraniana. Através do ultrassom Doppler colorido, foram investigadas 328 artérias carótidas extracranianas, de homens e mulheres brancos, com mais de 35 anos de idade, normotensos, não tabagistas e sem as principais doenças que constituam fatores de risco para doenças cardiovasculares. Foram divididos de acordo com o consumo de álcool por semana (em mililitros em abstêmios, etilistas leves (1 a 100, moderados (101 a 300 e pesados (301 ou mais. Houve menor incidência de placas de aterosclerose e de estenose naqueles que ingeriram moderada quantidade. CONCLUSÃO: O estudo sugere uma ação protetora do álcool etílico para aterosclerose carotídea, quando ingerido em moderada quantidade.There is less incidence of occlusive cerebrovascular disease, of coronarian atherosclerosis and of other arteries with a light to moderate consumption of alcohol, suggesting that the same may occur with respect with the extracranial carotid arteries. Using color Doppler ultrasonography, we studied 328 extracranial carotid arteries of white male and females over 35 year old, with normal blood pressure, non-smokers and free of the main diseases make up the risk factors for cardiovascular diseases. They were stratified, according to the level of weekly alcohol consumption in milliliters (ml, in abstainers, light drinkers (1 to 100, moderate drinkers (101 to 300 and heavy drinkers (over 301. There was a lower incidence of atherosclerotic plaque and stenosis in the moderate drinkers. CONCLUSION: The study suggests that ethyl alcohol when drunk with moderation exerts a protective action from carotid atherosclerosis.

A "crick" in the neck followed by massage offered him a stroke: An uncommon case of vertebral artery dissection.

Science.gov (United States)

Dutta, Gautam; Jagetia, Anita; Srivastava, Arvind K; Singh, Daljit; Singh, Hukum; Saran, Ravindra K

2018-04-10

We present an unusual case of vertebral artery dissection in a 30-year-old male patient following an episode of neck massage. He developed headache, nausea, vomiting, blurred vision, diplopia, dizziness, and ataxia following the procedure. We also discuss a review of the pathology, diagnosis, symptomatology, treatment, prognosis, and occurrence of this rare entity. Copyright © 2018 Elsevier Inc. All rights reserved.

Spontaneous Recanalization of Complete Internal Carotid Artery: A ...

African Journals Online (AJOL)

examination revealed global aphasia and right hemiplegia. No carotid bruits or heart murmurs were. ABSTRACT. Spontaneous recanalization of atherothrombotic extracranial cerebral arteries is rare vis-à-vis recanalization of intracranial vessels. The time course is unknown. The question is the advisability and timing of ...

Stent implantation and vascular healing of a spontaneous coronary artery dissection assessed by optical coherence tomography in a patient with acute coronary syndrome

DEFF Research Database (Denmark)

Hansen, Kirstine Nørregaard; Antonsen, Lisbeth; Jensen, Lisette Okkels

2018-01-01

A 60-year old woman with non-ST-segment elevation myocardial infarction, underwent coronary angiogram combined with optical coherence tomography (OCT) revealing a long dissection in the right coronary artery. The patient experienced peri-procedural chest pain, the electrocardiogram showed ST...

Spontaneous coronary artery dissection: A retrospective analysis of 19,676 coronary angiograms

Directory of Open Access Journals (Sweden)

Dinesha Basavanna

2017-01-01

Full Text Available Aim: Spontaneous coronary artery dissection (SCAD is a rare cause of angina, myocardial infarction (MI, and sudden cardiac death (SCD and may frequently manifest as acute coronary syndrome (ACS. The diagnosis of SCAD relies on angiographic visualization of a radiolucent intimal flap. Therapeutic options include medical therapy, percutaneous coronary interventions, and bypass surgery. The aim of this study is to analyze the clinical profile, inhospital outcomes, management, and follow-up of patients with angiographic SCAD. Methods: About 19,676 diagnostic coronary angiograms (CAGs were reviewed retrospectively during a 2-year period; 64 patients had SCAD and were included in the study. Complete medical histories before and during the event as well as treatment regimens were obtained from patients' hospital files. Results: A total of 64 cases of SCAD were considered for the study within an age range of 25–70 years. Fifty-eight patients presented with ACS, two patients presented with unstable angina, one patient presented with rheumatic mitral stenosis in atrial fibrillation, one patient presented with non-ST-elevation myocardial infarction, one patient with dilated cardiomyopathy with left ventricular dysfunction, and one patient with effort. Out of 64 patients, four patients died and the average hospital stay is 3–5 days. Conclusion: SCAD occurs in 0.32% of patients undergoing CAG for evaluation of coronary artery disease. Majority of SCAD occurs in men. The left coronary artery is most commonly affected. The inhospital outcomes are good. Most of the patients with SCAD have good prognosis following optimal medical therapy.

Primary extra-cranial meningioma following total hip replacement

Energy Technology Data Exchange (ETDEWEB)

Campbell, T.J.; Beggs, I. [Royal Infirmary, Department of Radiology, Edinburgh (United Kingdom); Patton, J.T.; Porter, D. [Royal Infirmary, Department of Orthopaedics, Edinburgh (United Kingdom); Salter, D.M.; Al-Nafussi, A. [Royal Infirmary, Department of Pathology, Edinburgh (United Kingdom)

2009-01-15

A 61-year-old man presented with pain at the left hip and decreased mobility 10 years after total hip replacement. Imaging demonstrated a large destructive expansile mass adjacent to the prosthesis. Histological analysis confirmed the presence of an extra-cranial meningioma. Primary tumours after total hip replacement are rare and include soft tissue sarcomas, bone sarcomas and lymphomas. To our knowledge, no previous cases of primary extracranial meningioma have been identified. The imaging features, histology, pathogenesis and differential diagnosis are discussed. (orig.)

Vertebral Artery Dissection in a Bouncy Castle Injury: Case Report and Literature Review.

Science.gov (United States)

Ripa, Valeria; Urakov, Timur M; Jernigan, Sarah C

2017-01-01

There is an increased rate of injuries associated with activities on bouncy castles. The purpose of this article was to describe the case of a 6-year-old boy who sustained a brain infarct as a consequence of a left posterior inferior cerebellar artery dissection due to improper landing in a bouncy castle and who required a suboccipital craniotomy. The second goal was to outline the literature review regarding cervical trauma related to trampoline or bouncy castle accidents in pediatric populations. Based on the described case and reviewed studies, bouncy castle or any other activity resulting in hyperflexion or hyperextension of the neck should be carefully evaluated for cervical spine fractures and vascular injuries. © 2017 S. Karger AG, Basel.

Cine MRI of dissecting aneurysm

International Nuclear Information System (INIS)

Takaki, Hajime

1991-01-01

Cine MRI was performed in 25 cases of aortic dissection and comparative study among cine MRI, spin-echo static MRI, contrast-enhanced CT and intravenous digital subtraction angiography (IVDSA) was made. Cine MRI accurately detected aortic dissection. It was most accurate among various diagnostic methods in demonstration of entry site of dissection. Take-off of renal artery and its relation to true and false channels was also accurately demonstrated by cine MRI. The above results suggest that cine MRI can be an important diagnostic modality with almost equal diagnostic quality to those of conventional angiography. However, further technical improvement to shorten the imaging time seems necessary to replace angiography. (author)

The Serial Change of Cerebral Hemodynamics by Vascular Territory after Extracranial-Intracranial Bypass Surgery in Patients with Atherosclerosis of Cerebral Arteries

International Nuclear Information System (INIS)

Hong, Il Ki; Kim, Jae Seung; Ahn, Jae Sung; Kwon, Sun Uck; Im, Ki Chun; Lee, Jai Hyuen; Moon, Dae Hyuk

2008-01-01

To assess the effect of extracranial-intracranial (EC-IC) bypass surgery on hemodynamic improvement, we evaluated serial regional cerebral hemodynamic change of the middle cerebral artery (MCA) in symptomatic patients with atherosclerotic occlusion of the internal carotid artery (ICA) or MCA using 99m Tc-ECD acetazolamide stress brain perfusion SPECT (Acetazolamide SPECT). The patients who had suffered a recent stroke with atherosclerotic ICA or MCA occlusion underwent EC-IC bypass surgery and Acetazolamide SPECT at 1 week before and three to six months after surgery. For image analysis, attenuation corrected images were spatially normalized to SPECT templates with SPM2. Anatomical automated labeling was applied to calculate mean counts of each Volume-Of-Interest (VOI). Seven VOIs of bilateral frontal, parietal, temporal regions of the MCA territory and the ipsilateral cerebellum were defined. Using mean counts of 7 VOIs, cerebral perfusion index and perfusion reserve index were calculated. Seventeen patients (M:F=12:5, mean age: 53±2yr) were finally included in the analysis. The cerebral blood flow of the parietal region increased at 1 week (p=0.003) and decreased to the preoperative level at 3-6 months (p=0.003). The cerebrovascular reserve of the frontal and parietal regions increased significantly at 1 week after surgery (p<0.01) and improved further at 3-6 months. Cerebrovascular reserve of the MCA territory was significantly improved at early postoperative period after EC-IC bypass and kept improved state during long-term follow-up, although cerebral blood flow did not significantly improved. Therefore, cerebrovascular reserve may be a good indicator of postoperative hemodynamic improvement resulted from bypass effect

The Serial Change of Cerebral Hemodynamics by Vascular Territory after Extracranial-Intracranial Bypass Surgery in Patients with Atherosclerosis of Cerebral Arteries

Energy Technology Data Exchange (ETDEWEB)

Hong, Il Ki; Kim, Jae Seung; Ahn, Jae Sung; Kwon, Sun Uck; Im, Ki Chun; Lee, Jai Hyuen; Moon, Dae Hyuk [Asan Medial Center, Ulsan University School of Medicine, Seoul (Korea, Republic of)

2008-02-15

To assess the effect of extracranial-intracranial (EC-IC) bypass surgery on hemodynamic improvement, we evaluated serial regional cerebral hemodynamic change of the middle cerebral artery (MCA) in symptomatic patients with atherosclerotic occlusion of the internal carotid artery (ICA) or MCA using {sup 99m}Tc-ECD acetazolamide stress brain perfusion SPECT (Acetazolamide SPECT). The patients who had suffered a recent stroke with atherosclerotic ICA or MCA occlusion underwent EC-IC bypass surgery and Acetazolamide SPECT at 1 week before and three to six months after surgery. For image analysis, attenuation corrected images were spatially normalized to SPECT templates with SPM2. Anatomical automated labeling was applied to calculate mean counts of each Volume-Of-Interest (VOI). Seven VOIs of bilateral frontal, parietal, temporal regions of the MCA territory and the ipsilateral cerebellum were defined. Using mean counts of 7 VOIs, cerebral perfusion index and perfusion reserve index were calculated. Seventeen patients (M:F=12:5, mean age: 53{+-}2yr) were finally included in the analysis. The cerebral blood flow of the parietal region increased at 1 week (p=0.003) and decreased to the preoperative level at 3-6 months (p=0.003). The cerebrovascular reserve of the frontal and parietal regions increased significantly at 1 week after surgery (p<0.01) and improved further at 3-6 months. Cerebrovascular reserve of the MCA territory was significantly improved at early postoperative period after EC-IC bypass and kept improved state during long-term follow-up, although cerebral blood flow did not significantly improved. Therefore, cerebrovascular reserve may be a good indicator of postoperative hemodynamic improvement resulted from bypass effect.

Open surgery versus endovascular approach in treatment of extracranial carotid artery aneurysms.

Science.gov (United States)

Ni, Leng; Weng, Huiling; Pu, Zuo; Zheng, Yuehong; Liu, Bao; Ye, Wei; Zeng, Rong; Liu, Changwei

2018-05-01

The objective of this study was to investigate and to compare the early and long-term results of open surgery with endovascular intervention in the treatment of extracranial carotid artery aneurysms (ECCAs). A retrospective review of patients diagnosed with ECCAs who underwent open surgical or endovascular treatment from 1997 to 2017 was performed. Clinical characteristics, aneurysm profile, and treatment outcomes were recorded. Early results (open surgery; endovascular repair was performed on 16 patients (33.3%). The 30-day stroke or transient ischemic attack rate was not significantly different between the open group (6.3% [2/32]) and the endovascular group (0% [0/16]; P = .307). Cranial nerve injuries occurred in eight patients in the open group (25%) and in no patient in the endovascular group (0%; P = .029). Median length of stay was significantly longer in the open group than in the endovascular group (20 vs 14 days, respectively; P = .013). Median follow-up was 46 months (range, 0-20 years), and no aneurysm-related death occurred during this period. Overall survival rates at 5 years were 88.7% (standard error [SE], 0.08) in the open group and 91.7% (SE, 0.08) in the endovascular group (P = .319; log-rank, .992). For the same time interval, stroke-free survival rates were 85.2% (SE, 0.10) in the open group and 92.2% (SE, 0.07) in the endovascular group (P = .653; log-rank, .201). One patient (1/28 [3.6%]) in the open group and two patients (2/16 [12.5%]) in the endovascular group underwent endovascular reinterventions because of restenosis during the follow-up period. Reintervention-free survival rates were 90.9% in the open group (SE, 0.09) and 69.2% in the endovascular group (SE, 0.21; P = .082; log-rank, 3.016). In this single-institutional experience, both operative and endovascular interventions for ECCAs provided acceptable early and 5-year results. The endovascular approach had significantly less cranial nerve injury and shorter length of

Surgical dissection of the internal carotid artery under flow control by proximal vessel clamping reduces embolic infarcts during carotid endarterectomy.

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Yoshida, Kazumichi; Kurosaki, Yoshitaka; Funaki, Takeshi; Kikuchi, Takayuki; Ishii, Akira; Takahashi, Jun C; Takagi, Yasushi; Yamagata, Sen; Miyamoto, Susumu

2014-01-01

To evaluate the efficacy of flow control of the internal carotid artery (ICA) by the clamping of the common carotid artery, external carotid artery, and superior thyroid artery during surgical ICA dissection to reduce ischemic complications after carotid endarterectomy (CEA). Sixty-seven patients (59 men; age, 70.5 ± 6.2 years) who underwent CEA by the same surgeon were retrospectively studied. Both conventional CEA (n = 29) and flow-control CEA (n = 38) were performed with the patient under general anesthesia and with the use of somatosensory-evoked potential and near-infrared spectroscopy monitoring as a guide for selective shunting. The number of new postoperative infarcts was assessed with preoperative and postoperative diffusion-weighted images (DWIs) obtained within 3 days of surgery. In addition to surgical technique, the effects of the following factors on new infarcts also were examined: age, side of ICA stenosis, high-grade stenosis, symptoms, and application of shunting. New postoperative DWI lesions were observed in 7 of 67 patients (10.4%), and none of them was symptomatic. With respect to operative technique, the incidence rate of DWI spots was significantly lower in the flow-control group (2.6%) than in the conventional group (20.7%), odds ratio: 0.069; 95% confidence interval: 0.006-0.779; P = 0.031). On multiple logistic regression analysis, age, side of ICA stenosis, high-grade stenosis, symptoms, and the use of internal shunting did not have significant effects on new postoperative DWI lesions, whereas technique did have an effect. The proximal flow-control technique for CEA helps avoid embolic complications during surgical ICA dissection. Copyright © 2014 Elsevier Inc. All rights reserved.

Extracranial soft-tissue swelling: a normal postmortem radiographic finding or a sign of trauma?

International Nuclear Information System (INIS)

Strouse, P.J.; Caplan, M.; Owings, C.L.

1998-01-01

Objective. To determine if extracranial soft-tissue swelling is an expected postmortem finding or a sign of trauma. Materials and methods. Extracranial soft-tissue thickness was measured at 5 standardized locations on postmortem skull films obtained of 18 infants with no evidence of trauma on autopsy. The same measurements were performed on the skull films of 100 living children, all less than 3 years old and without clinical history of trauma. Results. Extracranial soft tissues measured only slightly greater in the postmortem group than on films of living children; however, the difference did achieve statistical significance. Conclusion. Minimal extracranial soft-tissue swelling is a normal finding on a postmortem skeletal survey. The presence of substantial or asymmetric extracranial soft-tissue swelling should be viewed with suspicion for trauma. (orig.)

Extracranial soft-tissue swelling: a normal postmortem radiographic finding or a sign of trauma?

Energy Technology Data Exchange (ETDEWEB)

Strouse, P.J. [Section of Pediatric Radiology, University of Michigan Medical Center, Ann Arbor (United States); Caplan, M. [Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan (United States); Owings, C.L. [Department of Pediatrics and Communicable Diseases, C. S. Mott Children`s Hospital, Ann Arbor, Michigan (United States)

1998-08-01

Objective. To determine if extracranial soft-tissue swelling is an expected postmortem finding or a sign of trauma. Materials and methods. Extracranial soft-tissue thickness was measured at 5 standardized locations on postmortem skull films obtained of 18 infants with no evidence of trauma on autopsy. The same measurements were performed on the skull films of 100 living children, all less than 3 years old and without clinical history of trauma. Results. Extracranial soft tissues measured only slightly greater in the postmortem group than on films of living children; however, the difference did achieve statistical significance. Conclusion. Minimal extracranial soft-tissue swelling is a normal finding on a postmortem skeletal survey. The presence of substantial or asymmetric extracranial soft-tissue swelling should be viewed with suspicion for trauma. (orig.) With 2 tabs., 5 refs.

Renal Infarction from Type B Aortic Dissection

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Marit Tweet

2017-07-01

Full Text Available History of present illness: A 69-year-old-female with a medical history of hypertension presented to the emergency department (ED complaining of sudden onset of lower back and abdominal pain. Eight hours prior to presentation she reported turning to grab something on another counter and felt a sudden onset sharp pain in her lower back. She began to notice ill-defined abdominal pain, although she denied any shortness of breath, chest pain, numbness, weakness, or urologic symptoms. Her vital signs on presentation to the ED were temperature 36.5˚C, blood pressure 143/88, heart rate 84, respiratory rate 14, and oxygen saturation 93% on room air. On arrival, the patient was in significant discomfort and was rolling on the bed due to pain. Although she appeared to be in moderate distress she had minimal, if any, tenderness on abdominal exam, and only mild left lower back tenderness to palpation. This disconnect between the patient’s apparent discomfort and the lack of physical exam findings prompted the ordering of a computed tomography angiography (CTA of the abdomen/pelvis with greatest suspicion for abdominal aortic aneurysm. Significant findings: Initial abdominal images demonstrated a dissection flap; therefore, a CTA of the chest was also obtained. These images revealed a Stanford type B aortic dissection beginning just distal to the left subclavian artery and extending to the origin of the inferior mesenteric artery. The right renal artery arose from the true lumen of the dissection while the left renal artery arose from the false lumen. This case is interesting as imaging shows the lack of perfusion to the left kidney, residing in the retroperitoneum, which correlates with her non-descript abdominal and left flank pain. Discussion: Aortic dissection is defined as a tear within the wall of the aorta that allows blood to track between intima and media layers. A dissection is classified as Stanford Type A if it involves any portion of the

En Bloc Hilar Dissection of the Right Hepatic Artery in Continuity with the Bile Duct: a Technique to Reduce Biliary Complications After Adult Living-Donor Liver Transplantation.

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Abu-Gazala, Samir; Olthoff, Kim M; Goldberg, David S; Shaked, Abraham; Abt, Peter L

2016-04-01

Techniques that preserve the right hepatic artery and the common bile duct in continuity during the dissection may be associated with lower rates of biliary complications in living-donor liver transplants. This study sought to determine whether en bloc hilar dissections were associated with fewer biliary complications in living-donor liver transplants. This was a retrospective review of 41 adult LDLTs performed in a single, liver transplant center between February 2007 and September 2014. The primary outcome of interest was the occurrence of at least one of the following biliary complications: anastomotic leak, stricture, or biloma. The primary predictor of interest was the hilar dissection technique: conventional hilar dissection vs. en bloc hilar dissection. A total of 41 LDLTs were identified, 24 had a conventional, and 17 an en bloc hilar biliary dissection. The occurrence of any biliary complication was significantly more common in the conventional hilar dissection group compared to the en bloc hilar dissection group (66.7 vs. 35.3%, respectively, p = 0.047). In particularly, anastomotic strictures were significantly more common in the conventional hilar dissection group compared to the en bloc hilar dissection group (54.2 vs. 23.5%., respectively, p = 0.049). En bloc hilar dissection technique may decrease biliary complication rates in living donor liver transplants.

Presentation of Two Cases with Early Extracranial Metastases from Glioblastoma and Review of the Literature

DEFF Research Database (Denmark)

Johansen, Maria Dinche; Rochat, Per; Law, Ian

2016-01-01

Extracranial metastases from glioblastoma are rare. We report two patients with extracranial metastases from glioblastoma. Case 1 concerns a 59-year-old woman with multiple metastases that spread early in the course of disease. What makes this case unusual is that the tumor had grown into the fal...... and extensive bleeding during acute surgery with tumor removal, which might have induced extracranial seeding. The cases presented might have hematogenous spreading in common as an explanation to extracranial metastases from GBM....

Augmented reality-assisted bypass surgery: embracing minimal invasiveness.

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Cabrilo, Ivan; Schaller, Karl; Bijlenga, Philippe

2015-04-01

The overlay of virtual images on the surgical field, defined as augmented reality, has been used for image guidance during various neurosurgical procedures. Although this technology could conceivably address certain inherent problems of extracranial-to-intracranial bypass procedures, this potential has not been explored to date. We evaluate the usefulness of an augmented reality-based setup, which could help in harvesting donor vessels through their precise localization in real-time, in performing tailored craniotomies, and in identifying preoperatively selected recipient vessels for the purpose of anastomosis. Our method was applied to 3 patients with Moya-Moya disease who underwent superficial temporal artery-to-middle cerebral artery anastomoses and 1 patient who underwent an occipital artery-to-posteroinferior cerebellar artery bypass because of a dissecting aneurysm of the vertebral artery. Patients' heads, skulls, and extracranial and intracranial vessels were segmented preoperatively from 3-dimensional image data sets (3-dimensional digital subtraction angiography, angio-magnetic resonance imaging, angio-computed tomography), and injected intraoperatively into the operating microscope's eyepiece for image guidance. In each case, the described setup helped in precisely localizing donor and recipient vessels and in tailoring craniotomies to the injected images. The presented system based on augmented reality can optimize the workflow of extracranial-to-intracranial bypass procedures by providing essential anatomical information, entirely integrated to the surgical field, and help to perform minimally invasive procedures. Copyright © 2015 Elsevier Inc. All rights reserved.

Blunt Traumatic Extracranial Cerebrovascular Injury and Ischemic Stroke

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Paul M. Foreman

2017-04-01

Full Text Available Background: Ischemic stroke occurs in a significant subset of patients with blunt traumatic cerebrovascular injury (TCVI. The patients are victims of motor vehicle crashes, assaults or other high-energy collisions, and suffer ischemic stroke due to injury to the extracranial carotid or vertebral arteries. Summary: An increasing number of patients with TCVI are being identified, largely because of the expanding use of computed tomography angiography for screening patients with blunt trauma. Patients with TCVI are particularly challenging to manage because they often suffer polytrauma, that is, numerous additional injuries including orthopedic, chest, abdominal, and head injuries. Presently, there is no consensus about optimal management. Key Messages: Most literature about TCVI and stroke has been published in trauma, general surgery, and neurosurgery journals; because of this, and because these patients are managed primarily by trauma surgeons, patients with stroke due to TCVI have been essentially hidden from view of neurologists. This review is intended to bring this clinical entity to the attention of clinicians and investigators with specific expertise in neurology and stroke.

Diagnóstico y tratamiento de la enfermedad carotídea aterosclerótica extracraneal asintomática Diagnosis and treatment of asymptomatic extracranial atherosclerotic carotid artery disease

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Luciano A. Sposato

2011-12-01

Full Text Available La enfermedad aterosclerótica asintomática de la arteria carótida interna extracraneal alcanza una prevalencia de hasta el 12.5%. La angioplastia carotídea todavía no ha demostrado ser lo suficientemente segura y eficaz para prevenir el ACV isquémico en estos pacientes. Estudios aleatorizados demostraron que la endarterectomía carotídea es superior al tratamiento médico en cuanto a reducción del riesgo de ACV isquémico si es realizada por equipos con tasas de complicaciones (ACV o muerte menores que 3%. Sin embargo, los pacientes evaluados en estos estudios comenzaron a reclutarse hace más de 25 años, cuando la utilización de antiagregantes plaquetarios era menor que la actual, el tratamiento de la hipertensión arterial era menos efectivo y todavía no se usaban estatinas como componentes fundamentales de los esquemas de prevención vascular. La optimización de la calidad del tratamiento médico en las últimas décadas ha llevado a una significativa reducción del riesgo de ACV en pacientes no intervenidos quirúrgicamente. En base a estas observaciones y con la excepción de casos específicos, el tratamiento médico es la opción terapéutica de elección en pacientes con enfermedad aterosclerótica carotídea extracraneal asintomática.The reported prevalence of asymptomatic atherosclerotic disease of the extracranial internal carotid artery is up to 12.5%. Carotid angioplasty has not yet proven safe and effective enough to prevent ischemic stroke in these patients. Randomized studies showed that carotid endarterectomy is superior to medical therapy in reducing the risk of ischemic stroke when performed by surgical teams with complication rates (stroke or death of less than 3%. However, recruitment of these patients began more than 25 years ago, when the use of antiplatelet agents was lower than today, the treatment of hypertension was less effective than currently, and statins were not considered as key components of

Brachial plexus endoscopic dissection and correlation with open dissection.

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Lafosse, T; Masmejean, E; Bihel, T; Lafosse, L

2015-12-01

Shoulder endoscopy is evolving and becoming extra-articular. More and more procedures are taking place in the area of the brachial plexus (BP). We carried out an anatomical study to describe the endoscopic anatomy of the BP and the technique used to dissect and expose the BP endoscopically. Thirteen fresh cadavers were dissected. We first performed an endoscopic dissection of the BP, using classical extra-articular shoulder arthroscopy portals. Through each portal, we dissected as many structures as possible and identified them. We then did an open dissection to corroborate the endoscopic findings and to look for damage to the neighboring structures. In the supraclavicular area, we were able to expose the C5, C6 and C7 roots, and the superior and middle trunks in 11 of 13 specimens through two transtrapezial portals by following the suprascapular nerve. The entire infraclavicular portion of the BP (except the medial cord and its branches) was exposed in 11 of 13 specimens. The approach to the infraclavicular portion of the BP led directly to the lateral and posterior cords, but the axillary artery hid the medial cord. The musculocutaneous nerve was the first nerve encountered when dissecting medially from the anterior aspect of the coracoid process. The axillary nerve was the first nerve encountered when following the anterior border of the subscapularis medially from the posterior aspect of the coracoid process. Knowledge of the endoscopic anatomy of the BP is mandatory to expose and protect this structure while performing advanced arthroscopic shoulder procedures. Copyright © 2015 SFCM. Published by Elsevier Masson SAS. All rights reserved.

Direct reperfusion of the right common carotid artery prior to cardiopulmonary bypass in patients with brain malperfusion complicated with acute aortic dissection.

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Okita, Yutaka; Matsumori, Masamichi; Kano, Hiroya

2016-04-01

The cases of 3 patients with brain malperfusion secondary to acute aortic dissection who underwent preoperative perfusion of the right common carotid artery are presented. The patients were 64, 65 and 72 years old and 2 were female. All were in a comatose or semi-comatose state with left hemiplegia. The right common carotid artery was exposed and directly cannulated, using a 12-Fr paediatric arterial cannula. The right common femoral artery was chosen for arterial drainage, using a 14-Fr double-lumen cannula. The circuit contained a small roller pump and heat exchanger coil. Target flow was set at 90 ml/min and blood temperature at 30 °C. Durations of right carotid perfusion were 120, 100 and 45 min, respectively. All underwent partial arch replacement and survived. Postoperative neurological sequelae were minimal in all cases. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Intra- and Extracranial MR Venography: Technical Notes, Clinical Application, and Imaging Development

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M. Paoletti

2016-01-01

Full Text Available Scientific debate over chronic cerebrospinal venous insufficiency (CCSVI has drawn attention to venous system involvement in a series of pathologic brain conditions. In the last few decades, the MRI venography (MRV field has developed a number of valuable sequences to better investigate structural anatomy, vessel patency, and flow characteristics of venous drainage in the intra- and extracranial systems. A brief two-tier protocol is proposed to encompass the study of intra- and extracranial venous drainage with and without contrast administration, respectively. Contrast-enhanced protocol is based on time-resolved contrast-enhanced MRV of the whole region plus extracranial flow quantification through 2D Cine phase contrast (PC; non-contrast-enhanced protocol includes intracranial 3D PC, extracranial 2D time of flight (TOF, and 2D Cine PC flow quantification. Total scanning time is reasonable for clinical applications: approximately seven minutes is allocated for the contrast protocol (most of which is due to 2D Cine PC, while the noncontrast protocol accounts for around twenty minutes. We believe that a short though exhaustive MRI scan of the whole intra- and extracranial venous drainage system can be valuable for a variety of pathologic conditions, given the possible venous implication in several neurological conditions.

Carotid artery dissection on non-contrast CT: Does color improve the diagnostic confidence?

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Saba, Luca, E-mail: lucasaba@tiscali.it [Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato, s.s. 554 Monserrato, Cagliari 09045 (Italy); Argiolas, Giovanni Maria [Department of Radiology, Azienda Ospedaliero Brotzu (A.O.B.), di Cagliari, Cagliari 09100 (Italy); Raz, Eytan [Department of Radiology, New York University School of Medicine, New York (United States); Department of Neurology and Psychiatry, Sapienza University of Rome (Italy); Sannia, Stefano [Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato, s.s. 554 Monserrato, Cagliari 09045 (Italy); Suri, Jasjit S. [Diagnostic and Monitoring Division, AtheroPointTM LLC, Roseville, CA (United States); Electrical Engineering Department (Aff.), Idaho State University, ID (United States); Siotto, Paolo [Department of Radiology, Azienda Ospedaliero Brotzu (A.O.B.), di Cagliari, Cagliari 09100 (Italy); Sanfilippo, Roberto; Montisci, Roberto [Department of Vascular Surgery, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato, s.s. 554 Monserrato, Cagliari 09045 (Italy); Piga, Mario [Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari – Polo di Monserrato, s.s. 554 Monserrato, Cagliari 09045 (Italy); Wintermark, Max [Department of Radiology, Neuroradiology Division, University of Virginia, Box 800170, Charlottesville, VA, 22908 (United States)

2014-12-15

Highlights: • The use of a color scale to display the non-contrast CT images in lieu of the classic grayscale improves the diagnostic confidence of the readers. • Radiologists should consider the use of a color scale, rather than the conventional grayscale, to assess non-contrast CT studies for possible carotid artery dissection. - Abstract: Purpose: The purpose of this work was to evaluate if the use of color maps, instead of conventional grayscale images, would improve the observer's diagnostic confidence in the non-contrast CT evaluation of internal carotid artery dissection (ICAD). Materials and methods: One hundred patients (61 men, 39 women; mean age, 51 years; range, 25–78 years), 40 with and 60 without ICAD, underwent non-contrast CT and were included in this the retrospective study. In this study, three groups of patients were considered: patients with MR confirmation of ICAD, n = 40; patients with MR confirmation of ICAD absence, n = 20; patients who underwent CT of the carotid arteries because of atherosclerotic disease, n = 40. Four blinded observers with different levels of expertise (expert, intermediate A, intermediate B and trainee) analyzed the non-contrast CT datasets using a cross model (one case grayscale and the following case using the color scale). The presence of ICAD was scored on a 5-point scale in order to assess the observer's diagnostic confidence. After 3 months the four observers evaluated the same datasets by using the same cross-model for the alternate readings (one case color scale and the following case using the grayscale). Statistical analysis included receiver operating characteristics (ROC) curve analysis, the Cohen weighted test and sensitivity, specificity, PPV, NPV, accuracy, LR+ and LR−. Results: The ROC curve analysis showed that, for all observers, the use of color scale resulted in an improved diagnostic confidence with AUC values increasing from 0.896 to 0.936, 0.823 to 0.849, 0.84 to 0.909 and 0

Extracranial radiotherapy in stereotaxic conditions

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Noel, Georges; Moty-Monnereau, Celine; Meyer, Aurelia; David, Pauline; Pages, Frederique; Muller, Felix; Lee-Robin, Sun Hae; David, Denis Jean

2006-12-01

This document reports a literature survey and the discussion of an expert group with the objective to assess the use of extracranial radiotherapy devices in stereotaxic conditions. After a brief overview of the technological context, the authors proposes a technical description of radiotherapy in stereotaxic conditions, of the CyberKnife, of others radiotherapy techniques in stereotaxic conditions for extracranial indications, and of alternate techniques. They give an overview of concerned pathologies: skeleton, hepatic, bronchopulmonary, pancreas, prostate, kidney, and paediatric tumours. They describe the present care condition in France in terms of classification of medial acts, and of patient homogeneous groups. They provide the identification of this practice in foreign nomenclature. In the next part, they report the assessment, first through a critical analysis of published data and information in terms of act feasibility, efficiency and safety, of act role in the therapeutic strategy, of conditions of execution, and of impact on public health, and secondly through a statement of opinion of the working group in terms of terminology, indications, safety, and conditions of execution

Fibromuscular Dysplasia Leading to Spontaneous Coronary Artery Dissection with Sudden Cardiac Arrest

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Ata Bajwa

2015-01-01

Full Text Available A 30-year-old previously healthy female, who was six-week postpartum, experienced sudden collapse and tonic-clonic seizure. Emergency medicine services arrived at the scene and the patient was found to be in ventricular fibrillation. Advanced cardiovascular life support (ACLS was initiated with return of spontaneous circulation. Afterwards, her initial EKG showed atrial fibrillation with rapid ventricular rate, ST elevation in leads II, III, and aVF, and ST depression in V2–V4. She was transferred to a tertiary care hospital where emergent angiogram was performed revealing obstruction of blood flow in the proximal and mid right coronary artery (RCA. A hazy and irregularly contoured appearance of the RCA was consistent with diagnosis of fibromuscular dysplasia. Subsequently, intravascular ultrasonogram (IVUS was performed which confirmed the diagnosis of RCA dissection. Successful revascularization of the RCA was performed using two bare mental stents. After a complicated course in hospital, she was discharged in stable condition and did very well overall.

How I do it: transapical cannulation for acute type-A aortic dissection

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Alexiou Christos

2008-01-01

Full Text Available Abstract Aortic dissection is the most frequently diagnosed lethal disease of the aorta. Half of all patients with acute type-A aortic dissection die within 48 hours of presentation. There is still debate as to the optimal site of arterial cannulation for establishing cardiopulmonary bypass in patients with type-A aortic dissection. Femoral artery cannulation with retrograde perfusion is the most common method but because of the risk of malperfusion of vital organs and atheroembolism related to it different sites such as the axillary artery, the innominate artery and the aortic arch are used. Cannulation of these sites is not without risks of atheroembolism, neurovascular complications and can be time consuming. Another yet to be popularised option is the transapical aortic cannulation (TAC described in this article. TAC consists of the insertion of the arterial cannula through the apex of the left ventricle and the aortic valve to lie in the sinus of Valsalva. Trans-oesophageal guidance is necessary to ensure correct placement of the cannula. TAC is an excellent method of establishing cardiopulmonary bypass as it is quick, provides a more physiological method of delivering antegrade arterial flow and is the only method to assure perfusion of the true lumen.

Aortic dissection involving the brachio-cephalic trunk, celiac trunk, and left common iliac artery with left kidney ischemia: Case report

International Nuclear Information System (INIS)

Paslawski, M.; Krzyzanowski, K.

2006-01-01

Acute aortic dissection is one of the most dramatic cardiovascular emergencies. To limit the possibility of death, a detailed morphologic and functional diagnosis must be obtained quickly. Aortography has been the traditional method of assessing suspected aortic dissection; however, concern over the low sensitivity of aortography has prompted the investigation of other imaging techniques for this purpose. Transesophageal echocardiography and magnetic resonance imaging are increasingly used in the evaluation of aortic dissection. A recent study found that the sensitivity and specificity of helical computed tomography compare well with those of MR imaging and transesophageal echocardiography. The 55-year-old patient with acute chest and abdominal pain were examined due to suspected aortic dissection. CT examination of thoracic and abdomial aorta was performed. The examination begins with conventional, unenhanced CT. Both unenhanced CT scans and scans after administering of contrast agent were performed. Enhanced images reveal contrast flow in both the false and true aortic lumen. the intima flap in the ascending aorta, aortic arch, and descending aorta, extending to the brachiocephalic trunk, was seen on axial images. In the abdominal aorta, the intimal flap extended to the celiac trunk, without evidence of its occlusion. In one patient, the occlusion of the left renal artery with renal infract was seen on axial images. The intimal flap calcification enables diagnosis even on unenhanced images. The morphology and extent of the dissection was also seen on MPR and VRT images. Helical CT can be used to study the entire aorta in aortic dissection and for follow-up. This technique allows accurate diagnosis of the type of dissection, atypical forms of aortic dissection, and early and late complications after surgery or medical treatment. In addition, helical CT is useful in the surveillance of abdominal branch-vessel compromise, which can be life-threatening in the acute

Arterial elastic fiber structure. Function and potential roles in acute aortic dissection.

Science.gov (United States)

Pratt, B; Curci, J

2010-10-01

The lethality of acute aortic dissection is well recognized. Successful treatment and prevention of aortic dissection is going to be dependent upon an improved understanding of the molecular and physiologic events which predispose to dissection development and propagation. In this review, we will focus on the elastic fiber, one of the critical elements of the aortic wall matrix. Mechanical or functional failure of the elastin in the wall of the aorta likely predisposes to dissection as well as the post-dissection aortic degeneration with aneurysm formation. Insight into the role of the elastin and the elastic fiber in aortic dissection has recently been accelerated by research into the molecular mechanisms associated with hereditary propensity for aortic dissection, such as Marfan syndrome. These studies have implicated both structural and metabolic contributions of alterations in the scaffolding proteins in matrix elastic fibers. In particular, increased transforming growth factor-β (TGF-β) activity may play a prominent role in predisposing the aortic wall to dissection. The events which predispose to post-dissection aortic degeneration are somewhat less well defined. However, the loss of the structural integrity of the remaining elastic fibers leaves the wall weaker and prone to dilatation and rupture. It appears likely that the upregulation of several potent proteases, particularly those of the matrix metalloproteinase (MMP) family such as MMP-9, are participating in the subsequent matrix damage. Novel medical treatments based on this pathologic data have been proposed and in some cases have made it to clinical trials. The ongoing study evaluating whether therapeutic inhibition of TGF-β may be useful in reducing the risk of aortic dissection in patients at high risk represents one promising new strategy in the treatment of this deadly disease.

Early-onset osteoarthritis, Charcot-Marie-Tooth like neuropathy, autoimmune features, multiple arterial aneurysms and dissections: an unrecognized and life threatening condition.

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Mélodie Aubart

Full Text Available BACKGROUND: Severe osteoarthritis and thoracic aortic aneurysms have recently been associated with mutations in the SMAD3 gene, but the full clinical spectrum is incompletely defined. METHODS: All SMAD3 gene mutation carriers coming to our centre and their families were investigated prospectively with a structured panel including standardized clinical workup, blood tests, total body computed tomography, joint X-rays. Electroneuromyography was performed in selected cases. RESULTS: Thirty-four SMAD3 gene mutation carriers coming to our centre were identified and 16 relatives were considered affected because of aortic surgery or sudden death (total 50 subjects. Aortic disease was present in 72%, complicated with aortic dissection, surgery or sudden death in 56% at a mean age of 45 years. Aneurysm or tortuosity of the neck arteries was present in 78%, other arteries were affected in 44%, including dissection of coronary artery. Overall, 95% of mutation carriers displayed either aortic or extra-aortic arterial disease. Acrocyanosis was also present in the majority of patients. Osteoarticular manifestations were recorded in all patients. Joint involvement could be severe requiring surgery in young patients, of unusual localization such as tarsus or shoulder, or mimicking crystalline arthropathy with fibrocartilage calcifications. Sixty eight percent of patients displayed neurological symptoms, and 9 suffered peripheral neuropathy. Electroneuromyography revealed an axonal motor and sensory neuropathy in 3 different families, very evocative of type II Charcot-Marie-Tooth (CMT2 disease, although none had mutations in the known CMT2 genes. Autoimmune features including Sjogren's disease, rheumatoid arthritis, Hashimoto's disease, or isolated autoantibodies- were found in 36% of patients. INTERPRETATION: SMAD3 gene mutations are associated with aortic dilatation and osteoarthritis, but also autoimmunity and peripheral neuropathy which mimics type II

Contemporary Management of Type B Aortic Dissection in the Endovascular Era.

Science.gov (United States)

Bannazadeh, Mohsen; Tadros, Rami O; McKinsey, James; Chander, Rajiv; Marin, Michael L; Faries, Peter L

2016-04-01

Aortic dissection (AD) is one of the most common catastrophic pathologies affecting the aorta. Anatomic classification is based on the origin of entry tear and its extension. Type A dissections originate in the ascending aorta, whereas the entry tear in Type B dissections starts distal to the left subclavian artery. The patients with aortic dissection who manifest complications such as rupture, malperfusion, aneurysmal degeneration, and intractable pain are classified as complicated AD. Risk factors for developing aortic dissection include age, male gender, and aortic wall structural abnormalities. The most common presenting symptom of acute aortic dissection is pain. Malperfusion occurs as a result of end-organ ischemia due to involvement of aortic branches from the dissecting process. This can happen in various locations causing mesenteric ischemia (mesenteric vessels), stroke (aortic arch vessels), renal failure (renal arteries), spinal ischemia, and limb ischemia (iliac or subclavian arteries). Aneurysmal degeneration is the most common complication of patients with chronic Type B dissection who are managed with medical therapy. Management of Type B aortic dissection (TBAD) remains controversial. Many groups recommend conservative therapy for newly diagnosed TBAD and reserve surgical management for patients who develop complications such as rupture, malperfusion, aneurysmal dilatation, and refractory pain. The mainstay of medical therapy includes antihypertensive medication to reduced ΔP/ ΔT by lowering blood pressure and heart rate. With the continued success of thoracic endovascular aortic repair (TEVAR), this procedure has been extended to treat TBAD in selected patients. The outcomes of TEVAR are promising, with early mortality rates from 10% to 20%. With promising results from these series, some groups recommend early TEVAR in uncomplicated TBAD to prevent future adverse events. The goals of endovascular treatment of TBAD are to cover the entry tear

Strategy for acute type IIIb aortic dissection associated with abdominal-organ malperfusion

International Nuclear Information System (INIS)

Ozawa, Masamichi; Uchida, Naomichi; Shibamura, Hidenori; Iwako, Hiroshi

2006-01-01

The aim of this study was to evaluate our results of treatment for acute type IIIb aortic dissection associated with malperfusion of abdominal organs, and to consider the therapeutic strategies. Between December 1997 and August 2005, 123 patients with acute type IIIb aortic dissection were treated at our hospital. Of those, 11 patients (8.9%) required emergency treatment for malperfusion of abdominal organ. In our hospital, the indication of emergency treatment for acute type IIIb aortic dissection was any symptom of acute abdomen plus insufficiency of visceral arterial circulation on computed tomography or angiography. All of the 11 patients (100%) had cul-de-sac of a false lumen, 8 (72.7%) had at least one symptom of acute abdomen, and 3 (27.3%) had metabolic acidosis before surgical treatment. In 7 patients of the ''true lumen stenosis type,'' 5 patients who were treated with open stent grafting are alive. The other two patients, who were treated with transluminally placed endovascular stent grafting (TPEG) or with superior mesenteric artery (SMA) bypass, died. Of the 2 ''visceral arterial dissection type'' patient, one was treated with transluminal stenting of the celiac artery and the other was treated with resection of the intestine and ileocolic artery bypass, and both are alive. Two ''mixed type'' patients who were treated with open stent grafting died. The mortality rate of this series was 36.4%. In conclusion, to improve the prognosis of acute type IIIb aortic dissection associated with malperfusion of abdominal organ, it is important that we obtain early diagnosis of organ ischemia caused by cul-de-sac of a false lumen and choose the correct treatment based on understanding of the mechanism of organ ischemia. (author)

A rare cause of acute abdomen at a young patient: aorta and superior mesenteric artery dissection

International Nuclear Information System (INIS)

Kara, K.; Bozlar, U.; Guler, A.; Tasar, M.

2012-01-01

Full text: Introduction: Aortic emergencies are some of the most important causes of sudden death. Acute mesenteric ischemia has a low incidence about one in 1000 patients acutely admitted to a hospital but a high mortality rate of about 70%. In aortic dissection, only 3-5% of cases are found to be complicated by a superior mesentery artery (SMA) occlusion Objectives and tasks: The aim of the presentation is to demonstrate the computed tomography (CT) angiography findings of the dissection at aorta and SMA which is a rare cause of acute abdomen at a young patient. Materials and methods: A 22-year-old patient was admitted to emergency department suffering from severe abdominal pain, nausea and vomiting. Physical examination revealed abdominal tenderness. CT angiography was performed for the possible diagnosis like acute appendicitis and mesenteric ischemia. Formation of the intimal flap at the abdominal aorta and high grade narrowed celiac trunk at the origin that is in the true lumen were seen. Formation of the intimal flap at the aorta was extending through the SMA and SMA was filling both from true and false lumen. The same flap formation was narrowing the lumen of proximal SMA extensively. It was continued to the central part of SMA and a thrombus was detected at that level in the false lumen. Conclusion: Although patients at the younger age group, dissection should be considered in the differential diagnosis of acute abdominal pain. CT angiography is a rapid, noninvasive and effective method to detect vascular pathology, to asses the prevalence and to help treatment planning

Angioplasty or Stenting of Extra- and Intracranial Vertebral Artery Stenoses

International Nuclear Information System (INIS)

Hauth, Elke A.M.; Gissler, H. Martin; Drescher, Robert; Jansen, Christian; Jaeger, Horst J.; Mathias, Klaus D.

2004-01-01

Purpose: To determine the feasibility and safety of angioplasty or angioplasty and stenting of extra- and intracranial vertebral artery (VA) stenosis. Methods: In 16 consecutive patients (9 men, 7 women; mean age 61 years, range 49-74 years) 16 stenotic VAs were treated with angioplasty orangioplasty and stenting. Eleven stenoses were localized in V1 segment,1 stenosis in V2 segment and 4 stenoses in V4 segment of VA. Fourteen VA stenoses were symptomatic, 2 asymptomatic. The etiology of the stenoses was atherosclerotic in all cases. Results:Angioplasty was performed in 8 of 11 V1 and 2 of 4 V4 segments of the VA. In 3 of 11 V1 segments and 2 of 4 V4 segments of the VA we combined angioplasty with stenting. The procedures were successfully performed in 14 of 16 VAs (87%). Complications were asymptomatic vessel dissection resulting in vessel occlusion in 1 of 11 V1 segments and asymptomatic vessel dissection in 2 of 4 V4 segments of the VA. One patient died in the 24-hr period after the procedure because of subarachnoid hemorrhage as a complication following vessel perforation of the treated V4 segment. Conclusion: Angioplasty orangioplasty and stenting of extracranial VA stenoses can be performed with a high technical success rate and a low complication rate. In intracranial VA stenosis the procedure is technically feasible but complications can be life-threatening. The durability and procedural complication rates of primary stenting without using predilation in extra- and intracranial VA stenosis should be defined in the future

Stages of Childhood Extracranial Germ Cell Tumors

Science.gov (United States)

... tumors: Yolk sac tumors make a hormone called alpha-fetoprotein (AFP). They can form in the ovary, testicle, ... are used to detect extracranial germ cell tumors: Alpha-fetoprotein (AFP). Beta-human chorionic gonadotropin (β-hCG). For ...

Sequential Hybrid Repair of Aorta and Bilateral Common Iliac Arteries Secondary to Chronic Aortic Dissection with Extensive Aneurysmal Degeneration in a Marfan Patient.

Science.gov (United States)

Hinojosa, Carlos A; Anaya-Ayala, Javier E; Laparra-Escareno, Hugo; Lizola, Rene; Torres-Machorro, Adriana

2017-09-01

Marfan syndrome is a connective tissue disorder associated with aortic dissection, aneurysmal degeneration and rupture. These cardiovascular complications represent the main cause of mortality, therefore repair is indicated. We present a 35-year-old woman who experienced acute onset of chest pain. Her imaging revealed a chronic DeBakey type I dissection with aortic root dilation and descending thoracic aneurysmal degeneration. She underwent a Bentall procedure and endovascular exclusion of the descending thoracic aortic aneurysm. She was closely followed and 2 years later a computed tomography angiography (CTA) revealed the aneurysmal degeneration of the thoracoabominal aorta and bilateral iliac arteries. The patient underwent a composite reconstruction using multi-visceral branched and bifurcated Dacron grafts. At 5 years from her last surgery, a CTA revealed no new dissection or further aneurysmal degenerations. Aortic disease in Marfan patients is a complex clinical problem that may lead to secondary or tertiary aortic reconstructions; close follow-up is mandatory.

CBF before and after extracranial-intracranial bypass surgery in patients with ischemic cerebrovascular disease studied with 133Xe-inhalation tomography

DEFF Research Database (Denmark)

Vorstrup, S; Lassen, N A; Henriksen, L

1985-01-01

Cerebral blood flow (CBF) was studied by 133Xenon inhalation tomography in 22 patients with symptoms of ischemic cerebrovascular disease before and after establishment of an extracranial-intracranial bypass shunt. Selection of patients for shunting was based on angiographically demonstrated...... arterial occlusions and on the finding of focal low flow areas corresponding to the clinical symptoms, that consisted mainly of minor stroke with good remission and with or without subsequent TIAs. It was required that the area of low flow should clearly exceed the CT lesion present in practically all...

Vascular Ehlers-Danlos Syndrome With a Novel Missense COL3A1 Mutation Present With Pulmonary Complications and Iliac Arterial Dissection.

Science.gov (United States)

Gu, Guangchao; Yang, Hang; Cui, Lijia; Fu, Yuanyuan; Li, Fangda; Zhou, Zhou; Zheng, Yuehong

2018-02-01

Vascular Ehlers-Danlos syndrome (vEDS) is a life-threatening connective tissue disorder due to its high tendency of arterial and organ rupture. Pulmonary complications in vEDS are rare. We present a young male patient with vEDS who developed severe pulmonary complications and severe rupture of the iliac artery at different stages of his life. Vascular Ehlers-Danlos syndrome was diagnosed based on clinical manifestations and confirmed by the identification of COL3A1 gene mutation. Due to high bleeding tendency and weak cardiopulmonary capacity, conservative treatment was taken for him. To our knowledge, this is the first report of vEDS case in which the patient developed both pulmonary complications and dissection of large arteries. Our report emphasizes the importance of considering vEDS when an adolescent develops unexplained pulmonary cysts with fragility of lung tissues. Genetic counseling and close monitoring should be performed for earlier diagnosis and prevention of severe complications of large arteries. The typical presentations of vEDS were also discussed by means of a review of case reports on vEDS with pulmonary complications.

Pseudoaneurysm of the occipital artery: an unusual cause of persisting headache after minor head injury.

LENUS (Irish Health Repository)

Aquilina, K

2012-02-03

Post-traumatic pseudoaneurysms of the extracranial arteries in the scalp are uncommon sequelae of head injury. We report on a patient who presented four weeks after a minor head injury with a tender, pulsating and enlarging mass in the course of the left occipital artery. There was associated headache radiating to the vertex. Computed tomographic angiography confirmed the lesion to be a pseudoaneurysm of the occipital artery. The lump was resected with complete resolution of symptoms.

Age determination of vessel wall hematoma in spontaneous cervical artery dissection: A multi-sequence 3T Cardiovascular Magnetic resonance study

Directory of Open Access Journals (Sweden)

Habs Maximilian

2011-11-01

Full Text Available Abstract Background Previously proposed classifications for carotid plaque and cerebral parenchymal hemorrhages are used to estimate the age of hematoma according to its signal intensities on T1w and T2w MR images. Using these classifications, we systematically investigated the value of cardiovascular magnetic resonance (CMR in determining the age of vessel wall hematoma (VWH in patients with spontaneous cervical artery dissection (sCAD. Methods 35 consecutive patients (mean age 43.6 ± 9.8 years with sCAD received a cervical multi-sequence 3T CMR with fat-saturated black-blood T1w-, T2w- and TOF images. Age of sCAD was defined as time between onset of symptoms (stroke, TIA or Horner's syndrome and the CMR scan. VWH were categorized into hyperacute, acute, early subacute, late subacute and chronic based on their signal intensities on T1w- and T2w images. Results The mean age of sCAD was 2.0, 5.8, 15.7 and 58.7 days in patients with acute, early subacute, late subacute and chronic VWH as classified by CMR (p Conclusions Signal intensities of VWH in sCAD vary over time and multi-sequence CMR can help to determine the age of an arterial dissection. Furthermore, findings of this study suggest that the time course of carotid hematomas differs from that of cerebral hematomas.

Drug eluting stents trapping intramural hematoma in spontaneous coronary artery dissection and healing pattern at six months: Optical coherence tomography findings

Energy Technology Data Exchange (ETDEWEB)

Poon, Karl, E-mail: karlkpoon@gmail.com; Incani, Alexander; Small, Andrew; Raffel, O. Christopher

2013-05-15

Spontaneous coronary artery dissections (SCAD) are often difficult to diagnose and manage. Intravascular imaging such as optical coherence tomography (OCT) improves diagnosis and may assist in management. Recent data suggest that percutaneous coronary interventions (PCI) in in SCAD are associated with poor outcomes. This report provides striking OCT images of potential complications associated with PCI in SCAD, as well as demonstrates medium term OCT data in residual hematoma healing and stent coverage in SCAD.

Evaluation of Contrast MR Angiography in the Study of Internal Carotid Artery Stenosis. Systematic Review of the Literature; Evaluacion de la estenosis de la arteria carotida interna por angiografia REM con contraste: revision sistematica de la bibliografia

Energy Technology Data Exchange (ETDEWEB)

Rodriguez Perez, P.; Martinez Cantarero, J. [Hospital Universitario 12 de Octubre. Madrid (Spain); Ruiz Diaz, M.; Blazquez Morera, J. A. [Universidad Autonoma de Madrid (Spain); Llano Senaris, J. E. de [Fundacion Gaspar Casal. Madrid (Spain)

2004-07-01

To evaluate the diagnostic benefit of using contrast MR Angiography (MRA) in the study of extracranial internal carotid artery stenosis as opposed to intraarterial digital subtraction arteriography (LADSA). A search for relevant articles from 1990 to 2000 using MDLINE and EMBASE databases. Initial selection criteria: 1. articles which compare MRA and IADSA in the study of extracranial internal carotid artery stenosis; and 2, sample size of 10 or more subjects. Studies employing contrast MRA were subsequently selected. Contrast MRA diagnostic results were studied, as were those of non-contrast MRA (TOF) if included. Roc curves and 95% confidence intervals were calculated. In the studies, 324 patients and 648 extracranial internal carotid arteries were evaluated (12 articles). The diagnostic results in carotid artery stenosis discrimination using contrast MRA as opposed to IADSA were sensitivity and specificity=97.28% and 96.08%. With regard to contrast MRA vs. non-contrast MRA (TOF), significant differences favoring contrast MRA in both sensitivity and specificity were observed. (p=0.08 and p<0.001, respectively). MRA techniques demonstrate very high diagnostic capabilities in the detection of carotid stenosis, with contrast MRA being more effective than non-contrast. MRA. In spite of not being superior to IADSA, given the morbimortality risk which the latter is associated (0.7-1.2%). many authors defend contrast MRA (in association with Doppler echography) having become the method of choice for presurgical study of extracranial internal carotid artery stenosis. (Author) 53 refs.

Temporal fossa intra-extracranial dumbbell schwannoma.

LENUS (Irish Health Repository)

Wong, Limy

2012-02-01

Intra-extracranial schwannomas arising unrelated to major cranial nerves are exceedingly rare neoplasms. We report the case of a 23-year-old male who presented with a 9 month history of progressive temporal swelling which was excised and found histologically to be a schwannoma. A succinct review of the relevant literature is presented.

Temporal fossa intra-extracranial dumbbell schwannoma.

LENUS (Irish Health Repository)

Wong, Limy

2011-02-01

Intra-extracranial schwannomas arising unrelated to major cranial nerves are exceedingly rare neoplasms. We report the case of a 23-year-old male who presented with a 9 month history of progressive temporal swelling which was excised and found histologically to be a schwannoma. A succinct review of the relevant literature is presented.

Extracranial vascular malformation: value of antenatal and postnatal MRI in management

Energy Technology Data Exchange (ETDEWEB)

Roche, C.J.; Pilling, D.W. [Dept. of Radiology, Royal Liverpool Children' s Hospital NHS Trust (United Kingdom); Walkinshaw, S.A. [Dept. of Fetal Medicine, Liverpool Women' s Hospital (United Kingdom); May, P.L. [Dept. of Neurosurgery, Royal Liverpool Children' s Hospital NHS Trust (United Kingdom)

2001-10-01

We report a case where fetal MRI using a low-field-strength magnet (0.5 T) accurately confirmed a large extracranial vascular malformation, which was suspected on antenatal US. Fetal MRI enabled better counselling of the parents and allowed suitable plans to be made regarding method of delivery and early management of the neonate. To our knowledge this is the first case of an extracranial vascular malformation imaged using fetal MRI. (orig.)

Endovascular rescue from arterial rupture and thrombosis during middle cerebral artery stenting

Energy Technology Data Exchange (ETDEWEB)

Ahn, J.Y.; Chung, Y.S. [Department of Neurosurgery, College of Medicine, Pundang CHA Hospital, 351 Yatap-ding, Pundang-gu, 463-712, Sungnam (Korea); Lee, B.H. [Department of Interventional Neuroradiology, College of Medicine, Pundang CHA Hospital, 351 Yatap-dong, Pundang-gu, 463-712, Sungnam (Korea); Kim, O.J. [Department of Emergency Medicine, College of Medicine, Pundang CHA Hospital, 351 Yatap-dong, Pundang-gu, 463-712, Sungnam (Korea)

2003-08-01

Intravascular stents are being used with increasing frequency in interventional neuroradiology. Iatrogenic arterial rupture is an uncommon but serious complication. We present a case of arterial rupture and subarachnoid haemorrhage during middle cerebral artery stenting, treated by emergency additional, overlapping stenting and balloon tamponade of the dissected vessel. Thrombotic occlusion of the artery was managed by intra-arterial abciximab. Normal vessel patency was re-established within 20 min and the patient recovered with no neurological deficit. (orig.)

Spontaneous aortic dissecting hematoma in two dogs.

Science.gov (United States)

Boulineau, Theresa Marie; Andrews-Jones, Lydia; Van Alstine, William

2005-09-01

This report describes 2 cases of spontaneous aortic dissecting hematoma in young Border Collie and Border Collie crossbred dogs. Histology was performed in one of the cases involving an unusual splitting of the elastin present within the wall of the aorta, consistent with elastin dysplasia as described in Marfan syndrome in humans. The first case involved a young purebred Border Collie that died suddenly and the second case involved a Border Collie crossbred dog that died after a 1-month history of seizures. Gross lesions included pericardial tamponade with dissection of the ascending aorta in the former case and thoracic cavity hemorrhage, mediastinal hematoma, and aortic dissection in the latter. Histologic lesions in the case of the Border Collie crossbred dog included a dissecting hematoma of the ascending aorta with elastin dysplasia and right axillary arterial intimal proliferation.

[Midterm results of thoracic aortic dissection endovascular repair in conjunctions with the location of Adamkiewicz artery].

Science.gov (United States)

Jia, Ying-bin; Li, Jian; Su, Yong-hui; Ma, Jie-fei; Guan, Xiao-dong; Zhang, Bai-meng

2012-10-23

To evaluate the effects of using longer xenografts in conjunctions with the location of Adamkiewicz artery (AKA) on midterm outcomes of endovascular treatment for thoracic aortic dissection. From March 2005 to September 2011, 217 patients with type B dissection were recruited. There were 143 males and 74 females with a mean age of 65 ± 11 years. Among them, 43 patients were from Fifth Affiliated Hospital of Sun Yat-Sen University while another 174 patients from Affiliated Zhongshan Hospital of Fudan University. They were divided into 2 groups according to whether AKA was identified or not pre-operatively. Endovascular repairs were performed for all patients. Distal landing levels of xenografts were recorded. The thrombosis of false lumen and the complications of spinal cord injury and endoleak were analyzed. AKA was detected in 121 (55.8%) patients (group A) but not in 96 (44.2%) patients (group B). According to the levels of AKA, the patients of group A obtained the stabilization of affected thoracic aorta over a longer distance. And the ratio of patients with distal landing levels at T8-T10 was significantly higher than in group B (59.5% vs 12.5%, χ² = 49.85, P < 0.01). Also, during the follow-up period of 7.3 months, the ratio of patients with total thrombosis of false lumen in group A was significantly higher than that in group B (32.1% vs 19.1%, χ² = 4.34, P < 0.05). During the endovascular repair of thoracic aortic dissection, selecting a longer device may provide a better structural stability of affected aorta and promote false lumen thrombosis.

Internal Thoracic Artery Encircled by an Unusual Phrenic Nerve Loop

Directory of Open Access Journals (Sweden)

Robert Fu-Chean Chen

2007-12-01

Full Text Available We report an anatomic variation of the phrenic nerve. During a routine gross anatomical dissection course at our medical university, we found an unusual loop of the left phrenic nerve around the internal thoracic artery, about 1 cm from the take-off of the left subclavian artery. The phrenic nerve is close to the internal thoracic artery and is easily injured when dissecting the internal thoracic artery for coronary artery bypass conduit. Therefore, we suggest that the anatomic relationship of the phrenic nerve and internal thoracic artery is important in preventing incidental injury of the phrenic nerve.

Spontaneous coronary artery dissection and its association with heritable connective tissue disorders.

Science.gov (United States)

Henkin, Stanislav; Negrotto, Sara M; Tweet, Marysia S; Kirmani, Salman; Deyle, David R; Gulati, Rajiv; Olson, Timothy M; Hayes, Sharonne N

2016-06-01

Spontaneous coronary artery dissection (SCAD) is an under-recognised but important cause of myocardial infarction and sudden cardiac death. We sought to determine the role of medical and molecular genetic screening for connective tissue disorders in patients with SCAD. We performed a single-centre retrospective descriptive analysis of patients with spontaneous coronary artery disease who had undergone medical genetics evaluation 1984-2014 (n=116). The presence or absence of traits suggestive of heritable connective tissue disease was extracted. Genetic testing for connective tissue disorders and/or aortopathies, if performed, is also reported. Of the 116 patients (mean age 44.2 years, 94.8% women and 41.4% with non-coronary fibromuscular dysplasia (FMD)), 59 patients underwent genetic testing, of whom 3 (5.1%) received a diagnosis of connective tissue disorder: a 50-year-old man with Marfan syndrome; a 43-year-old woman with vascular Ehlers-Danlos syndrome and FMD; and a 45-year-old woman with vascular Ehlers-Danlos syndrome. An additional 12 patients (20.3%) had variants of unknown significance, none of which was thought to be a definite disease-causing mutation based on in silico analyses. Only a minority of patients with SCAD who undergo genetic evaluation have a likely pathogenic mutation identified on gene panel testing. Even fewer exhibit clinical features of connective tissue disorder. These findings underscore the need for further studies to elucidate the molecular mechanisms of SCAD. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Bilateral renal artery variation

OpenAIRE

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

2014-01-01

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

BILATERAL DUPLICATION OF RENAL ARTERIES

OpenAIRE

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

2014-01-01

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

Identification and Management of Iatrogenic Aortocoronary Dissection

Directory of Open Access Journals (Sweden)

Shao-Ping Nie, MD, PhD, FESC, FSCAI

2016-05-01

Full Text Available Iatrogenic aortocoronary dissection (IACD is a rare but potentially life-threatening complication during coronary catheterizations. Although the incidence was relatively low, the dissection often leads to procedure failure with increased risk of myocardial infarction and death. IACD is mainly caused by disruption of intima at the ostia of left or right coronary artery during interventional procedures, and appears as luminal filling defects or persistence of contrast (“extraluminal cap” or intimal tear outside the coronary lumen. Dissection could disseminate antegradely and lead to subtotal or total occlusion of the coronary lumen. Similarly, it could extend retrogradely into the sinus of Valsalva and cusp, or even the ascending aorta, aortic arch, or descending aorta, leading to hemodynamic collapse. Early identification and prompt management is crucial to the prognosis of patients with IACD. Immediate bail-out stenting should be performed as rapidly as possible in most cases of severe dissection, even when significant propagation has already occurred. Surgery should only be considered when stenting failed to seal the dissection and the patients had hemodynamic compromise.

Treatment Options for Childhood Extracranial Germ Cell Tumors

Science.gov (United States)

... tumors: Yolk sac tumors make a hormone called alpha-fetoprotein (AFP). They can form in the ovary, testicle, ... are used to detect extracranial germ cell tumors: Alpha-fetoprotein (AFP). Beta-human chorionic gonadotropin (β-hCG). For ...

General Information about Childhood Extracranial Germ Cell Tumors

Science.gov (United States)

... tumors: Yolk sac tumors make a hormone called alpha-fetoprotein (AFP). They can form in the ovary, testicle, ... are used to detect extracranial germ cell tumors: Alpha-fetoprotein (AFP). Beta-human chorionic gonadotropin (β-hCG). For ...

Dissection of descending aorta treated by stent-graft implantation in a patient with Marfan syndrome

Directory of Open Access Journals (Sweden)

Marat A. Aripov

2017-04-01

Full Text Available This report describes a 32 years old patient with Marfan syndrome and hypertension. David`s procedure was performed to the patient three months before due to dissection of the ascending thoracic aorta. Computer tomography scan showed DeBakey type III dissection of aorta beginning from left subclavian artery with transition to the ostium of the celiac trunk and proximal part of the left common iliac artery. Stent-grafts in the descending thoracic aorta with overlapping of left subclavian artery were implanted to the patient with Marfan syndrome. Patient was discharged and no complications recorded at 6th month follow-up.

Primary spontaneous coronary dissectİon in a young male and the role of intravascular ultrasonography for diagnosis and treatment

Directory of Open Access Journals (Sweden)

Sadık Volkan Emren

2015-09-01

Full Text Available Primary spontaneous coronary artery dissection (SCAD is a rare cause of acute coronary syndrome and is observed especially during gestation or the postpartum period of young healthy female patients. SCAD is much more rarely seen in young male patients. A 32 year-old male was admitted to our clinic with a typical anginal complaint that had begun after a verbal discussion in a family environment. The patient was hospitalized with a diagnosis of acute myocardial infarction without ST elevation. During coronary angiography, a lesion seen as a dissection in the proximal region of the left anterior descending artery (LAD, 30% stenosis in the circumflex artery and plaque in the right coronary artery were observed. In the LAD osteal region, a dissection flap and intimal rupture was observed at the 12:00–2:00 o'clock position using intravascular ultrasonography (IVUS. Our case was very young and had no atherosclerotic risk factors except for a history of smoking. It was suggested that intense emotional stress was the triggering factor for coronary dissection. The gold standard imaging method for spontaneous coronary dissection is coronary angiography. Recently, imaging methods like IVUS have made important contributions to the diagnosis of dissections that cannot be detected by coronary angiography. Treatment must be individual since there is no standard protocol. Medical therapy, percutaneous coronary intervention and coronary artery bypass surgery are the main treatment options.

[Morphological signs of mitochondrial cytopathy in skeletal muscles and micro-vessel walls in a patient with cerebral artery dissection associated with MELAS syndrome].

Science.gov (United States)

Sakharova, A V; Kalashnikova, L A; Chaĭkovskaia, R P; Mir-Kasimov, M F; Nazarova, M A; Pykhtina, T N; Dobrynina, L A; Patrusheva, N L; Patrushev, L I; Protskiĭ, S V

2012-01-01

Skin and muscles biopsy specimens of a patient harboring A3243G mutation in mitochondrial DNA, with dissection of internal carotid and vertebral arteries, associated with MELAS were studied using histochemical and electron-microscopy techniques. Ragged red fibers, regional variability of SDH histochemical reaction, two types of morphologically atypical mitochondria and their aggregation were found in muscle. There was correlation between SDH histochemical staining and number of mitochondria revealed by electron microscopy in muscle tissue. Similar mitochondrial abnormality, their distribution and cell lesions followed by extra-cellular matrix mineralization were found in the blood vessel walls. In line with generalization of cytopathy process caused by gene mutation it can be supposed that changes found in skin and muscle microvessels also exist in large cerebral vessels causing the vessel wall "weakness", predisposing them to dissection.

Geometrically based optimization for extracranial radiosurgery

International Nuclear Information System (INIS)

Liu Ruiguo; Wagner, Thomas H; Buatti, John M; Modrick, Joseph; Dill, John; Meeks, Sanford L

2004-01-01

For static beam conformal intracranial radiosurgery, geometry of the beam arrangement dominates overall dose distribution. Maximizing beam separation in three dimensions decreases beam overlap, thus maximizing dose conformality and gradient outside of the target volume. Webb proposed arrangements of isotropically convergent beams that could be used as the starting point for a radiotherapy optimization process. We have developed an extracranial radiosurgery optimization method by extending Webb's isotropic beam arrangements to deliverable beam arrangements. This method uses an arrangement of N maximally separated converging vectors within the space available for beam delivery. Each bouquet of isotropic beam vectors is generated by a random sampling process that iteratively maximizes beam separation. Next, beam arrangement is optimized for critical structure avoidance while maintaining minimal overlap between beam entrance and exit pathways. This geometrically optimized beam set can then be used as a template for either conformal beam or intensity modulated extracranial radiosurgery. Preliminary results suggest that using this technique with conformal beam planning provides high plan conformality, a steep dose gradient outside of the tumour volume and acceptable critical structure avoidance in the majority of clinical cases

Presentation of an uncommon form of aortic dissection and rupture in Marifoan syndrome

International Nuclear Information System (INIS)

Delgado, I.; Ruiz, R.; Villanueva, J.M.; Fernandez Cueto, J.L.

1995-01-01

In Marfan syndrome, aneurysmatic enlargement of ascending aorta and dissection starting at the root are the most common cardiovascular complications. We present an infrequent case of a 15-year-old patient with a typical case of Marfan syndrome. CT disclosed an aorta and aortic arch of normal size with dissection originating distally with respect to the point where left subclavian artery arises. The disecction extended to descending aorta and to iliac and femoral arteries. Aortic rupture occurred in the arch, with massive hemothorax. The CT findings were confirmed at necropsy. 9 refs

IVUS and OCT guided primary percutaneous coronary intervention for spontaneous coronary artery dissection with bioresorbable vascular scaffolds

Energy Technology Data Exchange (ETDEWEB)

Mahmood, Muhammad Muzaffar; Austin, David, E-mail: david.austin@stees.nhs.uk

2017-01-15

Summary: Spontaneous coronary artery dissection (SCAD) is an uncommon but important cause of acute coronary syndrome. The diagnosis of SCAD by an angiogram alone can be challenging and the increasing use of intracoronary imaging has proven an invaluable diagnostic adjunct in this regard. The appropriate initial management of SCAD has been a matter of significant debate. Owing to frequent spontaneous healing of coronary dissection and a higher risk of complications with percutaneous coronary intervention (PCI) in the setting of SCAD, a default approach of mechanical revascularization is not recommended. However in the presence of vessel occlusion and on-going myocardial infarction PCI is mandated. Bioresorbable vascular scaffolds (BVS) offer potential advantages over the conventional stents in the setting of SCAD. We describe a state-of-the-art approach to the acute treatment of SCAD causing STEMI, utilizing intravascular ultrasound (IVUS), optical coherence tomography (OCT) and BVS and discuss management strategies for the modern era. - Highlights: • SCAD is an infrequent but important cause of acute coronary syndrome. • Intracoronary imaging is a useful adjunct in the diagnosis of SCAD. • Revascularization is recommended in the presence on-going myocardial infarction. • BVS may be considered preferable to conventional stents in the setting of SCAD.

IVUS and OCT guided primary percutaneous coronary intervention for spontaneous coronary artery dissection with bioresorbable vascular scaffolds

International Nuclear Information System (INIS)

Mahmood, Muhammad Muzaffar; Austin, David

2017-01-01

Summary: Spontaneous coronary artery dissection (SCAD) is an uncommon but important cause of acute coronary syndrome. The diagnosis of SCAD by an angiogram alone can be challenging and the increasing use of intracoronary imaging has proven an invaluable diagnostic adjunct in this regard. The appropriate initial management of SCAD has been a matter of significant debate. Owing to frequent spontaneous healing of coronary dissection and a higher risk of complications with percutaneous coronary intervention (PCI) in the setting of SCAD, a default approach of mechanical revascularization is not recommended. However in the presence of vessel occlusion and on-going myocardial infarction PCI is mandated. Bioresorbable vascular scaffolds (BVS) offer potential advantages over the conventional stents in the setting of SCAD. We describe a state-of-the-art approach to the acute treatment of SCAD causing STEMI, utilizing intravascular ultrasound (IVUS), optical coherence tomography (OCT) and BVS and discuss management strategies for the modern era. - Highlights: • SCAD is an infrequent but important cause of acute coronary syndrome. • Intracoronary imaging is a useful adjunct in the diagnosis of SCAD. • Revascularization is recommended in the presence on-going myocardial infarction. • BVS may be considered preferable to conventional stents in the setting of SCAD.

Operated DeBakey type III dissecting aortic aneurysm: review of 12 cases

International Nuclear Information System (INIS)

Moon, Hi Eun; Lee, Ghi Jai; Oh, Sang Joon; Yoon, Sei Ra; Shim, Jae Chan; Kim, Ho Kyun; Han, Chang Yul

1995-01-01

We evaluated the indications of operation and radiologic findings in 12 operated DeBakey type III aortic dissections. We retrospectively reviewed radiologic findings of 12 operated DeBakey type III aortic dissections, using CT, MRI, or aortography, and correlations were made with clinical course of the patients. Three cases were uncomplicated dissections. There were aneurysm rupture in 4 cases, impending rupture in 4 cases, occlusion of common iliac artery in 2 cases, occlusion of renal artery in 1 case, and compression of bronchus and esophagus by dilated aorta in 1 case. Associated clinical sign and symptoms were chest and back pain in 12 cases, claudication in 3 cases, dyspnea and dysphagia in 1 case, hoarseness in 1 case, and hemoptysis in 1 case. Post-operative complications were death from aneurysm rupture in 1 case, paraplegia in 2 cases, acute renal failure in 3 cases, and hemopericardium in 1 case. Although medical therapy is preferred in management of DeBakey type III aortic dissection, surgical treatment should be considered in patients with radiological findings of aortic rupture, impending rupture, occlusion of aortic major branches

Predictive value of vertebral artery extracranial color-coded duplex sonography for ischemic stroke-related vertigo.

Science.gov (United States)

Liou, Li-Min; Lin, Hsiu-Fen; Huang, I-Fang; Chang, Yang-Pei; Lin, Ruey-Tay; Lai, Chiou-Lian

2013-12-01

Vertigo can be a major presentation of posterior circulation stroke and can be easily misdiagnosed because of its complicated presentation. We thus prospectively assessed the predictive value of vertebral artery extracranial color-coded duplex sonography (ECCS) for the prediction of ischemic stroke-related vertigo. The inclusion criteria were: (1) a sensation of whirling (vertigo); (2) intractable vertigo for more than 1 hour despite appropriate treatment; and (3) those who could complete cranial magnetic resonance imaging (MRI) and vertebral artery (V2 segment) ECCS studies. Eventually, 76 consecutive participants with vertigo were enrolled from Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan between August 2010 and August 2011. Demographic data, neurological symptoms, neurologic examinations, and V2 ECCS were assessed. We chose the parameters of peak systolic velocity (PSV), end diastolic velocity (EDV), PSV/EDV, mean velocity (MV), resistance index (RI), and pulsatility index (PI) to represent the hemodynamics. Values from both sides of V2 segments were averaged. We then calculated the average RI (aRI), average PI (aPI), average PSV (aPSV)/EDV, and average (aMV). Axial and coronal diffusion-weighted MRI findings determined the existence of acute ischemic stroke. We grouped and analyzed participants in two ways (way I and way II analyses) based on the diffusion-weighted MRI findings (to determine whether there was acute stroke) and neurological examinations. Using way I analysis, the "MRI (+)" group had significantly higher impedance (aRI, aPI, and aPSV/EDV ratio) and lower velocity (aPSV, aEDV, and aMV(PSV + EDV/2)), compared to the "MRI (-)" group. The cutoff value/sensitivity/specificity of aPSV, aEDV, aMV, aPI, aRI, and aPSV/EDV between the MRI (+) and MRI (-) groups were 41.15/61.5/66.0 (p = 0.0101), 14.55/69.2/72.0 (p = 0.0003), 29.10/92.1/38.0 (p = 0.0013), 1.07/76.9/64.0 (p = 0.0066), 0.62/76.9/64.0 (p = 0.0076), and 2.69/80.8/66.0 (p = 0

Marginal artery stump pressure in left colic artery-preserving rectal cancer surgery: a clinical trial.

Science.gov (United States)

Guo, Yuchen; Wang, Daguang; He, Liang; Zhang, Yang; Zhao, Shishun; Zhang, Luyao; Sun, Xuan; Suo, Jian

2017-07-01

The aim of this clinical trial is to evaluate the influence of high and low ligation of the inferior mesenteric artery with apical lymph node dissection on the anastomotic blood supply, lymph node retrieval rate, operative time and anastomotic leakage rate in rectal cancer surgery. A total of 57 Chinese patients were randomly distributed into group A and group B and underwent radical resection of rectal cancer. Patients in group A underwent high ligation of the inferior mesenteric artery, and patients in group B underwent apical lymph node resection around the root of the inferior mesenteric artery with preservation of the left colic artery. The marginal artery stump pressure was measured after colon and artery reconstruction. Systemic pressure, distal colon length, operative time and lymph node retrieval rate were measured and recorded. The results were analysed and related to patient characteristics and post-operative complications. The anastomotic blood supply negatively and linearly correlated with age and distal colon length and showed a positive linear correlation with systemic pressure. Patients who received low ligation with apical lymph node dissection had a better anastomotic blood supply than those who received high ligation. No differences were found in lymph node retrieval rate, operative time and anastomotic leakage rate. Anastomotic leakage was associated with a worse anastomotic blood supply. Low ligation with apical lymph node dissection in rectal cancer treatment provides better anastomotic blood supply but is not associated with differences in node retrieval rate or operation time. © 2015 Royal Australasian College of Surgeons.

Retreatment and outcomes of recurrent intracranial vertebral artery dissecting aneurysms after stent assisted coiling: a single center experience.

Directory of Open Access Journals (Sweden)

Ying Song

Full Text Available The retreatment of recurrent intracranial vertebral artery dissecting aneurysms (VADAs after stent assisted coiling (SAC has not yet been studied. The purpose of this study was to evaluate the strategies and outcomes for retreatment of recurrent VADAs after SAC.Between September 2009 and November 2013, six consecutive patients presenting with recurrent intracranial VADAs after SAC were enrolled in this study. They were all male with age ranging from 29 to 54 years (mean age, 46.2 years. The procedures of treatments and angiographic and clinical follow-up were reviewed retrospectively. Retreatment modalities were selected individually according to the characteristics of recurrence. The outcomes of retreatment were evaluated by angiographic and clinical follow-up.Six patients with recurrent intracranial VADAs after SAC were retreated, with second SAC in three patients, coil embolization, double overlapping stents placement and endovascular occlusion with aneurysm trapping in one patient, respectively. Immediate angiographic outcomes of retreatment were: complete occlusion in three patients, nearly complete occlusion in two patients, and contrast medium retention in dissecting aneurysm in one patient. All cases were technically successful. No complications related to endovascular procedures occurred. Angiographic follow-up was available in all five patients treated with second SAC or double overlapping stents, which was complete occlusion in four patients, obliteration of parent artery in one patient, showing no recurrence at 4-11 months (mean: 8.6 months. Clinical follow-up was performed in all six patients at 11-51 months after initial endovascular treatment and at 9-43 months after retreatment. The mRS of last clinical follow-up was excellent in five patients and mild disability in only one patient.Endovascular retreatment is feasible and effective for recurrent intracranial VADAs after SAC. Individualized strategies of retreatment should be

Dual origin of the left vertebral artery: extracranial MRA and CTA findings.

LENUS (Irish Health Repository)

Tobin, W Oliver

2012-02-01

A 48-year-old man presented with a posterior circulation stroke secondary to left lateral medullary infarction. Contrast-enhanced magnetic resonance angiography (CEMRA) revealed 40-45% intracranial left vertebral artery stenosis, likely atherosclerotic in nature. CEMRA and subsequent computed tomography angiography also identified a duplicate origin of the left vertebral artery. The importance of recognition of this rare anatomical variant, its potential contribution to stroke aetiology, and the advantage of non-invasive vascular imaging prior to catheter angiography is emphasised.

Urgent carotid stenting before cardiac surgery in a young male patient with acute ischemic stroke caused by aortic and carotid dissection

Directory of Open Access Journals (Sweden)

Popović Rade

2016-01-01

Full Text Available Introduction. Acute aortic dissection (AD is the most common life-threatening disorder affecting the aorta. Neurological symptoms are present in 17-40% of cases. The management of these patients is controversial. Case report. We presented a 37-year-old man admitted for complaining of left-sided weak-ness. Symptoms appeared two hours before admission. The patient had no headache, neither thoracic pain. Neurological examination showed mild confusion, left-sided hemiplegia, National Institutes of Health Stroke Scale (NIHSS score was 10. Ischemic stroke was suspected, brain multislice computed tomography (MSCT and angiography were performed and right intrapetrous internal carotid artery dissection noted. Subsequent color Doppler ultrasound of the carotid arteries showed dissection of the right common carotid artery (CCA. The patient underwent thoracic and abdominal MSCT aortography which showed ascending aortic dissection from the aortic root, propagating in the brachiocephalic artery and the right CCA. Digital subtraction angiography was performed subsequently and two stents were successfully implanted in the brachiocephalic artery and the right CCA prior to cardiac surgery, only 6 hours after admission. The ascending aorta was reconstructed with graft interposition and the aortic valve re-suspended. The patient was hemodynamically stable and with no neurologic deficit after surgery. Unfortinately, at the operative day 6, mediastinitis developed and after intensive treatment the patients died 35 days after admission. Conclusion. In young patients with suspected stroke and oscillatory neurological impairment urgent MSCT angiography of the brain and neck and/or Doppler sonography of the carotid and vertebral artery are mandatory to exclude carotid and aortic dissection. The prompt diagnosis permits urgent carotid stenting and cardiosurgery. To the best of our knowledge, this is the first published case of immediate carotid stenting in acute ischemic

Imaging of Dual Ophthalmic Arteries: Identification of the Central Retinal Artery

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Louise Louw

2014-01-01

Full Text Available Identification of the origin of the central retinal artery (CRA is imperative in tailoring angiographic studies to resolve a given clinical problem. A case with dual ophthalmic arteries (OAs, characterized by different origins and distinct branching patterns, is documented for training purposes. Pre-clinical diagnosis of a 9-year-old child who presented with a sharp wire in the left-side eyeball was primarily corneal laceration. For imaging, a selected six-vessel angiographic study with the transfemoral approach was performed. Embolization was not required and the wire could be successfully removed. Right-side OA anatomy was normal, while left-side dual OAs with external carotid artery (ECA and internal carotid artery (ICA origins were seen. The case presented with a left-side meningo-ophthalmic artery (M-OA anomaly via the ECA, marked by a middle meningeal artery (MMA (origin: Maxillary artery; course: Through foramen spinosum with normal branches (i.e. anterior and posterior branches, and an OA variant (course: Through superior orbital fissure with a distinct orbital branching pattern. A smaller OA (origin: ICA; course: Through optic foramen with a distinct ocular branching pattern presented with the central retinal artery (CRA. The presence of the dual OAs and the M-OA anomaly can be explained by disturbed evolutionary changes of the primitive OA and stapedial artery during development. The surgical interventionist must be aware of dual OAs and M-OA anomalies with branching pattern variations on retinal supply, because of dangerous extracranial-intracranial anastomotic connections. It is of clinical significance that the origin of the CRA from the ICA or ECA must be determined to avoid complications to the vision.

Vascular type Ehlers-Danlos Syndrome with fatal spontaneous rupture of a right common iliac artery dissection: case report and review of literature

Science.gov (United States)

Abayazeed, Aly; Hayman, Emily; Moghadamfalahi, Mana; Cain, Darren

2014-01-01

Vascular Ehlers-Danlos Syndrome (previously Ehlers-Danlos IV) is a rare autosomal dominant collagen vascular disorder caused by a 2q31 COL3A1 gene mutation encoding pro-alpha1 chain of type III collagen (in contrast to classic Ehlers-Danlos, caused by a COL5A1 mutation). The vascular type accounts for less than 4% of all Ehlers-Danlos cases and usually has a poor prognosis due to life threatening vascular ruptures and difficult, frequently unsuccessful surgical and vascular interventions. In 70% of cases, vascular rupture or dissection, gastrointestinal perforation, or organ rupture is a presenting sign. We present a case of genetically proven vascular Ehlers-Danlos with fatal recurrent retroperitoneal hemorrhages secondary to a ruptured right common iliac artery dissection in a 30-year-old male. This case highlights the need to suspect collagen vascular disorders when a young adult presents with unexplained retroperitoneal hemorrhage, even without family history of such diseases. PMID:24967021

Isolated Posterior Cerebral Artery Dissection: Report of Three Cases

National Research Council Canada - National Science Library

Sherman, Paul M

2005-01-01

.... We present three cases of dissection of the P2 segment of the PCA. In two patients, an association with minor axial head trauma was documented, suggesting shearing injury of the PCA as it crosses over the free edge of the tentorium...

Imaging the vertebral artery

Energy Technology Data Exchange (ETDEWEB)

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

2005-07-01

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

Imaging the vertebral artery

International Nuclear Information System (INIS)

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

2005-01-01

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

Evaluation of the patency of an extracranial-intracranial bypass using magnetic resonance angiography with selective presaturation of bypass vessels

Energy Technology Data Exchange (ETDEWEB)

Mabuchi, Shoji; Nakayama, Naoki; Isu, Toyohiko; Harata, Tatsuo; Nanbu, Toshikazu [Kushiro Rousai Hospital, Hokkaido (Japan)

1994-06-01

Three-dimensional time-of-flight magnetic resonance (MR) angiography using radiofrequency presaturation pulses was used to evaluate the patency of extracranial-intracranial (EC/IC) bypass in 11 patients. Presaturation causes signal loss in the vascular territory supplied by the presaturated EC/IC bypass graft. In all patients with a patent EC/IC bypass graft confirmed on conventional angiography, disappearance of the signal of the middle cerebral artery receiving blood flow from the bypass graft was clearly observed on MR angiograms with presaturation, indicating patency of the EC/IC bypass graft. MR angiography with presaturation pulses is a noninvasive and repeatable method for evaluation of the function of an EC/IC bypass graft. (author).

Fusiform-shaped nodules along the internal carotid artery demonstrated by follow-up sonography within the dissected neck area in patients with oral cancer

International Nuclear Information System (INIS)

Hayashi, Takafumi; Katsura, Kouji; Taira, Shuhzou; Shingaki, Susumu; Hoshina, Hideyuki

2004-01-01

In order to distinguish benign from malignant nodules within the dissected neck area in patients with oral cancer during the follow-up period, we retrospectively evaluated the frequency and characteristic findings of fusiform-shaped nodules along the internal carotid artery observed by follow-up sonography. From 1997 to 2003, 52 patients with oral cancer, who underwent radical neck dissections, were enrolled in this study. The study cohort consisted of 33 males and 19 females ranging in age from 29 to 84 years (mean, 62.0 years). After neck dissection, every patient was examined repeatedly with sonography during the follow-up period at an interval of one month. CT and/or MRI were performed when clinically required. Any patient with recurrent neck mass was excluded from this study. In the 52 patients, fusiform-shaped nodules were observed in 10 patients (19%) by the follow-up sonography. The nodules were homogenously hypoechoic and the margin was well-demarcated except for the upper end. A hyperechoic core was clearly observed in every nodule, which showed a fatty density on post-contrast CT. On post-contrast MRI, the nodules enhanced markedly and the core showed hypointensity on fat saturated images. In conclusion, it was suggested that the fusiform-shaped nodules observed by follow-up sonography within the dissected neck area might be the superior cervical ganglion of sympathetic trunk. However, further studies are needed to disclose the true character of the nodules. (author)

Odontogenic Pain as the Principal Presentation of Vertebral Artery Pseudoaneurysm; a Case Report

Directory of Open Access Journals (Sweden)

Marco Zenteno

2015-07-01

Full Text Available Dissection of the vertebral artery is an important but rare cause of cerebrovascular accidents. Here we report a 48-year-old man with toothache since 4 days before who presented to the emergency department with neck pain and final diagnosis of dissecting right vertebral artery pseudoaneurysm. To our knowledge, this maybe the first report of odontogenic pain as the first manifestation of vertebral artery pseudoaneurysm in the literatures.

Ischemic stroke: carotid and vertebral artery disease

Energy Technology Data Exchange (ETDEWEB)

Vilela, P.; Goulao, A. [Hospital Garcia de Orta, Servico de Neurorradiologia, Almada (Portugal)

2005-03-01

Ischemic strokes may have distinct aetiologies, including several different intrinsic arterial pathological disorders. The diagnosis and understanding of these arterial diseases is critical for the correct management of stroke as different treatment approaches are undertaken according to the aetiology. Atherosclerosis is by far the most common arterial disease among adults, and other pathological processes include arterial dissection, small vessel disease, inflammatory and non-inflammatory vasculopathy and vasomotor disorders. In children, there are several vasculopathies responsible for vaso-occlusive disease such as sickle-cell anemia, acute regressive angiopathy and Moya-Moya disease, neurofibromatosis, dissections, vasculitis associated with intracranial and systemic infections. An overview of the major carotid and vertebral pathological diseases responsible for ischemic stroke in adults and children, highlighting the accuracy of the different imaging modalities for its diagnosis and the imaging appearance of these diseases, is given. (orig.)

Ischemic stroke: carotid and vertebral artery disease

International Nuclear Information System (INIS)

Vilela, P.; Goulao, A.

2005-01-01

Ischemic strokes may have distinct aetiologies, including several different intrinsic arterial pathological disorders. The diagnosis and understanding of these arterial diseases is critical for the correct management of stroke as different treatment approaches are undertaken according to the aetiology. Atherosclerosis is by far the most common arterial disease among adults, and other pathological processes include arterial dissection, small vessel disease, inflammatory and non-inflammatory vasculopathy and vasomotor disorders. In children, there are several vasculopathies responsible for vaso-occlusive disease such as sickle-cell anemia, acute regressive angiopathy and Moya-Moya disease, neurofibromatosis, dissections, vasculitis associated with intracranial and systemic infections. An overview of the major carotid and vertebral pathological diseases responsible for ischemic stroke in adults and children, highlighting the accuracy of the different imaging modalities for its diagnosis and the imaging appearance of these diseases, is given. (orig.)

Internal Carotid Artery Aneurysm Mimicking Peritonsillar Abscess

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Jacek Brzost

2015-01-01

Full Text Available The extracranial internal carotid artery aneurysm (EICAA is an uncommon arterial lesion. Patients typically present with neurologic symptoms resulting from impaired cerebral perfusion and compression symptoms of cranial nerves. Often EICAA presents as a pulsatile neck mass, which is otherwise asymptomatic. We present a case of an 84-year-old female, who was initially referred to the Emergency Department for Otolaryngology with suspected peritonsillar abscess. The patient had a history of recent upper airway infection and cardiovascular comorbidities, including hypertension and ischaemic stroke complicated by extensive neurologic deficits. Physical examination revealed a compact, nonpulsatile mass in the lateral parapharyngeal space and local erythema of the mucosa. Duplex Doppler Ultrasonography and Computed Tomography revealed an atherosclerotic aneurysm of the right internal carotid artery, measuring 63×55×88 mm, stretching from the skull base to the angle of the mandible.

Isolated celiac trunk aneurysm dissection: A rare entity

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Esteban-Zubero, Eduardo

2017-04-01

Full Text Available Spontaneous and isolated celiac artery dissection is a rare clinical disease. It is the fourth cause of abdominal aneurysms behind those that occur in the splenic, hepatic, and superior mesenteric arteries. It is important to suspect the diagnosis of this entity whose clinical symptoms are unspecific. We report the case of a 60 year-old male treated in our hospital because of this illness, and present a review of this pathology, specially focused on the diagnosis and the different treatments available.

A unique case of bifid left testicular artery having its anomalous high origin from renal artery

OpenAIRE

Ashwini P Aithal; Naveen Kumar; Swamy S Ravindra; Jyothsna Patil

2016-01-01

The testicular arteries are known to originate from the ventrolateral aspect of the abdominal aorta and descend obliquely to the pelvic cavity and supply the testis. An anatomical description of an uncommon variation of the left testicular artery is presented in this case report, highlighting its clinical implications. During routine dissection of a male cadaver, we found that the left testicular artery was bifid and it was arising from the left renal artery. After its origin, it then coursed...

Impact of Intra-Extracranial Hemodynamics on Cerebral Ischemia by Arterial Hypertension (Part 2

Directory of Open Access Journals (Sweden)

Alexander G. Kruglov, PhD, ScD

2012-06-01

Full Text Available The association between hemodynamic and biochemical parameters of cerebral blood flow have been studied in man, using mathematical methods of statistics. The values have been obtained through catheterization using a probe jammed at the level of the bulb of the superior jugular vein. Relationships with central hemodynamic parameters have been evaluated, including the right atrium, the right ventricle, and the left ventricle, as well as with pressure and biochemical values of the arterial bed. Data have been acquired in patients with stable arterial hypertension. Analysis of all relationship between hemodynamic and biochemical parameters has shown that the uniform hemodynamic zone: Sin.P. – SJV – SEV – the right atrium, normally participates in regulation of gaseous exchange in the human brain depending on the minimum pressure on the way of outflow from the brain. In stable arterial hypertension, this type of regulation is lost. On the basis of the results of this study, it has been concluded that blood viscosity is normally a primary controlled parameter of homeostasis. In stable arterial hypertension, homeostatic control of factors determining rheological and thrombogenic properties of blood, as well as participating in the development of brain ischemic conditions is lost. This increases risk of disturbances in central hemodynamics.

Selective intra-arterial administration of 18F-FDG to the rat brain - effects on hemispheric uptake

International Nuclear Information System (INIS)

Arnberg, Fabian; Samen, Erik; Lundberg, Johan; Grafstroem, Jonas; Soederman, Michael; Stone-Elander, Sharon; Holmin, Staffan; Lu, Li

2014-01-01

The purpose of this study was to investigate the radioligand uptake and iodine contrast distribution in the intra- and extracranial circulation of the rat, after intra-arterial injections to the common carotid artery and different parts of the internal carotid artery. All animal experiments were carried out in accordance with Karolinska Institutet's guidelines and were approved by the local laboratory animal ethics committee. We used clinical neurointerventional systems to place microcatheters in the extra- or intracranial carotid artery of 15 Sprague-Dawley rats. Here, injection dynamics of iodine contrast was assessed using digital subtraction angiography. Maintaining the catheter position, the animals were placed in a micro PET and small-animal positron emission tomography (PET) was used to analyze injections [2- 18 F]-2-fluoro-2-deoxy-d-glucose ( 18 F-FDG). Microcatheters had to be placed in the intracranial carotid artery (iICA) for the infusate to distribute to the brain. Selective injection via the iICA resulted in a 9-fold higher uptake of 18 F-FDG in the injected hemisphere (p < 0.005) compared to both intravenous and more proximal carotid artery injections. Furthermore, selective injection gave a dramatically improved contrast between the brain and extracranial tissue. Intra-arterial injection increases the cerebral uptake of a radiotracer dramatically compared to systemic injection. This technique has potential applications for endovascular treatment of malignancies allowing intra-interventional modifications of injection strategy, based on information on tumor perfusion and risk to surrounding normal parenchyma. Furthermore the technique may increase diagnostic sensitivity and avoid problems due to peripheral pharmacological barriers and first passage metabolism of labile tracers. (orig.)

Functional Nerve Preservation in Extracranial Head and Neck Schwannoma Surgery.

Science.gov (United States)

Ijichi, Kei; Kawakita, Daisuke; Maseki, Shinichiro; Beppu, Shintaro; Takano, Gaku; Murakami, Shingo

2016-05-01

A schwannoma is an uncommon, benign neurogenic tumor of Schwann cells. Tumor enucleation is the recommended surgical method to preserve function of the original nerve, although enucleation does not guarantee completely intact nerve function after the operation. To establish a strategy for functional preservation in extracranial head and neck schwannoma treatment by using an electromyographic (EMG) system during tumor resection. A retrospective cohort study was conducted of 15 patients who underwent surgery for removal of schwannoma tumors between April 1, 2006, and March 31, 2015, at an academic tertiary referral center. Data analysis was conducted from April 3, 2006, to September 15, 2015. Neurogenic tumors were diagnosed according to preoperative findings, and during surgery tumors were exposed and given EMG-controlled electrical stimulation to analyze their origins. In motor nerve cases, the electrical activity of the muscle was measured and recorded by EMG. The tumor was then enucleated by incision along tumor fibers mapped using EMG stimulation. If a nerve bundle was visible, we incised along there and enucleated the tumor. A strategy using electrical stimulation to improve preservation of nerve function in extracranial head and neck schwannoma operations. Frequency and duration of postoperative neurologic complications associated with functional preservation surgery with tumor enucleation was evaluated using EMG monitoring according to tumor origin. Of the 15 patients with extracranial schwannoma, 9 (60%) were women (mean [SD] age, 36.3 [15.3] years). All 15 patients underwent surgery using a transcervical approach. The most common nerves of origin were the vagus nerve and the sympathetic chain. In sensory or sympathetic nerve cases, the EMG response was absent. Two of 5 patients with vagus schwannoma had postoperative temporary vocal nerve palsy. These symptoms showed improvement after 1 year. There was no tumor recurrence during the follow-up period in any

[Neonatal subgaleal haemorrhage; a potential life-threatening extracranial haemorrhage

NARCIS (Netherlands)

Fuijkschot, J.; Antonius, T.A.J.; Meijers, P.W.; Vrancken, S.L.A.G.

2008-01-01

A female neonate delivered at term developed hypovolemic shock due to a subgaleal haemorrhage, i.e. extracranial bleeding between the galea aponeurotica and the cranial periosteum. The subgaleal haemorrhage was most likely the result of a traumatic vacuum extraction. The patient was treated with

Coronary ostial involvement in acute aortic dissection: detection with 64-slice cardiac CT.

LENUS (Irish Health Repository)

Ryan, E Ronan

2012-02-01

A 41-year-old man collapsed after lifting weights at a gym. Following admission to the emergency department, a 64-slice cardiac computed tomography (CT) revealed a Stanford Type A aortic dissection arising from a previous coarctation repair. Multiphasic reconstructions demonstrated an unstable, highly mobile aortic dissection flap that extended proximally to involve the right coronary artery ostium. Our case is an example of the application of electrocardiogram-gated cardiac CT in directly visualizing involvement of the coronary ostia in acute aortic dissection, which may influence surgical management.

Analysis of intimal extent and predictors of renal atrophy in patients with aortic dissection

Energy Technology Data Exchange (ETDEWEB)

Chan, Wen-Hui; Huang, Yu-Chieh; Wan, Yung-Liang [Dept. of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Coll. of Medicine, Chang Gung Univ., Taoyuan, Taiwan (China)], e-mail: ylw0518@adm.cgmh.org.tw; Weng, Hsu-Huei [Dept. of Diagnostic Radiology, Chang Gung Memorial Hospital at Chia-Yi, Coll. of Medicine, Chang Gung Univ., Taoyuan, Taiwan (China); Ko, Sheung-Fat [Dept. of Diagnostic Radiology, Chang Gung Memorial Hospital at Kaohsiung, Coll. of Medicine, Chang Gung Univ., Taoyuan, Taiwan (China); Chu, Jaw-Ji; Lin, Pyng-Jing [Dept. of Cardiac Surgery, Chang Gung Memorial Hospital at Linkou, Coll. of Medicine, Chang Gung Univ., Taoyuan, Taiwan (China)

2012-09-15

Background: The intimal flap of aortic dissection may extend to the abdominal branches and probably lead to malperfusion syndrome. Renal malperfusion and renal atrophy are significantly related to patient outcomes. Purpose: To study the extent of the intimal flap and predisposing factors for renal atrophy in patients with aortic dissection. Material and Methods: From January 2001 to June 2008, 176 (137 men, aged 21-86 years, mean 51.9 years) of 225 subjects with aortic dissection and computed tomography (CT) met the inclusion criteria for this study. Of these 176 patients, 35 (19.9%) developed unilateral renal atrophy. A review of the CT was conducted to classify aortic branch vessel perfusion into three types: type 1, in which the branch vessels are perfused exclusively from the true lumen; type 2, in which the branches are perfused from both the true and false lumens; and type 3, in which the branches are perfused exclusively from the false lumen. Variables including age, gender, type of aortic dissection, type of perfusion of the abdominal branches, and the presence of thrombi in the false lumen were analyzed to determine whether these factors were related to the left or right side and global or focal renal atrophy. Results: Of 880 abdominal branches in 176 patients, 622 (70.7%) were classed as perfusion type 1, 50 (5.7%) as type 2, and 208 (23.6%) as type 3. Type 3 perfusion was most commonly observed in the left renal artery, at a frequency of 31.7% (66/208). Partial thrombosis in the false lumen above the level of the renal arteries was seen in 68.8% of patients; such thrombi and type 3 perfusion of the renal artery were significantly related to renal atrophy. The laterality (left or right) and extent (global or focal) of renal atrophy were not related to age, gender, type of aortic dissection, or perfusion type. Conclusion: Type 3 perfusion is most frequent in the left renal artery, and such perfusion and partial thrombi in the false lumen above the renal

Analysis of intimal extent and predictors of renal atrophy in patients with aortic dissection

International Nuclear Information System (INIS)

Chan, Wen-Hui; Huang, Yu-Chieh; Wan, Yung-Liang; Weng, Hsu-Huei; Ko, Sheung-Fat; Chu, Jaw-Ji; Lin, Pyng-Jing

2012-01-01

Background: The intimal flap of aortic dissection may extend to the abdominal branches and probably lead to malperfusion syndrome. Renal malperfusion and renal atrophy are significantly related to patient outcomes. Purpose: To study the extent of the intimal flap and predisposing factors for renal atrophy in patients with aortic dissection. Material and Methods: From January 2001 to June 2008, 176 (137 men, aged 21-86 years, mean 51.9 years) of 225 subjects with aortic dissection and computed tomography (CT) met the inclusion criteria for this study. Of these 176 patients, 35 (19.9%) developed unilateral renal atrophy. A review of the CT was conducted to classify aortic branch vessel perfusion into three types: type 1, in which the branch vessels are perfused exclusively from the true lumen; type 2, in which the branches are perfused from both the true and false lumens; and type 3, in which the branches are perfused exclusively from the false lumen. Variables including age, gender, type of aortic dissection, type of perfusion of the abdominal branches, and the presence of thrombi in the false lumen were analyzed to determine whether these factors were related to the left or right side and global or focal renal atrophy. Results: Of 880 abdominal branches in 176 patients, 622 (70.7%) were classed as perfusion type 1, 50 (5.7%) as type 2, and 208 (23.6%) as type 3. Type 3 perfusion was most commonly observed in the left renal artery, at a frequency of 31.7% (66/208). Partial thrombosis in the false lumen above the level of the renal arteries was seen in 68.8% of patients; such thrombi and type 3 perfusion of the renal artery were significantly related to renal atrophy. The laterality (left or right) and extent (global or focal) of renal atrophy were not related to age, gender, type of aortic dissection, or perfusion type. Conclusion: Type 3 perfusion is most frequent in the left renal artery, and such perfusion and partial thrombi in the false lumen above the renal

Primary mycotic aneurysm of the common carotid artery: Case report

International Nuclear Information System (INIS)

Lukasiewicz, A.; Molski, S.; Jundzill, W.; Meder, G.; Lasek, W.

2006-01-01

Aneurysms of the common carotid artery are relatively rare. Mycotic aneurysms in such location occur even less frequently. Causative factors can be sepsis, recent surgery, or dental procedures. Immunosuppression may also be a burdening factor. The authors present the case of a 70-year-old male patient with primary mycotic carotid artery aneurysm. The patient was diagnosed with ultrasound and multidetector spiral computed tomography and treated operatively with a PTFE prosthesis. Culture-appropriate antibiotic therapy was administered during the perioperative period. The rarity of extracranial carotid artery aneurysms might cause diagnostic and treatment difficulties. Open surgery is the recommended method, although the endovascular approach is gaining more acceptance. The choice of treatment modality might be facilitated by a detailed morphologic description of the aneurysm and its surroundings. Available methods of imaging are described. (author)

Identification of internal carotid dissection in patients with migraine--case report and literature review

International Nuclear Information System (INIS)

Sharif, M.; Trinick, T.; Khan, H.Y.

2010-01-01

Although patho-physiology of spontaneous internal carotid artery dissection (sICAD) is largely unknown, an association with migraine has been suggested but not proven. Migraine is a condition which is worth considering while one is hunting a possible cause for internal carotid artery dissection (ICAD) and it may be found more often than expected.2 To date it remains a diagnosis of exclusion in patients with migraine. As opposed to migraine with aura, migraine without aura is significantly more frequent among patients with SICAD. It has been suggested that ICAD produces stroke in 36-68% of patients as a result of occlusion of the artery at or near the site of the dissection, or embolization occurring distally from a dislodged fragment of thrombus. We report a 31-year old woman with headache and ptosis as initial symptoms. Magnetic resonance imaging (MRI) confirmed the diagnosis. Prompt treatment was instituted with anti-platelet agents and the patient had complete resolution of symptoms. Our case report highlights the importance of identifying the patients with ICD with history of migraine, in the absence of other risk factors and adds to the sparse literature currently available on the subject. (author)

Dissecting Dissection.

Science.gov (United States)

AV Magazine, 1996

1996-01-01

This journal features articles covering various aspects of dissection. "Biology--The Study of Life" (George Russell) offers students experiments that do not require using invasive procedures. "Animal Cruelty--Behind the Scenes" (Zoe Weil) describes sources of laboratory animals. "Doing without Dissection" (Juliana…

Selective intra-arterial administration of {sup 18}F-FDG to the rat brain - effects on hemispheric uptake

Energy Technology Data Exchange (ETDEWEB)

Arnberg, Fabian; Samen, Erik; Lundberg, Johan; Grafstroem, Jonas; Soederman, Michael; Stone-Elander, Sharon; Holmin, Staffan [Karolinska Institutet, Department of Clinical Neuroscience, Stockholm (Sweden); Karolinska University Hospital-Solna, Department of Neuroradiology, Stockholm (Sweden); Lu, Li [Karolinska University Hospital-Solna, KERIC, Stockholm (Sweden)

2014-05-15

The purpose of this study was to investigate the radioligand uptake and iodine contrast distribution in the intra- and extracranial circulation of the rat, after intra-arterial injections to the common carotid artery and different parts of the internal carotid artery. All animal experiments were carried out in accordance with Karolinska Institutet's guidelines and were approved by the local laboratory animal ethics committee. We used clinical neurointerventional systems to place microcatheters in the extra- or intracranial carotid artery of 15 Sprague-Dawley rats. Here, injection dynamics of iodine contrast was assessed using digital subtraction angiography. Maintaining the catheter position, the animals were placed in a micro PET and small-animal positron emission tomography (PET) was used to analyze injections [2-{sup 18}F]-2-fluoro-2-deoxy-d-glucose ({sup 18}F-FDG). Microcatheters had to be placed in the intracranial carotid artery (iICA) for the infusate to distribute to the brain. Selective injection via the iICA resulted in a 9-fold higher uptake of {sup 18}F-FDG in the injected hemisphere (p < 0.005) compared to both intravenous and more proximal carotid artery injections. Furthermore, selective injection gave a dramatically improved contrast between the brain and extracranial tissue. Intra-arterial injection increases the cerebral uptake of a radiotracer dramatically compared to systemic injection. This technique has potential applications for endovascular treatment of malignancies allowing intra-interventional modifications of injection strategy, based on information on tumor perfusion and risk to surrounding normal parenchyma. Furthermore the technique may increase diagnostic sensitivity and avoid problems due to peripheral pharmacological barriers and first passage metabolism of labile tracers. (orig.)

Heat stress redistributes blood flow in arteries of the brain during dynamic exercise.

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Sato, Kohei; Oue, Anna; Yoneya, Marina; Sadamoto, Tomoko; Ogoh, Shigehiko

2016-04-01

We hypothesized that heat stress would decrease anterior and posterior cerebral blood flow (CBF) during exercise, and the reduction in anterior CBF would be partly associated with large increase in extracranial blood flow (BF). Nine subjects performed 40 min of semirecumbent cycling at 60% of the peak oxygen uptake in hot (35°C; Heat) and thermoneutral environments (25°C; Control). We evaluated BF and conductance (COND) in the external carotid artery (ECA), internal carotid artery (ICA), and vertebral artery (VA) using ultrasonography. During the Heat condition, ICA and VA BF were significantly increased 10 min after the start of exercise (P Heat. Compared with the Control, either BF or COND of ICA and VA at the end of Heat tended to be lower, but not significantly. In contrast, ECA BF and COND at the end of Heat were both higher than levels in the Control condition (P Heat, a reduction in ICA BF appears to be associated with a decline in end-tidal CO2 tension (r = 0.84), whereas VA BF appears to be affected by a change in cardiac output (r = 0.87). In addition, a change in ECA BF during Heat was negatively correlated with a change in ICA BF (r = -0.75). Heat stress resulted in modification of the vascular response of head and brain arteries to exercise, which resulted in an alteration in the distribution of cardiac output. Moreover, a hyperthermia-induced increase in extracranial BF might compromise anterior CBF during exercise with heat stress. Copyright © 2016 the American Physiological Society.

Treatment of symptomatic isolated dissection of superior mesenteric artery.

Science.gov (United States)

Dong, Zhihui; Fu, Weiguo; Chen, Bin; Guo, Daqiao; Xu, Xin; Wang, Yuqi

2013-02-01

To present the short- to midterm outcomes after management of 14 patients with symptomatic isolated dissection of superior mesenteric artery (SIDSMA) and propose a preliminary treatment algorithm. SIDSMA is a rare but potentially fatal entity. However, most of these reports were isolated case reports, and a consensus treatment protocol remains lacking so far. It would be meaningful to propose a reasonable treatment algorithm for it. Patients with SIDSMA who were treated in our center between July 2007 and June 2011 were retrospectively collected and analyzed. Based upon the abdominal pain and signs, the clinical manifestations have been retrospectively classified into grade I (peritonitis absent) and grade II (peritonitis present). Medical treatment mainly included anticoagulation, antiplatelet, and bowel rest. Endovascular stent placement and surgical fenestration with exploratory laparotomy have been selected according to the grade classification. Computed tomographic angiography, magnetic resonance angiography, or duplex scans have been used for diagnosis and follow-up. Fourteen consecutive patients with SIDSMA were collected; among them, 13 cases belonged to grade I and one to grade II. The mean duration from the onset to the admission was 12 ± 12 days (range, 0.5-45 days). The mean distance from the primary tear to the ostium of superior mesenteric artery (SMA) was 26 ± 4 mm (range, 15-32 mm). Medical treatment was given for 13 patients of grade I for the first 3 to 5 days after admission, and the abdominal pain remarkably or completely resolved in four patients who received continued medical treatment, whereas the other unresolved nine patients were converted to endovascular stent placement that succeeded in four and failed in five patients. Since these five cases were free from peritoneal signs, medical treatment was given again instead of an immediate surgical intervention, and ultimately achieved complete alleviation of abdominal pain within the

Absent right common carotid artery associated with aberrant right subclavian artery.

Science.gov (United States)

Uchino, Akira; Uwabe, Kazuhiko; Osawa, Iichiro

2018-06-01

Rarely, the external and internal carotid arteries arise separately from the brachiocephalic trunk and right subclavian artery (SA) or the aortic arch and reflect the absence of a common carotid artery (CCA). We report a 45-year-old man with absent right CCA associated with aberrant right SA, an extremely rare combination, diagnosed by computed tomography (CT) angiography during follow-up for postoperative aortic dissection. Retrospective careful observation of preoperative postcontrast CT revealed the absent right CCA. Previously reported arch variations associated with absent CCA include cervical aortic arch, double aortic arch, and right aortic arch.

Bilateral triple renal arteries

International Nuclear Information System (INIS)

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

2009-01-01

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

Cerebral metabolism of patients with stenosis or occlusion of the internal carotid artery. A 1H-MR spectroscopic imaging study

NARCIS (Netherlands)

van der Grond, J.; Balm, R.; Kappelle, L. J.; Eikelboom, B. C.; Mali, W. P.

1995-01-01

BACKGROUND AND PURPOSE: Occlusion or severe stenosis of extracranial vessels may lead to hypoperfusion without overt infarction of brain tissue. The aim of this study was to investigate whether occlusion of the internal carotid artery or stenosis with reduction in diameter of more than 70% leads to

Internal Carotid Artery Hypoplasia: Role of Color-Coded Carotid Duplex Sonography.

Science.gov (United States)

Chen, Pei-Ya; Liu, Hung-Yu; Lim, Kun-Eng; Lin, Shinn-Kuang

2015-10-01

The purpose of this study was to determine the role of color-coded carotid duplex sonography for diagnosis of internal carotid artery hypoplasia. We retrospectively reviewed 25,000 color-coded carotid duplex sonograms in our neurosonographic database to establish more diagnostic criteria for internal carotid artery hypoplasia. A definitive diagnosis of internal carotid artery hypoplasia was made in 9 patients. Diagnostic findings on color-coded carotid duplex imaging include a long segmental small-caliber lumen (52% diameter) with markedly decreased flow (13% flow volume) in the affected internal carotid artery relative to the contralateral side but without intraluminal lesions. Indirect findings included markedly increased total flow volume (an increase of 133%) in both vertebral arteries, antegrade ipsilateral ophthalmic arterial flow, and a reduced vessel diameter with increased flow resistance in the ipsilateral common carotid artery. Ten patients with distal internal carotid artery dissection showed a similar color-coded duplex pattern, but the reductions in the internal and common carotid artery diameters and increase in collateral flow from the vertebral artery were less prominent than those in hypoplasia. The ipsilateral ophthalmic arterial flow was retrograde in 40% of patients with distal internal carotid artery dissection. In addition, thin-section axial and sagittal computed tomograms of the skull base could show the small diameter of the carotid canal in internal carotid artery hypoplasia and help distinguish hypoplasia from distal internal carotid artery dissection. Color-coded carotid duplex sonography provides important clues for establishing a diagnosis of internal carotid artery hypoplasia. A hypoplastic carotid canal can be shown by thin-section axial and sagittal skull base computed tomography to confirm the final diagnosis. © 2015 by the American Institute of Ultrasound in Medicine.

Decreased expression of fibulin-4 in aortic wall of aortic dissection.

Science.gov (United States)

Huawei, P; Qian, C; Chuan, T; Lei, L; Laing, W; Wenlong, X; Wenzhi, L

2014-02-01

In this research, we will examine the expression of Fibulin-4 in aortic wall to find out its role in aortic dissection development. The samples of aortic wall were obtained from 10 patients operated for acute ascending aortic dissection and five patients for chronic ascending aortic dissection. Another 15 pieces of samples from patients who had coronary artery bypass were as controls. The aortic samples were stained with aldehyde magenta dyeing to evaluate the arrangement of elastic fibers. The Fibulin-4 protein and mRNA expression were both determined by Western blot and realtime quantitative polymerase chain reaction. Compared with the control group, both in acute and chronic ascending aortic dissection, elastic fiber fragments increased and the expression of fibulin-4 protein significantly decreased (P= 0.045 < 0.05). The level of fibulin-4 mRNA decreased in acute ascending aortic dissection (P= 0.034 < 0.05), while it increased in chronic ascending aortic dissection (P=0.004 < 0.05). The increased amounts of elastic fiber fragments were negatively correlated with the expression of fibulin-4 mRNA in acute ascending aortic dissection. In conclusion, in aortic wall of ascending aortic dissection, the expression of fibulin-4 protein decreased and the expression of fibulin-4 mRNA was abnormal. Fibulin-4 may play an important role in the pathogenesis of aortic dissection.

A Unique Branching Pattern of the Axillary Artery: A Case Report

OpenAIRE

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

2013-01-01

During routine dissection classes for under graduate students, we found a unique and unusual case regarding the anomalous branching in the third part of the axillary artery was terminated into subscapular arterial trunk, superficial brachial artery and deep brachial artery. The subscapular arterial trunk was origin of several important arteries as the circumflex scapular, thoracodorsal, posterior circumflex humeral, thoraco-acromial and lateral thoracic arteries. The deep brachial artery in t...

En bloc resection of skull base tumor including internal carotid artery. Preoperative evaluation of cerebral blood flow

International Nuclear Information System (INIS)

Okamoto, Yoshitaka; Matsuzaki, Zensei; Kamijo, Atsushi; Ogino, Jun; Nagaseki, Yoshishige; Nukui, Hideaki; Yokomizo, Michinori; Togawa, Kiyoshi

1998-01-01

Carotid artery resection yields a possibility of cure in patients with advanced head and neck carcinoma involving the carotid artery. However, the criteria for the identification of those who are vulnerable to neurologic injury after resection have not been established. Interposition graft covered with a well-vascularized flap could minimize the rate of perioperative morbidity. Particularly, when an extensive resection of the skull base including carotid artery and sigmoid vein, is planned, extracranial-intracranial bypass should be considered to minimize the risks of neurologic morbidity, even if preresection positron emission tomography during balloon test occlusion of internal carotid artery suggested the adequacy of hemispheric collateral blood flow. In these cases, the temporary occlusion of the carotid artery is not an accurate prediction of the morbidity after permanent occlusion. (author)

Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association.

Science.gov (United States)

Hayes, Sharonne N; Kim, Esther S H; Saw, Jacqueline; Adlam, David; Arslanian-Engoren, Cynthia; Economy, Katherine E; Ganesh, Santhi K; Gulati, Rajiv; Lindsay, Mark E; Mieres, Jennifer H; Naderi, Sahar; Shah, Svati; Thaler, David E; Tweet, Marysia S; Wood, Malissa J

2018-05-08

Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. Patient-initiated research has spurred increased awareness of SCAD, and improved diagnostic capabilities and findings from large case series have led to changes in approaches to initial and long-term management and increasing evidence that SCAD not only is more common than previously believed but also must be evaluated and treated differently from atherosclerotic myocardial infarction. High rates of recurrent SCAD; its association with female sex, pregnancy, and physical and emotional stress triggers; and concurrent systemic arteriopathies, particularly fibromuscular dysplasia, highlight the differences in clinical characteristics of SCAD compared with atherosclerotic disease. Recent insights into the causes of, clinical course of, treatment options for, outcomes of, and associated conditions of SCAD and the many persistent knowledge gaps are presented. © 2018 American Heart Association, Inc.

Peri-stent aneurysm formation following a stent implant for stenotic intracranial vertebral artery dissection: a technical report of two cases successfully treated with coil embolization.

Science.gov (United States)

Ishimaru, Hideki; Nakashima, Kazuaki; Takahata, Hideaki; Matsuoka, Yohjiro

2013-02-01

Although stenting for stenotic vertebral artery dissection (VAD) improves compromised blood flow, subsequent peri-stent aneurysm (PSA) formation is not well-known. We report two cases with PSA successfully treated with coil embolization. Three patients with stenotic intracranial VAD underwent endovascular angioplasty at our institution because they had acute infarction in posterior circulation territory and clinical evidence of hemodynamic insufficiency. In two of three patients balloon angioplasty at first session failed to relieve the stenosis, and a coronary stent was implanted. Angiography immediately after stenting showed no abnormality in case 1 and minimal slit-like projection at proximal portion of the stent in case 2. Angiography obtained 16 months after the stenting revealed PSA in case 1. In case 2, angiography performed 3 months later showed that the projection at proximal portion enlarged and formed an aneurysm outside the stent. Because follow-up angiographies showed growth of the aneurysm in both cases, endovascular aneurysmal embolization was performed. We advanced a microcatheter into the aneurysm through the strut of existing stent and delivered detachable coils into the aneurysm lumen successfully in both cases. The post-procedural course was uneventful, and complete obliteration of aneurysm was confirmed on angiography in both cases. Stenting for stenotic intracranial VAD may result in delayed PSA; therefore, follow-up angiographies would be necessary after stenting for stenotic intracranial arterial dissection. Coil embolization through the stent strut would be a solution for enlarging PSA.

Spontaneous coronary dissection: case report

OpenAIRE

Couto, Gustavo J. Ventura; Deslandes, Alexandre de O.; Santos, Paulo César de Souza; Cruz, Alexandre de Araújo; Saraiva, Roberto Santos

2007-01-01

O objetivo do trabalho é demonstrar o caso de um homem de 62 anos, com quadro de dissecção coronariana espontânea, localizada em 1/3 inicial de coronária circunflexa esquerda, tratado cirurgicamente com revascularização miocárdica. A operação realizada com sucesso demonstra, nesse caso, ser o único meio possível de cura.The purpose of the paper is to demonstrate the case of a 62-year-old man, with spontaneous coronary dissection of the left circumflex artery, treated surgically by myocardial ...

Visceral hybrid reconstruction of thoracoabdominal aortic aneurysm after open repair of type a aortic dissection by the Bentall procedure with the elephant trunk technique: A case report

Directory of Open Access Journals (Sweden)

Marjanović Ivan

2014-01-01

Full Text Available Introduction. Reconstruction of chronic type B dissection and thoracoabdominal aortic aneurysm (TAAA remaining after the emergency reconstruction of the ascending thoracic aorta and aortic arch for acute type A dissection represents one of the major surgical challenges. Complications of chronic type B dissection are aneurysmal formation and rupture of an aortic aneurysm with a high mortality rate. We presented a case of visceral hybrid reconstruction of TAAA secondary to chronic dissection type B after the Bentall procedure with the elephant trunk technique due to acute type A aortic dissection in a high-risk patient. Case report. A 62 year-old woman was admitted to our institution for reconstruction of Crawford type I TAAA secondary to chronic dissection. The patient had had an acute type A aortic dissection 3 years before and undergone reconstruction by the Bentall procedure with the elephant trunk technique with valve replacement. On admission the patient had coronary artery disease (myocardial infarction, two times in the past 3 years, congestive heart disease with ejection fraction of 25% and chronic obstructive pulmonary disease. On computed tomography (CT of the aorta TAAA was revealed with a maximum diameter of 93 mm in the descending thoracic aorta secondary to chronic dissection. All the visceral arteries originated from the true lumen with exception of the celiac artery (CA, and the end of chronic dissection was below the origin of the superior mesenteric artery (SMA. The patient was operated on using surgical visceral reconstruction of the SMA, CA and the right renal artery (RRA as the first procedure. Postoperative course was without complications. Endovascular TAAA reconstruction was performed as the second procedure one month later, when the elephant trunk was used as the proximal landing zone for the endograft, and distal landing zone was the level of origin of the RRA. Postoperatively, the patient had no neurological deficit and

Standing tall after DeBakey Type I aortic dissection extending to left iliac artery

Science.gov (United States)

Natarajan, Deepak; Natarajan, Nalin

2015-01-01

This report describes DeBakey Type I aortic dissection in a middle-aged hypertensive female who had undergone mitral tissue valve replacement a decade previously. The patient had severe abrupt onset tearing pain in her throat, back, and chest, for which she got admitted in a community hospital, where because of no changes in her ECG and biomarkers, the dissection of aorta was missed. She was subjected to coronary angiography more than 6 weeks later for pain in her left shoulder, which demonstrated normal vessels. She then underwent multi-detector computerised tomography aortogram (MD CTA) that revealed aortic dissection involving ascending, the arch, and descending thoracic and abdominal aorta. The patient declined surgical intervention and has been provided medical therapy in the form of high dose oral beta-blocker and losartan. The patient continues to be stable for the past 18 weeks since the index event. The report highlights the importance of detecting aortic dissection by keeping high index of clinical suspicion in a patient with abrupt onset tearing pain in the throat/back and employment of MD CTA. PMID:26702700

Standing tall after DeBakey Type I aortic dissection extending to left iliac artery

Directory of Open Access Journals (Sweden)

Deepak Natarajan

2015-11-01

Full Text Available This report describes DeBakey Type I aortic dissection in a middle-aged hypertensive female who had undergone mitral tissue valve replacement a decade previously. The patient had severe abrupt onset tearing pain in her throat, back, and chest, for which she got admitted in a community hospital, where because of no changes in her ECG and biomarkers, the dissection of aorta was missed. She was subjected to coronary angiography more than 6 weeks later for pain in her left shoulder, which demonstrated normal vessels. She then underwent multi-detector computerised tomography aortogram (MD CTA that revealed aortic dissection involving ascending, the arch, and descending thoracic and abdominal aorta. The patient declined surgical intervention and has been provided medical therapy in the form of high dose oral beta-blocker and losartan. The patient continues to be stable for the past 18 weeks since the index event. The report highlights the importance of detecting aortic dissection by keeping high index of clinical suspicion in a patient with abrupt onset tearing pain in the throat/back and employment of MD CTA.

The effect of transluminal stent-graft placement on blood flow of abdominal branch vessels in type B aortic dissection

International Nuclear Information System (INIS)

Huang Lianjun; Yang Jian; Yu Feicheng; Sun Lizhong; Zhu Junming; Zhang Yan; Jiang Shiliang

2005-01-01

Objective: To evaluate the effect of TSGP on blood flow of abdominal branch vessels of Type B dissection. Methods: Thirty-five patients with type B aortic dissection underwent TSGP. The blood flow of abdominal branch vessels was analyzed via EBCT, MRI, and DSA before and after procedure. Results: A total of 140 important vessels from abdominal aorta in 35 patients, including celiac artery, SMA, right and left renal arteries were analyzed via EBCT, MRI, and DSA. 58 branches were affected by dissection, of which 14 (10% ) were dynamic impairment; and 44 (31.4%) were static impairment. After TSGP, the blood flow of impaired branches all showed improvement at different degrees, no post-operative ischemic complications occurred. Conclusion: TSGP could improve the blood flow immediately not only the dynamic but also the static ischemia of abdominal aorta branch vessels caused by type B aortic dissection. Further study is still need to observe the mid-term and long-term effect of TSGP. (authors)

Flow-diverting Stent in the Treatment of Cervical Carotid Dissection and Pseudoaneurysm: Review of Literature and Case Report.

Science.gov (United States)

Baptista-Sincos, Anna Paula Weinhardt; Simplício, Aline Bigatão; Sincos, Igor Rafael; Leaderman, Alex; Neto, Fernando Saliture; Moraes, Adjaldes; Aun, Ricardo

2018-01-01

The endovascular technique has been recommended over the past few years to extracranial carotid dissection and pseudoaneurysm with promising results, especially after medical therapy failure. Flow-diverting stents are an alternative for complex cases. These stents have proven to be effective treatment devices for intracranial aneurysms. The reference list of Pham's systematic review, published in 2011, and Seward's literature review, published in 2015, was considered, as well as all new articles with eligible features. Search was conducted on specific databases: MEDLINE and Literatura Latino-Americana e do Caribe em Ciências da Saúde. For carotid dissection and pseudoaneurysm, our review yielded 3 published articles including 12 patients. The technical success rate of flow-diverting stent was 100% with no procedural complication described. Mean clinical follow-up was 27.2 months (range 5-48), and in 5 months' angiographic follow-up, all lesions had healed. No new neurological events were reported during the clinical follow-up. Flow diverter stent use on intracranial and peripheral vascular surgery demonstrates satisfactory initial results, but it is still under investigation. There are very few cases treated till now and the initial results with flow-diverting stents to cervical carotid dissection are promising. In well-selected cases, where simple embolization or conventional stent is not appropriate, this technic may be considered. Copyright © 2017 Elsevier Inc. All rights reserved.

Familial Thoracic Aortic Aneurysm with Dissection Presenting as Flash Pulmonary Edema in a 26-Year-Old Man

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Sabry Omar

2014-01-01

Full Text Available We are reporting a case of familial thoracic aortic aneurysm and dissection in a 26-year-old man with no significant past medical history and a family history of dissecting aortic aneurysm in his mother at the age of 40. The patient presented with cough, shortness of breath, and chest pain. Chest X-ray showed bilateral pulmonary infiltrates. CT scan of the chest showed a dissection of the ascending aorta. The patient underwent aortic dissection repair and three months later he returned to our hospital with new complaints of back pain. CT angiography showed a new aortic dissection extending from the left carotid artery through the bifurcation and into the iliac arteries. The patient underwent replacement of the aortic root, ascending aorta, total aortic arch, and aortic valve. The patient recovered well postoperatively. Genetic studies of the patient and his children revealed no mutations in ACTA2, TGFBR1, TGFBR2, TGFB2, MYH11, MYLK, SMAD3, or FBN1. This case report focuses on a patient with familial TAAD and discusses the associated genetic loci and available screening methods. It is important to recognize potential cases of familial TAAD and understand the available screening methods since early diagnosis allows appropriate management of risk factors and treatment when necessary.

[Management of Acute Type A Dissection Complicated with Acute Mesenteric Ischemia].

Science.gov (United States)

Abe, Tomonobu; Usui, Akihiko

2017-07-01

Acute mesenteric ischemia as malperfusion syndrome associated with acute aortic dissection is a difficult situation. The incidence is approximately 3~4% in acute type A dissection. Traditionally, most of these patients underwent immediate simple central aortic repair expecting that mesenteric artery obstruction and intestinal ischemia would be resolved by simple central aortic repair. However, short term mortality has been reported very high in this strategy. With the aid of rapidly progressing imaging techniques and newer endovascular repair techniques, results seem to be improving in recent years. Newer management strategy include aggressive and patient specific revascularization to the mesenteric arteries, delayed central aortic repair, and meticulous intensive care. Diagnosis and management of this condition require high level of expertise. Cardiac surgeons, vascular surgeons, interventional radiologists, gastroenterologists, general surgeons, anesthesiologists, intensivists must corporate to save these patients' lives. Since this is a relatively rare condition, scientific evidence is insufficient to make robust recommendations. Further studies are warranted.

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

Science.gov (United States)

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

2000-11-01

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

Early control of distal internal carotid artery during carotid endarterectomy: does it reduce cerebral microemboli?

Science.gov (United States)

Mommertz, G; Das, M; Langer, S; Koeppel, T A; Krings, T; Mess, W H; Schiefer, J; Jacobs, M J

2010-06-01

According to the results of the large trials on carotid endarterectomy (CEA), this type of surgery is only warranted if perioperative mortality and morbidity are kept considerably low. Less attention has been paid to methods of cerebral protection during CEA, although intraoperative transcranial Doppler (TCD) can visualise intracerebral microemboli (MES) during routine carotid dissection, although MES occur throughout the CEA, only those during dissection are related to neurological outcome. Prevention of MES by means of early control of the distal internal carotid artery dislodging from the carotid artery plaque during dissection is very likely the mechanism behind an eventual benefit from this approach. Hence, the amount of MES might serve as a surrogate parameter for the risk of periprocedural neurological events. So, the aim of the present study was to evaluate whether early control of the distal carotid artery during CEA is capable of reducing the number of MES by means of a prospective randomised trial. Twenty-eight patients (29 procedures) could be prospectively included in our study. Before surgery we randomly assigned the patients to two groups: group A (N.=12): CEA by means of early control of the distal internal carotid artery; group B (N.=17): CEA with dissection of the total carotid bifurcation before clamping the arteries. Periprocedurally, we continuously monitored the cerebral blood flow in the ipsilateral middle cerebral artery by means of TCD. Pre- and postoperative morbidity were independently verified by a neurologist control of the distal internal carotid artery did not reduce the occurrence of MES during dissection of the carotid bifurcation. Also, the total number of MES throughout the procedure and postoperatively was comparable between both groups. The procedure related times as well as the clinical outcome did not differ significantly. Thus, early control of the distal internal carotid artery has got no advantage but also no disadvantage

The arterial supply of the thymus in dogs

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Frederico Ozanan Carneiro e Silva

1994-06-01

Full Text Available There were observed the origin, the number and the ordering of the thymic vessels in 30 dogs fetuses, by dissection after injection with Neoprene latex 450 solution and fixation with formalin solution at 10%. The results permited to conclude that: the thymic arteries come, directly and indirectly, from the internal thoracic arteries, brachiocephalic trunk, pericardicophrenics arteries, costocervicals trunks and subclavian arteries, wich combined by theirself given from five to fourteen contributions that showed a own vascularization model for each organ.

CT of extracranial hemorrhage and hematomas

International Nuclear Information System (INIS)

Swensen, S.J.; McLeod, R.A.; Stephens, D.H.

1984-01-01

Computed tomography was used to examine 100 patients with extracranial hemorrhage. Of these patients, 29 had serial scans that allowed for the study of evolutionary changes. Operation, anticoagulation, and trauma were the prime etiological factors. The most frequent sites included the retroperitoneum (27%), body wall or extremities (24%), peritoneal cavity (19%), and subcapsular (16%) and intraparenchymal (7%) locations. The computed tomographic features were carefully studied and documented. Age-related features included contrast-material extravasation, inhomogeneity, hematocrit effect, attenuation changes, lucent halo, pseudocapsule development, decreased size with time, peripheral calcification, and fascial plane thickening. This report discussed all these findings and their usefulness in diagnosis and patient care

Dose-dependent headache response and dilatation of limb and extracranial arteries after three doses of 5-isosorbide-mononitrate

DEFF Research Database (Denmark)

Iversen, Helle Klingenberg; Nielsen, T H; Garre, K

1992-01-01

of the temporal artery, but not for the radial artery. It is concluded that headache after 5-ISMN is caused by arterial dilatation or by mechanisms responsible for the arterial dilatation. Ultrasound monitoring of arterial diameters is an important and sensitive tool in the evaluation of nitrates and other...... and placebo on separate days. The diameters of the radial and superficial temporal arteries were repeatedly measured with high frequency ultrasound and pain was scored using a 10 point verbal scale. A clear dose-relationship was found for plasma concentrations and headache, and for changes in the diameter...

Robust frameless stereotactic localization in extra-cranial radiotherapy

International Nuclear Information System (INIS)

Riboldi, Marco; Baroni, Guido; Spadea, Maria Francesca; Bassanini, Fabio; Tagaste, Barbara; Garibaldi, Cristina; Orecchia, Roberto; Pedotti, Antonio

2006-01-01

In the field of extra-cranial radiotherapy, several inaccuracies can make the application of frameless stereotactic localization techniques error-prone. When optical tracking systems based on surface fiducials are used, inter- and intra-fractional uncertainties in marker three-dimensional (3D) detection may lead to inexact tumor position estimation, resulting in erroneous patient setup. This is due to the fact that external fiducials misdetection results in deformation effects that are poorly handled in a rigid-body approach. In this work, the performance of two frameless stereotactic localization algorithms for 3D tumor position reconstruction in extra-cranial radiotherapy has been specifically tested. Two strategies, unweighted versus weighted, for stereotactic tumor localization were examined by exploiting data coming from 46 patients treated for extra-cranial lesions. Measured isocenter displacements and rotations were combined to define isocentric procedures, featuring 6 degrees of freedom, for correcting patient alignment (isocentric positioning correction). The sensitivity of the algorithms to uncertainties in the 3D localization of fiducials was investigated by means of 184 numerical simulations. The performance of the implemented isocentric positioning correction was compared to conventional point-based registration. The isocentric positioning correction algorithm was tested on a clinical dataset of inter-fractional and intra-fractional setup errors, which was collected by means of an optical tracker on the same group of patients. The weighted strategy exhibited a lower sensitivity to fiducial localization errors in simulated misalignments than those of the unweighted strategy. Isocenter 3D displacements provided by the weighted strategy were consistently smaller than those featured by the unweighted strategy. The peak decrease in median and quartile values of isocenter 3D displacements were 1.4 and 2.7 mm, respectively. Concerning clinical data, the

The role of colour doppler ultrasonography of facial and occipital arteries in patients with giant cell arteritis: A prospective study.

Science.gov (United States)

Ješe, Rok; Rotar, Žiga; Tomšič, Matija; Hočevar, Alojzija

2017-10-01

Colour Doppler Sonography (CDS) in giant cell arteritis (GCA) allows the study of involvement of cranial arteries other than the temporal arteries, which are inconvenient to biopsy, such as the facial (FaA), and occipital (OcA) arteries. We aimed to estimate the frequency of the FaA, and OcA involvement in GCA; and to explore the clinical characteristics of these subgroups of patients. From 1 January 2014 to 31 December 2016 we prospectively performed a CDS of the FaA, and OcA in addition to the temporal (TA), and the extracranial supra-aortic arteries in all newly diagnosed patients suspected of having GCA. All the arteries were evaluated in two planes for the highly specific halo sign. During the 36-month observation period we performed a CDS of the cranial and extra-cranial arteries in 93 GCA patients. We observed the halo sign on the FaA, and OcA in 38 (40.9%), and 29 (31.2%) cases, respectively. The FaA, or OcA were affected in 4/22 (18.2%) patients with a negative TA CDS. FaA involvement significantly correlated with jaw claudication and with severe visual manifestations, including permanent visual loss. A fifth of patients with a negative CDS of the TAs had signs of vasculitis on the CDS of the FaA, or OcA. The addition of FaA and OcA CDS to the routine CDS of the TAs could identify 4.3% more patients and thus further improve the sensitivity of the CDS in the suspected GCA. Copyright © 2017 Elsevier B.V. All rights reserved.

Factors Affecting Optimal Aortic Remodeling After Thoracic Endovascular Aortic Repair of Type B (IIIb) Aortic Dissection

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Chen, I-Ming [National Yang Ming University, Institute of Clinical Medicine, School of Medicine (China); Chen, Po-Lin; Huang, Chun-Yang [National Yang Ming University, Department of Medicine, School of Medicine (China); Weng, Shih-Hsien; Chen, Wei-Yuan; Shih, Chun-Che, E-mail: ccshih@vghtpe.gov.tw [National Yang Ming University, Institute of Clinical Medicine, School of Medicine (China)

2017-05-15

PurposeThe purpose of this study was to determine factors associated with entire aortic remodeling after thoracic endovascular aortic repair (TEVAR) in patients with type B dissection.Materials and MethodsThe patients with type B (IIIb) dissections who underwent TEVAR from 2006 to 2013 with minimum of 2 years of follow-up computed tomography data were retrospectively reviewed. Based on the status of false lumen remodeling of entire aorta, patients were divided into three groups: complete regression, total thrombosis, and inadequate regression with patent abdominal false lumen.ResultsA total of 90 patients (72 males, 18 females; mean age 56.6 ± 16.4 years) were included and divided into the complete regression (n = 22), total thrombosis (n = 18), and inadequate regression (n = 50) groups. Multivariate logistic regression analysis indicated that dissection extension to iliac arteries, increased preoperative number of dissection tear over abdominal aorta, and decreased preoperative abdominal aorta bifurcation true lumen ratio, as compared between the inadequate and complete regression groups, were associated with a persistent false lumen (odds ratio = 33.33, 2.304, and 0.021; all, p ≤ 0.012). Comparison of 6, 12, and 24 months postoperative data revealed no significant differences at any level, suggesting that the true lumen area ratio might not change after 6 months postoperatively.ConclusionsIncreased preoperative numbers of dissection tear around the abdominal visceral branches, dissection extension to the iliac arteries, and decreased preoperative true lumen area ratio of abdominal aorta are predictive of entire aortic remodeling after TEVAR in patients with type B dissection.Level of EvidenceIII.

Factors Affecting Optimal Aortic Remodeling After Thoracic Endovascular Aortic Repair of Type B (IIIb) Aortic Dissection

International Nuclear Information System (INIS)

Chen, I-Ming; Chen, Po-Lin; Huang, Chun-Yang; Weng, Shih-Hsien; Chen, Wei-Yuan; Shih, Chun-Che

2017-01-01

PurposeThe purpose of this study was to determine factors associated with entire aortic remodeling after thoracic endovascular aortic repair (TEVAR) in patients with type B dissection.Materials and MethodsThe patients with type B (IIIb) dissections who underwent TEVAR from 2006 to 2013 with minimum of 2 years of follow-up computed tomography data were retrospectively reviewed. Based on the status of false lumen remodeling of entire aorta, patients were divided into three groups: complete regression, total thrombosis, and inadequate regression with patent abdominal false lumen.ResultsA total of 90 patients (72 males, 18 females; mean age 56.6 ± 16.4 years) were included and divided into the complete regression (n = 22), total thrombosis (n = 18), and inadequate regression (n = 50) groups. Multivariate logistic regression analysis indicated that dissection extension to iliac arteries, increased preoperative number of dissection tear over abdominal aorta, and decreased preoperative abdominal aorta bifurcation true lumen ratio, as compared between the inadequate and complete regression groups, were associated with a persistent false lumen (odds ratio = 33.33, 2.304, and 0.021; all, p ≤ 0.012). Comparison of 6, 12, and 24 months postoperative data revealed no significant differences at any level, suggesting that the true lumen area ratio might not change after 6 months postoperatively.ConclusionsIncreased preoperative numbers of dissection tear around the abdominal visceral branches, dissection extension to the iliac arteries, and decreased preoperative true lumen area ratio of abdominal aorta are predictive of entire aortic remodeling after TEVAR in patients with type B dissection.Level of EvidenceIII.

Ventricular Septal Dissection Complicating Inferior Wall Myocardial Infarction

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Lindsey Kalvin

2017-01-01

Full Text Available Postmyocardial infarction ventricular septal defect is an increasingly rare mechanical complication of acute myocardial infarction. We present a case of acute myocardial infarction from right coronary artery occlusion that developed hypotension and systolic murmur 12 hours after successful percutaneous coronary intervention. Although preoperative imaging suggested a large ventricular septal defect and a pseudoaneurysm, intraoperative findings concluded a serpiginous dissection of the ventricular septum. The imaging technicalities are discussed.

Multiple Re-entry Closures After TEVAR for Ruptured Chronic Post-dissection Thoraco-abdominal Aortic Aneurysm

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R. Kinoshita

Full Text Available Introduction: Although thoracic endovascular aortic repair (TEVAR has become a promising treatment for complicated acute type B dissection, its role in treating chronic post-dissection thoraco-abdominal aortic aneurysm (TAA is still limited owing to persistent retrograde flow into the false lumen (FL through abdominal or iliac re-entry tears. Report: A case of chronic post-dissection TAA treatment, in which a dilated descending FL ruptured into the left thorax, is described. The primary entry tear was closed by emergency TEVAR and multiple abdominal re-entries were closed by EVAR. In addition, major re-entries at the detached right renal artery and iliac bifurcation were closed using covered stents. To close re-entries as far as possible, EVAR was carried out using the chimney technique, and additional aortic extenders were placed above the coeliac artery. A few re-entries remained, but complete FL thrombosis of the rupture site was achieved. Follow-up computed tomography showed significant shrinkage of the FL. Discussion: In treating post-dissection TAA, entry closure by TEVAR is sometimes insufficient, owing to persistent retrograde flow into the FL from abdominal or iliac re-entries. Adjunctive techniques are needed to close these distal re-entries to obtain complete FL exclusion, especially in rupture cases. Recently, encouraging results of complete coverage of the thoraco-abdominal aorta with fenestrated or branched endografts have been reported; however, the widespread employment of such techniques appears to be limited owing to technical difficulties. The present method with multiple re-entry closures using off the shelf and immediately available devices is an alternative for the endovascular treatment of post-dissection TAA, especially in the emergency setting. Keywords: Aortic dissection, Ruptured aortic aneurysm, Post-dissection thoracoabdominal aortic aneurysm, Endovascular aortic repair, Reentry closure, Endovascular procedures

The relationship of flow velocities to vessel diameters differs between extracranial carotid and vertebral arteries of stroke patients.

Science.gov (United States)

Owolabi, Mayowa O; Agunloye, Atinuke M; Ogunniyi, Adesola

2014-01-01

Chronic changes in flow rate through arteries produce adjustment of arterial diameters. We compared the relationship between flow velocity and diameter in the carotid and in the vertebral arteries of stroke patients. Using triplex ultrasonography, the internal diameter and flow velocities of the common carotid, internal carotid, and vertebral arteries of 176 consecutive stroke patients were measured. Correlations were examined with Pearson's statistics at an alpha level of 0.05. Mean age of the patients was 59.3 ± 12 years, and 66% had cerebral infarcts. Diameter and blood flow velocities showed significant negative correlations (-0.115 ≥ r ≥ -0.382) in the carotid arteries on both sides, but positive correlations (0.211 ≤ r ≤ 0.320) in the vertebral arteries, even after controlling for age, gender, and blood pressure. Our study demonstrated different diameter/flow relationships in the carotid and the vertebral arteries of stroke patients, which may suggest pathologic changes in the adaptive processes governing vessel diameter and growth, especially in the carotid arteries. Copyright © 2013 Wiley Periodicals, Inc.

Acute Aortic Dissection Mimicking STEMI in the Catheterization Laboratory: Early Recognition Is Mandatory

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Alessio Arrivi

2012-01-01

Full Text Available Coronary malperfusion due to type A aortic dissection is a life-threatening condition where timely recognition and treatment are mandatory. A 77-year-old woman underwent an acute evolving type A aortic dissection mimicking acute myocardial infarction. Two pathophysiologic mechanisms are discussed: either thrombosis migrating from a previously treated giant aneurism of proximal left anterior descending or a local arterial complication due to left main stenting. Recognition of these occurrences in the catheterization laboratory is important to look immediately for surgery.

Case report: Iatrogenic brachial artery dissection with complete anterograde occlusion during elective arterial line placement

Directory of Open Access Journals (Sweden)

Laurence Weinberg

2018-01-01

Conclusion: We review our diagnostic pathway and treatment of this rare complication. Recommendations to minimise the risks of complications from brachial arterial line insertion are also overviewed. We recommend the routine utilization of ultrasound-guided technique and regular post-insertion neurovascular monitoring for the prevention and early recognition of complications from brachial artery catheter insertion.

Antiangiogenic Therapies and Extracranial Metastasis in Glioblastoma: A Case Report and Review of the Literature

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Mohamed H. Khattab

2015-01-01

Full Text Available We present a case report of a patient with glioblastoma multiforme (GBM complicated by extracranial metastasis (ECM whose survival of nearly four years surpassed the anticipated life expectancy given numerous negative prognostic factors including EGFRvIII-mutation, unmethylated MGMT promoter status, and ECM. Interestingly, while this patient suffered from locally aggressive disease with multiple intracranial recurrences, the proximal cause of death was progressive extracranial disease and complications related to pulmonary metastases. Herein, we review potential mechanisms of ECM with an emphasis upon glioblastoma molecular and genetic profiles and the potential implications of targeted agents such as bevacizumab.

Spontaneous Arterial Dissection—Risk Factors And Clinical Features: Study Of 70 Cases And Review Of Literature

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Haniyeh Javanmardi

2017-02-01

Full Text Available Dissection refers to a serious condition that begin as a tear or rupture in the inner layers of large vessel wall. Tear allows the blood to surges through the layers, leads to intramural hematoma or an aneurysmal dilatation, either of which can be a source of thromboembolism. Ischemic symptoms in surrounding structures are more often secondary to embolism. Dissections are labeled spontaneous in the absence of major blunt or penetrating trauma. The incidence rates for spontaneous carotid artery dissection have been reported to be 2.5 to 3 per 100,000 population. The average annual incidence for vertebral artery dissection were calculated to be 1 to 1.5 per 100,000. Typical clinical features seen with dissection include unilateral headache, ipsilateral Homer's syndrome, oculosympathetic palsy, prominent neck and facial pain, retinal ischemia, and symptoms of focal brain ischemia due to the site of dissection. The reason of dissection occurrence is still unknown but numerous factors e.g. connective tissue disorders, hyperhomocystinemia, fibromuscular dysplasia, recent infection, etc. may underlie spontaneous or minor trauma dissections. Patients with Spontaneous dissection are more susceptible to developing to stroke and its morbidity and mortality.     In this retrospective study, we evaluate the clinical features, risk factors, treatment and outcome of spontaneous dissection in 70 patients (31 female and 39 male, referred to Namazi hospital between September 2012 and September 2016. The diagnosis of arterial dissection was established by qualified physicians according to radiological and clinical features. Patients with traumatic dissection and a history of major or minor head and neck injury were excluded. Subjects were observed for multiple risk factors such as age dependent risk factors, family history of venous thrombosis, history of trauma, coagulopathies, infectious diseases, systemic disorders, arterio-venous malformations and

Unusual presentation of aortic dissection: Post-coital acute paraplegia with renal failure

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Dinith P Galabada

2014-01-01

Full Text Available We report the case of a 45-year-old chronic smoker who presented with acute paraplegia occurring during coitus and subsequently developed acute renal failure (ARF requiring dialysis. He had absent peripheral pulses in the lower limbs with evidence of acute ischemia. Doppler study showed dissecting aneurysm of thoracic aorta, thrombotic occlusion of the distal aorta from L1 level up to bifurcation and occlusion of the right renal artery by a thrombus that was confirmed by magnetic resonance imaging of the spine. He was not subjected to any vascular intervention as his lower limbs were not salvageable due to delay in the diagnosis. Post-coital aortic dissection and aortic dissection presenting with acute paraplegia and ARF are very rare. This is probably the first case report with post-coital acute aortic dissection presenting with paraplegia and ARF. This case emphasizes the importance of a careful examination of peripheral pulses in patients presenting with ARF and paraplegia.

Arterial supply of the intestines of New Zealand rabbits (Oryctolagus cuniculus

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Leandro Marcel Fernandes Cortellini

2008-03-01

Full Text Available The origin and ramification patterns of the intestinal arteries of rabbits were studied. The vessels were injected with a latex solution before dissection in 20 adult specimens. The cranial mesenteric artery originates from the abdominal aorta and gives off the following arteries: pancreatic branches; caudal pancreaticoduodenal; colic medium; jejunal (with variable number, ileocolic arteries, the colic branches, and ileal branches. The caudal mesenteric artery originates next to the end of the abdominal aorta and off a left colic artery that gives origin to the sigmoidal arteries and a cranial rectal artery.

Pure NOTES rectosigmoid resection: transgastric endoscopic IMA dissection and transanal rectal mobilization in animal models.

Science.gov (United States)

Park, Sun Jin; Lee, Kil Yeon; Choi, Sung Il; Kang, Byung Mo; Huh, Chang; Choi, Dong Hyun; Lee, Chang Kyun

2013-07-01

We report a pure natural orifice translumenal endoscopic surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and the Society of American Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) rectosigmoidectomy in animal models using transgastric endoscopic inferior mesenteric artery (IMA) dissection and transanal rectal mobilization. Ten live animals (2 pigs weighing 35-40 kg each and 8 dogs weighing 25-30 kg each) were used. A gastrotomy was made using a needle-knife puncture and the balloon dilatation technique or following the creation of a submucosal tunnel. A circular stapler shaft was transanally inserted up to the sigmoid colon for spatial orientation and traction of the mesocolon. The IMA was endoscopically dissected using a Coagrasper™ (Olympus, Tokyo, Japan) and then clipped. Endoscopic division of the sigmoid mesocolon was conducted laterally toward the marginal artery. Transanal full-thickness circumferential rectal and mesorectal dissections were performed, and a colorectal anastomosis was performed using a circular stapler with a single stapling technique. During the transanal approach, the gastrotomy was closed using four endoscopic clips. Endoscopic dissection of the IMA was successful in all cases, but minor bleedings occurred in 3 cases. The mean time from dissection and clipping to division of the IMA was 36.7 minutes (range, 25-45 minutes). The mean operation time was 180.5 minutes (range, 145-210 minutes). There were no intraoperative complications or hemodynamic instability. The mean length of the resected specimen was 11.2 cm (range, 9-17 cm). A pure NOTES approach to rectosigmoid resection using transgastric endoscopic IMA dissection is technically feasible in animal models.

CHARACTERIZATION OF PATIENTS WITH ENDOVASCULAR TREATMENT OF DISSECTING ANEURYSMS OF POSTERIOR CEREBRAL CIRCULATION IN CARTAGENA DE INDIAS

OpenAIRE

Rueda-Tamayo Leidy; Almeida-Pérez Rafael; De la Rosa-Manjarrez Ginna; Orozco-Gómez Fernando; Carrasquilla-Meléndez Rubén

2015-01-01

Introduction: the intracraneal aneurysms are local and permanent dilations in the artery. Objective: to describe the clinical, imagenologic and effectiveness of endovascular treatment in terms of its independence and mortality in patients with dissecting aneurysms of posterior cerebral circulation in Cartagena. Methods: a descriptive study was carried out with patients 18 years or older with a diagnosis of dissecting aneurysms of posterior cerebral circulation who received ...

A Case of Duplicated Right Vertebral Artery.

Science.gov (United States)

Motomura, Mayuko; Watanabe, Koichi; Tabira, Yoko; Iwanaga, Joe; Matsuuchi, Wakako; Yoshida, Daichi; Saga, Tsuyoshi; Yamaki, Koh-Ichi

2018-04-27

We encountered a case of duplicated right vertebral artery during an anatomical dissection course for medical students in 2015. Two vertebral arteries were found in the right neck of a 91-year-old female cadaver. The proximal leg of the arteries arose from the area between the right subclavian artery and the right common carotid artery that diverged from the brachiocephalic artery. The distal leg arose from the right subclavian artery as expected. The proximal leg entered the transverse foramen of the fourth cervical vertebra and the distal leg entered the transverse foramen of the sixth cervical vertebra. The two right vertebral arteries joined to form one artery just after the origin of the right vertebral artery of the brachiocephalic artery entered the transverse foramen of the fourth cervical vertebra. This artery then traveled up in the transverse foramina and became the basilar artery, joining with the left vertebral artery. We discuss the embryological origin of this case and review previously reported cases.

Acute aortic dissection type A discloses Corpus alienum

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Kolat Philipp

2009-01-01

Full Text Available Abstract We report an unusual case of an aortic type A dissection with a corpus alienum which compresses the right ventricle. The patient successfully underwent an aortic root replacement in deep hypothermia with re-implantation of the coronary arteries using a modified Bentall procedure and the resection of the corpus alienum. Intraoperative finding reveals 3 greatly adhered gauze compresses, which were most likely forgotten in the operation 34 years ago.

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

Science.gov (United States)

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

2015-12-01

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

Extracranial stereotactic radiotherapy: preliminary results with the CyberKnife.

Science.gov (United States)

Lartigau, Eric; Mirabel, Xavier; Prevost, Bernard; Lacornerie, Thomas; Dubus, Francois; Sarrazin, Thierry

2009-04-01

In the field of radiation oncology, equipment for fractionated radiotherapy and single-dose radiosurgery has become increasingly accurate, together with the introduction of robotized treatments. A robot is a device that can be programmed to carry out accurate, repeated and adjusted tasks in a given environment. Treatment of extracranial lesions involves taking into account organ mobility (tumor and healthy tissue) whilst retaining the ability to stereotactically locate the target. New imaging techniques (single-photon emission computed tomography (SPECT), magnetic resonance imaging (MRI), positron emission tomography (PET)) provide further relevant information to slice images (computed tomography (CT) scans, MRI) for target definition. Hypo-fractionated treatments can only be used for curative treatment if the target is accurately defined and tracked during treatment. The CyberKnife is a non-invasive system of radiosurgery and fractionated stereotactic radiotherapy. For intracranial lesions treated by single-dose radiosurgery, it has been used to treat meningioma, acoustic neuromas, pituitary adenoma, metastases, arteriovenous malformations and refractory pain (trigeminal neuralgia). More than 10,000 patients have been treated worldwide. Currently, the most significant developments are in the field of extracranial stereotactic radiotherapy (lung, liver, reirradiation, prostate, etc.). Clinical results obtained in the CyberKnife Nord-Ouest program after 1 year of experience are presented. Copyright 2009 S. Karger AG, Basel.

Standing tall after DeBakey Type I aortic dissection extending to left iliac artery

OpenAIRE

Deepak Natarajan; Nalin Natarajan

2015-01-01

This report describes DeBakey Type I aortic dissection in a middle-aged hypertensive female who had undergone mitral tissue valve replacement a decade previously. The patient had severe abrupt onset tearing pain in her throat, back, and chest, for which she got admitted in a community hospital, where because of no changes in her ECG and biomarkers, the dissection of aorta was missed. She was subjected to coronary angiography more than 6 weeks later for pain in her left shoulder, which demonst...

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

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

2014-01-01

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

Investigation of hemodynamics in the development of dissecting aneurysm within patient-specific dissecting aneurismal aortas using computational fluid dynamics (CFD) simulations.

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Tse, Kwong Ming; Chiu, Peixuan; Lee, Heow Pueh; Ho, Pei

2011-03-15

Aortic dissecting aneurysm is one of the most catastrophic cardiovascular emergencies that carries high mortality. It was pointed out from clinical observations that the aneurysm development is likely to be related to the hemodynamics condition of the dissected aorta. In order to gain more insight on the formation and progression of dissecting aneurysm, hemodynamic parameters including flow pattern, velocity distribution, aortic wall pressure and shear stress, which are difficult to measure in vivo, are evaluated using numerical simulations. Pulsatile blood flow in patient-specific dissecting aneurismal aortas before and after the formation of lumenal aneurysm (pre-aneurysm and post-aneurysm) is investigated by computational fluid dynamics (CFD) simulations. Realistic time-dependent boundary conditions are prescribed at various arteries of the complete aorta models. This study suggests the helical development of false lumen around true lumen may be related to the helical nature of hemodynamic flow in aorta. Narrowing of the aorta is responsible for the massive recirculation in the poststenosis region in the lumenal aneurysm development. High pressure difference of 0.21 kPa between true and false lumens in the pre-aneurismal aorta infers the possible lumenal aneurysm site in the descending aorta. It is also found that relatively high time-averaged wall shear stress (in the range of 4-8 kPa) may be associated with tear initiation and propagation. CFD modeling assists in medical planning by providing blood flow patterns, wall pressure and wall shear stress. This helps to understand various phenomena in the development of dissecting aneurysm. Copyright © 2011 Elsevier Ltd. All rights reserved.

Arterial vascularization of the pineal gland.

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

2013-10-01

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

Extracranial stereotactic radiotherapy: Evaluation of PTV coverage and dose conformity

International Nuclear Information System (INIS)

Haedinger, U.; Thiele, W.; Wulf, J.

2002-01-01

During the past few years the concept of cranial sterotactic radiotherapy has been successfully extended to extracranial tumoral targets. In our department, hypofractionated treatment of tumours in lung, liver, abdomen, and pelvis is performed in the Stereotactic Body Frame (ELEKTA Instrument AB) since 1997. We present the evaluation of 63 consecutively treated targets (22 lung, 21 liver, 20 abdomen/pelvis) in 58 patients with respect to dose coverage of the planning target volume (PTV) as well as conformity of the dose distribution. The mean PTV coverage was found to be 96.3%±2.3% (lung), 95.0%±4.5% (liver), and 92.1%±5.2% (abdomen/pelvis). For the so-called conformation number we obtained values of 0.73±0.09 (lung), 0.77±0.10 (liver), and 0.70±0.08 (abdomen/pelvis). The results show that highly conformal treatment techniques can be applied also in extracranial stereotactic radiotherapy. This is primarily due to the relatively simple geometrical shape of most of the targets. Especially lung and liver targets turned out to be approximately spherically/cylindrically shaped, so that the dose distribution can be easily tailored by rotational fields. (orig.) [de

Is a Swine Model of Arteriovenous Malformation Suitable for Human Extracranial Arteriovenous Malformation? A Preliminary Study

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Lv, Ming-ming, E-mail: lvmingming001@163.com [Ninth People' s Hospital, Shanghai Jiao Tong University School of Medicine, Department of Oral and Maxillofacial Surgery, Shanghai Key Laboratory of Stomatology (China); Fan, Xin-dong, E-mail: fanxindong@yahoo.com.cn [Ninth People' s Hospital, Shanghai Jiao Tong University School of Medicine, Department of Radiology (China); Su, Li-xin, E-mail: sulixin1975@126.com [Ninth People' s Hospital, Shanghai Jiao Tong University School of Medicine, Department of Oral and Maxillofacial Surgery, Shanghai Key Laboratory of Stomatology (China)

2013-10-15

Objective: A chronic arteriovenous malformation (AVM) model using the swine retia mirabilia (RMB) was developed and compared with the human extracranial AVM (EAVM) both in hemodynamics and pathology, to see if this brain AVM model can be used as an EAVM model. Methods: We created an arteriovenous fistula between the common carotid artery and the external jugular vein in eight animals by using end-to-end anastomosis. All animals were sacrificed 1 month after surgery, and the bilateral retia were obtained at autopsy and performed hematoxylin and eosin staining and immunohistochemistry. Pre- and postsurgical hemodynamic evaluations also were conducted. Then, the blood flow and histological changes of the animal model were compared with human EAVM. Results: The angiography after operation showed that the blood flow, like human EAVM, flowed from the feeding artery, via the nidus, drained to the draining vein. Microscopic examination showed dilated lumina and disrupted internal elastic lamina in both RMB of model and nidus of human EAVM, but the thickness of vessel wall had significant difference. Immunohistochemical reactivity for smooth muscle actin, angiopoietin 1, and angiopoietin 2 were similar in chronic model nidus microvessels and human EAVM, whereas vascular endothelial growth factor was significant difference between human EAVM and RMB of model. Conclusions: The AVM model described here is similar to human EAVM in hemodynamics and immunohistochemical features, but there are still some differences in anatomy and pathogenetic mechanism. Further study is needed to evaluate the applicability and efficacy of this model.

Is a Swine Model of Arteriovenous Malformation Suitable for Human Extracranial Arteriovenous Malformation? A Preliminary Study

International Nuclear Information System (INIS)

Lv, Ming-ming; Fan, Xin-dong; Su, Li-xin

2013-01-01

Objective: A chronic arteriovenous malformation (AVM) model using the swine retia mirabilia (RMB) was developed and compared with the human extracranial AVM (EAVM) both in hemodynamics and pathology, to see if this brain AVM model can be used as an EAVM model. Methods: We created an arteriovenous fistula between the common carotid artery and the external jugular vein in eight animals by using end-to-end anastomosis. All animals were sacrificed 1 month after surgery, and the bilateral retia were obtained at autopsy and performed hematoxylin and eosin staining and immunohistochemistry. Pre- and postsurgical hemodynamic evaluations also were conducted. Then, the blood flow and histological changes of the animal model were compared with human EAVM. Results: The angiography after operation showed that the blood flow, like human EAVM, flowed from the feeding artery, via the nidus, drained to the draining vein. Microscopic examination showed dilated lumina and disrupted internal elastic lamina in both RMB of model and nidus of human EAVM, but the thickness of vessel wall had significant difference. Immunohistochemical reactivity for smooth muscle actin, angiopoietin 1, and angiopoietin 2 were similar in chronic model nidus microvessels and human EAVM, whereas vascular endothelial growth factor was significant difference between human EAVM and RMB of model. Conclusions: The AVM model described here is similar to human EAVM in hemodynamics and immunohistochemical features, but there are still some differences in anatomy and pathogenetic mechanism. Further study is needed to evaluate the applicability and efficacy of this model

Abdominal Aortic Dissection with Acute Mesenteric Ischemia in a Patient with Marfan Syndrome

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Chii-Shyan Lay

2006-07-01

Full Text Available Marfan syndrome is an autosomal dominant inherited disorder of connective tissue, with various complications manifested primarily in the cardiovascular system. It potentially leads to aortic dissection and rupture, these being the major causes of death. We report a patient who complained of acute abdominal pain, which presented as acute mesenteric ischemia combined with abdominal aortic dissection. Echocardiography showed enlargement of the aortic root and mitral valve prolapse. Abdominal computed tomography scan revealed acute mesenteric ischemia due to abdominal aortic dissection. Finally, the patient underwent surgery of aortic root replacement and had a successful outcome. Therefore, we suggest that for optimal risk assessment and monitoring of patients with Marfan syndrome, both aortic stiffness and the diameter of the superior mesenteric vein compared with that of the superior mesenteric artery are useful screening methods to detect acute mesenteric ischemia secondary to abdominal aortic dissection. Early diagnosis and early treatment can decrease the high mortality rate of patients with Marfan syndrome.

O tratamento operatório da dissecção aórtica crônica tipo A em pacientes submetidos à revascularização cirúrgica do miocárdio Surgical treatment of chronic type A aortic dissection in patients undergoing coronary artery bypass grafting

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João Carlos Leal

2010-09-01

Full Text Available O tratamento operatório da dissecção aórtica é um desafio para o cirurgião cardíaco, sobretudo nos pacientes submetidos a operação cardíaca prévia. Nosso objetivo neste relato de caso é demonstrar como tratamos a dissecção aórtica crônica tipo A em paciente revascularizado utilizando cânulas arterial e venosa percutâneas.Surgical treatment of aortic dissection is a challenge for the cardiac surgeon, especially in patients undergoing cardiac operations. Our objective in this case report is to demonstrate how we treat the chronic type A aortic dissection in patients revascularized using percutaneous arterial and venous cannulae.

Principles for Management of Intraoperative Acute Type A Aortic Dissection.

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Gukop, Philemon; Chandrasekaran, Vankatachalam

2015-12-01

Intraoperative Type A aortic dissection is a rare pathology with incidence of 0.06-0.32%. It is associated with a high mortality between 30-50%. Some associated risk factors, including hypertension, enlarged aorta, peripheral vascular disease, advanced age, atheroma, and high arterial pressure on cardiopulmonary bypass, have been identified. Modification of these risk factors could reduce the incidence of this event. Prompt diagnosis and management, with the aid of intraoperative trans-esophageal echocardiography and/or epi-aortic ultrasound has been shown to reduce the mortality to 17%. We illustrate the principles of management of this pathology with the case of a 62-year-old female who developed acute Type A aortic dissection while undergoing minimally invasive mitral valve repair.

Case Report: High origin of the right testicular artery coursing ...

African Journals Online (AJOL)

During routine dissection we observed a high origin of the right testicular artery from the abdominal aorta in a middle-aged formalin-fixed male cadaver of indigenous Kenyan descent. The artery arched above the right renal vein to course through a hiatus in the inferior vena cava at its confluence with the right renal vein.

Dissecting and fusiform aneurysms of vertebro-basilar systems

International Nuclear Information System (INIS)

Iwama, T.; Andoh, T.; Sakai, N.; Iwata, T.; Yamada, H.; Hirata, T.

1990-01-01

The magnetic resonance (MR) findings of three cases with vertebro-basilar dissecting aneurysms (DA) were compared with those of two cases with vertebro-basilar fusiform aneurysms (FA). No abnormal findings, excepting a dilatation of a signal-void area corresponding to the arterial blood flow, were shown on the MR images in the patients with a FA. In contrast to the FA cases, various abnormalities were detected by the MR studies in all three DA cases. An intimal flap and a double lumen were demonstrated in one case. An intra-mural hematoma was shown in one case. A hematoma neighboring the parent artery was demonstrated in two cases. MR imaging was thought to be useful for detecting intracranial vascular lesions, such as a DA, and for discriminating between a DA and a FA. (orig.)

A Novel Fenestration Technique for Abdominal Aortic Dissection Membranes Using a Combination of a Needle Re-entry Catheter and the “Cheese-wire” Technique

International Nuclear Information System (INIS)

Kos, Sebastian; Gürke, Lorenz; Jacob, Augustinus L.

2011-01-01

Purpose: This study was designed to demonstrate the applicability of a combined needle-based re-entry catheter and “cheese-wire” technique for fenestration of abdominal aortic dissection membranes. Methods: Four male patients (mean age: 65 years) with acute complicated aortic type B dissections were treated at our institution by fenestrating the abdominal aortic dissection membrane using a hybrid technique. This technique combined an initial membrane puncture with a needle-based re-entry catheter using a transfemoral approach. A guidewire was passed through the re-entry catheter and across the membrane. Using a contralateral transfemoral access, this guidewire was then snared, creating a through-and-through wire access. The membrane was then fenestrated using the cheese-wire maneuver. Results: We successfully performed: (a) membrane puncture; (b) guidewire passage; (c) guidewire snaring; and (d) cheese-wire maneuver in all four cases. After this maneuver, decompression of the false lumen and acceptable arterial inflow into the true lumen was observed in all cases. The dependent visceral arteries were reperfused. In one case, portions of the fenestrated membrane occluded the common iliac artery, which was immediately and successfully stented. In another case, long-standing intestinal hypoperfusion before the fenestration resulted in reperfusion-related shock and intraoperative death of the patient. Conclusions: The described hybrid approach for fenestration of dissection membranes is technically feasible and may be established as a therapeutic method in cases with a complicated type B dissection.

A case of traumatic intracranial vertebral artery injury presenting with life-threatening symptoms

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Kishi S

2012-04-01

Full Text Available Seiji Kishi1, Kenji Kanaji2, Toshio Doi1, Tadashi Matsumura21Department of Nephrology, Tokushima University Hospital, Kuramoto-cho Tokushima, 2Department of General Internal Medicine, Rakuwakai Otowa Hospital, Otowachinji-cho Yamashina-ku Kyoto, JapanAbstract: Traumatic intracranial vertebral artery injury is a relatively rare but potentially fatal disease. We present a case of a 63-year-old man who presented with sudden onset of loss of consciousness after hitting his head. After immediate resuscitation, he showed quadriplegia and absence of spontaneous breathing. Brain and cervical spine magnetic resonance imaging revealed an atlantoaxial subluxation, fractured C2 odontoid process, left vertebral artery occlusion, and bilateral extensive ischemia in the medulla oblongata and high cervical spinal cord. Digital subtraction angiography demonstrated left vertebral artery dissection just below the level of vertebral body C2.Keywords: vertebral artery dissection, brainstem infarction, bilateral spinal cord infarction, neck trauma

Mixed reality for robotic treatment of a splenic artery aneurysm.

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Pietrabissa, Andrea; Morelli, Luca; Ferrari, Mauro; Peri, Andrea; Ferrari, Vincenzo; Moglia, Andrea; Pugliese, Luigi; Guarracino, Fabio; Mosca, Franco

2010-05-01

Techniques of mixed reality can successfully be used in preoperative planning of laparoscopic and robotic procedures and to guide surgical dissection and enhance its accuracy. A computer-generated three-dimensional (3D) model of the vascular anatomy of the spleen was obtained from the computed tomography (CT) dataset of a patient with a 3-cm splenic artery aneurysm. Using an environmental infrared localizer and a stereoscopic helmet, the surgeon can see the patient's anatomy in transparency (augmented or mixed reality). This arrangement simplifies correct positioning of trocars and locates surgical dissection directly on top of the aneurysm. In this way the surgeon limits unnecessary dissection, leaving intact the blood supply from the short gastric vessels and other collaterals. Based on preoperative planning, we were able to anticipate that the vascular exclusion of the aneurysm would result in partial splenic ischemia. To re-establish the flow to the spleen, end-to-end robotic anastomosis of the splenic artery with the Da Vinci surgical system was then performed. Finally, the aneurysm was fenestrated to exclude arterial refilling. The postoperative course was uneventful. A control CT scan 4 weeks after surgery showed a well-perfused and homogeneous splenic parenchyma. The final 3D model showed the fenestrated calcified aneurysm and patency of the re-anastomosed splenic artery. The described technique of robotic vascular exclusion of a splenic artery aneurysm, followed by re-anastomosis of the vessel, clearly demonstrates how this technology can reduce the invasiveness of the procedure, obviating an otherwise necessary splenectomy. Also, the use of intraoperative mixed-reality technology proved very useful in this case and is expected to play an increasing role in the operating room of the future.

Multi-parametric ultrasound criteria for internal carotid artery disease - comparison with CT angiography

International Nuclear Information System (INIS)

Barlinn, Kristian; Kepplinger, Jessica; Siepmann, Timo; Pallesen, Lars-Peder; Bodechtel, Ulf; Reichmann, Heinz; Puetz, Volker; Floegel, Thomas; Kitzler, Hagen H.; Alexandrov, Andrei V.

2016-01-01

The German Society of Ultrasound in Medicine (known by its acronym DEGUM) recently proposed a novel multi-parametric ultrasound approach for comprehensive and accurate assessment of extracranial internal carotid artery (ICA) steno-occlusive disease. We determined the agreement between duplex ultrasonography (DUS) interpreted by the DEGUM criteria and CT angiography (CTA) for grading of extracranial ICA steno-occlusive disease. Consecutive patients with acute cerebral ischemia underwent DUS and CTA. Internal carotid artery stenosis was graded according to the DEGUM-recommended criteria for DUS. Independent readers manually performed North American Symptomatic Carotid Endarterectomy Trial-type measurements on axial CTA source images. Both modalities were compared using Spearman's correlation and Bland-Altman analyses. A total of 303 acute cerebral ischemia patients (mean age, 72 ± 12 years; 58 % men; median baseline National Institutes of Health Stroke Scale score, 4 [interquartile range 7]) provided 593 DUS and CTA vessel pairs for comparison. There was a positive correlation between DUS and CTA (r s = 0.783, p < 0.001) with mean difference in degree of stenosis measurement of 3.57 %. Bland-Altman analysis further revealed widely varying differences (95 % limits of agreement -29.26 to 22.84) between the two modalities. Although the novel DEGUM criteria showed overall good agreement between DUS and CTA across all stenosis ranges, potential for wide incongruence with CTA underscores the need for local laboratory validation to avoid false screening results. (orig.)

Multi-parametric ultrasound criteria for internal carotid artery disease - comparison with CT angiography

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Barlinn, Kristian; Kepplinger, Jessica; Siepmann, Timo; Pallesen, Lars-Peder; Bodechtel, Ulf; Reichmann, Heinz; Puetz, Volker [Carl Gustav Carus University Hospital, Technische Universitaet Dresden, Department of Neurology, Dresden (Germany); Floegel, Thomas [Carl Gustav Carus University Hospital, Technische Universitaet Dresden, Department of Neurology, Dresden (Germany); Carl Gustav Carus University Hospital, Technische Universitaet Dresden, Department of Neuroradiology, Dresden (Germany); Kitzler, Hagen H. [Carl Gustav Carus University Hospital, Technische Universitaet Dresden, Department of Neuroradiology, Dresden (Germany); Alexandrov, Andrei V. [The University of Tennessee Health Science Center, Department of Neurology, Memphis, TN (United States)

2016-09-15

The German Society of Ultrasound in Medicine (known by its acronym DEGUM) recently proposed a novel multi-parametric ultrasound approach for comprehensive and accurate assessment of extracranial internal carotid artery (ICA) steno-occlusive disease. We determined the agreement between duplex ultrasonography (DUS) interpreted by the DEGUM criteria and CT angiography (CTA) for grading of extracranial ICA steno-occlusive disease. Consecutive patients with acute cerebral ischemia underwent DUS and CTA. Internal carotid artery stenosis was graded according to the DEGUM-recommended criteria for DUS. Independent readers manually performed North American Symptomatic Carotid Endarterectomy Trial-type measurements on axial CTA source images. Both modalities were compared using Spearman's correlation and Bland-Altman analyses. A total of 303 acute cerebral ischemia patients (mean age, 72 ± 12 years; 58 % men; median baseline National Institutes of Health Stroke Scale score, 4 [interquartile range 7]) provided 593 DUS and CTA vessel pairs for comparison. There was a positive correlation between DUS and CTA (r{sub s} = 0.783, p < 0.001) with mean difference in degree of stenosis measurement of 3.57 %. Bland-Altman analysis further revealed widely varying differences (95 % limits of agreement -29.26 to 22.84) between the two modalities. Although the novel DEGUM criteria showed overall good agreement between DUS and CTA across all stenosis ranges, potential for wide incongruence with CTA underscores the need for local laboratory validation to avoid false screening results. (orig.)

Acute coronary syndrome in a patient with Marfan syndrome following emergent surgical repair of aortic dissection.

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Bovolato, Francesca Elisa; Isabella, Giambattista; Rampazzo, Debora; Guglielmi, Cosimo; Gerosa, Gino; Iliceto, Sabino; Bilato, Claudio

2008-06-01

We report a case of acute coronary syndrome in a patient with suspect Marfan syndrome, 25 days after emergent modified Bentall-De Bono intervention for acute type I peripartum aortic dissection. She was admitted to our intensive care unit because of unstable angina, caused by critical blood flow reduction in a large portion of the myocardium, according to the severity of the symptoms and the electrocardiographic alterations. Coronary angiography showed a sub-occlusive stenosis of the left main coronary artery as a result of the dissection extension to the coronary ostium. Because of the high risk related to heart surgery, the patient was successfully treated by unprotected angioplasty and drug-eluting stent positioning. Short- and mid-term outcomes were favourable. Subsequent tests confirmed the diagnosis of Marfan syndrome. After 2 years of follow-up, the patient remains asymptomatic and in good health. To our knowledge, this is the first report of a successful percutaneous intervention of the left main coronary artery in a patient with Marfan syndrome who had already undergone ascending aortic root and valve replacement by the Bentall-De Bono procedure for acute dissection.

[Ultrasound dissection in laparoscopic cholecystectomy].

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Horstmann, R; Kern, M; Joosten, U; Hohlbach, G

1993-01-01

An ultrasound dissector especially developed for laparoscopic surgery was used during laparoscopic cholecystectomy on 34 patients. The ultrasound power, the volume of suction and irrigation could be determined individually at the generator and activated during the operation with a foot pedal. With the dissector it was possible to fragmentate, emulgate and aspirate simultaneously fat tissue as well as infected edematous structures. The cystic artery and cystic duct, small vessels, lymphatic and connective tissue were not damaged. Therefore this system seems to be excellent for the preparation of Calot's trigonum and blunt dissection of the gallbladder out of its bed, particularly in fatty, acute or chronic infected tissue. No complications were observed within the peri- and postoperative period.

Repair of Multiple Subclavian and Axillary Artery Aneurysms in a 58-Year-Old Man with Marfan Syndrome

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Dolapoglu, Ahmet; de la Cruz, Kim I.; Preventza, Ourania; Coselli, Joseph S.

2016-01-01

Dilation of the ascending aorta and aortic dissections are often seen in Marfan syndrome; however, true aneurysms of the subclavian and axillary arteries rarely seem to develop in patients who have this disease. We present the case of a 58-year-old man with Marfan syndrome who had undergone a Bentall procedure and thoracoabdominal aortic repair for an aortic dissection and who later developed multiple aneurysmal dilations of his right subclavian and axillary arteries. The aneurysms were succe...

Acute aortic dissection: be aware of misdiagnosis

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Asteri Theodora

2009-02-01

Full Text Available Abstract Background Acute aortic dissection (AAD is a life-threatening condition requiring immediate assessment and therapy. A patient suffering from AAD often presents with an insignificant or irrelevant medical history, giving rise to possible misdiagnosis. The aim of this retrospective study is to address the problem of misdiagnosing AD and the different imaging studies used. Methods From January 2000 to December 2004, 49 patients (41 men and 8 women, aged from 18–75 years old presented to the Emergency Department of our hospital for different reasons and finally diagnosed with AAD. Fifteen of those patients suffered from arterial hypertension, one from giant cell arteritis and another patient from Marfan's syndrome. The diagnosis of AAD was made by chest X-ray, contrast enhanced computed tomography (CT, transthoracic echocardiography (TTE and coronary angiography. Results Initial misdiagnosis occurred in fifteen patients (31% later found to be suffering from AAD. The misdiagnosis was myocardial infarction in 12 patients and cerebral infarction in another three patients. Conclusion Aortic dissection may present with a variety of clinical manifestations, like syncope, chest pain, anuria, pulse deficits, abdominal pain, back pain, or acute congestive heart failure. Nearly a third of the patients found to be suffering from AD, were initially otherwise diagnosed. Key in the management of acute aortic dissection is to maintain a high level of suspicion for this diagnosis.

Anomalies of radial and ulnar arteries

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Rajani Singh

Full Text Available Abstract During dissection conducted in an anatomy department of the right upper limb of the cadaver of a 70-year-old male, both origin and course of the radial and ulnar arteries were found to be anomalous. After descending 5.5 cm from the lower border of the teres major, the brachial artery anomalously bifurcated into a radial artery medially and an ulnar artery laterally. In the arm, the ulnar artery lay lateral to the median nerve. It followed a normal course in the forearm. The radial artery was medial to the median nerve in the arm and then, at the level of the medial epicondyle, it crossed from the medial to the lateral side of the forearm, superficial to the flexor muscles. The course of the radial artery was superficial and tortuous throughout the arm and forearm. The variations of radial and ulnar arteries described above were associated with anomalous formation and course of the median nerve in the arm. Knowledge of neurovascular anomalies are important for vascular surgeons and radiologists.

Role of radiotherapy in extracranial metastatic malignant melanoma in the modern era

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Ryan S. Youland

2017-10-01

Conclusions: SBRT for extracranial MM exhibited improved MF compared with CHRT, consistent with intracranial radiosurgery data. Though these data are retrospective and subject to selection bias, our findings support the prudent use of SBRT in a select group of favorable, oligometastatic MM patients, and should be discussed as an alternative to surgery and ablation.

A coincidental variation of the axillary artery: the brachioradial artery and the aberrant posterior humeral circumflex artery passing under the tendon of the latissimus dorsi muscle

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Marek Konarik

2014-09-01

Full Text Available A case of anomalous terminal branching of the axillary artery was encountered and described in a left upper limb of a male cadaver. A series of 214 upper limbs of Caucasian race was dissected. A variant artery, stemming from the very end of the axillary artery followed a superficial course distally. It passed the cubital fossa, ran on the lateral side of the forearm as usual radial artery, crossed ventrally to the palm and terminated in the deep palmar arch. This vessel is a case of the brachioradial artery (incorrectly termed as the “radial artery with high origin”. Moreover, it was associated with another variation, concerning the aberrant posterior humeral circumflex artery passing under the tendon of the latissimus dorsi muscle. The anatomical knowledge of the axillary region is essential for radiodiagnostic, surgical and traumatologic procedures. The superficially located artery brings an elevated danger of heavy bleeding in all unexpected situations, its variant branching can cause problems in radial catheterization procedures and the anomalously coursing other arterial variant poses an elevated danger in surgical procedures concerning the surgical neck of humerus.

Postoperative extracranial metastasis from glioblastoma: a case report and review of the literature.

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Wu, Wenjiao; Zhong, Dequan; Zhao, Zhan; Wang, Wentao; Li, Jun; Zhang, Wei

2017-12-29

Glioblastoma is the most common primary malignant brain tumor. Extraneural metastases are rarely reported in the literature. We report a case of a 38-year-old patient who was diagnosed with glioblastoma in 2015. Four months after surgery, local relapse was found and the patient received a second surgery. After another 4 months, we found a hard mass in the right posterior neck when she admitted to our department for fourth cycle of adjuvant chemotherapy. Immunohistochemical investigation supported the diagnosis of glioblastoma metastases to the neck after resection of the right neck mass. A few days later, spinal vertebral magnetic resonance imaging (MRI) confirmed multiple metastases in the thoracic, lumbar, sacral, and bilateral iliac bones. Glioblastoma is the most common primary malignant brain tumor. Whole tumor resection and early radiotherapy and chemotherapy can delay recurrence and prolong survival. Extracranial metastases are extremely rare. We report this case with the aim of bringing attention to extracranial metastasis of brain glioma.

A study of the area of paraaortic lymph nodes dissection in gastric cancer based on lymphatic flow of the stomach using radioactive isotope

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Sasagawa, Tsuyoshi (Tokyo Women' s Medical Coll. (Japan))

1992-04-01

In gastric cancer patients, I subdivided paraaortic lymph nodes (No.16) into 4 zones. Using RI lymphography I analyzed the lymphatic flow from the cardiac and pyloric region to the No.16. Also, based on these results as well as studies of clinical lymph node metastasis, I elucidate the rational No.16 area in extended lymph node dissection. The lymphatic flows to the No.16 by RI lymphography showed the following routes. The route from the cardiac region was: (1) along the left gastric artery heading towards lymph node around the celiac artery and into the left/right No.16; (2) along the posterior gastric artery and splenic artery from lymph node around the splenic artery directly to the left No.16; (3) along the inferior phrenic artery from left cardiac lymph node and lymph node at the splenic hilus directly to the left upper No.16. The route from the pyloric region was: (1) along the common hepatic artery heading towards lymph node around the celiac artery to the left/right No.16; (2) from infrapyloric lymph node along the gastrocolic trunc flowing to lymph node at the root of the mesenterium and No.16. In upper gastric cancer, there was a high rate of metastasis to lymph node along the lesser curvature and right cardial lymph node, and lymph node along the left gastric artery and splenic artery. There were 3 cases in which metastasis was positive only to cardial lymph node and upper left No.16. In lower gastric cancer, there was a high rate of metastasis to infrapyloric lymph node, lymph node along the lesser curvature, lymph node along the left gastric artery and the common hepatic artery. In all cases which metastasized in group 4, the No.16 metastasis rate was significantly higher in the upper left No.16, being 84.8%. Given the above, the area of paraaortic lymph node dissection in extended lymph node dissection, irrespective of whether it is upper or lower gastric cancer, must be done in the 4 zones, and especially, the upper left No.16 is important. (author).

Repair of Multiple Subclavian and Axillary Artery Aneurysms in a 58-Year-Old Man with Marfan Syndrome.

Science.gov (United States)

Dolapoglu, Ahmet; de la Cruz, Kim I; Preventza, Ourania; Coselli, Joseph S

2016-10-01

Dilation of the ascending aorta and aortic dissections are often seen in Marfan syndrome; however, true aneurysms of the subclavian and axillary arteries rarely seem to develop in patients who have this disease. We present the case of a 58-year-old man with Marfan syndrome who had undergone a Bentall procedure and thoracoabdominal aortic repair for an aortic dissection and who later developed multiple aneurysmal dilations of his right subclavian and axillary arteries. The aneurysms were successfully repaired by means of a surgical bypass technique in which a Dacron graft was placed between the carotid and brachial arteries. We also discuss our strategy for determining the optimal surgical approach in these patients.

Importance of Extracranial Disease Status and Tumor Subtype for Patients Undergoing Radiosurgery for Breast Cancer Brain Metastases

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Dyer, Michael A.; Kelly, Paul J. [Department of Radiation Oncology, Dana-Farber/Brigham and Women' s Cancer Center, Boston, MA (United States); Harvard Medical School, Boston, MA (United States); Chen, Yu-Hui [Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA (United States); Pinnell, Nancy E. [Department of Radiation Oncology, Dana-Farber/Brigham and Women' s Cancer Center, Boston, MA (United States); Claus, Elizabeth B. [Harvard Medical School, Boston, MA (United States); Department of Neurosurgery, Brigham and Women' s Hospital, Boston, MA (United States); Yale University School of Medicine, New Haven, CT (United States); Lee, Eudocia Q. [Harvard Medical School, Boston, MA (United States); Center for Neuro-Oncology, Dana-Farber/Brigham and Women' s Center, Boston, MA (United States); Weiss, Stephanie E. [Department of Radiation Oncology, Dana-Farber/Brigham and Women' s Cancer Center, Boston, MA (United States); Harvard Medical School, Boston, MA (United States); Arvold, Nils D. [Harvard Radiation Oncology Program, Boston, MA (United States); Lin, Nancy U. [Harvard Medical School, Boston, MA (United States); Department of Medical Oncology, Dana-Farber/Brigham and Women' s Cancer Center, Boston, MA (United States); Alexander, Brian M., E-mail: bmalexander@lroc.harvard.edu [Department of Radiation Oncology, Dana-Farber/Brigham and Women' s Cancer Center, Boston, MA (United States); Harvard Medical School, Boston, MA (United States)

2012-07-15

Purpose: In this retrospective study, we report on outcomes and prognostic factors for patients treated with stereotactic radiosurgery (SRS) for breast cancer brain metastases. Methods and Materials: We identified 132 consecutive patients with breast cancer who were treated with SRS for brain metastases from January 2000 through June 2010. We retrospectively reviewed records of the 51 patients with adequate follow-up data who received SRS as part of the initial management of their brain metastases. Overall survival (OS) and time to central nervous system (CNS) progression from the date of SRS were calculated using the Kaplan-Meier method. Prognostic factors were evaluated using the Cox proportional hazards model. Results: Triple negative subtype was associated with CNS progression on univariate analysis (hazard ratio [HR] = 5.0, p = 0.008). On multivariate analysis, triple negative subtype (HR = 8.6, p = 0.001), Luminal B subtype (HR = 4.3, p = 0.03), and omission of whole-brain radiation therapy (HR = 3.7, p = 0.02) were associated with CNS progression. With respect to OS, Karnofsky Performance Status (KPS) {<=} 80% (HR = 2.0, p = 0.04) and progressive extracranial disease (HR = 3.1, p = 0.002) were significant on univariate analysis; KPS {<=} 80% (HR = 4.1, p = 0.0004), progressive extracranial disease (HR = 6.4, p < 0.0001), and triple negative subtype (HR = 2.9, p = 0.04) were significant on multivariate analysis. Although median survival times were consistent with those predicted by the breast cancer-specific Graded Prognostic Assessment (Breast-GPA) score, the addition of extracranial disease status further separated patient outcomes. Conclusions: Tumor subtype is associated with risk of CNS progression after SRS for breast cancer brain metastases. In addition to tumor subtype and KPS, which are incorporated into the Breast-GPA, progressive extracranial disease may be an important prognostic factor for OS.

Severe gastric variceal haemorrhage due to splenic artery thrombosis and consecutive arterial bypass

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Wasmuth Hermann E

2011-06-01

Full Text Available Abstract Background Upper gastrointestinal haemorrhage is mainly caused by ulcers. Gastric varicosis due to portal hypertension can also be held responsible for upper gastrointestinal bleeding. Portal hypertension causes the development of a collateral circulation from the portal to the caval venous system resulting in development of oesophageal and gastric fundus varices. Those may also be held responsible for upper gastrointestinal haemorrhage. Case presentation In this study, we describe the case of a 69-year-old male with recurrent severe upper gastrointestinal bleeding caused by arterial submucosal collaterals due to idiopathic splenic artery thrombosis. The diagnosis was secured using endoscopic duplex ultrasound and angiography. The patient was successfully treated with a laparoscopic splenectomy and complete dissection of the short gastric arteries, resulting in the collapse of the submucosal arteries in the gastric wall. Follow-up gastroscopy was performed on the 12th postoperative week and showed no signs of bleeding and a significant reduction in the arterial blood flow within the gastric wall. Subsequent follow-up after 6 months also showed no further gastrointestinal bleeding as well as subjective good quality of life for the patient. Conclusion Submucosal arterial collaterals must be excluded by endosonography via endoscopy in case of recurrent upper gastrointestinal bleeding. Laparoscopic splenectomy provides adequate treatment in preventing any recurrent bleeding, if gastric arterial collaterals are caused by splenic artery thrombosis.

Fenestration of axillary vein by a variant axillary artery.

Science.gov (United States)

Hadimani, S; Desai, S D; Bagoji, I B; Patil, B S

2013-01-01

Variations of venous pattern in the arm are common. In this case report, we present a variation of axillary artery and vein. During routine educational dissections of axillary region, it was observed that a fenestrated axillary vein was perforated by a variant axillary artery in right arm of an old male cadaver. The axillary artery which was fenestrated through axillary vein had only two branches arising from its second part and no branches from its remaining distal parts. The branches are thoraco-acromial (usual) and another large collateral (unusual) branch. This collateral branch is the origin of several important arteries as the subscapular, circumflex scapular, posterior circumflex humeral and lateral thoracic arteries. We propose to name this artery as collateral axillary arterial trunk. The course of this collateral axillary arterial trunk and its branches and also clinical significance of this variation are discussed in the paper.

High-resolution MR imaging of periarterial edema associated with biological inflammation in spontaneous carotid dissection

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Naggara, Olivier; Marsico, Rodolpho; Meder, Jean-Francois; Oppenheim, Catherine [Paris-Descartes University, Department of Neuroradiology, Paris (France); Touze, Emmanuel; Mas, Jean-Louis [Paris-Descartes University, Department of Neurology, Paris (France); Leclerc, Xavier; Pruvo, Jean-Pierre [University Hospital Roger Salengro, Department of Neuroradiology, Lille (France); Nguyen, Thanh [Boston University Medical Center, Department of Neurology, Neurosurgery, and Radiology, Boston, MA (United States)

2009-09-15

It has been suggested that spontaneous cervical carotid artery dissection (sCAD) may result from arterial inflammation. Periarterial edema (PAE), occasionally described in the vicinity of the mural hematoma in patients with sCAD, may support this hypothesis. Using cervical high-resolution magnetic resonance imaging, three readers, blinded to the mechanism of carotid artery dissection, searched for PAE, defined as periarterial T2-hyperintensity and T1-hypointensity, in 29 consecutive CAD patients categorized as spontaneous CAD (sCAD, n = 18) or traumatic CAD (tCAD, n = 11; i.e., major head or neck trauma within 2 weeks before the clinical onset). The relationships between PAE, inflammatory biological markers, history of infection and CAD mechanism were explored. Multiple CADs (n = 8) were found only in sCAD patients. Compared with tCAD, patients with sCAD were more likely to have a recent history of infection (OR = 12.5 [{sub 95%}CI = 1.3-119], p = 0.03), PAE (83% vs. 27%; OR = 13.3 [{sub 95%}CI = 2.2-82.0], p = 0.005) and to have elevated CRP (OR = 6.1 [{sub 95%}CI = 1.2-32.1], p = 0.0002) or ESR (OR = 8.8 [{sub 95%}CI = 1.5-50.1], p = 0.002) values. Interobserver agreement was 0.84 or higher for PAE identification. sCAD was associated with PAE and biological inflammation. Our results support the hypothesis of an underlying arterial inflammation in sCAD. (orig.)

High-resolution MR imaging of periarterial edema associated with biological inflammation in spontaneous carotid dissection

International Nuclear Information System (INIS)

Naggara, Olivier; Marsico, Rodolpho; Meder, Jean-Francois; Oppenheim, Catherine; Touze, Emmanuel; Mas, Jean-Louis; Leclerc, Xavier; Pruvo, Jean-Pierre; Nguyen, Thanh

2009-01-01

It has been suggested that spontaneous cervical carotid artery dissection (sCAD) may result from arterial inflammation. Periarterial edema (PAE), occasionally described in the vicinity of the mural hematoma in patients with sCAD, may support this hypothesis. Using cervical high-resolution magnetic resonance imaging, three readers, blinded to the mechanism of carotid artery dissection, searched for PAE, defined as periarterial T2-hyperintensity and T1-hypointensity, in 29 consecutive CAD patients categorized as spontaneous CAD (sCAD, n = 18) or traumatic CAD (tCAD, n = 11; i.e., major head or neck trauma within 2 weeks before the clinical onset). The relationships between PAE, inflammatory biological markers, history of infection and CAD mechanism were explored. Multiple CADs (n = 8) were found only in sCAD patients. Compared with tCAD, patients with sCAD were more likely to have a recent history of infection (OR = 12.5 [ 95% CI = 1.3-119], p = 0.03), PAE (83% vs. 27%; OR = 13.3 [ 95% CI = 2.2-82.0], p = 0.005) and to have elevated CRP (OR = 6.1 [ 95% CI = 1.2-32.1], p = 0.0002) or ESR (OR = 8.8 [ 95% CI = 1.5-50.1], p = 0.002) values. Interobserver agreement was 0.84 or higher for PAE identification. sCAD was associated with PAE and biological inflammation. Our results support the hypothesis of an underlying arterial inflammation in sCAD. (orig.)

Microneurosurgical management of anterior choroid artery aneurysms.

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

2010-05-01

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

Dynamic renal scintigraphy of dissecting aneurysm of abdominal aorta

International Nuclear Information System (INIS)

Tsukamoto, Eriko; Itoh, Kazuo; Furudate, Masayori

1990-01-01

Dynamic renal scintigraphy on 15 patients with dissecting aneurysm of abdominal aorta extending below the renal arteries were retrospectively studied. The results were reviewed and classified into 3 types according to perfusion images and parenchymal tissue uptake: Type A--symmetric perfusion and parenchymal tissue uptake; Type B--asymmetrical perfusion and parenchymal tissue uptake; Type C--delayed perfusion of one kidney and symmetric parenchymal tissue uptake. The number of patients who showed Type A, Type B, and Type C were 3 cases, 6 cases, and 6 cases, respectively. In all Type A and 3 of Type B, perfusion of bilateral renal arteries was mainly from true lumen. In the remaining 3 cases of Type B, 2 had one renal artery obstructed with thrombus; 1 had a deformity of one kidney (the blood supply was mainly from a false lumen), suggestive of renal infarction. On the other hand, in all 6 Type C cases, the renal artery where perfusion was delayed was apparently supplied from false lumen. It is suggested in this retrospective study that the findings in Type C, where delayed perfusion of one kidney and symmetric parenchymal tissue uptake were found, were due to the presence of delayed flow through the false lumen; and therefore, specific to cases where the main blood supply of one renal artery from false lumen. (author)

Presentation of an uncommon form of aortic dissection and rupture in Marifoan syndrome; Presentacion de una forma infecuente de diseccion y rotura aortica en el sindrome de Marfan

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Delgado, I; Ruiz, R; Villanueva, J M; Fernandez Cueto, J L [Servicio de Radiodiagnostico, Complejo Hospitalario, Ciudad Real (Spain)

1995-11-01

In Marfan syndrome, aneurysmatic enlargement of ascending aorta and dissection starting at the root are the most common cardiovascular complications. We present an infrequent case of a 15-year-old patient with a typical case of Marfan syndrome. CT disclosed an aorta and aortic arch of normal size with dissection originating distally with respect to the point where left subclavian artery arises. The disecction extended to descending aorta and to iliac and femoral arteries. Aortic rupture occurred in the arch, with massive hemothorax. The CT findings were confirmed at necropsy. 9 refs.

Combined application of distal and proximal embolic protection devices in endovascular stenting for severe carotid artery stenosis

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Zhi-hua DU

2011-09-01

Full Text Available Objective To analyze and summarize methods and experiences of combined application of distal and proximal embolic protection devices(EPD in endovascular stenting for severe carotid artery stenosis.Methods Five patients with severe stenosis of the common carotid artery or with extracranial segment of the internal carotid artery diagnosed through digital subtraction angiography(DSA from March to July 2010 were involved in the present study.All patients received carotid angioplasty and stenting(CAS,with a combination of distal and proximal EPD via the percutaneous femoral artery approach.Results The operation failed in one patient,whereas technical success with no intraoperative complication was achieved in four patients.The symptoms disappeared or improved in the four cases that achieved technical success.The follow-up duration was one to three months,and no cerebral ischemia was found.Conclusion CAS with the combined application of distal and proximal EPD in some special cases of carotid artery stenosis may surmount the shortage of single EPD,reduce the risk of intraoperative embolization,decrease the time of intraoperative endovascular inflow occlusion,and reduce high-risk operations.CAS may be used as an individualized treatment strategy for patients with carotid artery stenosis.

Synchronized epiaortic two-dimensional and color Doppler echocardiographic guidance enables routine ascending aortic cannulation in type A acute aortic dissection.

Science.gov (United States)

Inoue, Yoshito; Takahashi, Ryuichi; Ueda, Toshihiko; Yozu, Ryohei

2011-02-01

Preference for arterial inflow during surgery for type A acute aortic dissection remains controversial. Antegrade central perfusion prevents malperfusion and retrograde embolism, and the ascending aorta provides arterial access for rapid establishment of systemic perfusion, especially if there is hemodynamic instability. It has not been used routinely, however, because of the disruption caused to the aorta. We evaluated the safety and efficacy of routine cannulation of the dissected aorta for the repair of type A dissection. Surgical results were analyzed for 83 consecutive patients with type A acute aortic dissection between 2002 and 2009. They were treated surgically by prosthetic graft replacement under hypothermic circulatory arrest. The ascending aorta was routinely cannulated using the Seldinger technique with epiaortic echocardiographic guidance; antegrade systemic perfusion was evaluated by color Doppler ultrasound. Systemic antegrade perfusion via the dissected ascending aorta was performed safely in all cases. There was no malperfusion or thromboembolism as a result of ascending aortic cannulation. Epiaortic 2-dimensional and color Doppler imaging provided real-time monitoring adequate for the placement and for proper systemic perfusion. There were 5 in-hospital deaths (5/83=6.0%) and 8 strokes (preoperative 6/83=7.2%, postoperative 2/83=2.4%). A total of 78 patients (78/83=94%) were discharged and have been followed up without major adverse cardiac events for a mean duration of 31.8 months. Ascending aortic cannulation is a simple and safe technique that provides a rapid and reliable route of antegrade central systemic perfusion in type A aortic dissection. Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

SU-E-T-517: Investigation of Factors Contributing to Extracranial Radiation Doses From Leksell Gamma Knife

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Kon, D [The University of Tokyo Graduate school of Medicine, Tokyo, JP (Japan); Kameda Medical Centre, Chiba, JP (Japan); Nakano, M [The University of Tokyo Graduate school of Medicine, Tokyo, JP (Japan); Nawa, K; Haga, A; Nakagawa, K [University of Tokyo Hospital, Tokyo, JP (Japan)

2015-06-15