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1.
Rev. argent. neurocir ; 34(3): 223-225, sept. 2020.
Article in Spanish | LILACS, BINACIS | ID: biblio-1120955

ABSTRACT

Introducción: En 1957, Takeuchi y Shimizu describen una vasculopatía oclusiva que involucra la arteria carótida interna bilateral, con la formación de vasos colaterales. En 1969, Suzuki y Takaku denominan a la conexión vascular colateral en las imágenes de angiografía "moyamoya" que significa nube de humo.2,3 Objetivos: El propósito del siguiente video es la descripción detallada de una cirugía de revascularización directa a través de un bypass temporosilviano en paciente con enfermedad Moyamoya. Materiales y Métodos: Se describe el caso de un paciente masculino de 27 años de edad que presentó de accidente vascular cerebral hemorrágico derecho. En la angiografía se diagnosticó estenosis del 70% de la arteria carótida interna supraclinoidea derecha, acompañado de estenosis de la arteria cerebral media y cerebral anterior homolateral. Se realizó cirugía de revascularización cerebral directa con bypass temporosilviano derecho.4,5 Resultados: Luego de realizado el bypass se confirmó adecuada permeabilidad del mismo y en la angiografía postoperatoria se observó el desarrollo de circulación colateral a través de la anastomosis. El paciente no presentó déficit en el periodo postoperatorio. Conclusión: Aunque la incidencia de enfermedad de Moyamoya no es elevada, es una causa probable de stroke isquémico o hemorrágico en niños y adultos. El manejo adecuado es fundamental para mejorar el pronostico a largo plazo de los pacientes con esta rara patología.


Introduction: In 1957, Takeuchi and Shimizu describes an occlusive vasculopathy involving the bilateral internal carotid arteries, with the formation of collateral vessels. In 1969, Suzuki and Takaku designate the collateral vascular connections in the angiographical images "moyamoya" which means puff of smoke.2,3 Objectives: The purpose of the following video is the detailed description of a direct revascularization surgery through a temporosilvian bypass in a patient with Moyamoya disease. Materials and methods: We present a case of a 27-year-old male patient with a history of right hemorrhagic cerebral vascular accident. In the angiography, 70% stenosis of the right supraclinoid internal carotid artery was diagnosed, accompanied by stenosis of the middle and anterior homolateral cerebral artery. Direct cerebral revascularization surgery was performed with right temporosilvian bypass.4,5 Results: After performing the bypass, adequate permeability is confirmed and in the postoperative angiography the development of collateral circulation through the anastomosis was observed. The patient did not present a deficit in the postoperative period. Conclusion: Although the incidence of Moyamoya disease is not high, it is a probable cause of ischemic or hemorrhagic stroke in children and adults. Proper management is essential to improve the long-term prognosis of patients with this rare pathology.


Subject(s)
Humans , Male , Moyamoya Disease , General Surgery , Cerebral Revascularization
2.
Braz. j. med. biol. res ; 52(10): e8396, 2019. tab, graf
Article in English | LILACS | ID: biblio-1039252

ABSTRACT

This study explores the safety and effect of acute cerebral infarction treatment by microcatheter injection of tirofiban combined with a Solitaire AB stent and/or stent implantation. Emergency cerebral angiograms showing the responsible vascular occlusion of 120 acute cerebral infarction patients who underwent emergency endovascular thrombectomy were included in the study. These patients were randomly divided into two groups using the random number table method: treatment group (n=60) that received thrombectomy (with cerebral artery stents) combined with intracerebral injection of tirofiban and control group (n=60) that only received thrombectomy (with cerebral artery stents alone). The baseline data, cerebral angiography before and after surgery, hospitalization, and follow-up results of patients in these two groups were compared. Furthermore, the incidence of major adverse cerebrovascular events of these two groups was compared (90-day modified Rankin scale, a score of 0-2 indicates a good prognosis). The difference between baseline clinical data and brain angiography between these two groups was not statistically significant. Patients in the treatment group had a higher prevalence of thrombolysis in cerebral infarction grade 2b/3 than patients in the control group (88.3% (53/60) vs 66.7% (40/60), P=0.036). Moreover, the National Institutes of Health Stroke Scale scores 7 days after surgery and the 90-day prognosis were all better for the patients who received tirofiban (P=0.048 and P=0.024). Mechanical thrombectomy with Solitaire AB stents in combination with the injection of tirofiban through a microcatheter appears to be safe and effective for the endovascular treatment of acute ischemic stroke.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Stents , Thrombectomy/methods , Stroke/therapy , Tirofiban/administration & dosage , Cerebral Revascularization/methods , Treatment Outcome , Combined Modality Therapy
3.
Article in English | WPRIM | ID: wpr-760265

ABSTRACT

OBJECTIVE: To determine the correlation between cerebral blood flow (CBF) on arterial spin labeling (ASL) MRI and the degree of postoperative revascularization assessed on digital subtraction angiography in children with moyamoya disease (MMD). MATERIALS AND METHODS: Twenty-one children (9 boys and 12 girls; mean age, 8.4 ± 3.6 years; age range, 3–16 years) with MMD who underwent both pseudocontinuous ASL MRI at 1.5T and catheter angiography before and after superficial temporal artery encephaloduroarteriosynangiosis were included in this retrospective study. The degree of revascularization in the middle cerebral artery (MCA) territory was evaluated on external carotid angiography and was graded on a 3-point scale. On ASL CBF maps, regions of interest were manually drawn over the MCA territory of the operated side at the level of the centrum semi-ovale and over the cerebellum. The normalized CBF (nCBF) was calculated by dividing the CBF of the MCA territory by the CBF of the cerebellum. Changes in nCBFs were calculated by subtracting the preoperative nCBF values from the postoperative nCBF values. The correlation between nCBF changes measured with ASL and the revascularization grade from direct angiography was evaluated. RESULTS: The nCBF value on the operated side increased after the operation (p = 0.001). The higher the degree of revascularization, the greater the nCBF change was: poor revascularization (grade 1), −0.043 ± 0.212; fair revascularization (grade 2), 0.345 ± 0.176; good revascularization (grade 3), 0.453 ± 0.182 (p = 0.005, Jockheere-Terpstra test). The interobserver agreement was excellent for the measured CBF values of the three readers (0.91–0.97). CONCLUSION: The nCBF values of the MCA territory obtained from ASL MRI increased after the revascularization procedure in children with MMD, and the degree of nCBF change showed a significant correlation with the degree of collateral formation evaluated via catheter angiography.


Subject(s)
Angiography , Angiography, Digital Subtraction , Catheters , Cerebellum , Cerebral Revascularization , Cerebrovascular Circulation , Child , Female , Humans , Magnetic Resonance Imaging , Middle Cerebral Artery , Moyamoya Disease , Perfusion , Retrospective Studies , Temporal Arteries
4.
Article in English | WPRIM | ID: wpr-714855

ABSTRACT

Intravenous thrombolysis (IVT) and endovascular treatment (EVT) are currently the main treatments for reperfusion in acute ischemic stroke. Although the EVT recanalization rate has increased, unsuccessful recanalization is still observed in 10-30% cases. Superficial temporal artery-middle cerebral artery (STA-MCA) bypass is considered a rescue therapy in such cases, but in most centers it is not usually performed for acute ischemic stroke. Graft occlusion is rare following STA-MCA bypass, but it might lead to recurrent ischemic stroke. We hereby report on a patient with right MCA infarction and in whom EVT failed due to complete proximal internal carotid artery occlusion. He underwent an emergency STA-MCA bypass, resulting in a full recovery of his motor weakness. However, six months later, the patient experienced recurrent acute ischemic stroke due to bypass graft occlusion. His EVT failed again but revision bypass surgery, using STA remnant branch, was successful with full motor weakness recovery. We recommend a revision bypass surgery as a feasible therapeutic option for recurrent cerebral infarction caused by delayed STA graft occlusion.


Subject(s)
Carotid Artery, Internal , Cerebral Arteries , Cerebral Infarction , Cerebral Revascularization , Emergencies , Graft Occlusion, Vascular , Humans , Infarction, Middle Cerebral Artery , Reoperation , Reperfusion , Stroke , Transplants
5.
Article in English | WPRIM | ID: wpr-717040

ABSTRACT

Intracranial arterial stenosis usually occurs due to atherosclerosis and is considered the most common cause of stroke worldwide. Although the effectiveness of bypass surgery for ischemic stroke is controversial, the superficial temporal artery to the middle cerebral artery bypass for ischemic stroke is a common procedure. In our report, a 50-year-old man presented with sudden-onset left side weakness and dysarthria. An angiogram showed significant stenosis in the junction of the right cavernous-supraclinoid internal carotid artery and right pericallosal artery. Symptoms altered between improvement and deterioration. Magnetic resonance imaging showed a repeated progression of anterior cerebral artery (ACA) infarction despite maximal medical therapy. We performed a STA-ACA bypass with contralateral STA interposition. Postoperative course was uneventful with no further progression of symptoms. Thus, bypass surgery may be considered in patients with symptomatic stenosis or occlusion of the ACA, especially when patients present progressive symptoms despite maximal medical therapy.


Subject(s)
Anterior Cerebral Artery , Arteries , Atherosclerosis , Carotid Artery, Internal , Cerebral Revascularization , Constriction, Pathologic , Dysarthria , Humans , Infarction , Magnetic Resonance Imaging , Middle Aged , Middle Cerebral Artery , Stroke , Temporal Arteries , Transplants
6.
Rev. cuba. angiol. cir. vasc ; 18(2): 154-166, jul.-dic. 2017. tab
Article in Spanish | LILACS | ID: biblio-844815

ABSTRACT

Objetivo: Caracterizar las variantes quirúrgicas realizadas a los pacientes ingresados con enfermedad cerebrovascular extracraneal en un período de dos años. Métodos: Estudio descriptivo prospectivo en 27 pacientes, sin distinción de edad y sexo, operados por enfermedad cerebrovascular de origen extracraneal. Se tuvieron en cuenta los criterios de cirugía, además del estadio clínico, enfermedad cerebrovascular extracraneal que motivó la operación, localización de la lesión carotidea, variantes quirúrgicas realizadas, la permeabilidad de estas y las complicaciones poscirugía. Los pacientes fueron seguidos en consulta externa por dos años. Resultados: Se encontró que el 44,4 por ciento tuvo un ataque transitorio isquémico. Fueron más frecuentes las lesiones unilaterales (85,2 por ciento) y las de la carótida derecha (48,1 por ciento). Se halló una asociación significativa entre el sexo masculino con el estadio clínico y la localización de las lesiones carotideas. La endarterectomía por eversión fue la variante quirúrgica más realizada (44,4 por ciento). El 96,3 por ciento de las intervenciones se mantuvo permeable hasta los 18 meses poscirugía, mientras que tres pacientes presentaron reestenosis a los 24 meses. El 40,7 por ciento no desarrolló complicaciones, y entre estas el sangrado fue la de mayor frecuencia (33 por ciento). Conclusiones: Las variantes quirúrgicas realizadas se caracterizaron por altos porcentajes de permeabilidad durante el tiempo de estudio, con un mínimo de complicaciones posquirúrgicas(AU)


Objective: To characterize the surgical variants performed in hospitalized patients with extracranial cerebrovascular diseases in two years. Methods: Prospective and descriptive study of 27 patients, regardless of age and sex, who had been operated on from cerebrovascular disease of extracranial origin. Surgical criteria, clinical condition, extracranial cerebrovascular disease that required surgery, location of the carotid lesion, surgical variants, their permeability and the post-surgery complications were all taken into account. The patients were followed-up in the outpatient service during two years. Results: It was found that 44.4 percent of patients had had a transient ischemic attack. Unilateral lesions (85.2 percent) and right carotid lesions (48.1 percent) were the most common. Significant association was found between the male sex and the clinical staging and the location of carotid lesions. Eversion endarterectomy was the most performed surgical technique (44.4 percent). In the study, 96.3 percent of operations were kept permeable up to 18 months after the surgery whereas three patients presented with re-stenosis after 24 months. In the study group, 40.7 percent did not develop complications, being bleeding the most frequent one (33 percent). Conclusions: The surgical variants performed in the study time were characterized by high percentages of permeability and minimal postsurgical complications(AU)


Subject(s)
Humans , Carotid Arteries/surgery , Cerebral Revascularization/methods , Endarterectomy/methods , Endarterectomy/rehabilitation , Stents , Epidemiology, Descriptive , Prospective Studies
7.
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
8.
Article in English | WPRIM | ID: wpr-37079

ABSTRACT

OBJECTIVE: So far, there is no study answering the question of which type of surgical technique is practically the most useful in the treatment of adult patients with ischemic type moyamoya disease (MMD). We evaluated the efficacy of single barrel superficial temporal artery (STA)-middle cerebral artery (MCA) bypass in the treatment of adult patients with ischemic type MMD by retrospectively collecting clinical and radiological data. MATERIALS AND METHODS: A retrospective review identified 31 adult patients who underwent 43 single barrel STA-MCA bypass procedures performed for treatment of ischemic-type MMD between 2006 and 2014. The male to female ratio was 17:14 and the mean age was 41 years (range, 21-65 years). Peri-operative complications, angiographic and clinical outcomes were analyzed retrospectively. RESULTS: The permanent neurological morbidity and mortality rates were 2.3% and 0%, respectively. During the observation period of a mean of 35 months (range, 12-73 months), 29 patients (93.5%) had no further cerebrovascular events and transient ischemic attack occurred in two patients (6.5%), resulting in an annual stroke risk of 2.2%. Follow-up computed tomography perfusion (CTP) (mean, 18.4 months after surgery) documented improved cerebral hemodynamics in the revascularized hemispheres (p < 0.001). Post-operative patency was clearly verified in 38 bypasses (88.4%) of 43 bypasses on follow-up imaging (mean, 16.5 months). CONCLUSION: Our results suggest that single barrel STA-MCA bypass with wide dural opening is safe and durable method of cerebral revascularization in adult patients with ischemic type MMD and can be considered as a potential treatment option for adult patients with ischemic type MMD.


Subject(s)
Adult , Cerebral Arteries , Cerebral Revascularization , Female , Follow-Up Studies , Hemodynamics , Humans , Ischemia , Ischemic Attack, Transient , Male , Methods , Mortality , Moyamoya Disease , Perfusion , Retrospective Studies , Stroke , Temporal Arteries
9.
Article in English | WPRIM | ID: wpr-37076

ABSTRACT

Although intravenous recombinant tissue plasminogen activator (IV rt-PA) is effective in many cases of acute ischemic stroke, the neurologic symptoms can worsen after IV rt-PA because of sustained vessel occlusion. For such cases, several reperfusion modalities are available, including intra-arterial thrombolysis (IAT), carotid endarterectomy, and superficial temporal artery-middle cerebral artery (STA-MCA) bypass. Invasive procedures, such as major surgery, should be generally avoided within 24 hours after the administration of IV rt-PA. A 66-year-old man with no previous medical history developed left hemiparesis. A computed tomography scan revealed no acute lesion and he received IV rt-PA within 1.5 hours after symptom onset. Emergent magnetic resonance imaging showed significant diffusion-perfusion mismatch. He received IAT 2 hours after IV rt-PA administration, but IAT failed because of total occlusion of the cervical internal carotid artery. We initially planned to perform STA-MCA bypass the next morning because he had received IV rt-PA, but, 8 hours after IV rt-PA administration, his hemiparesis worsened from motor grade 3/4 to motor grade 1/2. Because of the large perfusion defect in both MCA divisions, double-barrel STA-MCA bypass was performed 10 hours after IV rt-PA administration. His symptoms rapidly improved after surgery and his modified Rankin Scale score 3 months later was grade 0. We suggest that emergent double-barrel bypass can be a viable option in patients who have perfusion defects of both MCA divisions in acute ischemic stroke after IV rt-PA administration.


Subject(s)
Administration, Intravenous , Aged , Carotid Artery, Internal , Cerebral Arteries , Cerebral Infarction , Cerebral Revascularization , Endarterectomy, Carotid , Humans , Magnetic Resonance Imaging , Neurologic Manifestations , Paresis , Perfusion , Reperfusion , Stroke , Tissue Plasminogen Activator
10.
Article in English | WPRIM | ID: wpr-95388

ABSTRACT

OBJECTIVE: Hemorrhagic moyamoya disease (hMMD) is associated with a poor clinical course. Furthermore, poorer clinical outcomes occur in cases of recurrent bleeding. However, the effect of hemodynamic insufficiency on rebleeding risk has not been investigated yet. This study evaluated the prognostic implications of the perfusion status during the clinical course of adult hMMD. METHODS: This retrospective study enrolled 52 adult hMMD patients between April 1995 and October 2010 from a single institute. Demographic data, clinical and radiologic characteristics, including hemodynamic status using single photon emission computed tomography (SPECT), and follow up data were obtained via a retrospective review of medical charts and imaging. Statistical analyses were performed to explore potential prognostic factors. RESULTS: Hemodynamic abnormality was identified in 44 (84.6%) patients. Subsequent revascularization surgery was performed in 22 (42.3%) patients. During a 58-month (median, range 3-160) follow-up assessment period, 17 showed subsequent stroke (hemorrhagic n=12, ischemic n=5, Actuarial stroke rate 5.8+/-1.4%/year). Recurrent hemorrhage was associated with decreased basal perfusion (HR 19.872; 95% CI=1.196-294.117) and omission of revascularization (10.218; 95%; CI=1.532-68.136). CONCLUSION: Decreased basal perfusion seems to be associated with recurrent bleeding. Revascularization might prevent recurrent stroke in hMMD by rectifying the perfusion abnormality. A larger-sized, controlled study is required to address this issue.


Subject(s)
Adult , Cerebral Hemorrhage , Cerebral Revascularization , Follow-Up Studies , Hemodynamics , Hemorrhage , Humans , Moyamoya Disease , Perfusion , Retrospective Studies , Stroke , Tomography, Emission-Computed, Single-Photon
11.
Journal of Stroke ; : 21-30, 2016.
Article in English | WPRIM | ID: wpr-135897

ABSTRACT

Although the pathogenesis of moyamoya disease (MMD) has not been fully elucidated, the effectiveness of surgical revascularization in preventing stroke has been addressed by many studies. The main mechanism of surgical revascularization is augmenting the intracranial blood flow using an external carotid system by either direct bypass or pial synangiosis. This can improve resting cerebral blood flow as well as vascular reserve capacity. For direct revascularization, the superficial temporal artery is used as the donor artery in most cases, although the occipital artery may be used in limited cases. Usually, the cortical branch of the middle cerebral artery is selected as the recipient of direct anastomosis. As for indirect revascularization, various techniques using different kinds of connective tissues have been introduced. In some cases, reinforcing the anterior cerebral artery and the posterior cerebral artery territories can be considered. The effectiveness of surgical revascularization for preventing ischemic stroke had been generally accepted by many studies. However, for preventing hemorrhagic stroke, new evidence has been added by a recent randomized controlled trial. The incidence of peri-operative complications such as stroke and hyperperfusion syndrome seems to be high due to the nature of the disease and technical demands for treatment. Preventing and adequately managing these complications are essential for ensuring the benefits of surgery.


Subject(s)
Anterior Cerebral Artery , Arteries , Cerebral Revascularization , Connective Tissue , Humans , Incidence , Middle Cerebral Artery , Moyamoya Disease , Posterior Cerebral Artery , Stroke , Temporal Arteries , Tissue Donors , Treatment Outcome
12.
Journal of Stroke ; : 21-30, 2016.
Article in English | WPRIM | ID: wpr-135892

ABSTRACT

Although the pathogenesis of moyamoya disease (MMD) has not been fully elucidated, the effectiveness of surgical revascularization in preventing stroke has been addressed by many studies. The main mechanism of surgical revascularization is augmenting the intracranial blood flow using an external carotid system by either direct bypass or pial synangiosis. This can improve resting cerebral blood flow as well as vascular reserve capacity. For direct revascularization, the superficial temporal artery is used as the donor artery in most cases, although the occipital artery may be used in limited cases. Usually, the cortical branch of the middle cerebral artery is selected as the recipient of direct anastomosis. As for indirect revascularization, various techniques using different kinds of connective tissues have been introduced. In some cases, reinforcing the anterior cerebral artery and the posterior cerebral artery territories can be considered. The effectiveness of surgical revascularization for preventing ischemic stroke had been generally accepted by many studies. However, for preventing hemorrhagic stroke, new evidence has been added by a recent randomized controlled trial. The incidence of peri-operative complications such as stroke and hyperperfusion syndrome seems to be high due to the nature of the disease and technical demands for treatment. Preventing and adequately managing these complications are essential for ensuring the benefits of surgery.


Subject(s)
Anterior Cerebral Artery , Arteries , Cerebral Revascularization , Connective Tissue , Humans , Incidence , Middle Cerebral Artery , Moyamoya Disease , Posterior Cerebral Artery , Stroke , Temporal Arteries , Tissue Donors , Treatment Outcome
13.
Article in English | WPRIM | ID: wpr-11239

ABSTRACT

A giant serpentine aneurysm (GSA) in the anterior cerebral artery (ACA) poses a technical challenge in treatment given its large size, unique neck, and dependent distal vessels. Here we report the case of a GSA in the ACA successfully treated with a combined surgical and endovascular approach. A 54-year-old woman presented with dull headache. On brain computed tomography (CT), a large mass (7 cm × 5 cm × 5 cm) was identified in the left frontal lobe. Cerebral angiography revealed a GSA in the left ACA. Bypass surgery of the distal ACA was performed, followed byocclusion of the entry channel via an endovascular approach. Follow-up CT performed 5 days after treatment revealed disappearance of the vascular channel and peripheral rim enhancement. Follow-up imaging studies performed 7 months after treatment revealed gradual reduction of the mass effect and patency of bypass flow. No complications were noted over a period of 1 year after surgery.


Subject(s)
Aneurysm , Anterior Cerebral Artery , Brain , Cerebral Angiography , Cerebral Revascularization , Female , Follow-Up Studies , Frontal Lobe , Headache , Humans , Intracranial Aneurysm , Middle Aged , Neck
14.
Rev. cuba. angiol. cir. vasc ; 16(2): 216-222, jul.-dic. 2015. ilus
Article in Spanish | LILACS | ID: lil-756354

ABSTRACT

La oclusión de la arteria subclavia izquierda es un cuadro poco frecuente y que cursa de forma asintomática generalmente. La presencia de síntomas y posibles complicaciones indican el tratamiento quirúrgico. El bypass carótido-subclavio es la técnica quirúrgica más utilizada gracias a su baja morbilidad, mortalidad y elevados índices de permeabilidad a largo plazo. El propósito de este trabajo es presentar un procedimiento alternativo para el tratamiento quirúrgico de esta oclusión, en este caso, el bypass carótido-subclavio con injerto de vena safena interna. Se describe el caso de una paciente de 56 años, fumadora inveterada que acudió al Servicio de Cirugía Cardíaca y Vascular del Cardiocentro "Ernesto Guevara", Villa Clara en diciembre de 2014 por presentar dolor frecuente en el miembro superior izquierdo que limitaba la actividad física. Se diagnosticó oclusión de la primera porción de la arteria subclavia izquierda. Se realizó bypass carótido-subclavio con injerto de vena safena interna que solucionó su cuadro clínico. La paciente evolucionó satisfactoriamente con bypass permeable con ultrasonido y angio-tomografía computarizada a los dos años de operada. El bypass carótido-subclavio con injerto de vena safena interna representa una alternativa efectiva y segura en el tratamiento de la oclusión sintomática de la arteria subclavia izquierda(AU)


The occlusion of the left subclavian artery is an uncommon situation and mostly asymptomatic. The presence of symptoms and possible complications indicate the surgical treatment. The carotid-subclavian bypass is the classical surgical technique, due to its low morbidity and mortality rates, and long term permeability indexes. The objective of this paper was to present an alternative procedure for surgical treatment of this type of occlusion, that is, the carotid-subclavian bypass with internal saphenous vein graft. Here is a 56 year-old female , heavy smoker patient who went to the heart and vascular surgery of "Ernesto Guevara" cardiological center in Villa Clara province on December 2014. She presented with frequent pain in the left upper limb that restricted her daily physical activity; the diagnosis was occlusion of the first portion of the left subclavian artery. The patient underwent left carotid-subclavian bypass surgery using a greater saphenous vein graft that eliminated the clinical picture. The patient recovered satisfactorily with a permeable bypass and she was performed ultrasound and angiographic computer tomography after two years of operation. Carotid-subclavian bypass with greater saphenous vein graft represents an effective and safe alternative in the treatment of the symptomatic occlusion of the left subclavian artery(AU)


Subject(s)
Humans , Cerebral Revascularization , Saphenous Vein/surgery , Subclavian Artery/surgery
15.
Rev. chil. neurocir ; 41(2): 116-119, nov. 2015. ilus
Article in Spanish | LILACS | ID: biblio-869731

ABSTRACT

La Enfermedad Moyamoya es una arteriopatia oclusiva progresiva de los vasos cerebrales, específicamente de la porción distal de las arterias carótidas internas, por lo general con compromiso bilateral. Esta oclusión trae como consecuencia dilatación de los vasos sanguíneos colaterales con el objetivo de convertirse en vías de circulación colateral, de donde la enfermedad adopta su nombre, debido a la apariencia angiográfica de “nube de humo” de estos pequeños vasos dilatados. Clínicamente se manifiesta como eventos cerebrovasculares isquémicos debido a la oclusión de los vasos mencionados o como eventos hemorrágicos debido a la ruptura de los pequeños vasos sanguíneos dilatados. Presentamos el caso de una paciente femenina de 38 años, que acude al hospital en estado de coma, cuya tomografía computarizada revela hemorragia intraventricular que fue tratada con derivación ventricular externa más activador de plasminógeno tisular. Posterior a su estabilización clínica se realizó angiografía cerebral diagnóstica con hallazgos compatibles con Enfermedad Moyamoya. Se decidió realizar subduro-sinangiosis con el fin de inducir la formación de circulación colateral cerebral. Debido a la baja incidencia de la Enfermedad Moyamoya en Latinoamérica, generalmente no es incluida en el diagnóstico diferencial de los eventos cerebrales vasculares, por lo que recomendamos su sospecha en pacientes jóvenes y sin factores de riesgo que debutan con este tipo de eventos cerebrales.


Moyamoya disease is a progressive occlusive disease of the cerebral vessels, specifically the distal portion of the internal carotid arteries, usually with bilateral involvement. This occlusion results in dilatation of collateral blood vessels in order to form collateral circulation pathways, from which the disease takes its name due to the angiographic appearance of “puff of smoke” of these small dilated vessels. Clinically it manifests as ischemic cerebrovascular events due to occlusion of the vessel mentioned or hemorrhagic events due to rupture of small dilated blood vessels. We report the case of a female patient of 38 years old who was admitted to the hospital in coma state, the CT scan revealed intraventricular hemorrhage that was treated with an external ventricular derivation and tissue plasminogen activator. After clinical stabilization diagnostic cerebral angiography was performed with findings consistent with Moyamoya disease. We decided to perform a subduro-sinangiosis, in order to induce the formation of cerebral collateral circulation. Due to the low incidence of Moyamoya disease in Latin America, generally it is not included in the differential diagnosis of cerebral vascular events, we recommend suspect it in young patients without risk factors who present with this type of brain events.


Subject(s)
Humans , Adult , Female , Brain Ischemia , Cerebral Hemorrhage , Cerebral Revascularization , Diagnostic Imaging , Moyamoya Disease/surgery , Moyamoya Disease/complications , Moyamoya Disease/diagnosis , Moyamoya Disease/etiology , Cerebral Ventricles/blood supply
16.
Horiz. méd. (Impresa) ; 15(3): 64-67, jul.-set. 2015. ilus
Article in Spanish | LIPECS, LILACS, LIPECS | ID: lil-781152

ABSTRACT

Se presenta el caso de un paciente varón de 82 años con Insuficiencia Cardiaca Congestiva (Fracción de Eyección de 20%) y Edema Agudo de Pulmón secundarios a Infarto Agudo de Miocardio extenso que requería cirugía de Bypass Coronario. Además, presentaba Enfermedad Oclusiva Aortoiliaca crónica con oclusión total de la Arteria Iliaca Izquierda dependiente de circulación colateral a través de la Arteria Mamaria Interna Izquierda. Se decidió realizar la cirugía de bypass coronario sin utilizar dicha arteria mamaria como injerto, dado que suponía una alta probabilidad de isquemia del miembro inferior y realizar el procedimiento de revascularización del miembro inferior previo a la cirugía cardiaca para poder utilizar la mamaria, acarrearía en este caso un alto riesgo de complicaciones. En el seguimiento postoperatorio a 2 meses, el paciente cursó con evolución favorable...


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


Subject(s)
Humans , Aged, 80 and over , Iliac Artery , Mammary Arteries , Coronary Artery Bypass , Cerebral Revascularization , Heart Failure
17.
Rev. chil. neurocir ; 41(1): 76-82, jul. 2015. ilus
Article in Spanish | LILACS | ID: biblio-836047

ABSTRACT

Las técnicas de anastomosis extra e intracraneales se han utilizado desde los aٌos 70 para el manejo de diferentes patologيasvasculares, que van desde la enfermedad cerebrovascular hasta la exclusiَn de aneurismas y malformaciones arteriovenosasde la circulaciَn o el manejo de condiciones como la enfermedad de Moya Moya. Si bien se ha cuestionado su aplicaciَnen algunas de estas patologيas hoy en dيa se sabe que constituyen una opciَn terapéutica. Las técnicas descritas requierende un entrenamiento especializado del Neurocirujano en el laboratorio de microcirugيa, entrenamiento que no siempre estلal alcance de todos los residentes. Existen dilemas éticos en cuanto al uso de animales y es poco probable que durante losaٌos de formaciَn el residente tenga la oportunidad de realizar anastomosis vasculares en el quirَfano dada la complejidadde estos procedimientos. En el presente artيculo se describe la técnica quirْrgica y microquirْrgica para la realizaciَn de unbypass extra e intracraneal en un modelo animal (cabeza de cerdo), donde se describe paso por paso el procedimiento ylos utensilios con los que debe contar el estudiante. Se hace una revisiَn de la literatura acerca de la patologيa vascular, lastécnicas de bypass y las particularidades de la anatomيa de estos animales.


Extracranial-intracranial bypass techniques have been used since the 70’s for the handling of different vascular diseases, fromcerebrovascular disease to the exclusion of aneurysms and arteriovenous malformations from the circulation or the managementof conditions such as Moyamoya disease. Although its application has been questioned in some of these diseases weknown now that this technic constitutes a therapeutic option. The described techniques require specialized training of the neurosurgeonin the of microsurgery laboratory, training that is not always available to all residents. There are ethical dilemmasregarding the use of animals and it is unlikely that during the formative years the resident may have the opportunity to performvascular anastomosis in the operating room because of the complexity of these procedures. In this article we describe thesurgical and microsurgical techniques for carrying extra- intracranial bypass in an animal model (pig’s head), and outline stepby step the procedure and utensils which the student must have. It is a review of the literature on vascular disease, bypasstechniques and peculiarities of the anatomy of these animals.


Subject(s)
Animals , Animal Experimentation , Arteriovenous Anastomosis , Arteriovenous Fistula , Anastomosis, Surgical/methods , Cerebral Revascularization , Models, Animal , Moyamoya Disease , Microsurgery/methods , Hemodynamics , Perfusion , Shock , Stroke
18.
Arq. bras. neurocir ; 34(2): 110-115, jun. 2015. fig
Article in English | LILACS | ID: biblio-1778

ABSTRACT

Objective To present a case-series study of extracranial­intracranial (EC­IC) bypass procedures performed in our service and evaluate indications and results. Method The medical records of 30 patients undergoing 32 EC­IC anastomosis procedures were evaluated. Seventeen patients were male (56.6%). The age ranged from 26 to 85 years (mean: 58.2). The follow-up ranged from 1 to 211 months (mean: 54). We evaluated the indications and complications of the surgical procedures. Results The bypass procedures comprised 28 STA­MCA anastomosis (87,5%) and four posterior circulation anastomosis. The main indications included cervical internal carotid artery occlusion (19 cases), Moyamoya disease (3 cases), giant aneurysms (3 cases), intracranial arterial stenosis (2 cases), and vertebral­basilar insufficiency (3 cases). On follow-up, graft patency was 93.7%, confirmed in half of the cases by arterial digital subtraction angiography, magnetic resonance angiography, and CT angiography. There was no surgical mortality. Three patients had PO complications (9.3%), including one case of ischemia (3.1%). Conclusion The EC­IC bypass is a procedure with low morbidity and mortality. The indication of EC­IC bypass surgery for cerebral atherosclerotic disease should not be generalized. The EC­IC bypass can be indicated for cerebral revascularization in Moyamoya disease, intracranial stenosis, and in the management of complex aneurysms. This procedure can be an alternative in the treatment of vertebral­basilar insufficiency.


Objetivo Apresentar uma série de casos de anastomose extra-intracraniana (EC-IC) avaliando suas indicações e resultados. Método Foram avaliados retrospectivamente os prontuários de 30 pacientes submetidos a 32 procedimentos de anastomose EC-IC. Dezessete pacientes eram do sexo masculino (56,6%) com média de idade de 58,2 anos. O período de seguimento variou de um a 211 meses (média: 54). Foram avaliadas as indicações e complicações dos procedimentos cirúrgicos. Resultados Foram realizadas 28 anastomoses entre a artéria temporal superficial e a cerebral média (87,5%) e quatro anastomoses na circulação posterior. As principais indicações foram oclusão de carótida interna cervical (19 casos), doença de Moyamoya (3 casos), aneurismas gigantes (3 casos), estenose arterial intracraniana (2 casos) e insuficiência vertebrobasilar (3 casos). A patência tardia do bypass confirmada em metade dos casos por angiografia, angiorressonância ou angiotomografia foi de 93,7%. Não houve mortalidade cirúrgica. Um paciente (3,1%) apresentou isquemia no pósoperatório. Outros dois pacientes (6,2%) apresentaram complicações não isquêmicas. Conclusões A revascularização EC-IC é procedimento de baixa morbidade e mortalidade. A indicação do procedimento para oclusão carotídea não pode ser generalizada. O bypass EC-IC pode ser indicado na doença deMoyamoya, nas estenoses intracranianas e no manejo de aneurismas complexos. Pode ser alternativa no tratamento da insuficiência vertebrobasilar.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Arteriovenous Anastomosis , Cerebral Revascularization , Middle Cerebral Artery , Temporal Arteries
19.
Article in English | WPRIM | ID: wpr-205815

ABSTRACT

Dural arteriovenous fistulas (AVFs) are uncommon, representing only 10% to 15% of all intracranial AVFs. Here we present the case of a patient with cerebral infarction who experienced a dural AVF after craniotomy for superficial temporal artery (STA) to middle cerebral artery (MCA) bypass surgery. A 48-year-old man presented with dysarthria and right side hemiparesis. A brain magnetic resonance imaging scan revealed multiple acute infarctions and severe stenosis of the left MCA. Therefore, STA-MCA bypass surgery was performed. A follow-up angiography performed 2 weeks after the surgery showed an abnormal vascular channel from the left middle meningeal artery (MMA) to the middle meningeal vein (MMV) just anterior to the border of the craniotomy margin. This fistula originated from a screw used for cranial fixation. The screw injured the MMA and MMV, and this resulted in the formation of a fistula. The fistula was successfully treated with transarterial embolization. Surgeons should be careful when fixing bones with screws and plates as fistulas can develop if vessels are injured.


Subject(s)
Angiography , Brain , Central Nervous System Vascular Malformations , Cerebral Infarction , Cerebral Revascularization , Constriction, Pathologic , Craniotomy , Dysarthria , Fistula , Follow-Up Studies , Humans , Infarction , Magnetic Resonance Imaging , Meningeal Arteries , Middle Aged , Middle Cerebral Artery , Paresis , Temporal Arteries , Veins
20.
Article in English | WPRIM | ID: wpr-189967

ABSTRACT

A 74-year-old patient was diagnosed with a subarachnoid hemorrhage suspected from a dissecting aneurysm located at the lateral medullary segment of the posterior inferior cerebellar artery (PICA). Because perforators to the medulla arose both proximal and distal to the dissecting segment, revascularization for distal flow was essential. However, several previously reported methods for anastomosis, such as an occipital artery-PICA bypass or resection with PICA end-to-end anastomosis could not be used. Ultimately, we performed an in situ side-to-side anastomosis of the proximal loop of the PICA with distal caudal loops within a single artery, as a "closing omega," followed by trapping of the dissected segment. The aneurysm was obliterated successfully, with intact patency of the revascularized PICA.


Subject(s)
Aged , Aneurysm , Aneurysm, Dissecting , Arteries , Cerebral Revascularization , Humans , Pica , Subarachnoid Hemorrhage
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