Hemodynamic changes of cerebral arteries in patients with chronic unilateral internal carotid artery occlusion / 中国综合临床

Objective To analyze the hemodynamic changes of cerebral arteries in patients with chronic extracranial internal carotid artery occlusion (EICAO).Methods Ninety-six patients with chronic unilateral EICAO who were admitted to Kailuan General Hospital from September 2012 to December 2015 were selected as the case group (EICAO group),and 30 volunteers were selected as the control group.Color transcranial Doppler ultrasonography was used to detect the anterior communicating artery (ACOA) of the grade Ⅰ collateral circulation,the posterior communicating artery (PCOA),the ocular artery of the grade Ⅱ collateral circulation,and the pial collateral branch.Circulation rate and cerebral hemodynamic parameters:(Mean blood flow velocity (Vm) and pulsatility index).Results In the left and right EICAO groups,the opening rates of collateral circulation at grade Ⅰ were 86.96％ (40/46),96.00％ (48/50) and 78.26％ (36/46) and 88.00％ (44/50) respectively.There were significant differences in the opening rates of collateral circulation at grade Ⅰ between the two groups (x2 =4.114,P =0.043).There was no significant difference in the opening rates of collateral circulation at grade Ⅱ between the two groups (x2 =3.544,P =0.060).The left and right sides of EICAO group were compared with the same side of control group.The Vm of the common carotid artery (left side of the EICAO group (24.08 ± 9.25) cm/s),left side of the control group (32.52±3.28) cm/s,P＜0.01);right side of the EICAO group (22.20±5.51) cm/s),right side of the control group(31.58±3.35) cm/s,P＜0.01)) and the end-carotid artery end stage (TICA) The pulsation index (left side of left EICAO group (0.78 ±0.17),left side of control group (0.92±0.08),P ＜0.01);right side of right EICAO group (0.75 ± 0.19),right side of control group (0.91 ± 0.10),P ＜0.01),Vm of middle cerebral artery (MCA) (left side of left EICAO group(40.29 ±20.61) cm/s,left side of control group(55.72 ±5.60) cm/s,right side of EICAO;The right side of group (37.10±19.70) cm/s),the right side of control group (53.70±6.28) cm/s,P＜0.01),the pulsation index of MCA (left side of left EICAO group(0.74±0.19),left side of control group(0.87±0.10),P＜0.01;right side of right EICAO group (0.69±0.23),right side of control group:(0.90 ± 0.08),P ＜ 0.01).There were significant differences.NIHSS score of neurological impairment:normal 17.39％ (8/46),mild 39.13％ (18/46),moderate 30.44％ (14/46),moderate severe 13.04％ (6/46) in left EICAO group,and normal 18.00％ (9/50),mild 54.00％ (27/50),moderate 24.00％ (12/50),moderate severe 4.00％ (2/50) in right EICAO group.There was no significant difference between the two groups (P =0.178).Conclusion The ipsilateral common carotid artery and its distal middle cerebral artery in patients with chronic unilateral internal carotid artery occlusionshow hypoperfusion of hemodynamics,accompanied by neurological impairment.

Effect of family support nursing system on continuous nursing of home recuperation after symptomatic internal carotid artery occlusion symptomatic internal carotid artery occlusion intervention / 中国实用护理杂志

Objective@#To observe the role of family support nursing system in the continuous care of patients with home rest and recuperation after symptomatic internal carotid artery occlusion (SICAO) intervention.@*Methods@#Selecting patients with SICAO interventional procedures from August 2015 to July 2017, According to the continuous nursing method during the rest period, they were divided into the control group and the research group, with 45 cases in each group. The control group underwent routine continuous nursing intervention, and the study group implemented continuous nursing intervention based on the family support nursing system. The modified Rankin Scale (mRS) score, Barthel Index (BI) score, and Comprehension Social Support Scale (PSSS) scores were compared between the 2 groups at discharge and at 6 months of care intervention. The compliance of the two groups was compared at 2 weeks and 6 months, and the complications of the 2 groups were compared between 2 weeks and 6 months.@*Results@#There were no significant differences in the scores of mRS, BI and PSSS between the two groups at the time of discharge (P>0.05).When the nursing intervention is 6 months,mRS, BI score and PSSS scores, the research team is(1.54±0.23), (68.36±7.15), (23.75±2.36), (45.34±5.63), (69.09±7.12), the control group was(1.96±0.25), (61.33±6.70), (21.33±2.62), (41.15±4.71), (62.48±6.12), the study group was superior to the control group, and the difference was statistically significant (t=-8.294-5.182, P<0.05).The treatment adherence rate of the study group at 2 and 6 months was82.22%(37/45), 93.33%(42/45). Higher than the control group 57.78%(26/45), 64.44%(29/45). The difference was statistically significant(χ2=6.402, 11.275, P<0.05). The complication rate of the study group intervention from 2 weeks to 6 months2.22%(1/45). Lower than the control group13.33% (6/45). The difference was statistically significant (χ2=87.333, P<0.05).@*Conclusions@#Continuing nursing intervention based on family support nursing system can significantly improve the neurological function of patients after SICAO intervention, comprehend family and social support, improve daily living ability and treatment compliance, and reduce complications.

Visual Loss with Ophthalmoplegia after Prone Position Spinal Surgery

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

Determination of Clamp Site with Reference to a Cerebral Blood Flow Monitoring System in a Patient with a Right Subclavian Artery Aneurysm Complicated by Right Internal Carotid Artery Occlusion / 日本心臓血管外科学会雑誌

A 66-year-old man was referred to our hospital for the treatment of a right subclavian artery aneurysm. Computed tomography showed a 35-mm aneurysm in the right subclavian artery, and occlusion of the right internal carotid artery. A surgical approach with maintenance of intracranial blood flow was required. During anastomosis of the graft to the native vessel, we clamped the distal and proximal portions of the right subclavian artery, to maintain the blood flow of the right common carotid artery. The INVOS® cerebral oximeter (Somanetics Corp., Troy, MI, USA) was useful in determining the clamping site and surgical strategy. The procedure was completed without complications, and the patient was discharged from the hospital on postoperative day 8 following a good clinical course.

Study on the optimization of nursing mode for interventional open operation of symptomatic internal carotid artery occlusion guided by Joint Commission International concept / 中国实用护理杂志

Objective To explore the influence of perioperative nursing for interventional open operation of patients with symptomatic internal carotid artery occlusion under the guidance of the Joint Commission International(JCI) concept. Methods The clinical data of 90 patients with symptomatic internal carotid artery occlusion treated by elective interventional open operation from January 2016 to February 2018 were retrospectively analyzed, of which 40 patients receiving routine nursing from January 2016 to January 2017 were set as control group, of which 50 patients receiving nursing guided by JCI concept from February 2017 to February 2018 were set as observation group. The Hamilton Depression Scale (HAMD) was used to evaluate the anxiety of patients at preoperative 1 h and postoperative 48 h, and the extubation time and hospitalization time were compared, as well as the incidence of complications and the patient's coordination degree. Results The HAMD scores of preoperative 1 h and postoperative 48 h of the observation group respectively was (26.58 ± 5.79) and (17.41 ± 4.18) points, of which the control group respectively was (29.75 ± 5.21) points and (22.26 ± 4.64) points, and the HAMD scores between the postoperative 48 h and preoperative 1 h in the 2 groups were statistically significant differences (t=9.080, 6.790, all P < 0.01), of which between the 2 groups were statistically significant differences (t=2.697, 5.208, all P < 0.01). The extubation time and hospitalization time of the observation group respectively was (3.81 ± 0.62) and (12.97 ± 3.65) d, of which the control group respectively was (4.39 ± 0.71) and (16.18±3.54) d, with statistically significant differences (t=4.134, 4.201, all P<0.01). The total incidence rate of complications of the observation group was 18.00％(9/50), of which the control group was 40.00％(16/40), with statistically significant differences (χ2=5.361, P<0.05). The good rate of coordination of the observation group was 76.00％(38/50), of which the control group was 55.00％(22/40), with statistically significant differences (χ2=4.410, P < 0.05). Conclusions The perioperative nursing based on the JCI concept guidance can relieve the anxiety of patients with symptomatic internal carotid artery occlusion treated by elective interventional open operation, shorten the postoperative recovery time, reduce the incidence of complications and improve the nursing coordination.

Clinical application of intravascular ultrasound in the interventional treatment of internal carotid artery occlusion: initial experience of one case / 介入放射学杂志

Objective To discuss the clinical value of intravascular ultrasound (IVUS) in treatinginternal carotid arteries occlusion.Methods The patient was diagnosed with internal carotid artery occlusionthat was confirmed by CTA.Cerebral perfusion imaging showed that low perfusion area was consistent withischemic symptoms.Guided by IVUS,percutaneous transluminal angioplasty (PTA) was performed.By usingmicro-catheter coaxial technology,the micro guide wire was inserted in the carotid artery until it passedthrough the obstructed segment;After IVUS examination proved that the micro guide wire was in the truelumen of carotid artery,angiography through micro-catheter was carried out to confirm that the distal arterywas unobstructed;after adjusting the device position the embolism protector was placed.The plaque andlumen condition were assessed with IVUS,which was reevaluated after pre-expansion of balloon.After normaldirection blood flow was regained,the plaque stability was assessed with IVUS virtual organization sequence.Simple balloon dilatation therapy was adopted as the fibrous cap of plaque was in stable condition and thelumen stenosis rate was ＜40％.Results After balloon dilatation,the obstructed artery was reopened and theblood flow regained normal direction.IVUS examination showed that during the whole operation process thefibrous cap of plaque at the narrowed segment remained in stable condition,the lumen stenosis rate was ＜40％.Cerebral perfusion imaging revealed that after the treatment the low perfusion state was markedlyimproved.Conclusion IVUS plays an important guiding role in performing PTA for internal carotid arteryocclusion.This technique can increase the success rate of vascular recanalization and reduce the incidence ofcomplications.

Role of balloon occlusion test in the treatment of permanent internal carotid artery occlusion / 局解手术学杂志

Objective To investigate the relation between the balloon occlusion test ( BOT) and the anatomy of the circle of Willis ( CW) , and to explore the role of balloon occlusion test in the treatment of internal carotid artery permanent occlusion. Methods Selected the clinical data of 49 patients (52 sides) who had BOT in our hospital from October 2009 to June 2015,and analyzed the relationship be-tween the occurrence rate of anterior communicating artery ( AcoA) / posterior communicating artery ( PcoA) and the positive rate of BOT retrospectively. Results The occurrence rate of the AcoA was 97. 9%, and the occurrence rate of PcoA in one side was 82. 7%. Negative rate BOT accounted for 92. 3% and AcoA occurred in all, while the positive rate accounted for 7. 7%, including 2 cases of right superior ar-teria cerebri anterior combined with ipsilateral PcoAs absence, 1 case of left superior arteria cerebri anterior combined with ipsilateral PcoAs absence, and 1 case of AcoA and PcoAs absence. Conclusion Before the permanent occlusion of the internal carotid artery, it’ s necessary to clarify the redistribution of the compensatory way of blood flow in the AcoA-absent cases. Implementing permanent occlusion for cases with complete circle of Willis would cause less ischemic risk.

Coil Embolization of a Ruptured Basilar Tip Aneurysm Associated with Bilateral Cervical Internal Carotid Artery Occlusion: A Case Report and Literature Review

We report here on a rare case of a ruptured basilar tip aneurysm that was successfully treated with coil embolization in the bilateral cervical internal carotid artery (ICA) occlusions with abnormal vascular networks from the posterior circulation. A 43-year old man with a familial history of moyamoya disease presented with subarachnoid hemorrhage. Digital subtraction angiography demonstrated complete occlusion of the bilateral ICAs at the proximal portion and a ruptured aneurysm at the basilar artery bifurcation. Each meningeal artery supplied the anterior cranial base, but most of both hemispheres were supplied with blood from the basilar artery and the posterior cerebral arteries through a large number of collateral vessels to the ICA bifurcation as well as the anterior cerebral and middle cerebral arteries. The perfusion computed tomography (CT) scans with acetazolamide (ACZ) injection revealed no reduction of cerebral blood flow and normal cerebrovascular reactivity to ACZ. An abdominal CT aortogram showed no other extracranial vessel abnormalities. A ruptured basilar tip aneurysm was successfully treated with coil embolization without complications. Endovascular embolization may be a good treatment option with excellent safety for a ruptured basilar tip aneurysm that accompanies proximal ICA occlusion with vulnerable collateral flow.

Occlusion of the Internal Carotid Artery due to Intracranial Fungal Infection

In recent years the immunocompromised population has increased rapidly to include people with acquired immune deficiency syndrome (AIDS), drug abusers, and transplant patients. Accordingly, the incidence of intracranial fungal infection has increased. Our institution experienced 2 cases of internal carotid artery (ICA) occlusion due to invasion of the cavernous sinus by an intracranial fungal infection. The first case was a 60-year-old man who presented with headache, eye pain, conjunctival injection, right-sided diplopia, and blurred vision. Infected tissues within the frontal and ethmoid sinuses were removed via bifrontal craniotomy and endoscopic sinus surgery through the Caldwell Luc approach. The second case was a 63-year-old woman who developed right-sided facial pain after a tooth extraction. The infection was not controlled despite continuous use of antifungal agents, resulting in death from sepsis. We believe that when intracranial fungal infection is suspected in a patient with orbital symptoms and a focal neurologic deficit, immediate angiographic investigation of possible ICA occlusion is warranted. Aggressive treatment with antifungal agents is the only way to improve prognosis.

Acute Bilateral Internal Carotid Artery Territory Infarction Associated with a Variant of Aortic Arch Branching

Acute bilateral internal carotid artery occlusion (ICAO) is a rare form of ischemic stroke. The possible role of variants of the aortic arch in bilateral ICAO has never been reported. Two patients presented with abrupt coma with quadriplegia. Magnetic resonance images revealed acute ischemic lesions on both hemispheres, except the area supplied by the vertebrobasilar artery. Both patients showed variation of the origin of the brachiocephalic trunk and left common carotid artery. This variation might explain simultaneous bilateral carotid territory infarctions.

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

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

A Case of Hydranencephaly Caused by Internal Carotid Artery Occlusion / 대한소아신경학회지

Hydranencephaly is a condition in which cerebral hemisheres are absent and reduced to fluid-filled sacs in a normal skull. Numerous causes have been proposed, but bilateral occlusion of the internal carotid arteries during early fetal development can explain most of the pathologic abnormalities. We evaluated a case of hydranencephaly by brain CT and magnetic resonance angiography. Magnetic resonance angiography showed flow within the vertebral and basilar arteries without internal carotid intracranial flow above the supraclinoid segment. A brief review of the related literature was given on this subject.

Patterns of Stroke and Collateralization of the Internal Carotid Artery Occlusion in the Neck

BACKGROUND & PURPOSE: The aim of our study is to evaluate the stroke pattern, the correlation of collateralization with cerebral perfusion and stroke severity, and the utility of transcranial Doppler(TCD) to detect collateral pathways in patients with internal carotid artery(ICA) occlusion in the neck. METHODS: Thirty-six patients(28 men and 8 women, mean age of 59.6 ? 12.9 years) with ICA occlusion confirmed by transfemoral cerebral angiography(25 patients) or magnetic resonance angiography(MRA, 11 patients) were studied retrospectively. They had no potential cardiac source of stroke. We evaluated the pattern of cerebral infarcts by magnetic resonance imaging, and the number and the patency of collateral vessels, and the degree of perfusion through collaterals by cerebral angiography. The collateral vessels detected by TCD and MRA were compared with those by cerebral angiography. RESULTS: We found territorial infarcts in 23 patients(64%) and borderzone infarcts in 15(42%). Territorial infarcts(p<0.0001) and borderzone infarcts(p=0.02) occurred more in the ipsilateral hemisphere to the occluded ICA. The prevalence of small subcortical infarcts did not differ between hemispheres. Collateralizations through leptomeningeal anastomosis(p<0.01) and ophthalmic artery(OA, p<0.05) were associated with angiographically reduced cerebral perfusion. Collateralization through OA was also associated with severe symptomatic group(p<0.05); and collateralization through anterior or posterior communicating artery was associated with mild symptomatic group with marginal statistical significance(p=0.097). The number of collateral vessels was associated with neither the degree of perfusion nor the stroke severity. The sensitivity and specificity of TCD to detect collateralization through anterior communicating artery were 100% and 78%, through posterior communicating artery, 67% and 75%, and through OA, 67% and 63%, respectively. CONCLUSION: Cerebral infarcts related to a proximal ICA occlusion are more likely to be ipsilateral territorial or borderzone. The type of collateralization is more important factor for cerebral perfusion and stroke severity than the number of collateral vessels. TCD is a reliable tool for the evaluation of the collateral vessels in the patients with ICA occlusion.