ABSTRACT
OBJECTIVE: To investigate the relationship between acute perfusion-weighted imaging (PWI) lesions occurring within the first hours after a TIA or a minor brain infarction (BI) and the incidence of new BI detected on a systematic MRI at 1 week. METHODS: Consecutive patients who experienced a TIA or BI with a neurologic deficit that lasted <24 hours, did not receive any revascularization therapy (thrombolysis/thrombectomy), and underwent DWI/PWI at baseline and fluid-attenuated inversion recovery (FLAIR)/DWI 1 week after symptom onset were enrolled. Investigators blinded to clinical information independently assessed the presence of acute ischemic lesions on baseline DWI/PWI and follow-up DWI and FLAIR. Baseline and follow-up MRIs were then compared to determine the occurrence and location of new infarctions. RESULTS: Sixty-four patients met the inclusion criteria. Median (IQR) ABCD2 score was 4 (3-5). Median delay from onset to baseline and follow-up MRI was 5 (2-10) hours and 6 (5-7) days, respectively. MRI revealed an acute ischemic lesion on DWI and/or PWI in 38 patients. Nine patients (14%) had a new infarction on follow-up MRI. Each had a PWI and 4 had a DWI lesion on baseline MRI. All new BIs except one were asymptomatic and in the same location as the acute PWI lesion. CONCLUSIONS: Our results showed that 30% of the acute focal PWI lesions detected after a TIA are associated with a new BI at 1 week. Those new BIs may result from the progression of the initial ischemic injury.
Subject(s)
Brain Infarction/diagnostic imaging , Brain/diagnostic imaging , Ischemic Attack, Transient/diagnostic imaging , Magnetic Resonance Imaging , Stroke/diagnostic imaging , Adult , Brain Infarction/etiology , Disease Progression , Female , Follow-Up Studies , Humans , Incidence , Ischemic Attack, Transient/complications , Ischemic Attack, Transient/drug therapy , Male , Middle Aged , Prognosis , Single-Blind Method , Stroke/complications , Stroke/drug therapy , Time FactorsABSTRACT
Subclavian steal is a relatively common vascular phenomenon usually caused by atherosclerotic disease. While symptoms are rare, arm claudication of the ipsilateral limb is most common, with paroxysmal symptoms of vertebrobasilar insufficiency (often exercise induced) being relatively uncommon. Here we present a case of brachial artery embolism during mechanical thrombectomy for basilar artery thrombosis, secondary to subclavian steal phenomenon. This atypical and potentially irreversible complication should be considered in patients with acute ischemic stroke undergoing neurointerventional management when subclavian steal is discovered angiographically.
Subject(s)
Lung Neoplasms/diagnostic imaging , Mechanical Thrombolysis/adverse effects , Subclavian Steal Syndrome/diagnostic imaging , Vertebrobasilar Insufficiency/diagnostic imaging , Aged , Basilar Artery/diagnostic imaging , Basilar Artery/surgery , Female , Humans , Lung Neoplasms/complications , Lung Neoplasms/surgery , Subclavian Steal Syndrome/etiology , Subclavian Steal Syndrome/surgery , Thrombectomy/adverse effects , Vertebrobasilar Insufficiency/complications , Vertebrobasilar Insufficiency/surgeryABSTRACT
Subclavian steal is a relatively common vascular phenomenon usually caused by atherosclerotic disease. While symptoms are rare, arm claudication of the ipsilateral limb is most common, with paroxysmal symptoms of vertebrobasilar insufficiency (often exercise induced) being relatively uncommon. Here we present a case of brachial artery embolism during mechanical thrombectomy for basilar artery thrombosis, secondary to subclavian steal phenomenon. This atypical and potentially irreversible complication should be considered in patients with acute ischemic stroke undergoing neurointerventional management when subclavian steal is discovered angiographically.
