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Objective To evaluate the accuracy of measurements of atherosclerotic middle cerebral artery (MCA) stenosis with 3.0 T high-resolution magnetic resonance imaging (HR-MRI).Methods Forty patients with symptomatic atherosclerotic stenosis of middle cerebral artery (MCA) confirmed by digital subtraction angiography (DSA) in the Affiliated Hospital of Binzhou Medical College from September 2017 to May 2018 were enrolled in the study.Patients were scanned by HR-MRI sequence (including T1WI,T2WI,PDWI).The MCA M1 stenosis rate on HR-MR images was assessed by warfarin-aspirin symptomatic intracranial artery disease (WASID) method and area measurement algorithm,respectively,and based on the stenosis rate the degree of stenosis (semi-quantitative measurement) was determined.The accuracy of the two measurement methods was evaluated with DSA results as the gold standard.Results The HR-MRI images showed the structure of the vessel wall clearly in 30 patients meeting the measurement requirements.The inner edge of the vessel was clearly distinguishable and smooth,showing eccentric stenosis.The stenosis rate of MCA measured by DSA,WASID method and area measurement algorithm were (82± 17)％,(70± 12)％,(81 ± 16)％,respectively (P＞0.05).The result of area measurement algorithm was better correlated with DSA (r=0.893);and the coincidence of the stenosis degree rate of two measurement method was 90％(27/30).Conclusion The area measurement algorithm based on the HS-MRI has high accuracy in measuring the degree of MCA stenosis,which is of high clinical application value.
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OBJECTIVE:To investigate the effects of clopidogrel combined with aspirin on related indexes of patients with cerebral infarction induced by middle cerebral artery stenosis in stable phase.METHODS:Clinical data of 127 patients with cerebral infarction induced by middle cerebral artery stenosis in stable phase were analyzed retrospectively and divided into observation group (65 cases) and control group (62 cases) according to therapy drugs.Both groups received routine treatment.Control group was additionally given Aspirin enteric-coated tablet 200 mg orally,once a day.Observation group was additionally given Clopidogrel sulfate tablet 75 mg orally,once a day,on the basis of control group.Both group received treatment for consecutive 1 year.Coagulation function related indexes [D-dimer,PLT,AA-induced platelet inhibition rate,ADP-induced platelet inhibition rate],daily life quality score [modified Fugl-Meyer scale,Barthel indexes,NIHSS score] before and after treatment,the occurrence of 1-year accumulative cerebral infraction recurrence and ADR were observed and compared between 2 groups.RESULTS:Before treatment,there was no statistical significance in above indexes between 2 groups (P＞0.05).After treatment,D-dimer level and NIHSS score of 2 groups were significantly lower than before treatment,and the observation group was significantly lower than the control group;AA-induced platelet inhibition rate,ADP-induced platelet inhibition rate,Fugl-Meyer score and Barthel indexes of 2 groups were significantly higher than before treatment,and the observation group was significantly higher the control group,with statistical significance (P＜0.05).The recurrence rate of 1-year accumulative cerebral infraction in observation group was significantly lower than control group,with statistical significance (9.23％ vs.22.58％,P＜0.05).No severe ADR was found in 2 groups during treatment.CONCLUSIONS:Compared with aspirin alone,aspirin combined with clopidogrel in the treatment of cerebral infarction induced by middle cerebral artery stenosis in stage phase can effectively improve coagulation function and quality of daily life,reduce recurrence rate with good safety.
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Objective To evaluate the efficacy and safety of percutaneous transluminal angioplasty and stenting of intravascular stenting (PTAS) and internal medicine in the treatment of secondary severe stroke in young patients with severe symptomatic middle cerebral artery stenosis.Methods The clinical data of 77 cases with severe symptomatic middle cerebral artery stenosis(ste nosis rate≥70％)confirmed by digital subtraction angiography(DSA) were collected retrospectively in our hospital from January 2011 to June 2015.The patients were divided into PTAS group and medical treatment group,and the data were collected including the modified Rankin Score (mRS score) at admission,the US National Institutes of Health Stroke volume neurological impairments score (NIHSS score)at admission,as well as mRS score,the recurrence of ischemic stroke,death and intracerebral hemorrhage within 1 year.Results The primary end-point rates within 30 days after enrollment in PTAS group and medical treatment group were 0％ and 5.77％ respectively,and the stroke recurrence rates within 1 year were 4.35％ and 13.46％ respectively,The differ ence was not statistically significant(P＞0.05).Meanwhile,there was no death and intracerebral hemorrhage in both two groups.The rates of mRS≤1 were 91.30 ％ and 69.23 ％ respectively in PTAS group and medical treatment group,and the difference was statistically significant (P＜0.05).The rates of mRS≤2 were 95.65 ％ and 84.62 ％ respectively in PTAS group and medical treat ment group,and the difference was not statistically significant(P＞0.05).Conclusion PTAS is safe for the severe symptomatic middle cerebral artery stenosis,and is more efficient in dectasing the risk of recurrent stroke in young population compared with medical treatment.
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Objective To analyze the efficacy and hemodynamic changes in patients with complex symptomatic middle cerebral artery stenosis after Solitaire AB stent implantation.Methods From June 2013 to June 2016,7 consecutive patients with complex symptomatic middle cerebral artery stenosis treated with Solitaire stents at the Department of Neurology,the Third People's Hospital of Hubei Province were enrolled retrospectively.The stenosis rate ≥70% was confirmed by digital subtraction angiography (DSA).Of the 7 patients,5 were male and 2 were female,with an average age of 70±8 years.The general data of the patients were documented,including clinical symptoms,modified Rankin scale(mRS)score,stenosis degree,vascular pathways LMA classification and Mori typing for stenosis,and postoperative residual stenosis or restenosis.The hemodynamic parameters at day 1,7,and 3 months before and after procedure were compared.Results All patients were successfully implanted with the Solitaire AB stents.(1) Of the 7 patients,the Mori type A of stenosis lesions was in 4 cases,B in 2 cases,and C in 1 case.The LMA typing of vascular approaches were Type Ⅲ in 3 cases,type Ⅱ in 4 cases.The preoperative stenosis rate was 80±7%,the residual stenosis rate was 24±13%,and there were no operation-related complications.No ischemic events occurred during the follow-up period.(2) Before stent implantation and at 1 d,7 d,and 3 months after procedure,the peak systolic velocity (PSV) were 297±41,144±34,145±27,and 143±40 cm/s,respectively,the end diastolic velocity (EDV) were 159±22,68±16,68±14,and 66±17 cm/s,respectively,and the pulse index (PI) were 0.67±0.06,0.80±0.08,0.80±0.07,and 0.82±0.06,respectively.PSV,EDV,and PI at 1 d,7 d,and 3 months were improved compared with before procedure (all P0.05).Conclusions Initial analysis showed that no procedure-related complications were observed in the treatment of vascular tortuosity and complex middle cerebral artery stenosis with the Solitaire stents.The short-term curative effect is exact;However,it still needs to be validated further.
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objective To investigate the recurrence of stroke,clinical prognosis and vascular changes in patients with ischemic stroke due to middle cerebral artery stenosis. Methods The ischemic stroke patients with symptomatic middle cerebral artery stenosis were enrolled continuously and followed up prospectively for six months. The recurrence of ipsilateral stroke,clinical prognosis and dynamic changes of vessels were analyzed. Results Eighty patients were included,and 20.0% of the patients(16 cases)presented with recurrence of ipsilateral ischemic stroke and 56 cases (70.0%)with a good outcome(modified Rankin scale[mRS]≤1)during the 6 months follow-up;38.6% patients (27 cases) presented with significant vascular changes with progression in 12 cases (17.1%)and regression in 15 cases (21.4%). Conclusion The patients with simple symptomatic middle cerebral artery stenosis have an high rate recurrence of ipsilateral stroke but have good prognosis;Lesioned artery of the majority of patients in the short period after stroke was stable,but vascular stenosis in some patients could appear progression or remission.
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Objective To analyze the relationship between the level of serum homocysteine and cerebral artery stenosis in cerebral infarction patients.Methods Clinical data from 165 cerebral infarction patients who had been done cerebral angiography examination were analyzed.According to the level of serum homocysteine,the patients were divided into 5.0-15.0 μmol/L group,15.1-20.0 μmol/L group and above 20.1 μmol/L group.Other risk fac-tors including age,gender,blood pressure,blood lipid and blood glucose were recorded.The number of cerebral vascu-lar stenosis in different parts of brain were analyzed,and then make a decision of the relationship between the level of serum homocysteine and cerebral artery stenosis,as well as the other risk factors.Results Among 165 cases,74 cases (48.15%)came from 5.0-15.0 μmol/L group and the number of stenosal cerebral vascular was 36strips,50 cases (30.12%)came from 15.0-20.0 μmol/L group and the number of stenosal cerebral vascular was 66 strips,41 cases (24.70%)came from above 20.1 μmol/L group and the number of stenosal cerebral vascular was 67.Analysis of variance was conducted between the numbers of stenosal cerebral vascular of each group,the differences were significant (F =4.12,P <0.05).Conclusion In cerebral infarction patients,the incidence of Hcy(hyperhomocysteinemia) was higher than that of normal hcy.2.shows more serious damage of intracranial and extracranial arterial sclerosis occur in patients with the increase of homocysteine levels.
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Objective To investigate the correlation of the middle cerebral artery stenosis (MCAS) and the mild cognitive function impairment (MCI),and the clinical efficacy of statins in patients with MCI. Methods Six hundred and thirty-six patientse,who received transcranial color doppler ultrasound (TCD)assay, were enrolled in our hospital hospitalization or outpatients. The simple mental state examination (MMSE) and clinical dementia rating scale (CDR) were used as cognitive function assessment indexes. Forty-four cases of MCI with MCAS and 58 cases of MCI with NMCAS were used as the treatment group , who received the atorvastatin 20 mg every day , 56 cases of MCI with NMCAS were used as the control group , who only received the routine and basic diseases treatment. One yearlater,we determined the changes of MMSE and CDRagain. Results We detected 124 patients with MCAS, 512 patients with NMCAS, and 44 cases of MCAS patients with MCI, the prevalence was 35.5%,114 cases of NMCAS in patients with MCI, with the prevalence of 22.3%, the prevalence between the two groups was statistically different. One year later, the patients in the treatment group, MMSE score was improved, the score of MCI of the MCAS group improved more significantly. Conclusion The middle cerebral artery stenosis correlated with the occurrence of MCI. Atorvastatin could improve cognitive function in patients with MCI, especially for MCI which was caused by middle cerebral artery stenosis.
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Objective To investigate the distribution characteristics of cerebral artery stenosis and its risk factors in patients with acute ischemic stroke.Methods The patients with acute ischemic stroke examined with MRI and magnetic resonance angiography (MRA) were divided into either a stenosis group or a non-stenosis group according to whether they had cerebral artery stenosis or not.The patients in the stenosis group were redivided into a simple intracranial stenosis,simple extracranial stenosis,and intracranial + extracranial stenosis subgroups according to their stenotic sites; they were redivided into either a young and middle-aged subgroup (＜60) or an elderly subgroup (≥60) according to their age; they were redivided into either a single-branch lesion subgroup or multibranch lesion subgroup according to the number of vascular stenosis.The distribution characteristics and influencing factors of cerebral artery stenosis were analyzed.Results A total of 232 patients with acute ischemic stroke were enrolled,and 114 of them (62.0％) were simple intracranial stenosis,30 (16.3％) were simple extracranial stenosis,and 40 (21.7％) were intracranial+ extracranial stenosis.The patients with anterior circulation stenosis (76.6％) were more common than those with posterior circulation stenosis (33.7％).They were mainly in the middle cerebral artery (64.4％) and posterior cerebral artery (53.8％) respectively.Multivariate logistic regression analysis showed that age (odds ratio [OR] 1.049,95％ confidence interval [CI] 1.015-1.084; P =0.005),hypertension (OR 10.063,95％ CI 4.402-23.004; P ＜ 0.001),diabetes (OR 3.873,95％ CI 1.141-13.147; P =0.030),smoking (OR 3.311,95 ％ CI 1.112-9.855; P =0.031),and fibrinogen (OR 6.085,95％ CI 1.396-26.533; P=0.016) were the independent risk factors for cerebral artery stenosis in patients with acute ischemic stroke; hypertension (OR 10.779,95％ CI 4.468-26.007; P＜ 0.001),diabetes (OR 3.593,95％ CII.018-12.685; P =0.047),and smoking (OR 4.408,95％ CI 1.403-13.826; P =0.011) were the independent risk factors for simple intracranial artery stenosis; hypertension (OR 6.143,95％ CI 1.838-20.537; P=0.003),diabetes (OR 8.179,95％ CI 1.844-36.287; P=0.006),and fibrinogen (OR 2.410,95％ CI 1.046-5.551; P =0.039) were the independent risk factors for simple extracranlal artery stenosis.C reactive protein (CRP) level of the intracranial + extracranial stenosis group was significantly higher than that of the simple intracranial stenosis (P=0.001) and simple extracranial stenosis (P =0.018) groups.There was no significant difference between the two groups,but the mean level of the 3 groups was higher than that of the normal value.The simple intracranial stenosis and the simple extracranial stenosis were most common in the young and middle-aged group,and the simple intracranial stenosis and the intracranial + extracranial stenosis were more common in the elderly group.The age (P=0.036) and uric acid level (P=0.006) in the subgroup of multiple branches stenosis were significantly higher than those in the subgroup of single branch stenosis,but only age (OR 1.030,95％ CI 1.003-1.057; P =0.028) was significantly independent correlated with the multiple branches stenosis.Conclusions Intracranial artery stenosis is common in cerebral artery stenosis of patients with acute ischemic stroke.The proportion of intracranial + extracranlal stenosis increases sfightly with age.Age,hypertension,diabetes,smoking,and fibrinogen are the independent risk factors for cerebral artery stenosis in patients with acute ischemic stroke.Hypertension and diabetes are the common independent risk factors for simple intracranial and extracranial artery stenosis in patients with acute ischemic stroke.Smoking is an independent risk factor for simple intracranial artery stenosis in patients with acute ischemic stroke.Fibrinogen is a simple independent risk factor for extracranial artery stenosis in patients with acute ischemic stroke.CRP and uric acid may be the inflammatory predictive factors associated with the patients with acute ischemic stroke and cerebral artery stenosis.
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Objective To investigate the relationship between the dynamic changes of hs-CRP and IL-6 with restenosis after stent angioplasty in cerebral arterial stenosis .Methods 65 patients with cerebral artery stenosis stent angioplasty in Nanyang Mu-nicipal Central Hospital from March 2011 to March 2013 were retrospectively analyzed .The changes of hs-CRP and IL-6 levels be-fore operation and at different postoperative time points were observed and their correlation with vascular restenosis was anlyzed . Results (1)The cerebral artery stenosis degree and serum hs-CRP and IL-6 levels were positively correlated(P0 .05);△hs-CRP and △IL-6 had sta-tistically significant differences between the patients with restenosis and the patients without restenosis (P<0 .05) .Conclusion hs-CRP and IL-6 may play an important role in the process of restenosis after stent angioplasty in cerebral arterial stenosis .Monitoring the dynamic changes of hs-CRP and IL-6 has certain value for evaluating vascular restenosis .
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Objective To investigate the sensitivity and specificity of transcranial Doppler (TCD) diagnosis for intracranial posterior circulation artery stenosis or occlusion.Methods Seventy-two cases of patients treated for posterior circulation intracranial artery stenosis or occlusion were chosen,TCD and CT angiography (CTA) tests were carried out and the results were compared and analyzed.Results Compared with CTA,the sensitivity for period of posterior circulation intracranial arteries by TCD was 82.50％,while specificity reached 94.64％.Positive predictive value attained 91.67％,while negative predictive value reached 88.33％ and the accuracy was 89.58％.Conclusions TCD diagnosis for period of posterior circulation intracranial arterial has high specificity,normal sensitivity,and the highest diagnosis accuracy for intracranial segment of vertebral artery.TCD can serve as early inspecting method for intracranial artery.
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Objective Toinvestigatetherelationshipbetweendifferenttypesofinternalwatershed infarctionandtandemstenosesofinternalcarotidartery(ICA).Methods Atotalof55patientswith internal watershed infarction confirmed by head MRI and diffusion-weighted imaging (DWI )examination were enrolled. They all underwent the extracranial internal carotid artery (ICA ) ultrasonography and intracranial cerebral artery MR angiography (MRA)examinations. According to the findings of imaging,the 55 patients with internal watershed infarction were divided into a simple internal watershed infarction (IWSI)group and an internal watershed infarction accompanied with ipsilateral cortical watershed infarction (C-IWSI)group. The relationship between the two types of internal watershed infarction and tandem stenoses of ICA was analyzed. Results (1 ) Of the 55 patients with internal watershed infarction,24 cases (43. 6%)were in the internal watershed infarction group and 31 cases (56. 4%)were in the C-IWSI group. The ipsilateral vascular stenosis were ICA 20 cases (36. 4%,including extracranial segment 11 cases and intracranial segment 17 cases),middle cerebral artery (MCA)44 cases (80. 0%), and tandem stenoses of ICA 15 cases (27. 3%). (2)Ipsilateral tandem stenoses of ICA:2 cases were in the IWSI group (intracranial ICA+MCA 2 cases);13 cases were in the C-IWSI group (extracranial ICA+intracranial ICA +MCA 4 cases,extracranial ICA + intracranial ICA 1 case,extracranial ICA + MCA 2 cases,and intracranial ICA+MCA 6 cases). (3)Compared with the IWSI group,the incidences of ipsilateral ICA stenosis and tandem stenoses of ICA in patients of the C-IWSI group were higher (54. 8%[n=17]vs. 12. 5%[n=3],41. 9%[n=13]vs. 8. 3%[n =2]),and there were significant differences(P =0. 001, 0.006]). The incidences of extracranial and intercranial ICA stenosis were higher than those of the IWSI group (35. 5%[n=11]vs. 0,45. 2%[n=14]vs. 12. 5%[n=3]),and there were significant differences (P=0.003,0.009).Conclusion Inthedifferenttypesofinternalwatershedinfarction,theincidenceof tandem stenoses of ICA is different. The IWSI patients with ipsilateral cortical watershed infarction often accompany by tandem stenoses of ICA.
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BACKGROUND: Microembolic signals (MES) are associated with the pathogenic mechanism of ischemic stroke with large-artery atherosclerotic disease. We examined the relationship between MES on a transcranial Doppler ultrasonography (TCD) and lesion patterns on diffusion-weighted MR imaging (DWI) in acute ischemic strokes associated with atherosclerotic diseases of the middle cerebral artery (MCA) and internal carotid artery (ICA). METHODS: A total of 405 consecutive patients were monitored for MES within 48 hours of symptom onset. Patients with MES and DWI lesions in the territory of the MCA or ICA and corresponding MCA/ICA stenosis or occlusion on MR angiography (MRA) were included. MCA velocities and lesion patterns on DWI were compared. RESULTS: MES were detected in 25 patients (MCA: 13, ICA: 12). The mean number of MES during 30 minutes of monitoring was 14.2+/-17.3 (range: 1-64, MCA: 13.9+/-13.6, ICA: 14.5+/-21.6, p-value=0.098). The mean flow velocity in the ipsilateral MCA in patients with MCA disease was higher than in patients with ICA disease (129.9+/-74.4 cm/s vs 61.1+/-28.2 cm/s, p=0.006). The frequency of multiple lesions on DWI was higher inpatients with ICA disease than in those with MCA disease (46.1% vs 100%, p=0.003). CONCLUSIONS: Multiple lesions on DWI were more frequent in ICA disease with MES than in MCA disease. Artery-to-artery embolism may be a more important stroke mechanism in acute ischemic stroke with ICA disease.
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Humanos , Angiografía , Arterias , Arteria Carótida Interna , Estenosis Carotídea , Constricción Patológica , Embolia , Pacientes Internos , Arteria Cerebral Media , Accidente Cerebrovascular , Ultrasonografía Doppler TranscranealRESUMEN
@#ObjectiveTo evaluate the value of transcranial Doppler (TCD) in pecutaneous transtuminl angioplasty and stenting (PTAS).MethodsThe index of hemodynamics, include mean peak flow velocity (Vm), systolic peak flow velocity (Vs), enddiastolic peak flow velocity (Vd), pulsatility index (Pi), resistance index (Ri) in 47 cases with the stenosis of the middle cerebral artery were investigated, while compared with that of intra arterial digital subtraction angiography (DSA). ResultsVs and Vm of 41 cases increased while the Pi reduced after operation, Ri had no change; Vs, Vm, Vd increased and Pi reduced with no reflow signal in 5 cases. Vs and Vm increased with Vd reduced in only 1 case. The accuracy rate with DSA in moderate or severe stenosis was 75% or 83% respectively. ConclusionTCD, as it's reliable, no-invasive, convenience and cheap, can play an important role in assessing the effect of PTAS in middle cerebral artery stenosis.
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BACKGROUND: Microembolic signals (MES) have been implicated as an important mechanism of acute ischemic stroke in middle cerebral artery (MCA) stenosis. We conducted a prospective study to correlate MES and patterns of diffusion-weighted MR images (DWI). METHODS: A total of 211 consecutive patients with MCA territory ischemic symptoms within 24 hours of symptom onset were monitored for MES. Among them patients with acute ischemic lesion in MCA territory on DWI were included. MCA velocities on transcranial Doppler (TCD) examination, patterns and multiplicity of DWI lesions, and the degree of stenosis on MR angiography (MRA) were compared between MES positive and negative groups. RESULTS: MES were detected in 9 patients (17.3%) among 52 patients who fulfilled our inclusion criteria. The mean number of MES per 30 minutes was 9.11+/-5.94 (range, 1-19). Mean flow velocity of insonated ipsilateral MCA in MES positive group was higher than that of MES negative group (115.67+/-81.9 cm/s vs 58.07+/-23.5 cm/s, p= 0.032). The degree of MCA stenosis on MRA and the presence of MES had significant relationship (p=0.039), but there was no significant relationship between lesion multiplicity on DWI and the presence of MES (p=0.431). The frequency of symptom recurrence in the corresponding MCA territory during 90 days from the index stroke did not show statistical significance between two groups (p=0.681). CONCLUSIONS: Our results do not support the idea of direct causal relationship between MES and the mechanism of atherothrombotic MCA stroke. Further study is needed to identify whether the appearance of MES implicates a predictor for further ischemic events or a sign of recanalization.
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Humanos , Angiografía , Constricción Patológica , Imagen por Resonancia Magnética , Arteria Cerebral Media , Estudios Prospectivos , Recurrencia , Accidente CerebrovascularRESUMEN
@#ObjectiveTo determine the frequency of cerebral microembolism in patients with asymptomatic or symptomatic extracranial and intracranial arterial stenosis and to assess its relationship to the onset and course of ischemic stroke.MethodsTCD was used to monitor patients with extracranial and intracranial cerebral arterial stenosis. Double channel four-gated and power M-Mode were used to detect microembolic signals (MES). The recording time was 60 min and the number of MES was counted. Patients were divided into 2 groups as extracranial internal carotid artery (ICA) stenosis and middle cerebral artery (MCA) stenosis. Each group was divided into 3 subgroups as asymptomatic, acute ischemic stroke (<30 d) and old ischemic stroke (≥30 d).ResultsThe total number of monitored artery was 74 in 63 patients. In ICA stenosis with asymptom, old ischemic stroke and acute ischemic stroke, the frequency of MES was 0(0/10), 0(0/7), 33%(6/18) and the number of MES in acute ischemic stroke was 3, 9, 8, 10, 1, 40 (mean=11.8). In MCA stenosis with asymptom, old ischemic stroke and acute ischemic stroke, the frequency of MES was 14%(2/14), 14%(1/7), 39%(7/18) and the number of MES was 4 and 1 in asymptom, 1 in old ischemic stroke, 4, 1, 4, 15, 16, 1 and 29(mean=10) in acute ischemic stroke. In ICA stenosis, the difference between acute ischemic stroke and asymptom (P=0.013), between acute and old ischemic stroke (P=0.031) reached statistic significance.In MCA stenosis, there was no significant difference between acute ischemic stroke and asymptom (P=0.115), so as between acute and old ischemic stroke (P=0.214).ConclusionEmbolism was important in the mechanism of ischemic stroke due to extracranial and intracranial arterial stenosis. The closer to ischemic stroke onset, the higher the frequency and the number of MES. TCD monitor was helpful to study the pathogenesis of ischemic stroke due to extracranial and intracranial arterial stenosis and determine the treatment.
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BACKGROUND: To investigate the optimal values of transcranial doppler (TCD) index in the evaluation of leptomeningeal collateral circulation (CC) in patients with middle cerebral artery (MCA) stenosis. METHODS: Forty-one patients, with angiographically confirmed single stenosis or occlusion of the M1 segment of the MCA, were studied with TCD and brain MRI. Patients were divided into two groups according to the existence of CC though ipsilateral anterior cerebral artery on transfemoral cerebral angiography (TFCA). Mean flow velocities (mFV) of anterior and middle cerebral arteries (ACA, MCA) were analyzed. We then investigated the optimal values of TCD flow index: 1) ipsilateral mFV ACA/MCA (AMVR), 2) ACA velocity ratio (ACAVR), 3) mFVACA. We then correlated TCD flow index with TFCA results. RESULTS: TFCA revealed single moderate to severe M1 stenosis (n=35) and occlusion (n=6). Presence of CC was found in 11 (27%), absence of CC in 30 (73%). The mean of AMVR, ACAVR and mFVACA differed between the two groups: 1.76 +/- 0.69, 1.43 +/- 36, 86.27 +/- 31.73 cm/s in the presence of CC; 0.48 +/- 0.24, 1.21 +/- 0.39, 65.93 +/- 23.24 in the absence of CC. The optimal cutoff values for detection of CC were found at AMVR>or=0.9, ACAVR>or=1.30 and mFVACA>or=80 cm/s. The combination of individual TCD indexes had improved the specificity and positive predicted value in the detection of CC. CONCLUSIONS: TCD enables detecting the existence of CC in patients with MCA stenoocclusion. These optimal values may provide a noninvasive method for evaluate the pathomechanism of stroke and prospect the prognosis of these patients.
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Humanos , Arteria Cerebral Anterior , Encéfalo , Angiografía Cerebral , Circulación Colateral , Constricción Patológica , Infarto de la Arteria Cerebral Media , Imagen por Resonancia Magnética , Arteria Cerebral Media , Pronóstico , Sensibilidad y Especificidad , Accidente CerebrovascularRESUMEN
Intravascular stents are being used with increasing frequency in interventional neuroradiology. We present two cases of arterial rupture and subarachnoid hemorrhage during middle cerebral artery stenting. Extravasation of contrast material and massive subarachnoid hemorrhage during stenting in one case resulted in mortality. In the other case, overlapping stenting and balloon tamponade on the dissected vessel, however, were performed emergently. Thereafter, thrombotic occlusion of the middle cerebral artery was managed by intraarterial abciximab administration. Serial angiography showed that normal vessel patency was reestablished within 20 min. We discuss complications of stenting for symptomatic middle cerebral artery stenosis and their rescue work.
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Angiografía , Oclusión con Balón , Constricción Patológica , Arteria Cerebral Media , Mortalidad , Trabajo de Rescate , Rotura , Stents , Hemorragia SubaracnoideaRESUMEN
Recent advances in stent technology have allowed the introduction of more flexible stents that may be tracked more easily in the intracranial vessels. We present a patient with improved cerebral perfusion as assessed by single-photon emission computed tomographic(SPECT) scan after stent-assisted angioplasty for symptomatic middle cerebral artery stenosis. A 72-year-old man presented with multiple episodes of transient verbral disturbance and right-sided motor weakness for 5 months despite treatment with aspirin and clopedigrel. Angiography revealed a 50% to 60% stenosis of the left middle cerebral artery. 99m Tc-exametazime-SPECT scan demonstrated decreased cerebral blood flow in the left cerebral hemisphere, particularly in the left middle cerebral artery territory. The patient was recommended a stent-assisted angioplasty for middle cerebral artery stenosis. The patient underwent uncomplicated stenting with S-660 2.5- by 9-mm stent(Arterial Vascular Engineering, Santa Rosa, CA) of the left middle cerebral artery, with excellent angiographic results. Follow-up brain SPECT scan showed markedly improved perfusion. Stent-assisted percutaneous transluminal angioplasty can provide a favorable clinical course as well as improved cerebral perfusion for a patient with middle cerebral artery stenosis. Long-term follow-up data and additional clinical experience are required to assess the durability of this procedure.
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Anciano , Humanos , Angiografía , Angioplastia , Aspirina , Encéfalo , Cerebro , Constricción Patológica , Estudios de Seguimiento , Arteria Cerebral Media , Perfusión , Rosa , Stents , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
Recent advances in stent technology have allowed the introduction of more flexible stents that may be tracked more easily in the intracranial vessels. We present a patient with improved cerebral perfusion as assessed by single-photon emission computed tomographic(SPECT) scan after stent-assisted angioplasty for symptomatic middle cerebral artery stenosis. A 72-year-old man presented with multiple episodes of transient verbral disturbance and right-sided motor weakness for 5 months despite treatment with aspirin and clopedigrel. Angiography revealed a 50% to 60% stenosis of the left middle cerebral artery. 99m Tc-exametazime-SPECT scan demonstrated decreased cerebral blood flow in the left cerebral hemisphere, particularly in the left middle cerebral artery territory. The patient was recommended a stent-assisted angioplasty for middle cerebral artery stenosis. The patient underwent uncomplicated stenting with S-660 2.5- by 9-mm stent(Arterial Vascular Engineering, Santa Rosa, CA) of the left middle cerebral artery, with excellent angiographic results. Follow-up brain SPECT scan showed markedly improved perfusion. Stent-assisted percutaneous transluminal angioplasty can provide a favorable clinical course as well as improved cerebral perfusion for a patient with middle cerebral artery stenosis. Long-term follow-up data and additional clinical experience are required to assess the durability of this procedure.
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Anciano , Humanos , Angiografía , Angioplastia , Aspirina , Encéfalo , Cerebro , Constricción Patológica , Estudios de Seguimiento , Arteria Cerebral Media , Perfusión , Rosa , Stents , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
BACKGROUND: Middle cerebral artery (MCA) steno-occlusive disease is known to be more common in Eastern than in Western, however, clinical characteristics have not been well documented. We aimed to find clinical characteristics of isolated MCA disease comparing with other MCA steno-occlusive disease. METHODS: Patients with lesion in M1 portion of MCA divided into three groups by angiographic finding ; isolated MCA stenosis (IMCAS, n=39), isolated MCA occlusion (IMCAO, n=29), and multiple (ICA, BA or VA) steno-occlusion involving MCA (Combined, n=48). Patients with evidence of cardioembolic MCA occlusion and Moyamoya disease were excluded. We analyzed clinical features, neuroimaging findings, and prognosis retrospectively. RESULTS: MRI showed large deep (36%), small deep (26%), cortical (21%), and mixed (cortical & deep, 15%) infarct in IMCAS group ; mixed (38%), large deep (21%), small deep (17%), and cortical (17%) infarct in IMCAO group ; large deep (31%), cortical (23%), small deep (17%), and no lesion (17%) in Combined group. Site of MCA steno-occlusion on angiogram was middle (44%), distal (39%), and proximal (18%) in IMCAS group ; proximal (48%), middle (35%), and distal (17%) in IMCAO group ; middle (42%), proximal (31%), and distal (27%) in Combined group. Patient's neurologic status, assessed by NIHSS, during first 7 days was 'not changed' or 'worsening' (>93%) in all 3 groups. Neurologic outcome at 3 months later was improving (65%) in IMCAS group by modified Rankin scale. CONCLUSIONS: Isolated MCA stenotic disease was not significantly different from iso-lated MCA occlusion group or Combined group in clinical features, neuroimaging findings, and prognosis.