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1.
Rev. cuba. oftalmol ; 34(1): e907, 2021. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1289537

ABSTRACT

El diagnóstico temprano de las lesiones compresivas del nervio óptico adquiere cada vez mayor importancia. La descompresión precoz de este o del quiasma puede resultar una mejora significativa de la función visual, mientras que el diagnóstico erróneo puede ocasionar pérdida visual irreversible, disfunción neurológica o la muerte. Las causas de la compresión de la vía visual anterior son increíblemente variadas. Los meningiomas, los tumores hipofisarios y los aneurismas son las lesiones comúnmente más identificadas como causa de neuropatía óptica compresiva sin edema del disco. Presentamos una paciente femenina de 50 años de edad, quien se sometió a la cirugía de catarata congénita del ojo izquierdo, sin mejoría de la función visual, a lo que se sumó el empeoramiento inespecífico de la calidad visual. La psicofísica visual, la campimetría automatizada y la tomografía de coherencia óptica aportaron hallazgos sugestivos de compresión de la vía visual intracraneal. Se indicó imagen por resonancia magnética de cráneo y órbitas para confirmar la sospecha diagnóstica. La angiografía cerebral demostró la presencia de un aneurisma de la arteria carótida interna, que se trató por vía endovascular con resultados satisfactorios(AU)


The importance of early diagnosis of compressive lesions of the optic nerve is on the increase. Timely decompression of the optic nerve or the optic chiasm may bring about significant visual function improvement, whereas erroneous diagnosis may result in irreversible visual loss, neurological dysfunction or death. The causes of compression of the anterior visual pathway are incredibly varied. Meningiomas, pituitary tumors and aneurysms are the lesions most commonly identified as causes of compressive optic neuropathy without disc edema. A case is presented of a female 50-year-old patient undergoing congenital cataract surgery of her left eye without visual function improvement, alongside unspecific visual quality worsening. Visual psychophysical testing, automated campimetry and optical coherence tomography contributed findings suggestive of intracranial visual pathway compression. Magnetic resonance imaging of the brain and orbits was indicated to confirm the diagnostic suspicion. Cerebral angiography revealed the presence of an internal carotid artery aneurysm which was treated by endovascular procedure with satisfactory results(AU)


Subject(s)
Humans , Female , Middle Aged , Carotid Artery, Internal/diagnostic imaging , Tomography, Optical Coherence/adverse effects , Early Diagnosis , Endovascular Procedures/methods , Visual Field Tests/methods
2.
Rev. ADM ; 78(1): 51-55, ene.-feb- 2021. ilus
Article in Spanish | LILACS | ID: biblio-1178203

ABSTRACT

La endarterectomía carotídea es el procedimiento quirúrgico de elección para tratar la obstrucción y/o estenosis de la arteria carótida extracraneal y prevenir los eventos neurológicos. La aparición de síntomas depende de la gravedad y progresión de la lesión, del adecuado flujo colateral, de las características de la placa y de la presencia de otros factores de riesgo. Analizamos el resultado de la endarterectomía carotídea como procedimiento quirúrgico de elección para la estenosis carotídea, así como la presentación de un caso clínico de un adulto mayor con oclusión del 100% y la resolución completa de los síntomas posteriores al procedimiento quirúrgico (AU)


Endarterectomy of the carotid is the surgical procedure of choice to treat obstruction and/or stenosis of the extracranial carotid artery and prevent neurological events. The appearance of symptoms depends on the severity and progression of the lesion, the adequate collateral flow, the characteristics of the plaque and the presence of other risk factors. We analyze the result of carotid endarterectomy as the surgical procedure of choice for carotid stenosis as well as the presentation of a clinical case of an elderly adult patient with 100% occlusion and complete resolution of symptoms after the surgical procedure (AU)


Subject(s)
Humans , Male , Aged , Carotid Artery, Internal , Endarterectomy, Carotid , Carotid Stenosis , Endarterectomy , Signs and Symptoms , Surgical Procedures, Operative , Risk Factors , Constriction, Pathologic , Mexico
3.
ABC., imagem cardiovasc ; 34(2)2021. ilus
Article in Portuguese | LILACS | ID: biblio-1291096

ABSTRACT

Adulto jovem de 18 anos que evoluiu após traumatismo craniencefálico leve com fístula carotídea direta. Apresentou zumbido e exoftalmia, ambos de característica pulsátil e à esquerda. Foi submetido a estudo com Doppler das carótidas, que mostrou elevadas velocidades do fluxo sanguíneo e índices de resistência reduzidos nas artérias carótidas comum e interna esquerdas, compatíveis com fístula carotídea direta. A angiotomografia computadorizada cerebral confirmou a fístula carotídea. Foi encaminhado para tratamento endovascular por embolização, com sucesso. O Doppler de carótidas pode ter papel importante no diagnóstico das fístulas carotídeas diretas e acompanhamento de pacientes submetidos à terapêutica endovascular.(AU)


Subject(s)
Humans , Adolescent , Carotid Artery Diseases/physiopathology , Carotid Artery, Internal/pathology , Carotid-Cavernous Sinus Fistula/therapy , Carotid-Cavernous Sinus Fistula/diagnostic imaging , Brain Injuries, Traumatic/diagnostic imaging , Echocardiography, Doppler, Color/methods , Embolization, Therapeutic/methods , Endovascular Procedures/methods , Computed Tomography Angiography/methods
4.
Rev. méd. (La Paz) ; 26(2): 49-56, Julio - Diciembre, 2020. Ilus.
Article in Spanish | LILACS | ID: biblio-1152058

ABSTRACT

Se presenta un caso del primer Bypass cerebro vascular realizado en Bolivia por un aneurisma gigante de arteria carotida interna derecha, en segmento cavernoso tratado mediante bypass de alto flujo de arteria carótida externa a arteria cerebral media derecha, con injerto de arteria radial y posterior oclusión y exclusión del aneurisma. Se desciben los pasos de la cirugia y se destacan las dificultades de la tecnica y los beneficios de la cirugia. SE discuten los elementos a considerar en la toma de decisiones para la indicación y realización del bypass en el tratamiento de los aneurismas gigantes de la ACI.


Subject(s)
Carotid Artery, Internal
5.
Int. j. morphol ; 38(4): 1026-1031, Aug. 2020. tab, graf
Article in English | LILACS | ID: biblio-1124892

ABSTRACT

The carotid canal is located in the petrous part of the temporal bone and transmits the internal carotid artery along with the venous and sympathetic nerve plexus. The shape, location and dimensions of the carotid canal are clinically very important especially in cases of skull base surgery. The aim of this study was to investigate the morphological and morphometric parameters of the external aperture of the carotid canal in Serbian population. The study included 24 dry adult skulls and 36 dry adult temporal bones. Diameters and distances of the external aperture of the carotid canal from various important landmarks of the skull base were measured. The shape of the external carotid canal aperture was also noted. Digital data were processed in the ImageJ software. The average length of the external aperture of the carotid canal in all investigated specimens (skulls and temporal bones) on the right and left sides was 7.31±1.01 mm and 7.71±1.06 mm, respectively. The average width of the external aperture of the carotid canal on the right side was 5.82±0.78 mm while on the left side was 6.20±1.04 mm. The frequency of different shapes of the external aperture of the carotid canal was as follows: round in 45 (53.57 %), oval in 25 (29.76 %), and the rarest was almond shape noted in 13 (15.47 %) cases. There were no statistically significant differences in all measured parameters between genders and body sides. The only statistical significance was found in females between right and left side in relation with length (AP diameter) of the external aperture of the carotid canal. The results of this study will be useful for neurosurgeons to improve different surgical approaches to the petrous part of the internal carotid artery and prevent its complications.


El conducto carotídeo se encuentra en la parte petrosa del hueso temporal y da paso a la arteria carótida interna junto con el plexo nervioso venoso y simpático. La forma, ubicación y dimensiones del canal carotídeo son clínicamente muy importantes, especialmente en casos de cirugía de la base del cráneo. El objetivo de este estudio fue investigar los parámetros morfológicos y morfométricos de la apertura externa del canal carotídeo en la población serbia. El estudio incluyó 24 cráneos adultoss y 36 huesos temporales adultos secos. Se midieron los diámetros y distancias de la apertura externa desde varios puntos de referencia de la base del cráneo. También se observó la forma de la apertura del canal carotídeo externo. Los datos digitales se procesaron con Software ImageJ. La longitud promedio de la apertura en todos los especímenes investigados (cráneos y huesos temporales) en los lados derecho e izquierdo fue de 7,31 ± 1,01 mm y 7,71 ± 1,06 mm, respectivamente. El ancho promedio de la apertura en el lado derecho fue de 5,82 ± 0,78 mm mientras que en el lado izquierdo fue de 6,20 ± 1,04 mm. La frecuencia de las diferentes formas de la abertura externa fue la siguiente: redonda en 45 (53,57 %), ovalada en 25 (29,76 %), y la más rara fue la forma de almendra observada en 13 (15,47 %) casos. No hubo diferencias estadísticamente significativas en todos los parámetros medidos entre sexos y lados del cuerpo. La única estadística significativa se encontró en las mujeres entre el lado derecho e izquierdo en relación con la longitud (diámetro AP) de la apertura externa del conducto carotídeo. Los resultados de este estudio serán útiles para un mejor enfoque quirúrgico de los neurocirujanos en la parte petrosa de la arteria carótida interna, y advertir posibles complicaciones.


Subject(s)
Humans , Male , Female , Temporal Bone/anatomy & histology , Carotid Artery, Internal , Petrous Bone/anatomy & histology , Skull/anatomy & histology , Serbia
6.
Rev. cuba. angiol. cir. vasc ; 21(1): e89, ene.-abr. 2020. fig
Article in Spanish | LILACS, CUMED | ID: biblio-1126372

ABSTRACT

Introducción: El aneurisma de la arteria carótida interna es una enfermedad muy poco frecuente. Sus complicaciones son muy graves si se tiene en cuenta la zona que irrigan estas arterias. Su incidencia es baja Objetivo: Presentar las manifestaciones clínicas de esta enfermedad y el tratamiento realizado en el paciente. Presentación del caso: paciente masculino de 58 años de edad con antecedentes de hipertensión arterial y un aneurisma de la arteria carótida interna derecha desde hace cinco años; el cual aumentó su tamaño en los últimos seis meses. El diagnóstico fue confirmado por ecodoppler y angiotomografía. Se empleó el tratamiento quirúrgico convencional, la aneurismectomía e injerto por sustitución, con prótesis de politetrafluroetileno sin complicaciones. Conclusiones: El paciente evolucionó satisfactoriamente después de la cirugía, en la actualidad lleva tres meses intervenido sin complicaciones y mantiene el tratamiento con antiagregantes plaquetarios(AU)


Introduction: The aneurysm of the right internal carotid artery is a very rare disease. Its complications are very serious if we take into account the area that irrigates these arteries. The incidence of this disease is low. Objective: To present the clinical manifestations of this disease and the surgical treatment used in this patient. Presentation of the case: Male patient, 58 years old, with a history of arterial hypertension and presenting an aneurysm of the right internal carotid artery with five years of evolution. Such lump increased its size in the last six months; this was confirmed by ecodoppler and angiotomography, so he came to the consultation. The conventional surgical treatment was used: aneurysmectomy and grafting by substitution with polytetrafluroethylene prosthesis without complications. Conclusions: The patient developed successfully after surgery; he is currently evolving after three months of being operated on without complications and he keeps the treatment with antiplatelet agents(AU)


Subject(s)
Humans , Male , Middle Aged , Carotid Artery, Internal/surgery , Hypertension/diagnosis , Aneurysm/complications
7.
Rev. Assoc. Med. Bras. (1992) ; 66(1): 31-35, Jan. 2020. tab, graf
Article in English | LILACS | ID: biblio-1091903

ABSTRACT

SUMMARY Homozygous familial hypercholesterolemia is a rarely agentic disorder of the lipoprotein metabolism intimately related to premature atherosclerotic cardiovascular disease that can lead to high disability and mortality. Homozygous familial hypercholesterolemia typically affects not only the aortic root, compromising the coronary ostia, but also affects other territories such as the carotid, descending aorta, and renal arteries. Multi-contrast high-resolution magnetic resonance imaging (MRI) provides a validated and useful method to characterize carotid artery atherosclerotic plaques quantitatively. However, very few studies have been done on assessing plaque composition in patients with Homozygous familial hypercholesterolemia using high-resolution MRI. This report is to evaluate the value of MRI in accessing carotid artery disease in patients with Homozygous familial hypercholesterolemia. We describe a 28-year-old patient from Beijing, China, who presented to the Neurology Clinic with intermittent blurred vision of the right eye, headache, nausea, and vomiting for eight years without obvious causes. Familial hypercholesterolemia was suspected based on medical history and laboratory examination. Carotid Doppler ultrasound showed bilateral common carotid artery, internal carotid artery, and external carotid artery wall thickening with hyperechoic signals. Subsequently, high-resolution multi-contrast MRI of the carotid showed calcification with hypo-intense areas located at the middle layer of the plaque, with moderate stenosis. The plaque located at the right bifurcation of the common carotid artery extended to the internal carotid artery, causing lumen stenosis close to occlusion. The patient was treated with right carotid artery endarterectomy. At a 6-month follow-up, there had been no recurrence of the patient's symptoms.


RESUMO A hipercolesterolemia familiar homozigótica, uma doença patogênica rara do metabolismo da lipoproteína intimamente relacionada com a doença cardiovascular aterosclerótica prematura, pode conduzir a uma elevada deficiência e mortalidade. A hipercolesterolemia familiar homozigótica afeta tipicamente não só a raiz aórtica, comprometendo os óstios coronários, mas também outros territórios, como a carótida, a aorta descendente e as artérias renais. Imagens de ressonância magnética multicontraste de alta resolução (RM) fornecem um método validado e útil para caracterizar quantitativamente as placas de aterosclerose da artéria carótida. No entanto, muito poucos estudos foram feitos sobre a avaliação da composição da placa em doentes com hipercolesterolemia familiar homozigótica utilizando ressonância magnética de alta resolução. Este trabalho deve avaliar o valor da ressonância magnética no acesso à doença da artéria carótida em doentes com hipercolesterolemia familiar homozigótica. Descrevemos um paciente de 28 anos de Pequim, China, que se apresentou à clínica neurológica com visão turva intermitente do olho direito, dor de cabeça, náuseas e vômitos por oito anos sem causas aparentes. Suspeitava-se de hipercolesterolemia familiar com base no histórico médico e no exame laboratorial. O ultrassom Doppler carotídeo mostrou uma artéria carótida bilateral comum, artéria carótida interna e parede da carótida externa espessando-se com sinais hiperecoicos. Posteriormente, a ressonância multicontraste de alta resolução da carótida mostrou calcificação com áreas hipointensas localizadas na camada média da placa, com estenose moderada. A placa localizada na bifurcação direita da artéria carótida comum estendia-se até a artéria carótida interna, causando estenose do lúmen próxima à oclusão. O paciente foi tratado com endarterectomia da artéria carótida direita. Em seis meses de acompanhamento, não houve recorrência dos sintomas do paciente.


Subject(s)
Humans , Female , Adult , Thrombosis/diagnostic imaging , Coronary Artery Disease/diagnostic imaging , Magnetic Resonance Imaging/methods , Carotid Stenosis/diagnostic imaging , Plaque, Atherosclerotic/diagnostic imaging , Hyperlipoproteinemia Type II/diagnostic imaging , Carotid Artery, External/pathology , Carotid Artery, External/diagnostic imaging , Carotid Artery, Internal/pathology , Carotid Artery, Internal/diagnostic imaging , Ultrasonography, Doppler, Color/methods , Plaque, Atherosclerotic/pathology , Carotid Intima-Media Thickness , Computed Tomography Angiography/methods
10.
Braz. j. otorhinolaryngol. (Impr.) ; 85(4): 435-446, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019586

ABSTRACT

Abstract Introduction: Various aspects of the round window anatomy and anatomy of posterior tympanum have relevant implications for designing cochlear implant electrodes and visualizing the round window through facial recess. Preoperative information about possible anatomical variations of the round window and its relationships to the adjacent neurovascular structures can help reduce complications in cochlear implant surgery. Objective: The present study was undertaken to assess the common variations in round window anatomy and the relationships to structures of the tympanum that may be relevant for cochlear implant surgery. Methods: Thirty-five normal wet human cadaveric temporal bones were studied by dissection for anatomy of round window and its relation to facial nerve, carotid canal, jugular fossa and other structures of posterior tympanum. The dissected bones were photographed by a digital camera of 18 megapixels, which were then imported to a computer to determine various parameters using ScopyDoc 8.0.0.22 version software, after proper calibration and at 1× magnification. Results: When the round window niche is placed posteriorly and inferiorly, the distance between round window and vertical facial nerve decreases, whereas that with horizontal facial nerve increases. In such cases, the distance between oval window and round window also increases. Maximum height of the round window in our study ranged from 0.51-1.27 mm (mean of 0.69 ± 0.25 mm). Maximum width of round window ranged from 0.51 to 2.04 mm (mean of 1.16 ± 0.47 mm). Average minimum distance between round window and carotid canal was 3.71 ± 0.88 mm (range of 2.79-5.34 mm) and that between round window and jugular fossa was 2.47 ± 0.9 mm (range of 1.24-4.3 mm). Conclusion: The distances from the round window to the oval window and facial nerve are important parameters in identifying a difficult round window niche. Modification of the electrode may be a better option than drilling off the round window margins for insertion of cochlear implant electrodes.


Resumo Introdução: Vários aspectos da anatomia da janela redonda e da anatomia da caixa timpânica posterior são relevantes, devido a suas implicações no desenho dos eletrodos para o implante coclear e na visibilidade da janela redonda através do recesso facial. Informações prévias sobre possíveis variações anatômicas da janela redonda e suas relações com as estruturas neurovasculares adjacentes podem ajudar a reduzir as complicações dessa cirurgia. Objetivo: O presente estudo foi realizado para avaliar as diversas variações da anatomia da janela redonda e sua relação com as estruturas adjacentes, o que pode ser relevante para a cirurgia de implante coclear. Método: Trinta e cinco ossos temporais normais de cadáveres humanos frescos foram dissecados para avaliação da anatomia da janela redonda e sua relação com o nervo facial, canal carotídeo, fossa jugular e outras estruturas da caixa timpânica posterior. Os ossos dissecados foram fotografados com uma câmera digital de 18 megapixels e as imagens importadas para um computador para determinar diversos parâmetros, utilizando-se o software ScopyDoc versão 8.0.0.22, após a calibração adequada e com ampliação de 1×. Resultados: Quando o nicho da janela redonda se encontra posicionado posteriormente e inferiormente, a distância entre a janela redonda e o nervo facial vertical diminui, enquanto aquela com o nervo facial horizontal aumenta. Em tais casos, a distância entre a janela oval e a janela redonda também aumenta. A altura máxima da janela redonda em nosso estudo variou de 0,51 a 1,27 mm (média de 0,69 ± 0,25 mm). A largura máxima da janela redonda variou de 0,51 a 2,04 mm (média de 1,16 a 0,47 mm). A distância mínima média entre a janela redonda e o canal carotídeo foi de 3,71 ± 0,88 mm (variação de 2,79 a 5,34 mm) e entre a janela redonda e a fossa jugular, em nosso estudo, foi de 2,47 ± 0,9 mm (variação de 1,24 ± 4,3 mm). Conclusão: A distância da janela redonda a partir da janela oval e do nervo facial são parâmetros importantes para a identificação do difícil nicho da janela redonda. A modificação do desenho do eletrodo pode ser uma opção melhor do que o broqueamento das margens da janela redonda para a inserção dos eletrodos no implante coclear.


Subject(s)
Humans , Round Window, Ear/anatomy & histology , Temporal Bone/anatomy & histology , Tympanic Membrane/anatomy & histology , Oval Window, Ear/anatomy & histology , Cadaver , Carotid Artery, Internal/anatomy & histology , Cochlear Implantation , Dissection , Facial Nerve/anatomy & histology
11.
Article in English | WPRIM | ID: wpr-785923

ABSTRACT

OBJECTIVE: Selecting an appropriate guiding catheter to provide both sufficient supportability for working devices and sufficient distal navigability is essential for ensuring the success of a procedure. This study aimed to evaluate the advantages and disadvantages of using the ENVOY 6F distal access (DA) guiding catheter in coil embolization of anterior circulation cerebral aneurysms.METHODS: We included 98 patients (72 [73.5%] women, median age: 63 [range: 25–84] years) who underwent endovascular coiling with the ENVOY 6F DA guiding catheter from May to November 2016. We analyzed data on patient demographics and the number of co-axial techniques to position the guiding catheter, initial and final location of the catheter, and complications related to the catheter.RESULTS: The co-axial technique was used to position the ENVOY 6F DA guiding catheter in the internal carotid artery (ICA) in 20 cases (20.41%). The initial position of the ENVOY 6F DA guiding catheter involved the cervical ICA (79.6%), horizontal petrous ICA (17.3%), and vertical petrous ICA (3.1%). Final control angiograms after endovascular coiling showed proximal change in the final, compared to the initial, position of the ENVOY 6F DA guiding catheter in 25 cases (25.51%). Procedure-related complications were observed in nine patients (9.18%), involving vasospasm in all cases; however, there was no symptomatic case.CONCLUSION: The ENVOY 6F DA guiding catheter had relatively sufficient distal navigability without symptomatic procedural complications. However, the change in the catheter position after endovascular coiling denoted insufficient supportability.


Subject(s)
Aneurysm , Carotid Arteries , Carotid Artery, Internal , Catheterization , Catheters , Cerebrovascular Circulation , Demography , Embolization, Therapeutic , Female , Humans , Intracranial Aneurysm
12.
Article in Chinese | WPRIM | ID: wpr-775229

ABSTRACT

Restoration of cerebral blood flow is particularly important for the treatment of ischemic cerebrovascular disease. It is notable that surgical approaches play a unique role in treating this devastating disease. Among them, mechanical thrombectomy facilitates rapid and effective recanalization of occluded intracranial large vessels causing ischemic stroke, which contributes to improvement of cerebral perfusion in the ischemic penumbra; decompressive craniectomy is an important therapeutic option for acute massive cerebral infarction, and the timing of surgery determines the final clinical outcomes; for carotid endarterectomy in carotid-artery stenosis, individualized surgical plan is important for the safety and effectiveness of the operation; in the surgical revascularization of Moyamoya disease, precise evaluation of clinical and radiological characteristics, optimal surgical strategies and accuracy of intraoperative judgment will yield maximal therapeutic effects; and hybrid surgery is feasible for the therapy of complex ischemic cerebrovascular diseases, such as extracranial/intracranial arteries tandem stenosis and symptomatic chronic total occlusion of carotid artery. This paper reviews recent technical and clinical advances in the surgical treatment of ischemic cerebrovascular disease.


Subject(s)
Brain Ischemia , General Surgery , Carotid Artery, Internal , General Surgery , Carotid Stenosis , General Surgery , Endarterectomy, Carotid , Humans , Stroke , General Surgery , Treatment Outcome
13.
Article in Korean | WPRIM | ID: wpr-766873

ABSTRACT

PURPOSE: We report a case of acute visual loss with ophthalmoplegia after prone position spinal surgery who had blood supply dependence on collateral circulation due to occlusion of the Internal carotid artery. CASE SUMMARY: A 74-year-old man was referred to the department of ophthalmology for acute visual loss and ophthalmoplegia after lumbar spine surgery performed in prone position. On the initial visit, his right visual acuity was 0.8 and the left visual acuity was negative light perception. Intraocular pressure was normal. There was a relative afferent pupillary defect and ophthalmoplegia of all directions in the left eye. Because of the ptosis of the upper eyelid in the left eye, it was impossible to tune the eye voluntarily. The cherry red spot and pale retina were observed on the fundus examination. On brain magnetic resonance imaging angiography, we found complete obstruction of the left internal carotid artery. He had intravenous injection of 1 g methylprednisolone for 3 days, and discharged with per oral medicine. After 1 month of treatment, the ophthalmoplegia was slightly improved, but visual acuity was not recovered. CONCLUSIONS: In this case, unlike previous reports, acute visual loss and ophthalmoplegia occurred after spinal surgery the patient who had collateral circulation for ocular blood supply because of complete obstruction of the left internal carotid artery. This report highlights the importance of being aware of the anatomical variant in possible complications of external ocular compression after non-ocular surgery.


Subject(s)
Aged , Angiography , Brain , Carotid Artery, Internal , Collateral Circulation , Eyelids , Humans , Injections, Intravenous , Intraocular Pressure , Magnetic Resonance Imaging , Methylprednisolone , Ophthalmology , Ophthalmoplegia , Oral Medicine , Prone Position , Pupil Disorders , Retina , Retinal Artery Occlusion , Spine , Visual Acuity
17.
Article in Korean | WPRIM | ID: wpr-766555

ABSTRACT

Moyamoya disease (MMD) refers to a chronic progressive steno-occlusive disease at the distal portion of the internal carotid artery with abnormal collateral vessel formation of unknown etiology. The definite diagnosis of MMD requires cerebral angiography or magnetic resonance angiography and/or magnetic resonance imaging after excluding other underlying diseases, particularly in adult patients. The treatment aims to improve regional cerebral blood flow to prevent cerebral ischemic events and alleviate hemodynamic instability that can provoke cerebral hemorrhage. Although various surgical revascularization methods have been introduced, combined revascularization surgery including direct revascularization is preferred over indirect revascularization only in adult MMD patients. Several recent studies have shown that surgical treatment has better outcomes and prognosis for symptomatic hemodynamically unstable MMD patients with both ischemic and hemorrhagic presentations. For asymptomatic patients, follow up with appropriate imaging is recommended. Surgery should be considered when new symptoms emerge with hemodynamic aggravation.


Subject(s)
Adult , Carotid Artery, Internal , Cerebral Angiography , Cerebral Hemorrhage , Cerebrovascular Circulation , Diagnosis , Follow-Up Studies , Hemodynamics , Humans , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Moyamoya Disease , Prognosis
18.
Journal of Stroke ; : 332-339, 2019.
Article in English | WPRIM | ID: wpr-766258

ABSTRACT

BACKGROUND AND PURPOSE: To investigate the number and characteristics of patients eligible for endovascular treatment (EVT) determined using three different selection methods: clinical-core mismatch, target mismatch, and collateral status. METHODS: Using the data of consecutive patients from two prospectively maintained registries of university medical centers, the number and characteristics of patients according to the three selection methods were investigated and their correlation was analyzed. Patients with anterior circulation stroke due to occlusion of the middle cerebral and/or internal carotid artery and a National Institute of Health Stroke Scale (NIHSS) score of ≥6 points, who arrived within 8 hours or between 6 and 12 hours of symptom onset and underwent magnetic resonance imaging prior to EVT, were included. Collateral status was assessed using magnetic resonance perfusion-derived collateral flow maps. RESULTS: Three hundred thirty-five patients were investigated; the proportions of patients who were eligible and ineligible for EVT in all three selection methods were both small (n=85, 25.4%; n=54, 16.1%, respectively). The intercorrelation among the three selection methods was low (κ=0.235). The baseline NIHSS score and onset-to-selection time interval were associated with the presence of clinical-core mismatch, while the penumbra/core volume ratio and onset-to-selection time interval were related to target mismatch; none of these variables were associated with collateral status. The infarct core volume was associated with favorable profiles in all three selection methods. CONCLUSIONS: Although the application of individual selection methods resulted in favorable outcomes after EVT in clinical trials, there is a significant discrepancy in EVT eligibility depending on the selection method used.


Subject(s)
Academic Medical Centers , Carotid Artery, Internal , Humans , Magnetic Resonance Imaging , Methods , Prospective Studies , Registries , Stroke
19.
Article in English | WPRIM | ID: wpr-765381

ABSTRACT

OBJECTIVE: Penumbra ACE68 reperfusion catheter is a new large bore aspiration catheter used for reperfusion of large vessel occlusion. The objective of this study was to investigate the efficacy of this catheter in comparison to that of previous Penumbra catheters in patients with acute ischemic stroke related to internal carotid artery (ICA) occlusion. METHODS: Data of all eligible patients who received endovascular treatment (EVT) for ICA occlusion using Penumbra aspiration catheters between January 2015 and December 2018 were retrospectively reviewed. After dividing into two groups according to use of penumbra ACE68, baseline characteristics of patients, successful recanalization rate, puncture to recanalization time, and switch to stent base technique rate were assessed. Successful recanalization was defined by a thrombolysis in cerebral infarction (TICI) score ≥2b and favorable functional outcome was defined according to modified Rankin scale (score, 0–2). RESULTS: ACE68 reperfusion catheter was used in 29 of 75 eligible patients (39%). The puncture to recanalization time was significantly shorter (26±18.2 minutes vs. 40±24.9 minutes, p=0.011) and the rate of switch to stent-based retrieval was significantly lower (3% vs. 20%, p=0.046) in ACE68 catheter group. Moreover, although not statistically significant, the successful recanalization rate was higher (83% vs. 76%, p=0.492) in ACE68 catheter group. Favorable functional outcome was observed in 48% of patients treated with ACE68 reperfusion catheter and in 30% of patients treated using other Penumbra systems (p=0.120). Baseline Alberta Stroke Program Early CT Scores ≥8 (odds ratio [OR], 9.74; 95% confidence interval [CI], 1.72–54.99; p=0.010) and successful recanalization (OR, 10.20; 95% CI, 1.13–92.46; p=0.039) were independent predictors of favorable outcome. CONCLUSION: EVT using ACE68 reperfusion catheter can be considered a first-line therapy in patients with acute ICA occlusion as it can achieve rapid recanalization and reduce the frequency of conversion to stent-retrieve therapy.


Subject(s)
Alberta , Brain Ischemia , Carotid Artery, Internal , Catheters , Cerebral Infarction , Humans , Punctures , Reperfusion , Retrospective Studies , Stents , Stroke , Thrombectomy
20.
Article in English | WPRIM | ID: wpr-765340

ABSTRACT

Moyamoya disease (MMD) is a progressive cerebrovascular disease with unknown etiology, characterized by bilateral stenoocclusive changes at the terminal portion of the internal carotid artery and an abnormal vascular network formation at the base of the brain. MMD has an intrinsic nature to convert the vascular supply for the brain from internal carotid (IC) system to the external carotid (EC) system, as indicated by Suzuki’s angiographic staging. Insufficiency of this ‘IC-EC conversion system’ could result not only in cerebral ischemia, but also in intracranial hemorrhage from inadequate collateral anastomosis, both of which represent the clinical manifestation of MMD. Surgical revascularization prevents cerebral ischemic attack by improving cerebral blood flow, and recent evidence further suggests that extracranial-intracranial bypass could powerfully reduce the risk of re-bleeding in MMD patients with posterior hemorrhage, who were known to have extremely high re-bleeding risk. Although the exact mechanism underlying the hemorrhagic presentation in MMD is undetermined, most recent angiographic analysis revealed the characteristic angio-architecture related to high re-bleeding risk, such as the extension and dilatation of choroidal collaterals and posterior cerebral artery involvement. We sought to update the current management strategy for hemorrhagic MMD, including the outcome of surgical revascularization for hemorrhagic MMD in our institute. Further investigations will clarify the optimal surgical strategy to prevent hemorrhagic manifestation in patients with MMD.


Subject(s)
Angiography , Brain , Brain Ischemia , Carotid Artery, Internal , Cerebrovascular Circulation , Cerebrovascular Disorders , Choroid , Dilatation , Hemorrhage , Humans , Intracranial Hemorrhages , Moyamoya Disease , Posterior Cerebral Artery
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