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1.
World Neurosurg ; 176: e8-e13, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36681321

RESUMO

BACKGROUND: Optimal management of acute ischemic stroke (AIS) secondary to intracranial atherosclerotic disease (ICAD) refractory to conventional mechanical thrombectomy remains unclear. We aimed to investigate the clinical outcome of patients undergoing rescue intracranial balloon angioplasty with or without stent placement in the setting of AIS in our institution. METHODS: This is a retrospective single-arm observational study to evaluate the efficacy and safety of rescue balloon angioplasty with or without stent placement in emergent large vessel occlusion (EVLO) strokes with underlying ICAD. We included all patients undergoing such rescue intervention within 24 hours of AIS presentation with EVLO between 2017 and 2021. We further evaluated stent or vessel reocclusion. RESULTS: Of 20 patients undergoing rescue intervention, 3 cases achieved adequate recanalization of artery using balloon angioplasty alone. Seventeen patients required stent placement. Fourteen (70%) procedures resulted in National Institutes of Health Stroke Scale improvement in postprocedure and upon discharge. Among 6 (30%) procedures with worsening neurological measures, 3 had reoccluded stent 24-48 hours after procedure, 2 had symptomatic hemorrhagic conversion, and 1 had perforator occlusion. Nine patients (45%) had favorable functional outcome (modified Rankin Scale ≤2) at discharge, unchanged or improved at 3-month follow-up. The median modified Rankin Scale score was 4 (Interquartile range: 1.75-4) at discharge, improving to 3 (Interquartile range: 0-4) at 3-month follow-up. Two patients (10%) died during hospital stay. CONCLUSIONS: Rescue angioplasty with or without stenting can lead to significant clinical improvement in patients with ICAD presenting with ELVO and refractory to thrombectomy; however, this procedure is associated with a high rate of morbidity in acute setting.


Assuntos
Angioplastia com Balão , Arteriosclerose Intracraniana , AVC Isquêmico , Acidente Vascular Cerebral , Humanos , Estudos Retrospectivos , AVC Isquêmico/etiologia , Resultado do Tratamento , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/cirurgia , Angioplastia/métodos , Trombectomia/métodos , Stents , Arteriosclerose Intracraniana/complicações , Arteriosclerose Intracraniana/cirurgia
2.
J Neurointerv Surg ; 14(4): e3, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34732533

RESUMO

A teenager with a history of acute myeloid leukemia presented with headache, nausea and blurry vision over a 2 week period. The MRI of the brain was concerning for the presence of a myeloid sarcoma within the right sigmoid sinus. For evaluation of venous obstruction and the underlying lesion the patient underwent a cerebral angiogram and transvenous biopsy of the sigmoid sinus lesion using a stent retriever and aspiration catheter. The tissue extracted was consistent with myeloid sarcoma. This pathologic finding was consistent with the recurrence of leukemia and guided the targeted oncologic treatment.


Assuntos
Cavidades Cranianas , Trombectomia , Adolescente , Biópsia , Catéteres , Cavidades Cranianas/diagnóstico por imagem , Cavidades Cranianas/cirurgia , Humanos , Stents , Resultado do Tratamento
3.
World Neurosurg ; 143: 332-335, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32781141

RESUMO

BACKGROUND: Neoplastic cerebral aneurysms are rare presentations of cardiac myxomas. The natural history of such aneurysms is not well understood, and the optimal treatment strategy remains unclear. Clipping and coiling are effective, although can carry significant morbidity. Chemotherapy and radiation can theoretically be effective, although their clinical efficacy remains to be proven. CASE DESCRIPTION: Here we describe a patient with cardiac myxoma presenting with multiple progressively fusiform aneurysms. These aneurysms were noted to be growing during conservative monitoring given the eloquent location. Subsequently, the patient underwent multiple sessions of targeted radiation therapy, which lead to obliteration, shrinkage, or halting in growth of these aneurysms. CONCLUSIONS: Low-dose targeted radiation therapy can be safe and effective in treatment of neoplastic myxomatous aneurysms.


Assuntos
Neoplasias Cardíacas/complicações , Aneurisma Intracraniano/etiologia , Aneurisma Intracraniano/radioterapia , Mixoma/complicações , Radioterapia/métodos , Idoso , Angiografia Digital , Angiografia Cerebral , Feminino , Humanos , Ataque Isquêmico Transitório/etiologia , Doses de Radiação , Resultado do Tratamento
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