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1.
Clinics ; 74: e715, 2019. graf
Article in English | LILACS | ID: biblio-989640

ABSTRACT

Cerebrovascular diseases pose a serious threat to human survival and quality of life and represent a major cause of human death and disability. Recently, the incidence of cerebrovascular diseases has increased yearly. Rapid and accurate diagnosis and evaluation of cerebrovascular diseases are of great importance to reduce the incidence, morbidity and mortality of cerebrovascular diseases. With the rapid development of medical ultrasound, the clinical relationship between ultrasound imaging technology and the diagnosis and treatment of cerebrovascular diseases has become increasingly close. Ultrasound techniques such as transcranial acoustic angiography, doppler energy imaging, three-dimensional craniocerebral imaging and ultrasound thrombolysis are novel and valuable techniques in the study of cerebrovascular diseases. In this review, we introduce some of the new ultrasound techniques from both published studies and ongoing trials that have been confirmed to be convenient and effective methods. However, additional evidence from future studies will be required before some of these techniques can be widely applied or recommended as alternatives.


Subject(s)
Humans , Cerebrovascular Disorders/diagnostic imaging , Ultrasonography/trends , Cerebral Angiography/methods , Thrombolytic Therapy/instrumentation , Ultrasonography/methods , Ultrasonography, Doppler, Transcranial/methods
2.
Medicina (B.Aires) ; 78(5): 364-367, oct. 2018. ilus
Article in Spanish | LILACS | ID: biblio-976126

ABSTRACT

Presentamos dos casos de accidente cerebrovascular en sujetos con trayecto extracraneal de la arteria cerebeloso póstero-inferior. Caso 1: varón de 21 años, quien presentó ataxia y dismetría derecha luego de un traumatismo cervical en un partido de rugby. Caso 2: mujer de 56 años, quien inició con vértigo y hemiparesia izquierda luego de esfuerzo físico intenso. En ambos casos, los estudios angiográficos mostraron un trayecto extracraneal de la arteria cerebelosa póstero-inferior. Este vaso raramente se origina por debajo del foramen magno, en relación cercana con las primeras tres vértebras cervicales y la articulación atlanto-axial. En este nivel, está expuesta a daño mecánico causante de disección, como por ejemplo trauma directo, manipulación cervical abrupta o extensión cefálica prolongada. Por lo tanto, en pacientes con accidente cerebrovascular de región lateral de bulbo y trayecto extracraneal de la arteria cerebelosa póstero-inferior se debería considerar esta asociación.


We present two cases of lateral medullary stroke in subjects with extracranial trajectory of the postero-inferior cerebellar artery. Case 1: a 21-year-old male who presented ataxia and right dysmetria after cervical trauma in a rugby match. Case 2: 56-year-old woman, who started with vertigo and left hemiparesis after intense physical effort. In both cases, the angiographic studies showed an extracranial trajectory of the posterior inferior cerebellar artery. This vessel rarely originates below the foramen magnum, in close relationship with the first three cervical vertebrae and the atlanto-axial joint. At this level, it is exposed to mechanical damage causing dissection, such as direct trauma, abrupt cervical manipulation or prolonged cephalic extension. Therefore, this association should be considered in patients with stroke of the lateral region of the bulb and extracranial trajectory of the posterior-inferior cerebellar artery.


Subject(s)
Humans , Male , Female , Middle Aged , Lateral Medullary Syndrome/etiology , Cerebellum/blood supply , Posterior Cerebral Artery/injuries , Aneurysm, Dissecting/complications , Lateral Medullary Syndrome/pathology , Lateral Medullary Syndrome/diagnostic imaging , Magnetic Resonance Imaging/methods , Cerebral Angiography/methods , Cerebellum/injuries , Cerebellum/pathology , Cerebellum/diagnostic imaging , Posterior Cerebral Artery/pathology , Posterior Cerebral Artery/diagnostic imaging , Aneurysm, Dissecting/pathology , Aneurysm, Dissecting/diagnostic imaging
3.
Medicina (B.Aires) ; 78(5): 305-310, oct. 2018. ilus, tab
Article in Spanish | LILACS | ID: biblio-976118

ABSTRACT

Los tumores del tronco cerebral son infrecuentes en la población adulta. Las controversias surgen cuando se considera la necesidad de confirmar el diagnóstico histopatológico en esta área elocuente del cerebro, balanceando los beneficios de obtener un diagnóstico certero y las desventajas de los procedimientos invasivos. Existen escasas publicaciones acerca de su tratamiento quirúrgico en adultos, todas series pequeñas analizadas retrospectivamente. Presentamos nuestra experiencia con el propósito de contribuir al proceso de toma de decisiones. Diez de 13 pacientes fueron intervenidos. Las lesiones se clasificaron en focales (n:7), infiltrativa difusa (n:1), tectal (1) y exofítica (1). El estado neurológico según la escala Karnofsky Performance Status fue ≥ 70 en 6 casos y < 70 en 7. Las muestras fueron obtenidas mediante abordaje microquirúrgico directo o por biopsia estereotáctica. Los hallazgos histopatológicos fueron confirmados en todos los casos: astrocitoma pilocítico (n:1), glioma de bajo grado (n:1), glioblastoma (n:1), hemangioblastoma celular (n:1), subependimoma (n:1), disgerminoma (n:1), y lesiones pseudotumorales (n:4, 3 cavernomas, 1 pseudotumor inflamatorio). La amplia variedad de hallazgos patológicos en esta localización en adultos exige una precisa definición histopatológica, que no solo determina la terapéutica adecuada sino que también previene las consecuencias potencialmente catastróficoas de los tratamientos empíricos.


Brainstem tumors are uncommon beyond childhood. Controversies arise regarding the need of histological diagnosis in this eloquent area of the brain, weighting the benefits of a reliable diagnosis against the disadvantages of invasive procedures. There are scant publications about the surgical management of brainstem tumors in adults, all of them involving small retrospective cohorts. We are reporting our experience with the aim of contributing to the decision making process. Out of a series of 13 patients, 10 were approached surgically. According to Guillamo´s classification the lesions were: focal (n:7), diffuse infiltrative (n:1), tectal (n:1), and exophytic (n:1). According to the Karnofsky Performance Status scale, the neurological status was ≥ 70 in 6 cases and < 70 in 7. Histopathology was confirmed in all 10 treated cases and the samples were obtained by a direct microsurgical approach or by stereotactic biopsy. Histopathological findings were: pilocytic astrocytoma (n:1), low grade glioma (n:1), glioblastoma (n:1), cellular haemangioblastoma (n:1), subependimoma (n:1), pseudotumoral lesions (n:4; 3 cavernomas, 1 inflammatory pseudotumor), and disgerminoma (n:1). As a broad variety of pathologies could be found in this brain localization, an accurate histopathological definition can not only determine the adequate therapy, but also avoid the disastrous consequences of empiric treatments.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Brain Stem Neoplasms/surgery , Brain Stem Neoplasms/pathology , Biopsy , Magnetic Resonance Imaging , Cerebral Angiography/methods , Retrospective Studies , Karnofsky Performance Status , Hemangioblastoma/diagnosis , Hemangioma, Cavernous, Central Nervous System/surgery , Hemangioma, Cavernous, Central Nervous System/diagnosis , Brain Stem Neoplasms/diagnosis , Glioma/diagnosis , Granuloma, Plasma Cell/diagnosis
4.
Rev. chil. neurocir ; 43(1): 23-33, July 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-869776

ABSTRACT

Introducción: El manejo actual de la isquemia cerebral aguda (IA) contempla el uso de r-tPA y terapia endovascular, mientrasque en la isquemia cerebral crónica (IC) la mejor terapia aún no está definida. La revascularización cerebral microquirúrgicaha sido descrita como tratamiento alternativo para pacientes con IA y contraindicación para r-tPA o terapia endovascular, asícomo para pacientes con IC en quienes la terapia médica ha fracasado. Objetivo: Comunicar la experiencia inicial en cirugíade revascularización cerebral, con énfasis en la utilidad de la embolectomía microquirúrgica y del bypass cerebral comoterapia de rescate en IA, así como del bypass cerebral en IC. Pacientes y Método: Serie prospectiva de 5 pacientes conisquemia cerebral tratados con cirugía de revascularización cerebral en el período 2013 a 2016. Se describe la técnica y resultadosquirúrgicos, así como el estado funcional a los 3, 6 y 12 meses de seguimiento según modified Rankin Scale (mRS)...


Background: Tissue Plasminogen Activator (t-PA) and mechanical thrombectomy are today the best treatment approachfor acute ischemic stroke (AIS). However, the best management for chronic cerebral ischemia (CCI) is still debated. Microsurgicalrevascularization has been described as alternative treatment for patients with AIS and contraindication for t-PA orendovascular therapy, and for patients with CCI and failure of maximal medical therapy. Aim: To describe the effectiveness ofmicrosurgical embolectomy and cerebral bypass as salvage therapy in AIS, as well as cerebral bypass in CCI. Methods: Fivepatients were treated by cerebral revascularization between 2013 and 2016. Surgical and functional results were analyzed.Neurological outcomes were assessed by modified Rankin Scale (mRS) at 3, 6 & 12 months...


Subject(s)
Humans , Male , Middle Aged , Embolectomy/methods , Moyamoya Disease/complications , Brain Ischemia/surgery , Brain Ischemia/complications , Reperfusion Injury , Cerebral Revascularization/methods , Stroke/complications , Cerebral Angiography/methods , Carotid Artery, Internal , Magnetic Resonance Spectroscopy/methods , Middle Cerebral Artery , Treatment Outcome
5.
Rev. chil. neurocir ; 42(1): 52-61, jul. 2016. ilus, tab
Article in Spanish | LILACS | ID: biblio-869754

ABSTRACT

Los cavernomas son malformaciones angiográficamente ocultas, pueden ser únicos o múltiples y esporádica o familiar.Suelen asociarse a otras malformaciones vasculares como las anomalías de drenaje venoso, sin embargo no es habitual su asociación con aneurismas cerebrales. Los aneurismas son malformaciones evidenciables en angiografía, sin embargo cuando se encuentran trombosados puede dificultarse su diagnostico, observándose en algunos casos como lesiones pseudotumorales. Nuestro objetivo es exponer una rara asociación entre cavernomatosis múltiple y aneurisma cerebral trombosado en un paciente pediátrico. Presentamos una paciente de 2 años de edad con diagnóstico de cavernomatosis múltiple y aneurisma cerebral trombosado. Se realiza una revisión de la literatura de ambas entidades y su rara asociación, medianteuna búsqueda exhaustiva en la base de datos de PUBMED Y COCHRANE utilizando las siguientes palabras claves: Cavernous angioma. Familial cavernomatosis. Hemorrhagic stroke. Multiple cavernomatosis. Cerebral aneurysm. Thrombosed aneurysm. Se discute la epidemiologia, diagnóstico y manejo quirúrgico de la cavernomatosis múltiple y sus asociaciones, preconizando fundamentalmente la evaluación pre quirúrgica de estos pacientes. No encontramos ningún caso de asociación entre cavernomatosis múltiple y aneurismas en nuestra revisión bibliográfica. Dado que se pueden presentar como lesiones pseudotumorales, la tomografía computada, resonancia magnética y la angiografía cerebral son métodos fundamentales para llegar a un diagnostico prequirúrgico certero. La indicación quirúrgica debe ser evaluada individualmente en cada paciente, y se debe realizar un seguimiento clínico-imagenologico.


Cavernomas are angiographically occult malformations may be single or multiple and sporadic or familial. Usually associated with other vascular malformations such as venous drainage anomalies, however it is not common its association with brain aneurysms. Aneurysms are into evidence malformations in angiography, however when they meet their diagnosis can be difficult thrombosed observed in some cases as pseudotumoral injuries. Our goal is to present a rare association between multiple cavernous haemangioma and thrombosed cerebral aneurysm in a pediatric patient. We present a patient 2 years old diagnosed with multiple cavernous haemangioma and thrombosed cerebral aneurysm. A review of the literature of both entities and its rare association is done through an exhaustive search in the database PUBMED and COCHRANE using the following keywords: Cavernous angioma. Familial cavernous haemangioma. Hemorrhagic stroke. Multiple cavernous haemangioma. Brain aneurysm. Thrombosed aneurysm. The epidemiology, diagnosis and surgical management of multiple cavernous haemangioma and their associations is discussedessentially advocating the presurgical evaluation of these patients. No case of association between multiple cavernous haemangioma and aneurysms in our literature review. Because can be presented as pseudotumoral lesions, computed tomography, magnetic resonance imaging and cerebral angiography are fundamental methods to reach an certain diagnosis preoperatively. The surgical indication should be evaluated individually for each patient, and should be performed a clinical-imaging follow-up.


Subject(s)
Humans , Female , Child, Preschool , Cerebral Angiography/methods , Cerebral Hemorrhage , Cerebral Veins , Epilepsy , Hemangioma, Cavernous , Intracranial Aneurysm , Brain Neoplasms/pathology , Anticonvulsants/therapeutic use , Dexamethasone/therapeutic use , Diagnostic Imaging/methods , Phenytoin/therapeutic use
6.
Yonsei Medical Journal ; : 1178-1184, 2016.
Article in English | WPRIM | ID: wpr-34046

ABSTRACT

PURPOSE: To investigate the clinical and morphological characteristics in relation to risk of bifurcation intracranial aneurysm rupture. MATERIALS AND METHODS: Data from 202 consecutive patients with 219 bifurcation aneurysms (129 ruptured and 90 unruptured) managed at the authors' facility between August 2011 and July 2014 were retrospectively reviewed. Based on their clinical records and CT angiographic findings, the ability of risk factors to predict aneurysm rupture was assessed using statistical methods. RESULTS: Age, hypertension, diabetes mellitus, and cerebral atherosclerosis were negatively correlated with aneurysm rupture. Aneurysms located in the middle cerebral artery, daughter artery ratio, lateral angle ratio (LA ratio), and neck width were negatively correlated with rupture. Aneurysms located in the anterior communicating artery, irregularity, with daughter sac, depth, width, maximum size, aspect ratio (AR), depth-to-width ratio, and bottleneck factor were significantly and positively correlated with rupture. Binary logistic regression model revealed that irregular shape [odds ratio (OR) 6.598] and AR (OR 3.507) strongly increased the risk of bifurcation aneurysm rupture, while age (OR 0.434), cerebral atherosclerosis (OR 0.125), neck width (OR 0.771), and LA ratio (OR 0.267) were negatively correlated with rupture (p<0.05). Receiver operating characteristic analysis revealed the threshold values of AR and LA ratio to be 1.18 and 1.50, respectively. CONCLUSION: Age (≥60 yr), cerebral atherosclerosis, and aneurysms with a larger neck width and larger LA ratio are protective factors against bifurcation aneurysm rupture. An aneurysm with an irregular shape and an increased AR reflect the greater likelihood of a rupture.


Subject(s)
Adult , Age Factors , Aged , Aged, 80 and over , Aneurysm, Ruptured/diagnostic imaging , Cerebral Angiography/methods , Computed Tomography Angiography , Developmental Disabilities , Diabetic Angiopathies/complications , Female , Humans , Hypertension/complications , Intracranial Aneurysm/diagnostic imaging , Intracranial Arteriosclerosis/complications , Logistic Models , Male , Middle Aged , Middle Cerebral Artery/diagnostic imaging , Odds Ratio , Protective Factors , ROC Curve , Retrospective Studies , Risk Factors
7.
Arq. neuropsiquiatr ; 73(7): 607-610, 07/2015. tab, graf
Article in English | LILACS | ID: lil-752386

ABSTRACT

Indocyanine green (ICG) video angiography has been used for several medical indications in the last decades. It allows a real time evaluation of vascular structures during the surgery. This study describes the surgical results of a senior vascular neurosurgeon. We retrospectively searched our database for all aneurysm cases treated with the aid of intraoperative ICG from 2009 to 2014. A total of 61 aneurysms in 56 patients were surgically clipped using intraoperative ICG. Clip reposition after ICG happened in 2 patients (3.2%). Generally, highly variable clip adjustment rates of 2%–38% following ICG have been reported since the introduction of this imaging technique. The application of ICG in vascular neurosurgery is still an emerging challenge. It is an adjunctive strategy which facilitates aneurismal evaluation and treatment in experienced hands. Nevertheless, a qualified vascular neurosurgeon is still the most important component of a high quality work.


A angiografia intraoperatória com indocianina verde (ICG) já foi aplicada em diversas situações clínicas por vários anos. O ICG permite avaliação em tempo real de estruturas vasculares durante a cirurgia. Este artigo descreve os resultados cirúrgicos do autor sênior. Avaliamos retrospectivamente os casos de aneurismas intracranianos operados de 2009 a 2014. Um total de 61 aneurismas em 56 pacientes foram operados com ICG. O reposicionamento do clip ocorreu em 2 casos (3.2%). Geralmente, taxas variáveis de reposicionamento do clip têm sido descritas (2%–38%). A aplicação de ICG na neurocirurgia vascular ainda é um desafio crescente. É um artifício que auxilia na avaliação e tratamento de aneurismas intracranianos em mãos experientes. No entanto, um neurocirurgião vascular continua sendo o principal componente de um resultado cirúrgico de alto nível.


Subject(s)
Female , Humans , Male , Coloring Agents , Cerebral Angiography/methods , Indocyanine Green , Intracranial Aneurysm , Intracranial Aneurysm/surgery , Monitoring, Intraoperative/methods , Angiography, Digital Subtraction/methods , Intraoperative Period , Neurosurgical Procedures/methods , Reproducibility of Results , Retrospective Studies , Surgical Instruments , Treatment Outcome , Video-Assisted Surgery/methods
8.
Arq. neuropsiquiatr ; 73(5): 408-414, 05/2015. tab, graf
Article in English | LILACS | ID: lil-746490

ABSTRACT

Objective The potential of computed tomography angiography (CTA) was assessed for early determination of stroke subtypes in a Brazilian cohort of patients with stroke. Method From July 2011 to July 2013, we selected patients with suspected hyperacute stroke (< 6 hours). Intracranial and cervical arteries were scrutinized on CTA and their imaging features were correlated with concurrent subtype of stroke. Results Stroke was documented in 50/106 selected patients (47.2%) based on both clinical grounds and imaging follow-up (stroke group), with statistically significant arterial stenosis and vulnerable plaques on CTA. Intracranial large artery disease was demonstrated in 34% of patients in the stroke group. Partial territorial infarct prevailed (86%) while artery-to-artery embolization was the most common stroke mechanism (52%). Conclusion Multidetector CTA was useful for the etiologic work-up of hyperacute ischemic stroke and facilitated the knowledge about the topographic pattern of brain infarct in accordance with its causative mechanism. .


Objetivo Avaliar o potencial da angiotomografia computadorizada multidetectores (ATCM) na determinação etiológica precoce do acidente vascular encefálico (AVE) e correlacionar o mecanismo causal com o padrão de infarto. Método De Julho de 2011 a Julho de 2013, foram selecionados os pacientes com suspeita clínica de AVE hiperagudo. Os achados da ATCM dos vasos intracranianos e cervicais foram correlacionados com a etiologia final do evento. Resultados AVE foi confirmado em 50/106 pacientes (47,2%). Estes apresentaram alterações angiográficas estatisticamente mais relevantes. Aterosclerose dos grandes vasos intracranianos esteve presente em 34% destes pacientes. O padrão radiológico topográfico de infarto mais comum foi o infarto territorial parcial (86%). A embolização arterio-arterial foi o mecanismo mais prevalente (52%). Conclusão A utilização da ATCM traz benefícios na detecção etiológica precoce dos pacientes com suspeita de AVE hiperagudo, além de possibilitar o entendimento do padrão radiológico topográfico de acordo com o mecanismo causal do evento isquêmico. .


Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Brain Infarction/etiology , Brain Infarction , Brain Ischemia/etiology , Brain Ischemia , Cerebral Angiography/methods , Multidetector Computed Tomography/methods , Acute Disease , Brazil , Brain Infarction/pathology , Brain Ischemia/pathology , Early Diagnosis , Intracranial Arteriosclerosis/complications , Intracranial Arteriosclerosis , Retrospective Studies , Time Factors
9.
Acta cir. bras ; 30(3): 229-234, 03/2015. tab
Article in English | LILACS | ID: lil-741034

ABSTRACT

PURPOSE: To assess comparative results of robot-assisted radical laparoscopic prostatectomy (RARP) performed by surgeons without any experience in laparoscopic prostatectomy and the open procedure performed by surgeons with large experience. METHODS: We analyzed 84 patients (50 subjected to robotic surgery) from June 2012 to September 2013. Data were prospectively collected in a customized database. Two surgeons carried out all the RARP cases. These two surgeons and six more performed the open cases. The perioperative outcomes between the two groups were analyzed with a minimum followup of 12 months. RESULTS: The corporal mass index (BMI) was higher in the open group (p=0.001). There was more operatve time, less hospitalization and blood loss, better trifecta and pentafecta and earlier continence (p=0.045) in the robotic group (p=0.001). There was no difference in positive surgical margins but with greater extraprostatic extension in the open group (p=0.002). CONCLUSIONS: Robot-assisted radical prostatectomy is a safe procedure even in the hands of surgeons with no previous experience. Besides this, better operative outcomes can be reached with this modern approach. .


Subject(s)
Animals , Rats , Brain Neoplasms , Cerebral Angiography/methods , Glioma , Neovascularization, Pathologic , Principal Component Analysis , Radiographic Image Enhancement/methods , Tomography, X-Ray Computed/methods , Algorithms , Brain Neoplasms/blood supply , Cell Line, Tumor , Data Interpretation, Statistical , Glioma/blood supply , Perfusion Imaging/methods , Rats, Wistar , Reproducibility of Results , Radiographic Image Interpretation, Computer-Assisted/methods , Sensitivity and Specificity
10.
Yonsei Medical Journal ; : 403-409, 2015.
Article in English | WPRIM | ID: wpr-141641

ABSTRACT

PURPOSE: The purpose was to evaluate the incidence and risk factors for rebleeding during cerebral angiography in ruptured intracranial aneurysms. MATERIALS AND METHODS: Among 1896 patients with ruptured intracranial aneurysms between September 2006 and December 2013, a total of 11 patients who experienced rebleeding of the ruptured aneurysms during digital subtraction angiography (DSA) were recruited in this study. RESULTS: There were 184 patients (9.7%) who had suffered rebleeding prior to the securing procedure. Among them, 11 patients experienced rebleeding during DSA and other 173 patients at a time other than DSA. Eight (72.7%) of the 11 patients experienced rebleeding during three-dimensional rotational angiography (3DRA). The incidence of rebleeding during DSA was 0.6% in patients with ruptured intracranial aneurysms. Multivariate logistic regression analysis showed that aneurysm location in anterior circulation [odds ratio=14.286; 95% confidence interval (CI), 1.877 to 250.0; p=0.048] and higher aspect ratio (odds ratio=3.040; 95% CI, 1.896 to 10.309; p=0.041) remained independent risk factors for rebleeding during DSA. CONCLUSION: Ruptured aneurysms located in anterior circulation with a high aspect ratio might have the risk of rebleeding during DSA, especially during 3DRA.


Subject(s)
Adult , Aged , Aneurysm, Ruptured , Angiography, Digital Subtraction/methods , Cerebral Angiography/methods , Female , Humans , Imaging, Three-Dimensional/methods , Incidence , Intracranial Aneurysm/epidemiology , Intracranial Hemorrhages/epidemiology , Male , Middle Aged , Recurrence , Risk Factors , Tomography, X-Ray Computed
11.
Yonsei Medical Journal ; : 403-409, 2015.
Article in English | WPRIM | ID: wpr-141640

ABSTRACT

PURPOSE: The purpose was to evaluate the incidence and risk factors for rebleeding during cerebral angiography in ruptured intracranial aneurysms. MATERIALS AND METHODS: Among 1896 patients with ruptured intracranial aneurysms between September 2006 and December 2013, a total of 11 patients who experienced rebleeding of the ruptured aneurysms during digital subtraction angiography (DSA) were recruited in this study. RESULTS: There were 184 patients (9.7%) who had suffered rebleeding prior to the securing procedure. Among them, 11 patients experienced rebleeding during DSA and other 173 patients at a time other than DSA. Eight (72.7%) of the 11 patients experienced rebleeding during three-dimensional rotational angiography (3DRA). The incidence of rebleeding during DSA was 0.6% in patients with ruptured intracranial aneurysms. Multivariate logistic regression analysis showed that aneurysm location in anterior circulation [odds ratio=14.286; 95% confidence interval (CI), 1.877 to 250.0; p=0.048] and higher aspect ratio (odds ratio=3.040; 95% CI, 1.896 to 10.309; p=0.041) remained independent risk factors for rebleeding during DSA. CONCLUSION: Ruptured aneurysms located in anterior circulation with a high aspect ratio might have the risk of rebleeding during DSA, especially during 3DRA.


Subject(s)
Adult , Aged , Aneurysm, Ruptured , Angiography, Digital Subtraction/methods , Cerebral Angiography/methods , Female , Humans , Imaging, Three-Dimensional/methods , Incidence , Intracranial Aneurysm/epidemiology , Intracranial Hemorrhages/epidemiology , Male , Middle Aged , Recurrence , Risk Factors , Tomography, X-Ray Computed
12.
Article in English | WPRIM | ID: wpr-50485

ABSTRACT

OBJECTIVE: Described herein is a microcatheter looping technique to facilitate aneurysm selection in paraclinoid aneurysms, which remains to be technically challenging due to the inherent complexity of regional anatomy. MATERIALS AND METHODS: This retrospective study was approved by our Institutional Review Board, and informed consent was waived. Microcatheter looping method was employed in 59 patients with paraclinoid aneurysms between January 2012 and December 2013. In the described technique, construction of a microcatheter loop, which is steam-shaped or pre-shaped, based on the direction of aneurysms, is mandatory. The looped tip of microcatheter was advanced into distal internal carotid artery and positioned atop the target aneurysm. By steering the loop (via inner microguidewire) into the dome of aneurysm and easing tension on the microcatheter, the aneurysm was selected. Clinical and morphologic outcomes were assessed with emphasis on technical aspects of the treatment. RESULTS: Through this looping technique, a total of 59 paraclinoid aneurysms were successfully treated. After aneurysm selection as described, single microcatheter technique (n = 25) was most commonly used to facilitate coiling, followed by balloon protection (n = 21), stent protection (n = 7), multiple microcatheters (n = 3), and stent/balloon combination (n = 3). Satisfactory aneurysmal occlusion was achieved through coil embolization in 44 lesions (74.6%). During follow-up of 53 patients (mean interval, 10.9 +/- 5.9 months), only one instance (1.9%) of major recanalization was observed. There were no complications related to microcatheter looping. CONCLUSION: This microcatheter looping method facilitates safe and effective positioning of microcatheter into domes of paraclinoid aneurysms during coil embolization when other traditional microcatheter selection methods otherwise fail.


Subject(s)
Adult , Carotid Artery, Internal/diagnostic imaging , Catheterization/methods , Cerebral Angiography/methods , Embolization, Therapeutic/methods , Female , Humans , Intracranial Aneurysm/therapy , Male , Middle Aged , Retrospective Studies , Stents
13.
Article in English | WPRIM | ID: wpr-111043

ABSTRACT

Advances in imaging-based management of acute ischemic stroke now provide crucial information such as infarct core, ischemic penumbra/degree of collaterals, vessel occlusion, and thrombus that helps in the selection of the best candidates for reperfusion therapy. It also predicts thrombolytic efficacy and benefit or potential hazards from therapy. Thus, radiologists should be familiar with various imaging studies for patients with acute ischemic stroke and the applicability to clinical trials. This helps radiologists to obtain optimal rapid imaging as well as its accurate interpretation. This review is focused on imaging studies for acute ischemic stroke, including their roles in recent clinical trials and some guidelines to optimal interpretation.


Subject(s)
Brain/blood supply , Brain Infarction/diagnostic imaging , Cerebral Angiography/methods , Diagnostic Imaging , Diffusion Magnetic Resonance Imaging/methods , Fibrinolytic Agents/therapeutic use , Humans , Intracranial Hemorrhages/diagnosis
15.
Article in English | WPRIM | ID: wpr-184378

ABSTRACT

OBJECTIVE: The aim of this study was to determine the interobserver and intermodality agreement in the interpretation of time-of-flight (TOF) MR angiography (MRA) for the follow-up of coiled intracranial aneurysms with the Enterprise stent. MATERIALS AND METHODS: Two experienced neurointerventionists independently reviewed the follow-up MRA studies of 40 consecutive patients with 44 coiled aneurysms. All aneurysms were treated with assistance from the Enterprise stent and the radiologic follow-up intervals were greater than 6 months after the endovascular therapy. Digital subtraction angiography (DSA) served as the reference standard. The degree of aneurysm occlusion was determined by an evaluation of the maximal intensity projection (MIP) and source images (SI) of the TOF MRA. The capability of the TOF MRA to depict the residual flow within the coiled aneurysms and the stented parent arteries was compared with that of the DSA. RESULTS: DSA showed stable occlusions in 25 aneurysms, minor recanalization in 8, and major recanalization in 11. Comparisons between the TOF MRA and conventional angiography showed that the MIP plus SI had almost perfect agreement (kappa = 0.892, range 0.767 to 1.000) and had better agreement than with the MIP images only (kappa = 0.598, range 0.370 to 0.826). In-stent stenosis of more than 33% was observed in 5 cases. Both MIP and SI of the MRA showed poor depiction of in-stent stenosis compared with the DSA. CONCLUSION: TOF MRA seemed to be reliable in screening for aneurysm recurrence after coil embolization with Enterprise stent assistance, especially in the evaluation of the SI, in addition to MIP images in the TOF MRA.


Subject(s)
Angiography, Digital Subtraction/methods , Cerebral Angiography/methods , Embolization, Therapeutic/instrumentation , Female , Follow-Up Studies , Humans , Intracranial Aneurysm/diagnosis , Magnetic Resonance Angiography/methods , Male , Middle Aged , Observer Variation , Recurrence , Reference Standards , Stents
16.
Arq. neuropsiquiatr ; 71(10): 791-797, out. 2013. tab, graf
Article in English | LILACS | ID: lil-689790

ABSTRACT

Intracerebral hemorrhage (ICH) causes high rates of disability and neurological sequelae Objective To evaluate spot signs as predictors of expansion and worse prognosis in non-traumatic ICH in a Brazilian cohort. Method We used multidetector computed tomography angiography to study 65 consecutive patients (40 men, 61.5%), with ages varying from 33 to 89 years (median age 55 years). Clinical and imaging findings were correlated with the findings based on the initial imaging. Results Of the individuals who presented a spot sign, 73.7% died (in-hospital mortality), whereas in the absence of a spot sign the mortality rate was 43.0%. Although expansion of ICH was detected in 75% of the patients with a spot sign, expansion was observed in only 9.0% of the patients who did not present a spot sign. Conclusions The spot sign strongly predicted expansion in non-traumatic ICH and an increased risk of in-hospital mortality. .


A hemorragia intraparenquimatosa cerebral (HIC) apresenta altas taxas de incapacidade e sequela neurológica. Objetivo Avaliar a presença de spot sign como preditor de expansão e pior prognóstico no follow-up de HIC não-traumática em brasileiros. Método Usamos a ângio-tomografia para estudar prospectivamente 65 pacientes consecutivos (40 homens 61,5%), com idades variando de 33 a 89 anos (mediana 55 anos). Evolução clínica e achados de imagem foram correlacionados com a interpretação dos achados do exame inicial. Resultados 73,7% dos indivíduos com spot sign no estudo tomográfico inicial evoluíram para óbito e, na sua ausência, a taxa de mortalidade foi 43,0%. Enquanto a expansão da HIC foi detectada em 75% dos pacientes com spot sign, ela foi notada em 9% daqueles sem este sinal. Conclusão O spot sign mostrou-se forte preditor de expansão da HIC não traumática e representa maior risco de morte hospitalar nesta coorte de pacientes. .


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Cerebral Hemorrhage , Extravasation of Diagnostic and Therapeutic Materials , Cerebral Angiography/methods , Cerebral Hemorrhage/mortality , Extravasation of Diagnostic and Therapeutic Materials/complications , Hospital Mortality , Multidetector Computed Tomography/methods , Predictive Value of Tests , Prognosis , Reference Values , Risk Factors , Sensitivity and Specificity , Statistics, Nonparametric , Time Factors
17.
Rev. bras. cardiol. invasiva ; 21(2): 159-164, abr.-jun. 2013. ilus, graf, tab
Article in Portuguese | LILACS, SES-SP | ID: lil-681950

ABSTRACT

INTRODUÇÃO: O tipo de proteção cerebral utilizado durante o implante de stent carotídeo é controverso em idosos. Nosso objetivo foi avaliar os resultados dos dispositivos de proteção embólica cerebral (PEC), proximal e distal, em pacientes > 70 anos de idade, por meio da ressonância magnética ponderada de difusão (RM-PD). MÉTODOS: Entre 2008 e 2011, 60 pacientes com indicação de stent carotídeo foram randomizados para PEC com Mo.Ma® ou Angioguard®, dos quais 26 tinham > 70 anos de idade. Os resultados da RM-PD realizada antes e 48 horas após o procedimento foram avaliados por neuro­logista independente e cego para o tipo de PEC utilizado. Foram analisados o número de novos focos isquêmicos, sua localização e o tamanho. RESULTADOS: Novos focos isquêmicos cerebrais foram encontrados em 8/12 (66,7%) pacientes do grupo Mo.Ma® e em 12/14 (85,7%) pacientes do grupo Angioguard® (P = 0,37). A maioria das lesões (> 90%) era ipsilateral à artéria tratada em ambos os grupos, e o tamanho das lesões foi < 0,5 cm na maioria dos casos. O número de lesões por paciente foi menor com o dispositivo Mo.Ma® (mediana [variação]: 3 [1 a 8] lesões vs. 15 [2 a 76] lesões; P < 0,001). Todos os pacientes que tiveram mais de 40 lesões pertenciam ao grupo Angioguard®. CONCLUSÕES: Mesmo utilizando PEC (proximal ou distal), novas lesões isquêmicas foram observadas em ambos os grupos em pacientes idosos. Proporcionalmente maior número de pacientes com Angioguard® teve novos focos isquêmicos se comparados aos pacientes do grupo Mo.Ma®. O dispositivo de PEC Mo.Ma® parece diminuir o número de lesões por paciente.


BACKGROUND: The type of cerebral protection used during carotid stenting in the elderly is controversial. Our objective was to evaluate the results of proximal and distal cerebral embolic protection devices (EPDs), in patients > 70 years through diffusion-weighted magnetic resonance imaging (DW-MRI). METHODS: Between 2008 and 2011, 60 patients with indication for carotid stenting were randomized to EPD with Mo.Ma® or Angioguard®, of which 26 patients were > 70 years of age. Results of DW-MRI performed before and 48 hours after the procedure were evaluated by an independent neurologist blinded to the type of EPD used. New ischemic lesions, their localization and size were analyzed. RESULTS: New cerebral ischemic lesions were found in 8/12 (66.7%) patients in the Mo.Ma® group and 12/14 (85.7%) patients in the Angioguard® group (P = 0.37). The vast majority of the lesions (> 90%) were ipsilateral to the treated artery in both groups and the size of the lesions was < 0.5 cm in most cases. The number of lesions per patient was lower with the Mo.Ma® device (median [variation]: 3 [1 to 8] lesions vs 15 [2 to 76] lesions; P < 0.001). All of the patients with more than 40 lesions were in the Angioguard® group. CONCLUSIONS: Despite the use of EPDs (proximal or distal), new ischemic lesions were observed in both groups in elderly patients. A proportionately larger number of patients with Angioguard® had new ischemic lesions when compared to those with Mo.Ma®. The Mo.Ma® device seems to decrease the number of lesions per patient.


Subject(s)
Humans , Male , Female , Aged , Cerebral Angiography/methods , Cerebral Angiography , Carotid Stenosis/complications , Carotid Stenosis/diagnosis , Aged , Stents , Angioplasty/methods , Risk Factors
18.
Arq. neuropsiquiatr ; 71(6): 349-356, jun. 2013. tab, graf
Article in English | LILACS | ID: lil-677610

ABSTRACT

Multidetector computed tomography (MDCT) scanning has enabled the early diagnosis of hyperacute brain ischemia. We aimed at validating a standardized protocol to read and report MDCT techniques in a series of adult patients. The inter-observer agreement among the trained examiners was tested, and their results were compared with a standard reading. No false positives were observed, and an almost perfect agreement (Kappa>0.81) was documented when the CT angiography (CTA) and cerebral perfusion CT (CPCT) map data were added to the noncontrast CT (NCCT) analysis. The inter-observer agreement was higher for highly trained readers, corroborating the need for specific training to interpret these modern techniques. The authors recommend adding CTA and CPCT to the NCCT analysis in order to clarify the global analysis of structural and hemodynamic brain abnormalities. Our structured report is suitable as a script for the reproducible analysis of the MDCT of patients on suspicion of ischemic stroke.

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A tomografia computadorizada multidetectores (TCMD) permitiu o diagnóstico precoce de isquemia cerebral hiperaguda. O presente estudo objetivou validar a interpretação e a descrição padronizada de um protocolo de TCMD multiparamétrica em uma série de pacientes adultos. A concordância entre os examinadores foi testada, e seus resultados confrontados com uma leitura padrão. Não foram observados resultados falso-positivos, e foi documentado um elevado grau de concordância (Kappa>0,81) quando os dados da angiotomografia (ATC) e dos mapas de perfusão cerebral por TC (PCTC) foram adicionados à análise da TC sem contraste (TCSC). A concordância interobservador foi superior para os leitores melhor treinados, corroborando a necessidade de formação específica para a interpretação dos exames. Os autores recomendam acrescer a interpretação da ATC e da PCTC à análise da TCSC, visando à análise global das anormalidades cerebrais estruturais e hemodinâmicas. O presente protocolo é adequado como um roteiro reprodutível para a análise da TCMD de pacientes com suspeita de acidente vascular cerebral isquêmico.

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Subject(s)
Adult , Female , Humans , Male , Brain Ischemia , Multidetector Computed Tomography/standards , Stroke , Acute Disease , Cerebral Angiography/methods , Multidetector Computed Tomography/methods , Observer Variation , Reproducibility of Results
19.
Medisan ; 17(1): 140-147, ene. 2013.
Article in Spanish | LILACS | ID: lil-665624

ABSTRACT

Se describen 3 casos clínicos de pacientes ingresados en el Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba por sospecharse la presencia de aneurismas cerebrales, teniendo en cuenta las manifestaciones neurológicas que presentaban. Mediante los estudios de resonancia magnética y angiorresonancia realizados, se observaron las imágenes de la lesión vascular, las cuales fueron confirmadas por angiografía carotídea


Three clinical cases of patients admitted in Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba due to the suspicious presence of cerebral aneurysms are described, keeping in mind the neurological manifestations they presented. By means of the studies of magnetic resonance and angiographic resonance carried out, the images of the vascular lesion were observed, which were confirmed by carotid angiography


Subject(s)
Humans , Female , Middle Aged , Intracranial Aneurysm/diagnosis , Cerebral Angiography/methods , Magnetic Resonance Angiography/methods
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