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Santos Neto EPD, Sousa ÍAD, Ricarte IF, Pontes-Neto OM. Reversible Cerebral Vasoconstriction Syndrome And Fibromuscular Dysplasia: An Epiphenomenon Or A Causal Relationship? Acta Neurol Taiwan 2024; 33(3):122-126. [PMID: 37968850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Fibromuscular dysplasia (FMD) is a rare non-atherosclerotic arterial disease that primarily affects middle-aged Caucasian women. Carotid web (CW) is a variant of FMD characterized by a nonatheromatous, membrane-like tissue protrusion into the carotid bulb. Reversible cerebral vasoconstriction syndrome (RCVS) is defined by severe headaches and reversible narrowing of cerebral arteries, which typically resolves within three months. While most RCVS cases have identifiable triggers, a significant portion occurs without known causes. Recent studies have reported a high prevalence of neurovascular abnormalities in RCVS patients. We present a case of a thirty-year-old woman with a sudden-onset severe headache, diagnosed with RCVS associated with carotid web. The patient had no ischemic involvement and responded well to flunarizine treatment. Follow-up imaging showed no stenosis. This case highlights a potential association between carotid web and RCVS, suggesting that FMD may contribute to vascular hyperreactivity and presents as a risk factor for RCVS. Further investigations are needed to understand the underlying mechanisms connecting these two vascular disorders. Keywords: reversible vasoconstriction syndrome; fibromuscular dysplasia; carotid web; structural abnormalities; vascular hyperreactivity.
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Affiliation(s)
- Elizeu Pereira Dos Santos Neto
- Institute of Radiology, University of São Paulo School of Medicine, Hospital das Clínicas, São Paulo SP, Brazil; Neurologist and Interventional Neuroradiologist, Department of Neurology, Hospital Getúlio Vargas, Teresina PI, Brazil
| | - Ícaro Araújo de Sousa
- Department of Neuroscience and Behavior Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Irapuá Ferreira Ricarte
- Department of Neurology and Neurosurgery, São Paulo Federal University, São Paulo, SP, Brazil
| | - Octávio Marques Pontes-Neto
- Department of Neuroscience and Behavior Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Liu C, Liu M, Yang X, Luo T, Wang J, Li G. The efficacy and safety of aspirin-ticagrelor vs. aspirin-clopidogrel in ischemic stroke patients with cerebral artery stenting. Clin Neurol Neurosurg 2024; 239:108229. [PMID: 38479036 DOI: 10.1016/j.clineuro.2024.108229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/04/2024] [Accepted: 03/02/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE First, the efficacy and safety of aspirin-ticagrelor after cerebral artery stenting in ischemic stroke patients is controversial. Second, there is a gap in the research on guiding two antiplatelet therapy (DAPT) after stenting based on the CYP2C19 genotype. METHODS This retrospective study included patients who underwent cerebral artery stenting at the First Affiliated Hospital of Chongqing Medical University from January 2019 to February 2023. We divided them into the aspirin-clopidogrel group and aspirin-ticagrelor group and carefully collected baseline information laboratory data and imaging results from the patients. The efficacy outcomes were 30 days recurrent stroke, 90 days recurrent stroke, and 180 days recurrent stroke, and the safety outcome was intracranial hemorrhage. T-tests or Fisher's tests were performed for study outcomes in both groups of patients. OUTCOME A total of 372 patients were included. For efficacy outcomes, aspirin-ticagrelor was associated with a reduced risk of 180 days recurrent stroke, in patients with CYP2C19 LOF allele (OR = 0.426, CI = 0.184-0.986, P = 0.042) and CYP2C19 intermediate metabolic genotype (OR = 0.237, CI = 0.026-1.034, P = 0.044), compared with aspirin-clopidogrel. There was no significant difference in the rate of intracranial hemorrhage (ICH) between patients with aspirin-clopidogrel and aspirin-ticagrelor, regardless of overall (OR = 1.221, CI = 0.115-7.245, P = 0.683), CYP2C19 LOF allele carriers (OR = 1.226, CI = 0.411-3.658, P = 0.715), or CYP2C19 intermediate metabolizer (OR = 1.221, CI = 0.115-7.245, P = 0.683). No significant differences were found between the two DAPTs on other efficacy and safety outcomes. CONCLUSION A cohort study found that aspirin-ticagrelor was significantly superior to aspirin-clopidogrel in reducing 180 days recurrent stroke in CYP2C19 LOF allele carriers and CYP2C19 intermediate metabolizers. There was no significant difference between aspirin-ticagrelor and aspirin-clopidogrel in the risk of intracranial hemorrhage in terms of ICH rates.
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Affiliation(s)
- Chenxi Liu
- Department of Neurology, The Frist Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
| | - Mingsu Liu
- Department of Neurology, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China.
| | - Xun Yang
- Department of Neurology, Hechuan District People's Hospital, Chongqing 401500, China.
| | - Tingting Luo
- Department of Neurology, The Frist Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
| | - Jinping Wang
- Department of Neurology, Chongqing University Central Hospital, Chongqing 400050, China.
| | - Guangqin Li
- Department of Neurology, The Frist Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
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Huynh K. Heartbeat-induced pressure pulsations in cerebral arteries modulate neuronal activity. Nat Rev Cardiol 2024; 21:218. [PMID: 38374341 DOI: 10.1038/s41569-024-00999-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
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Lee JH, Vu HD, Park MH, Huynh PT, Youn SW, Kwon DR. Microcurrent wave alleviates mouse intracranial arterial dolichoectasia development. Sci Rep 2024; 14:7496. [PMID: 38553592 PMCID: PMC10980802 DOI: 10.1038/s41598-024-58333-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/27/2024] [Indexed: 04/02/2024] Open
Abstract
Intracranial arterial dolichoectasia (IADE) is associated with the interaction of hypertension and inflammation, and microcurrent can be effective in hypertension. Therefore, this study aimed to investigate the therapeutic effect of microcurrent electrical stimulation in a mouse IADE model. This study randomly categorized 20 mice into five groups: group 1-C (healthy control), group 2-D (IADE model), group 3-M + D (microcurrent administration before nephrectomy and until brain surgery), group 4-D + M (microcurrent administration for 4 weeks following brain surgery), and group 5-M (microcurrent administration for 4 weeks). Cerebral artery diameter and thickness and cerebral arterial wall extracellular matrix components were assessed. Among the five groups, group 2-D showed significantly higher cerebral arterial wall diameter (117.79 ± 17.05 µm) and proportion of collagen (42.46 ± 14.12%) and significantly lower arterial wall thickness (9.31 ± 2.26 µm) and proportion of smooth muscle cell (SMC) and elastin in the cerebral arterial wall (SMC: 38.05 ± 10.32%, elastin: 11.11 ± 6.97%). Additionally, group 4-D + M exhibited a non-significantly lower diameter (100.28 ± 25.99 µm) and higher thickness (12.82 ± 5.17 µm). Group 5-M demonstrated no evidence of toxicity in the liver and brain. The pilot study revealed that microcurrent is effective in preventing IADE development, although these beneficial effects warrant further investigation.
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Affiliation(s)
- Jae Hee Lee
- Department of Rehabilitation Medicine, Daegu Catholic University School of Medicine, Daegu, South Korea
| | - Huy Duc Vu
- Department of Radiology, Kyungpook National University, Daegu, South Korea
| | - Min Hee Park
- Department of Radiology, Kyungpook National University, Daegu, South Korea
| | - Phuong Tu Huynh
- Department of Radiology, Kyungpook National University, Daegu, South Korea
| | - Sung Won Youn
- Department of Radiology, Kyungpook National University, Daegu, South Korea.
| | - Dong Rak Kwon
- Department of Rehabilitation Medicine, Daegu Catholic University School of Medicine, Daegu, South Korea.
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Maibach F, Czaplinski A, Peters N, Paliantonis A. A case report on concomitant reversible cerebral vasoconstriction syndrome and transient global amnesia. Cortex 2024; 172:49-53. [PMID: 38159443 DOI: 10.1016/j.cortex.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
Reversible Cerebral Vasoconstriction Syndrome clinically presents as severe headaches with or without neurological deficits accompanied by multilocal caliber variation of the cerebral arteries on imaging studies. Transient Global Amnesia is a benign neurological condition that implies sudden temporary antero- and retrograde amnesia. The exact pathophysiological mechanisms involved in transient global amnesia and reversible cerebral vasoconstriction syndrome remain unclear but suggest similar pathways as both can be triggered by factors that activate the sympathetic nervous system. We herein discuss a potential relationship of the two conditions in a 65-year-old woman that initially presented herself to the emergency department with temporary memory impairment, indicating Transient Global Amnesia. Four days later, the patient revealed a thunderclap headache accompanied by a subarachnoid hemorrhage with transient segmental narrowing of the arteries of the anterior circulation on neuroimaging. In this case report we hypothesize that Reversible Cerebral Vasoconstriction Syndrome might be a potential cause for the clinical symptoms and imaging patterns with Transient Global Amnesia as a possible prodromal stage of Reversible Cerebral Vasoconstriction Syndrome.
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Affiliation(s)
- F Maibach
- Neurology Clinic, Zürich, Switzerland
| | | | - N Peters
- Neurology Clinic, Zürich, Switzerland; University of Basel, Basel, Switzerland
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Zedde M, Moratti C, Pavone C, Napoli M, Valzania F, Nguyen TN, Abdalkader M, Pascarella R. Twig-like Middle Cerebral Artery: Case Series in a European Population. World Neurosurg 2024; 183:e11-e21. [PMID: 37806521 DOI: 10.1016/j.wneu.2023.09.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES Twig-like middle cerebral artery (MCA) is a rare anomaly where the M1 MCA is partially or completely replaced by a plexiform network. It has been described in angiographic series from Asian and South-American cohorts, but has not yet been reported in a European population. METHODS The digital subtraction angiograms (DSAs) of adult patients referred to a single neurovascular center for a diagnostic hypothesis of moyamoya arteriopathy (MMA) from 2018 to 2023 were prospectively and retrospectively checked by experienced neuroradiologists for identifying patients with twig-like MCA. The angioarchitecture of twig-like MCA was systematically evaluated and described. RESULTS Five of 30 (16.7%) male patients (mean age 55.8 + 14.7 years) of European ancestry were identified as having twig-like MCA. The clinical presentations were ischemic stroke (2 of 5), hemorrhagic stroke (1 of 5), and headache (2 of 5). All patients showed a unilateral involvement on DSA and in 1 of 5 (20%) an intracranial aneurysm was found. DSA was used to confirm the diagnosis of twig-like MCA and define the angioarchitecture and associated anomalies. An accessory MCA and recurrent artery of Heubner were found in 3 of 5 (60%) cases, feeding the network together with the anterior choroidal artery (4 of 5, 80%). CONCLUSIONS Twig-like MCA is a rare vascular anomaly, but it seems to be less rare than expected among adult European patients with suspected MMA on noninvasive neuroimaging studies. DSA is fundamental for a reliable differential diagnosis and should not be omitted in these patients.
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Affiliation(s)
- Marialuisa Zedde
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Reggio Calabria, Italy.
| | - Claudio Moratti
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Reggio Calabria, Italy
| | - Claudio Pavone
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Reggio Calabria, Italy
| | - Manuela Napoli
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Reggio Calabria, Italy
| | - Franco Valzania
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Reggio Calabria, Italy
| | - Thanh N Nguyen
- Departments of Neurology, Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Rosario Pascarella
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Reggio Calabria, Italy
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Kehmeier MN, Khurana A, Bedell BR, Cullen AE, Cannon AT, Henson GD, Walker AE. Effects of dietary soy content on cerebral artery function and behavior in ovariectomized female mice. Am J Physiol Heart Circ Physiol 2024; 326:H636-H647. [PMID: 38156886 DOI: 10.1152/ajpheart.00618.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
As females age, they transition through menopause, experiencing a decrease in estrogen and an increase in cardiovascular and neurodegenerative disease risk. Most standard rodent chows contain phytoestrogen-rich soybean meal, which can mimic the effects of estrogen. Understanding the impact of this soybean meal on vascular outcomes is crucial to proper experimental design. Thus, this study aimed to compare the effects of standard and soy-free chows on cerebral artery endothelial function and cognitive function in ovariectomized mice. Young female C57Bl/6J mice (n = 43; ∼6 mo) were randomly assigned to three groups: sham, ovariectomy (OVX), or ovariectomy on a diet containing soy (OVX + Soy). In posterior cerebral arteries, the OVX mice had a 27% lower maximal response to insulin compared with the sham mice. The OVX + Soy mice had a 27% greater maximal vasodilation to insulin compared with the OVX mice and there were no differences in vasodilation between the OVX + Soy and sham groups. The group differences in vasodilation were mediated by differences in nitric oxide bioavailability. The OVX + Soy mice also had greater insulin receptor gene expression in cerebral arteries compared with the OVX mice. However, no differences in aortic or cerebral artery stiffness were observed between groups. Interestingly, the OVX + Soy group scored better on nesting behavior compared with both sham and OVX groups. In summary, we found that ovariectomy impairs insulin-mediated vasodilation in cerebral arteries, but a diet containing soy mitigates these effects. These findings highlight the importance of considering dietary soy when performing vascular and behavioral tests in mice, particularly in females.NEW & NOTEWORTHY To properly design experiments, we must consider how variables like diet impact our outcomes, particularly the effects of soy on females. We found that cerebral artery vasodilation in response to insulin was impaired in ovariectomized female mice compared with intact shams. However, ovariectomized mice fed a soy diet had a preserved cerebral artery insulin-mediated vasodilation. These results highlight that the effects of diet on vascular function may explain inconsistencies found between studies.
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Affiliation(s)
- Mackenzie N Kehmeier
- Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Aleena Khurana
- Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Bradley R Bedell
- Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Abigail E Cullen
- Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Audrey T Cannon
- Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Grant D Henson
- Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Ashley E Walker
- Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
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Uchino A, Irie T. Accessory posterior cerebral artery (hyperplastic anterior choroidal artery) associated with contralateral accessory middle cerebral artery incidentally diagnosed by magnetic resonance angiography. Surg Radiol Anat 2024; 46:313-316. [PMID: 38319360 DOI: 10.1007/s00276-024-03298-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE To describe a case of accessory posterior cerebral artery (PCA) [hyperplastic anterior choroidal artery (AChA)] associated with contralateral accessory middle cerebral artery (MCA) incidentally diagnosed by magnetic resonance (MR) angiography. METHODS A 71-year-old man with paroxysmal atrial fibrillation underwent cranial MR imaging and MR angiography of the intracranial region using a 1.5-T scanner for the evaluation of brain and vascular lesions. RESULTS On MR angiography, two right PCAs of equal size arose from the internal carotid artery instead of the basilar artery. Additionally, a small left MCA branch arose from the proximal A2 segment of the anterior cerebral artery (ACA). CONCLUSION One of the branches of the PCA rarely arises from the AChA. This variation is referred to as a hyperplastic AChA or accessory PCA. The latter name was recently proposed and may be more appropriate than the former name. An MCA branch arising from the ACA is called an accessory MCA. It is a frontal branch of two types: proximal-origin and distal-origin. The distal-origin accessory MCA arises from the distal A1 segment, A1-A2 junction or proximal A2 segment. Distal-origin accessory MCAs are rare. Our patient had two rare variations: an accessory right PCA and a distal-origin accessory left MCA. To identify cerebral arterial variations, especially accessory MCA, volume-rendering images are more useful than maximum-intensity projection images on MR angiography.
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Affiliation(s)
- Akira Uchino
- Department of Radiology, Saitama Sekishinkai Hospital, 2-37-20 Irumagawa, Sayama, Saitama, 350-1305, Japan.
| | - Tadanobu Irie
- Department of Cardiology, Saitama Sekishinkai Hospital, 2-37-20 Irumagawa, Sayama, Saitama, 350-1305, Japan
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Endo H, Ishikawa K, Ono H, Honjo K, Nakamura H. Replaced posterior cerebral artery. Surg Radiol Anat 2024; 46:299-302. [PMID: 38316649 DOI: 10.1007/s00276-023-03294-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/27/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE Replaced posterior cerebral artery (PCA), defined as a hyperplastic anterior choroidal artery (AChA) supplying all branches of the PCA, is an extremely rare anatomical variation. To the best of our knowledge, there are only a few reports of replaced PCA. METHODS Herein, we report a case of replaced PCA diagnosed by digital subtraction angiography. RESULTS A 76-year-old woman visited a neurosurgical clinic because of headache and vertigo. Magnetic resonance imaging and magnetic resonance angiography incidentally revealed a left internal carotid artery aneurysm. She was referred to our hospital for further examination and treatment of the unruptured intracranial aneurysm. Left internal carotid angiography revealed a paraclinoid aneurysm. We also incidentally found an anomalous hyperplastic AChA distal to the aneurysm. This hyperplastic AChA supplied not only the AChA territory but also the entire PCA territory. No vessels that could be a normal AChA or posterior communicating artery were identified along the left internal carotid artery. Vertebral angiography demonstrated that the left PCA was not visualized. With these findings, we diagnosed anomalous hyperplastic AChoA in this case as replaced PCA. CONCLUSION Careful imaging assessment is important to identify replaced PCA. Both direct findings of a hyperplastic AChA course and perfusion territory and indirect findings of the absence of the original PCA are useful in the diagnosis of replaced PCA.
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Affiliation(s)
- Hideki Endo
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-Ku, Sapporo, Hokkaido, 060-8570, Japan.
| | - Kohei Ishikawa
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-Ku, Sapporo, Hokkaido, 060-8570, Japan
| | - Hidetoshi Ono
- Department of Radiology, Nakamura Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Kaori Honjo
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-Ku, Sapporo, Hokkaido, 060-8570, Japan
| | - Hirohiko Nakamura
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-Ku, Sapporo, Hokkaido, 060-8570, Japan
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Tatsuta Y, Endo H, Ogino T, Yamaguchi Y, Kamiyama K, Osato T, Nakamura H. Internal carotid artery-persistent primitive anterior choroidal artery aneurysms: report of two cases and literature review. Acta Neurochir (Wien) 2024; 166:94. [PMID: 38376611 DOI: 10.1007/s00701-024-05988-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 12/28/2023] [Indexed: 02/21/2024]
Abstract
PURPOSE Persistent primitive anterior choroidal artery (PPAChA) is a rare vascular anomaly. The clinical course of internal carotid artery (ICA)-PPAChA aneurysms has not been well described. CASE REPORTS We report two patients with an ICA-PPChA aneurysm and summarize previously reported cases. RESULTS Including our two, a total of 10 patients with an ICA-PPAChA aneurysm have been reported. Data were not described for one. Among the remaining nine, five patients (56%) experienced aneurysmal rupture. Five patients underwent surgical clipping and four underwent endovascular coiling. The procedure was completed in all but one patient who had a tiny branch artery adherent to the aneurysm; this patient was converted from clipping to aneurysm coating with a cotton sheet. Among the other eight patients, one who underwent coiling experienced an internal capsule infarction. The remaining seven had a satisfactory postoperative course; however, an asymptomatic occlusion of the PPAChA at its origin was noted on postoperative angiography in one. CONCLUSION PPChA is associated with a high incidence of aneurysm formation and rupture. During treatment of ICA-PPAChA aneurysms, obstruction of the PPAChA and any surrounding perforating arteries should be avoided to prevent ischemic stroke.
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Affiliation(s)
- Yasuyuki Tatsuta
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-Ku, Sapporo, Hokkaido, 060-8570, Japan.
| | - Hideki Endo
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-Ku, Sapporo, Hokkaido, 060-8570, Japan
| | - Tatsuya Ogino
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-Ku, Sapporo, Hokkaido, 060-8570, Japan
| | - Yohei Yamaguchi
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-Ku, Sapporo, Hokkaido, 060-8570, Japan
| | - Kenji Kamiyama
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-Ku, Sapporo, Hokkaido, 060-8570, Japan
| | - Toshiaki Osato
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-Ku, Sapporo, Hokkaido, 060-8570, Japan
| | - Hirohiko Nakamura
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-Ku, Sapporo, Hokkaido, 060-8570, Japan
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Hsieh JT, Chia GS, Wong CP, Lim WEH, Wen DW. Off-label use of large diameter Concerto fibered coils through a 0.017 inch microcatheter for transvenous embolization of indirect carotid-cavernous fistulas: two case reports. J Med Case Rep 2024; 18:43. [PMID: 38311749 PMCID: PMC10840205 DOI: 10.1186/s13256-024-04344-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 12/29/2023] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND A carotid-cavernous fistula is an abnormal communication between the arteries and veins within the cavernous sinus. While conservative management may be prudent in low risk cases, many patients require intervention and endovascular embolization has evolved as the preferred method of treatment. Embolization can be performed via either the transarterial or transvenous approach. One major challenge of the transvenous approach is the complex and variable compartmentation of the cavernous sinus, which often requires the use of low profile microcatheters to navigate and reach the fistulous point. Fibered coils are also preferred when performing transvenous embolization of carotid-cavernous fistula, as they are of higher thrombogenicity and allow for faster occlusion of the fistula. However, most low profile (0.017-inch) microcatheters are not able to deploy fibered coils based on the manufacturer's instructions. CASE PRESENTATION We present two successful cases of off-label use of Medtronic Concerto fibered coils via a 0.017-inch microcatheter during transvenous embolization of carotid-cavernous fistula in a 60-year-old and an 80-year-old Chinese female, respectively. CONCLUSION Our case series highlight the possibility of deploying large diameter (up to 10 mm) Concerto fibered coils through a low profile (0.017-inch) microcatheter in an off-label manner for transvenous embolization of indirect carotid-cavernous fistula.
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Affiliation(s)
- Justin T Hsieh
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore.
| | - Ghim Song Chia
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
| | - Chen Pong Wong
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
| | - Winston Eng Hoe Lim
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
| | - David W Wen
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
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Sun T, Huang L, Sun J, Wu Z, Chen C, Wang H. Persistent trigeminal artery in a patient with moyamoya disease:a case report and literature review. BMC Neurol 2024; 24:54. [PMID: 38308221 PMCID: PMC10835905 DOI: 10.1186/s12883-024-03545-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/18/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUNDS Persistent trigeminal artery (PTA) is a rare anastomosis between internal carotid artery (ICA) and basilar artery. In rare conditions, the PTA could be combined with others cerebrovascular anomalies, moyamoya disease (MMD) is one of them. CASE PRESENTATION Here, we reported one rare case of MMD associated with PTA, the patient admitted to our department for severe dizziness and headache, imaging examination suggested MMD combined with right PTA, which arising from the ipsilateral cavernous portion of ICA. The patient received phased bilaterral revascularization with no any complication. In the subsequent follow-up, the patient's symptoms and intracranial vascular condition gradually improved. Moreover, we conducted a literature review of coexistence of PTA and MMD, the results of a web of science regarding such condition, and a deep discussion providing brief insight into the status of co-occurrence of PTA and MMD, including its manifestation, treatment and outcome. CONCLUSIONS The coexistence of PTA and MMD was rarely reported, the pathogenesis of such condition remains unknown. We found that the features of the coexistence of PTA and MMD were diverse, revascularization might be a feasible for such patient.
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Affiliation(s)
- Tao Sun
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, No. 600th Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Lixin Huang
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, No. 600th Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Jun Sun
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, No. 600th Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Zhimin Wu
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, No. 600th Tianhe Road, Guangzhou, 510630, Guangdong, China
| | - Chuan Chen
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, No. 600th Tianhe Road, Guangzhou, 510630, Guangdong, China.
| | - Hui Wang
- Department of Neurosurgery, Third Affiliated Hospital of Sun Yat-Sen University, No. 600th Tianhe Road, Guangzhou, 510630, Guangdong, China.
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13
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Abstract
Introduction: Alcohol (ethanol) and cannabis are among the most widely used recreational drugs in the world. With increased efforts toward legalization of cannabis, there is an alarming trend toward the concomitant (including simultaneous) use of cannabis products with alcohol for recreational purpose. While each drug possesses a distinct effect on cerebral circulation, the consequences of their simultaneous use on cerebral artery diameter have never been studied. Thus, we set to address the effect of simultaneous application of alcohol and (-)-trans-Δ-9-tetrahydrocannabinol (THC) on cerebral artery diameter. Materials and Methods: We used Sprague-Dawley rats because rat cerebral circulation closely mimics morphology, ultrastructure, and function of cerebral circulation of humans. We focused on the middle cerebral artery (MCA) because it supplies blood to the largest brain territory when compared to any other cerebral artery stemming from the circle of Willis. Experiments were performed on pressurized MCA ex vivo, and in cranial windows in vivo. Ethanol and THC were probed at physiologically relevant concentrations. Researchers were "blind" to experimental group identity during data analysis to avoid bias. Results: In males, ethanol mixed with THC resulted in greater constriction of ex vivo pressurized MCA when compared to the effects exerted by separate application of each drug. In females, THC, ethanol, or their mixture failed to elicit measurable effect. Vasoconstriction by ethanol/THC mixture was ablated by either endothelium removal or pharmacological block of calcium- and voltage-gated potassium channels of large conductance (BK type) and cannabinoid receptors. Block of prostaglandin production and of endothelin receptors also blunted constriction by ethanol/THC. In males, the in vivo constriction of MCA by ethanol/THC did not differ from ethanol alone. In females, the in vivo constriction of this artery by ethanol was significantly smaller than in males. However, artery constriction by ethanol/THC did not differ from the constriction in males. Conclusions: Our data point at the complex nature of the cerebrovascular effects elicited by simultaneous use of ethanol and THC. These effects include both local and systemic components.
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Affiliation(s)
- Alexandria Slayden
- Department of Pharmacology, Addiction Science and Toxicology, College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Steven Mysiewicz
- Department of Pharmacology, Addiction Science and Toxicology, College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kelsey North
- Department of Pharmacology, Addiction Science and Toxicology, College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Alex Dopico
- Department of Pharmacology, Addiction Science and Toxicology, College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Anna Bukiya
- Department of Pharmacology, Addiction Science and Toxicology, College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Coccarelli A, Pant S, Polydoros I, Harraz OF. A new model for evaluating pressure-induced vascular tone in small cerebral arteries. Biomech Model Mechanobiol 2024; 23:271-286. [PMID: 37925376 PMCID: PMC10901969 DOI: 10.1007/s10237-023-01774-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/17/2023] [Indexed: 11/06/2023]
Abstract
The capacity of small cerebral arteries (SCAs) to adapt to pressure fluctuations has a fundamental physiological role and appears to be relevant in different pathological conditions. Here, we present a new computational model for quantifying the link, and its contributors, between luminal pressure and vascular tone generation in SCAs. This is assembled by combining a chemical sub-model, representing pressure-induced smooth muscle cell (SMC) signalling, with a mechanical sub-model for the tone generation and its transduction at tissue level. The devised model can accurately reproduce the impact of luminal pressure on different cytoplasmic components involved in myogenic signalling, both in the control case and when combined with some specific pharmacological interventions. Furthermore, the model is also able to capture and predict experimentally recorded pressure-outer diameter relationships obtained for vessels under control conditions, both in a Ca2 + -free bath and under drug inhibition. The modularity of the proposed framework allows the integration of new components for the study of a broad range of processes involved in the vascular function.
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Affiliation(s)
- Alberto Coccarelli
- Zienkiewicz Institute for Modelling, Data and AI, Faculty of Science and Engineering, Swansea University, Swansea, UK.
| | - Sanjay Pant
- Zienkiewicz Institute for Modelling, Data and AI, Faculty of Science and Engineering, Swansea University, Swansea, UK
| | - Ioannis Polydoros
- Zienkiewicz Institute for Modelling, Data and AI, Faculty of Science and Engineering, Swansea University, Swansea, UK
| | - Osama F Harraz
- Department of Pharmacology, Larner College of Medicine, and Vermont Center for Cardiovascular and Brain Health, University of Vermont, Burlington, USA
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15
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Sampaio L, Morana G, Gonçalves H, Rossi A, Ramalho C. Fetal brain MR angiography at 1.5 T: a feasible study. Neuroradiology 2024; 66:271-278. [PMID: 37993731 DOI: 10.1007/s00234-023-03243-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/23/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE The use of magnetic resonance angiography (MRA) for assessing CNS fetal vasculature has been limited. The aim of this study was to determine the feasibility and added value of 2D time-of-flight (TOF) MRA of the fetal brain vasculature with a 1.5 T scanner. METHODS We conducted a prospective study (September 2018 to October 2022) by consecutively selecting pregnant women (≥ 18 years) with clinical indication to fetal brain MRI. On a 1.5 T scanner, a 2D TOF MRA acquisition was obtained at the end of the clinical protocol. Two neuroradiologists independently reviewed all MRIs; a qualitative scale of motion artifacts was applied to MRA images; represented vessels in MRA and T2 images were registered. RESULTS Thirty-five fetal brain MRIs. Mean maternal age: 32 years; mean fetal gestational age (GA): 31 weeks. Artifacts were found in 74% of MRA. The number of MRAs performed without artifacts increased with GA. On MRA, the identification of the majority of vessels increased with GA; statistical significance was reached in the identification of torcular Herophili (p = 0.026), vein of Galen (p < 0.001), internal cerebral veins (p = 0.002), basilar artery (p = 0.027), vertebral arteries (p = 0.025), and middle cerebral arteries (p = 0.044). Significantly, MRA depicted the sigmoid sinuses and internal jugular veins more frequently. Vascular pathology was found in 3/35 fetal brain MRIs. CONCLUSION Although artifacts were found in 74% of cases, MRA acquisitions were informative and of sufficient diagnostic quality in most studies. This technique may represent a valuable complimentary tool in CNS prenatal vascular studies.
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Affiliation(s)
- Luísa Sampaio
- Department of Neuroradiology, Centro Hospitalar Universitário de São João, Porto, Portugal.
- Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Giovanni Morana
- Division of Neuroradiology, Department of Diagnostic Imaging and Radiotherapy, "Città Della Salute E Della Scienza" University Hospital, University of Turin, Turin, Italy
- Department of Neurosciences, University of Turin, Turin, Italy
| | - Hernâni Gonçalves
- Center for Health Technology and Services Research (CINTESIS@RISE), Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Andrea Rossi
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Carla Ramalho
- Department of Obstetrics, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Obstetrics-Gynecology and Pediatrics, Faculty of Medicine, University of Porto, Porto, Portugal
- Instituto de Investigação E Inovação Em Saúde i3S, Porto, Portugal
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16
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Alhowaish TS, Alhamadh MS, Alsulayhim A, Alotaibi N, Alrashid AA, Alhabeeb AY, Alqirnas MQ, Alrushid E, Alnafisah MS, Anversha AA. Intraluminal Thrombus of the Extracranial Cerebral Arteries in Acute Ischemic Stroke: Manifestations, Treatment Strategies, and Outcome. Vasc Health Risk Manag 2024; 20:1-12. [PMID: 38192438 PMCID: PMC10771733 DOI: 10.2147/vhrm.s435227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/21/2023] [Indexed: 01/10/2024] Open
Abstract
Background Intraluminal thrombus (ILT) of the cervical arteries is an uncommon finding that can lead to acute or recurrent ischemic stroke. Currently, antithrombotic therapy in the form of antiplatelet and/or anticoagulation is considered the mainstay of treatment, but evidence of which one has a better outcome is lacking. Methods A retrospective cohort study included 28 patients diagnosed with acute stroke or transient ischemic attack with ILT of the extracranial arteries from 2013 to 2022. The primary efficacy outcome was assessed as recurrent stroke, and the primary safety outcome was assessed as hemorrhagic complications. Secondary outcomes were assessed as the resolution of thrombi by CT angiography (CTA) and clinical improvement by the Modified Rankin Scale (mRS) and NIH Stroke Scale (NIHSS). Results Out of 28 patients, more than half (57.1%; n = 16) were males with a mean age of 57.8 ± 9.5 years and an average BMI of 26.9 ± 4.5 kg/m2. As initial treatment, twenty-four patients received anticoagulation and four received antiplatelet agents. Recurrent strokes were found in four patients (14.29%), and all were initially treated with anticoagulation. One patient in the anticoagulation group had a significant retroperitoneal hemorrhage. None of the patients in the antiplatelets group had a recurrent stroke or bleeding event. Initial treatment with antiplatelet agents significantly improved the NIHSS on day 7 (P = 0.017). A significant improvement in NIHSS on day 90 was observed in the anticoagulant group (P = 0.011). In the follow-up CTA performed on 24 patients, 18 (75%) showed complete resolution (3 out of 3 (100%) in the antiplatelet group and 15 out of 21 (71.43%) in the anticoagulant group). Conclusion Initial treatment with anticoagulants improves neurologic outcomes in patients with ILT-induced acute ischemic stroke but carries the risk of recurrent stroke and bleeding. However, initial treatment with dual antiplatelet agents appears to have comparable efficacy without sequelae, particularly in atherosclerosis-induced ILT.
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Affiliation(s)
- Thamer S Alhowaish
- Division of Neurology, Department of Medicine, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs (MNGHA), Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of the National Guard-Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
| | - Moustafa S Alhamadh
- King Abdullah International Medical Research Center, Ministry of the National Guard-Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of the National Guard-Health Affairs, Riyadh, 14611, Kingdom of Saudi Arabia
| | - Abdullah Alsulayhim
- King Abdullah International Medical Research Center, Ministry of the National Guard-Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
- Radiology Department, King Abdul Aziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Najla Alotaibi
- College of Public Health, Oregon State University, Corvallis, OR, USA
| | - Azzam Abdulaziz Alrashid
- King Abdullah International Medical Research Center, Ministry of the National Guard-Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of the National Guard-Health Affairs, Riyadh, 14611, Kingdom of Saudi Arabia
| | - Abdulrahman Yousef Alhabeeb
- King Abdullah International Medical Research Center, Ministry of the National Guard-Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of the National Guard-Health Affairs, Riyadh, 14611, Kingdom of Saudi Arabia
| | - Muhannad Q Alqirnas
- King Abdullah International Medical Research Center, Ministry of the National Guard-Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of the National Guard-Health Affairs, Riyadh, 14611, Kingdom of Saudi Arabia
| | - Eythar Alrushid
- Division of Neurology, Department of Medicine, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs (MNGHA), Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of the National Guard-Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
| | - Mohammed S Alnafisah
- Division of Neurology, Department of Medicine, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs (MNGHA), Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of the National Guard-Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
| | - Ajmal Ali Anversha
- Division of Neurology, Department of Medicine, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs (MNGHA), Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of the National Guard-Health Affairs, Riyadh, 11481, Kingdom of Saudi Arabia
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17
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Ruan X, Lei T, Xiang X, Liu F, Shi X. Insights on Moyamoya Disease: Vascular Inflammation and Nuclear Autoschizis in Cranial Arteries. Stroke 2024; 55:e5-e7. [PMID: 38018829 DOI: 10.1161/strokeaha.123.045064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Affiliation(s)
- Xiaoling Ruan
- Department of Neurosurgery, University of Pavia, Italy (X.R.)
| | - Ting Lei
- Department of Neurosurgery, Sanbo Brain Hospital (T.L., X.X., F.L.)
- Department of Neurosurgery, Fuxing Hospital, Capital Medical University, Beijing, China (T.L., X.S.)
| | - Xin Xiang
- Department of Neurosurgery, Sanbo Brain Hospital (T.L., X.X., F.L.)
| | - Fangjun Liu
- Department of Neurosurgery, Sanbo Brain Hospital (T.L., X.X., F.L.)
| | - Xiang'en Shi
- Department of Neurosurgery, Fuxing Hospital, Capital Medical University, Beijing, China (T.L., X.S.)
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18
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Pal SC, Toumpanakis D, Wikstrom J, Ahuja CK, Strand R, Dhara AK. Multi-Level Residual Dual Attention Network for Major Cerebral Arteries Segmentation in MRA Toward Diagnosis of Cerebrovascular Disorders. IEEE Trans Nanobioscience 2024; 23:167-175. [PMID: 37486852 DOI: 10.1109/tnb.2023.3298444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Segmentation of major brain vessels is very important for the diagnosis of cerebrovascular disorders and subsequent surgical planning. Vessel segmentation is an important preprocessing step for a wide range of algorithms for the automatic diagnosis or treatment of several vascular pathologies and as such, it is valuable to have a well-performing vascular segmentation pipeline. In this article, we propose an end-to-end multiscale residual dual attention deep neural network for resilient major brain vessel segmentation. In the proposed network, the encoder and decoder blocks of the U-Net are replaced with the multi-level atrous residual blocks to enhance the learning capability by increasing the receptive field to extract the various semantic coarse- and fine-grained features. Dual attention block is incorporated in the bottleneck to perform effective multiscale information fusion to obtain detailed structure of blood vessels. The methods were evaluated on the publicly available TubeTK data set. The proposed method outperforms the state-of-the-art techniques with dice of 0.79 on the whole-brain prediction. The statistical and visual assessments indicate that proposed network is robust to outliers and maintains higher consistency in vessel continuity than the traditional U-Net and its variations.
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19
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Shtadler DI, Shtadler VD, Staroverov MS, Fukalov GA, Karakulov OG, Lebedev MA, Kurnikov DV, Goryunov SN, Gagai AA, Yakunina AS, Lukyanchikov VA. [Cerebral persistent primitive arteries. Clinical case of combination with intracranial aneurysm and review of the literature]. Zh Vopr Neirokhir Im N N Burdenko 2024; 88:77-86. [PMID: 38549414 DOI: 10.17116/neiro20248802177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Cerebral persistent primitive arteries are uncommon and associated with cerebrovascular diseases, like cerebral aneurysms. They can cause vertebrobasilar ischemia and neuropathy of the cranial nerves. The authors present a patient with trigeminal artery associated with giant partially thrombosed cavernous internal cerebral artery aneurysm.
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Affiliation(s)
| | - V D Shtadler
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - M S Staroverov
- Pirogov Russian National Research Medical University, Moscow, Russia
- Federal Brain and Neurotechnology Center, Moscow, Russia
| | - G A Fukalov
- Wagner Perm State Medical University, Perm, Russia
| | | | - M A Lebedev
- Perm City Clinical Hospital No. 4, Perm, Russia
| | | | | | - A A Gagai
- Perm City Clinical Hospital No. 4, Perm, Russia
| | - A S Yakunina
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V A Lukyanchikov
- Pirogov Russian National Research Medical University, Moscow, Russia
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
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20
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Liu J, Cao F, Zhenmei N, Guo Y, Li Y, Yuan D, Jiang W, Yan J. Flow-diverter stents in intracranial aneurysm treatment: impact on covered cerebral artery branches. Int J Surg 2024; 110:53-65. [PMID: 37851516 PMCID: PMC10793757 DOI: 10.1097/js9.0000000000000762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/10/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE Flow diverter stents (FDSs) have attracted interest for intracranial aneurysm (IA) treatment; however, occlusion of side branches and related complications have been reported. This study aimed to investigate the effects of FDSs in IA management when different branches of intracranial arteries are covered. MATERIALS AND METHODS A cross-sectional study was conducted using PUBMED, Embase, Web of Science, and Cochrane databases to include randomized or nonrandomized comparative-designed studies from January 2000 to August 2022 which reported outcomes of occlusion/narrowing of branches after IA treatment using FDSs. The PRISMA guidelines were used for our report. A random-effects meta-analysis was conducted to pool the outcomes, which included incidence rates of occlusion/narrowing of FDS-covered branches, branch occlusion-related symptoms, obliteration of IAs, and ideal clinical outcomes (modified Rankin Scale score ≤2). RESULTS The authors identified 57 studies involving 3789 patients with IA managed by FDSs covering different branches. During the median imaging follow-up at 12 months, the IA obliteration rate was satisfactory (>70%) when covering the ophthalmic artery (OA), posterior communicating artery (PComA), anterior choroidal artery (AChoA) or anterior cerebral artery (ACA), but not the middle cerebral artery-M2 segment (MCA-M2; 69.5%; 95% CI: 60.8-77.5%) and posterior inferior cerebellar artery (PICA; 59.1%, 13/22). The overall ideal clinical outcome was observed in 97.4% of patients (95% CI: 95.5-98.9%). Higher rates of occlusion/narrowing of branches were identified when FDSs covered the ACA (66.6%; 95% CI: 45.1-85.3%), PComA (44.3%; 95% CI: 34.2-54.6%), or MCA-M2 (39.2%; 95% CI: 24.5-54.7%); the risks were lower when covering the OA (11.8%; 95% CI: 8.8-15.1%), PICA (6.8%; 95% CI: 1.5-14.5%), and AchoA (0.5%; 95% CI: 0.0-2.9%). The risk of branch occlusion-related complications was low (incidence rate <5%) for each of the six evaluated branches. CONCLUSIONS Acceptable outcomes were identified following treatment of IAs when FDSs were placed across each of the six studied cerebral arteries. Treatment decisions regarding FDS placement across branch arteries should be made with the risk of complications from branch occlusion in mind.
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Affiliation(s)
- Junyu Liu
- Department of Neurosurgery, XiangYa Hospital
- Department of Pharmacology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Fang Cao
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, Changsha, People’s Republic of China
| | | | - Yuxin Guo
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, Changsha, People’s Republic of China
| | - Yifeng Li
- Department of Neurosurgery, XiangYa Hospital
| | - Dun Yuan
- Department of Neurosurgery, XiangYa Hospital
| | - Weixi Jiang
- Department of Neurosurgery, XiangYa Hospital
| | - Junxia Yan
- Hunan Provincial Key Laboratory of Clinical Epidemiology
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, Changsha, People’s Republic of China
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21
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Roopnarinesingh R, Leppert M, Mukherjee D. Evidence and Mechanisms for Embolic Stroke in Contralateral Hemispheres From Carotid Artery Sources. J Am Heart Assoc 2023; 12:e030792. [PMID: 38014680 PMCID: PMC10727331 DOI: 10.1161/jaha.123.030792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/23/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Disambiguation of embolus pathogenesis in embolic strokes is often a clinical challenge. One common source of embolic stroke is the carotid arteries, with emboli originating due to plaque buildup or perioperatively during revascularization procedures. Although it is commonly thought that thromboemboli from carotid sources travel to cerebral arteries ipsilaterally, there are existing reports of contralateral embolic events that complicate embolus source destination relationship for carotid sources. Here, we hypothesize that emboli from carotid sources can travel to contralateral hemispheres and that embolus interactions with collateral hemodynamics in the circle of Willis influence this process. METHODS AND RESULTS We use a patient-specific computational embolus-hemodynamics interaction model developed in prior works to conduct an in silico experiment spanning 4 patient vascular models, 6 circle of Willis anastomosis variants, and 3 different thromboembolus sizes released from left and right carotid artery sites. This led to a total of 144 different experiments, estimating trajectories and distribution of approximately 1.728 million embolus samples. Across all cases considered, emboli from left and right carotid sources showed nonzero contralateral transport (P value <-0.05). Contralateral movement revealed a size dependence, with smaller emboli traveling more contralaterally. Detailed analysis of embolus dynamics revealed that collateral flow routes in the circle of Willis played a role in routing emboli, and transhemispheric movement occurred through the anterior and posterior communicating arteries in the circle of Willis. CONCLUSIONS We generated quantitative data demonstrating the complex dynamics of finite size thromboembolus particles as they interact with pulsatile arterial hemodynamics and traverse the vascular network of the circle of Willis. This leads to a nonintuitive source-destination relationship for emboli originating from carotid artery sites, and emboli from carotid sources can potentially travel to cerebral arteries on contralateral hemispheres.
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Affiliation(s)
| | - Michelle Leppert
- Department of NeurologyUniversity of Colorado Anschutz Medical CampusAuroraCO
| | - Debanjan Mukherjee
- Paul M Rady Department of Mechanical EngineeringUniversity of Colorado BoulderBolderCO
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22
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Uchino A, Kondo R. Medial-type persistent trigeminal artery and ipsilateral posterior communicating artery supplying bilateral posterior cerebral arteries combined with an aberrant right subclavian artery and bicarotid trunk. Surg Radiol Anat 2023; 45:1557-1561. [PMID: 37814096 DOI: 10.1007/s00276-023-03247-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/24/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE To describe a case of a medial-type persistent trigeminal artery (PTA) associated with multiple arterial variations. METHODS A 34-year-old woman with multiple sclerosis underwent cranial magnetic resonance (MR) angiography from the aortic arch to the neck region and intracranial region for the evaluation of an unruptured cerebral aneurysm that was previously detected on MR imaging. The MR machine was a 3-T scanner. RESULTS There was an aberrant right subclavian artery and bicarotid trunk, medial-type left PTA and ipsilateral posterior communicating artery (PCoA) supplying bilateral posterior cerebral arteries (PCAs). The unruptured aneurysm was located at the paraclinoid segment of the left internal carotid artery and was treated successfully by coil embolization via a transfemoral approach. CONCLUSION Only 10% of PTAs are classified as the medial type. The association with extremely large ipsilateral PCoA, which supplies the bilateral PCAs, has not been previously reported. Aberrant right subclavian arteries are common and are frequently associated with a bicarotid trunk. Before catheterization of the cerebral arteries, the aortic arch and its branches must be evaluated by MR angiography or computed tomography angiography to prevent catheterization failure via the right transradial approach.
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Affiliation(s)
- Akira Uchino
- Department of Radiology, Saitama Sekishinkai Hospital, 2-37-20 Irumagawa, Sayama, Saitama, 350-1305, Japan.
| | - Ryushi Kondo
- Department of Neuroendovascular Therapy, Saitama Sekishinkai Hospital, 2-37-20 Irumagawa, Sayama, Saitama, 350-1305, Japan
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23
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Zdun M, Melnyk OP, Melnyk OO, Nabzdyk M. Blood supply to the cranial cavity in the patagonian mara (Dolichotis patagonum). Vet Res Commun 2023; 47:2199-2205. [PMID: 36976443 DOI: 10.1007/s11259-023-10113-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/20/2023] [Indexed: 03/29/2023]
Abstract
Rodents are the most numerous order of mammals. The literature presents information on the arterial circle of the brain in capybara, the guinea pig of the family Caviidae and many other not so closely related rodent species. Information on the blood supply to the brain is often incomplete and focuses on one pathway in a broader comparative aspect. The supply of oxygen and nutrients to the brain is very important for its proper functioning. The aim of this study is to describe the pathways supplying blood to the cranial cavity and to describe the arterial circle of the brain in the Patagonian mara. The study was conducted on 46 specimens using two methods. The first of them used a stained solution of the chemo-setting acrylic material. The second one, the colored liquid LBS 3060 latex. The arterial circle of the brain is a heart-shaped structure. It is formed by rostral cerebral arteries, caudal communicating arteries and the basilar artery. Blood supplies the arterial circle of the brain in three ways. First one is the basilar artery, which originates from the vertebral arteries. The second one is the internal carotid artery which joins a branch from the external ophthalmic artery. The third is the internal ophthalmic artery, which branches from the external ophthalmic artery.
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Affiliation(s)
- Maciej Zdun
- Department of Animal Anatomy, Poznan University of Life Sciences, Wojska Polskiego 71C, Poznań, 60-625, Poland.
- Department of Basic and Preclinical Sciences, Nicolaus Copernicus University, Lwowska 1, Toruń, 87-100, Poland.
- Department of Animal Anatomy, Histology and Pathomorphology, National University of Life and Environmental Sciences of Ukraine, Heroiv Oborony Str.15, Kyiv, 03041, Ukraine.
| | - Oleg P Melnyk
- Department of Animal Anatomy, Histology and Pathomorphology, National University of Life and Environmental Sciences of Ukraine, Heroiv Oborony Str.15, Kyiv, 03041, Ukraine
| | - Oleksii O Melnyk
- Department of Animal Anatomy, Histology and Pathomorphology, National University of Life and Environmental Sciences of Ukraine, Heroiv Oborony Str.15, Kyiv, 03041, Ukraine
| | - Maria Nabzdyk
- Department of Animal Anatomy, Poznan University of Life Sciences, Wojska Polskiego 71C, Poznań, 60-625, Poland
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Kumagai K, Hayashi M, Takahashi T, Honma H, Nishida S, Hayashi S, Ishihara H. Three-dimensional vessel wall imaging with 1.5-T MRI to visualize invisible occluded cerebral artery. Acta Radiol 2023; 64:3052-3055. [PMID: 37828855 DOI: 10.1177/02841851231205487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Endovascular thrombectomy (EVT) is performed for acute ischemic stroke (AIS) caused by large vessel occlusion; therefore, preoperative visualization of the occluded invisible vessel course reduces complications and ensures success. Three-dimensional (3D) proton density-weighted (PDW) vessel wall imaging (VWI) using variable refocusing flip angle pulse-turbo spin-echo sequences (VRFA-TSE) with 3.0-T magnetic resonance imaging (MRI) can provide this information. PURPOSE To assess the effectiveness of 3D PDW-VWI using 1.5-T MRI without VRFA function. MATERIAL AND METHODS Five consecutive patients with AIS caused by large vessel occlusion underwent EVT in our institute. VWI with 1.5-T MRI using 3D PDW-fast spin echo (FSE) technique was added to conventional brain imaging. RESULTS PDW-FSE was successfully performed in all cases. 3D PDW-FSE was useful to visualize both the anterior and posterior circulations by clearly revealing invisible vessels but could not demonstrate the length and size of the clot in all five cases. CONCLUSION 3D PDW-FSE with 1.5-T MRI without VRFA could clearly depict the course of the invisible occluded artery and might support favorable outcomes after EVT in patients with AIS.
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Affiliation(s)
- Kosuke Kumagai
- Department of Neurosurgery, Ken-o-Tokorozawa Hospital, Tokorozawa, Saitama, Japan
| | - Miyuka Hayashi
- Department of Neurosurgery, Ken-o-Tokorozawa Hospital, Tokorozawa, Saitama, Japan
| | - Takahiro Takahashi
- Department of Neurosurgery, Ken-o-Tokorozawa Hospital, Tokorozawa, Saitama, Japan
| | - Hiroyuki Honma
- Department of Diagnostic Imaging Application, FUJIFILM Healthcare Corporation, Tokyo, Japan
| | - Shou Nishida
- Department of Neurosurgery, Ken-o-Tokorozawa Hospital, Tokorozawa, Saitama, Japan
| | - Shinji Hayashi
- Department of Neurosurgery, Ken-o-Tokorozawa Hospital, Tokorozawa, Saitama, Japan
| | - Hideaki Ishihara
- Department of Neurosurgery, Ken-o-Tokorozawa Hospital, Tokorozawa, Saitama, Japan
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Choi JH, Park W, Park JC, Kwun BD, Ahn JS. Clipping of Unruptured Anterior Choroidal Artery Aneurysms Together with Small Branches: Safety Confirmation Using Intraoperative Indocyanine Green Video-Angiography and Intraoperative Neurophysiological Monitoring. World Neurosurg 2023; 180:e19-e29. [PMID: 37331470 DOI: 10.1016/j.wneu.2023.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/11/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND In treating anterior choroidal artery (AChA) aneurysms, preserving the AChA main trunk is of course necessary to prevent postoperative ischemic complications. However, in practice, complete occlusions are often limited by small branches. OBJECTIVE We aimed to demonstrate that even in cases where complete occlusion of the AChA aneurysm is complex due to small branches, complete occlusion can be safely achieved using indocyanine green video-angiography and intraoperative neurophysiological monitoring (IONM). METHODS We performed a retrospective review of all unruptured AChA aneurysms surgically treated at our institution from 2012 to 2021. All available surgical videos were reviewed to find AChA aneurysms clipped with small branches; clinical and radiological data were collected for these cases. RESULTS Among 391 cases of unruptured AChA aneurysms treated surgically, 25 AChA aneurysms were clipped with small branches. AChA-related ischemic complications occurred in 2 cases (8%) without retrograde indocyanine green filling to the branches. These 2 cases had changes in IONM. There were no ischemic complications in the remaining cases with retrograde indocyanine green filling to the branches and no change in IONM. During an average follow-up of 47 months (12-111 months), a small residual neck was observed in 3 cases (12%) and recurrence or progression of the aneurysm was observed in only 1 case (4%). CONCLUSIONS The surgical treatment of AChA aneurysms carries the risk of devastating ischemic complications. Even in cases where complete clip ligation seems impossible due to small branches associated with AChA aneurysms, complete occlusion can be safely achieved using indocyanine green video-angiography and IONM.
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Affiliation(s)
- June Ho Choi
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wonhyoung Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Duk Kwun
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Sekiguchi H, Kikuchi N, Ishida I, Sekiguchi N, Nishimura K, Shiga T, Kawana M, Hagiwara N, Takemura Y, Yamaguchi J. Direct Link Between Cardiac Failure and Global Cerebral Atrophy in a Young Adult: A Case Report on Reduced Cerebral Artery Blood Flow. Am J Case Rep 2023; 24:e940892. [PMID: 37943737 PMCID: PMC10643886 DOI: 10.12659/ajcr.940892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/28/2023] [Accepted: 09/30/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Heart failure is associated with structural brain abnormalities, including atrophy of multiple brain regions. Previous studies have reported brain atrophy in middle-aged patients with systolic heart failure. In this report, we present the case of a 21-year-old woman with idiopathic dilated cardiomyopathy, cardiac failure, and global cerebral atrophy due to reduced cerebral artery blood flow. We also discuss the impact of brain atrophy in this young adult patient with severe heart failure and no risk factors for atherosclerosis. CASE REPORT A 21-year-old woman with dyspnea and leg edema was admitted to our hospital. After several examinations, an endomyocardial biopsy led to a diagnosis of idiopathic dilated cardiomyopathy, and transthoracic ultrasound cardiography revealed that her left ventricular ejection fraction was 36%. One year after the first hospitalization, her heart failure was classified as New York Heart Association Class III. Magnetic resonance imaging showed severe global brain atrophy, and single-photon emission computed tomography combined with brain computed tomography showed reduced blood flow to the entire brain. She had no risk factors for atherosclerosis and no atherosclerotic changes to her brain or carotid arteries, but her neuropsychological and neurological findings indicated more pronounced brain and cognitive dysfunction. CONCLUSIONS This young adult patient with idiopathic dilated cardiomyopathy, cardiac failure, and global cerebral atrophy showed reduced cerebral artery blood flow and cognitive impairment. The findings of this report indicate that low cardiac output may directly cause brain atrophy in patients with systolic heart failure.
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Affiliation(s)
- Haruki Sekiguchi
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
- Department of General Medicine, Tokyo Women’s Medical University, Tokyo, Japan
- Department of Comprehensive Sleep Medicine, Tokyo Women’s Medical University, Tokyo, Japan
- National Hospital Organization Yokohama Medical Center, Yokohama, Kanagawa, Japan
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Noriko Kikuchi
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Issei Ishida
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Naoki Sekiguchi
- Department of Psychiatry, Tokyo Women’s Medical University, Tokyo, Japan
- Cosmetic Dermatology, UB CLINIC Shinjyuku, Tokyo, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women’s Medical University, Tokyo, Japan
| | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine, Tokyo, Japan
| | - Masatoshi Kawana
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
- Department of General Medicine, Tokyo Women’s Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Yousuke Takemura
- Department of General Medicine, Tokyo Women’s Medical University, Tokyo, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
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27
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Geers MS, van der Sar-van der Brugge S, van Norden AGW, van Hulst RA, De Backer ICF. [Cerebral arterial air embolism: the effect of hyperbaric oxygen therapy]. Ned Tijdschr Geneeskd 2023; 167:D7480. [PMID: 37994739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Iatrogenic gas embolism is the presence of gas in vascular structures. Feared are those in coronary or cerebral arteries. These can result in cerebral or myocardial infarction. CASE DESCRIPTION A 79-year-old female underwent CT-guided biopsy of the lung. Minutes later she developed neurological symptoms. After administration of oxygen her symptoms initially improved, but later worsened. Based on her symptoms air embolism was suspected. She recovered fully after treatment with hyperbaric oxygen. CONCLUSION Air embolism is a potentially life-threatening complication of surgical, radiological or vascular interventions. Early recognition can lead to prompt treatment and better prognosis. If air embolism is suspected the patient should be treated according to ABCDE principles and oxygen should be administered. In case of neurological or circulatory symptoms a hospital that could provide hyperbaric oxygen therapy should be contacted as soon as possible.
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Affiliation(s)
- Marloes S Geers
- Erasmus MC, afd. Longgeneeskunde, Rotterdam
- Contact: Marloes S. Geers
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Zhang Z, Kong Q, Zhang Y, Zhu W, Wei N, Xu Y, Suo Y, Meng X, Liebig P, Zhang Z, Wang Y, Jing J. Improved characterization of lenticulostriate arteries using compressed sensing time-of-flight at 7T. Eur Radiol 2023; 33:6939-6947. [PMID: 37062772 DOI: 10.1007/s00330-023-09629-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 01/22/2023] [Accepted: 02/17/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVES To evaluate the feasibility of 0.2-mm isotropic lenticulostriate arteries (LSAs) imaging using compressed sensing time-of-flight (CS TOF) at around 10 min on 7T, and compare the delineation and characterization of LSAs using conventional TOF and CS TOF. METHODS Thirty healthy volunteers were examined with CS TOF and conventional TOF at 7T for around 10 min each. CS TOF was optimized to achieve 0.2-mm isotropic LSA imaging. The numbers of LSA stems and branches were counted and compared on a vascular skeleton. The length and distance were measured and compared on the most prominent branch in each hemisphere. Another patient with intracranial artery stenosis was studied to compare LSA delineation in CS TOF and digital subtraction angiography (DSA). RESULTS The number of stems visualized with CS TOF was significantly higher than with conventional TOF in both left (p = 0.002, ICC = 0.884) and right (p < 0.001, ICC = 0.938) hemispheres. The number of branches visualized by conventional TOF was significantly lower than that by CS TOF in both left (p < 0.001, ICC = 0.893) and right (p < 0.001, ICC = 0.896) hemispheres. The lengths were statistically higher in CS TOF than in conventional TOF (left: p < 0.001, ICC = 0.868; right: p < 0.001, ICC = 0.876). CONCLUSIONS The high-resolution CS TOF improves the delineation and characterization of LSAs over conventional TOF. High-resolution LSA imaging using CS TOF can be a promising tool for clinical research and applications in patients with neurologic diseases. KEY POINTS • 0.2-mm isotropic LSA imaging for around 10 min using CS TOF at 7T is feasible. • More stems and branches of LSAs with longer lengths can be delineated with CS TOF than with conventional TOF at the same scan time. • High-resolution CS TOF can be a promising tool for research and applications on LSA.
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Affiliation(s)
- Zhe Zhang
- Tiantan Neuroimaging Center of Excellence, Beijing Tiantan Hospital, Capital Medical University, No 119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Qingle Kong
- MR Collaboration, Siemens Healthineers Ltd., Beijing, China
| | - Yingkui Zhang
- Tiantan Neuroimaging Center of Excellence, Beijing Tiantan Hospital, Capital Medical University, No 119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wanlin Zhu
- Tiantan Neuroimaging Center of Excellence, Beijing Tiantan Hospital, Capital Medical University, No 119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ning Wei
- Tiantan Neuroimaging Center of Excellence, Beijing Tiantan Hospital, Capital Medical University, No 119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuyuan Xu
- Tiantan Neuroimaging Center of Excellence, Beijing Tiantan Hospital, Capital Medical University, No 119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yue Suo
- Tiantan Neuroimaging Center of Excellence, Beijing Tiantan Hospital, Capital Medical University, No 119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- Tiantan Neuroimaging Center of Excellence, Beijing Tiantan Hospital, Capital Medical University, No 119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | - Zihao Zhang
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Yongjun Wang
- Tiantan Neuroimaging Center of Excellence, Beijing Tiantan Hospital, Capital Medical University, No 119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jing Jing
- Tiantan Neuroimaging Center of Excellence, Beijing Tiantan Hospital, Capital Medical University, No 119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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von Kummer R. Is ischemic core volume a valid argument to withhold thrombectomy from ischemic stroke patients with major cerebral artery occlusions? Neuroradiology 2023; 65:1423-1424. [PMID: 37658882 PMCID: PMC10497644 DOI: 10.1007/s00234-023-03218-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Rüdiger von Kummer
- Institute of Diagnostic and Interventional Neuroradiology, Universitätsklinikum Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
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30
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Alnafie MA. Bilateral duplicated hypoplastic superior cerebellar arteries one of which originates from a full-type fetal posterior cerebral artery. Surg Radiol Anat 2023; 45:1295-1300. [PMID: 37563217 DOI: 10.1007/s00276-023-03230-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE The association of bilateral duplication of the superior cerebellar artery with an origin from the posterior cerebral artery is rare but of great interest to anatomists, radiologists, and surgeons. This article reports bilateral duplicated hypoplastic superior cerebellar arteries, one of which arises from a full-type fetal cerebral artery. MATERIAL AND METHOD A 59-year-old woman admitted to the neurosurgery department for a subarachnoid hemorrhage underwent a brain CTA with 3D reconstruction using «3D slicer 4.11» software. Brain CTA and the 3D model were used to analyze the configuration of the posterior circulation. RESULTS CTA images and the 3D model showed an unusual configuration of the posterior circulation. The basilar artery prolonged the left vertebral artery, while the right vertebral artery ended in the right posterior inferior cerebellar artery. On both sides, a full-type fetal posterior cerebral artery and duplicated hypoplastic superior cerebellar artery were observed. Three cerebellar arteries arose from the basilar artery, while the fourth one emerged from the right fetal posterior cerebral artery. CONCLUSION Knowledge of such a configuration of the posterior circulation and others is necessary before radiological and surgical procedures. It helps to understand hemodynamic events, and neurovascular conflicts, improve revascularization procedures, and avoid surgical arterial and nervous injuries.
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Affiliation(s)
- Mohammed Assaad Alnafie
- Faculty of Medicine of Oran, University of Oran 1 Ahmed Ben Bella, El'Mnaouer, BP 1510, 31000, Oran, Algeria.
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Barosa M, Barroso T, Marques R, Caetano J, Alves JD. Clinically significant contrast-associated acute kidney injury after emergent computed tomography angiography of the cerebral arteries. Eur J Intern Med 2023; 115:146-148. [PMID: 37316354 DOI: 10.1016/j.ejim.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Mariana Barosa
- Serviço Medicina IV, Hospital Professor Doutor Fernando Fonseca, IC 19, 2720-276 Amadora, Portugal.
| | - Tiago Barroso
- Serviço de Oncologia Médica, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Ricardo Marques
- Unidade de Urgência Médica, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Joana Caetano
- Serviço Medicina IV, Hospital Professor Doutor Fernando Fonseca, IC 19, 2720-276 Amadora, Portugal; NOVA Medical Research - Immune Response and Vascular Disease, Chronic Diseases Research Centre, Nova Medical School, Lisboa, Portugal
| | - José Delgado Alves
- Serviço Medicina IV, Hospital Professor Doutor Fernando Fonseca, IC 19, 2720-276 Amadora, Portugal; NOVA Medical Research - Immune Response and Vascular Disease, Chronic Diseases Research Centre, Nova Medical School, Lisboa, Portugal
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32
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Senol YC, Sayin B, Oz ZG, Gurpinar I, Dereli B, Ozbakir MO, Akmangit I, Daglioglu E. Treatment of Ruptured Anterior Choroidal Artery Aneurysms by Acute Coiling Followed by Flow Diversion. World Neurosurg 2023; 176:e162-e172. [PMID: 37178914 DOI: 10.1016/j.wneu.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/05/2023] [Accepted: 05/06/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Flow-diverter treatments are successful endovascular treatments in protecting important perforating branches during aneurysm treatments. Because these treatments are performed under antiplatelet therapy, acute flow-diverter treatments in ruptured aneurysms are still controversial. Acute coiling followed by flow diversion has emerged as an intriguing and feasible treatment option for ruptured anterior choroidal artery aneurysm treatment. As a single-center retrospective case series study, this study reported the clinical and angiographic results of staged endovascular treatment in patients with a ruptured anterior choroidal aneurysm. METHODS This is a single-center retrospective case series study between March 2011 and May 2021. Patients with ruptured anterior choroidal aneurysm received flow-diverter therapy in a different session after acute coiling. Patients treated with primary coiling or only flow diversion were excluded. Preoperative demographic and presenting symptoms, aneurysm morphology, perioperative and postoperative complications, and long-term clinical and angiographic outcome as measured using the modified Rankin Scale and O'Kelly Morata Grading scale and also Raymond-Roy occlusion classification respectively. RESULTS Sixteen patients underwent coiling in the acute phase to undergo flow diversion later. The mean maximum aneurysm diameter is 5.44 ± 3.39 mm. All patients had a subarachnoid hemorrhage and were treated acutely between days 0 and 3 of acute bleeding. The mean age at the presentation was 54.12 ± 12 years (32-73 years). Two patients (12.5%) had minor ischemic complications, which are seen on magnetic resonance angiography as clinically silent infarcts, after the procedure. One patient (6.2%) had a technical complication with the flow-diverter shortening and deployed a second flow diverter telescopically. No mortality or permanent morbidity was reported. The mean interval time between the 2 treatments was 24.06 ± 11.83 days. All patients were followed up with digital subtraction angiography; 14/16 patients (87.5%) had aneurysms that were completely occluded and 2/16 (12.5%) showed near-complete occlusion. Mean follow-up was 16.62 ± 3.22 months; all patients had modified Rankin Scale scores ≤2; 14/16 (87.5%) had a total occlusion 14/16 (87.5%) had near-complete occlusion. None of the patients had retreatment or rebleeding. CONCLUSIONS Staged treatment of ruptured anterior choroidal artery aneurysms with acute coiling and flow-diverter treatment after recovery from subarachnoid hemorrhage is safe and effective. In this series, no cases of rebleeding occurred during the interval between coiling and flow diversion. Staged treatment should be considered a valid option in patients with challenging ruptured anterior choroidal aneurysms.
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Affiliation(s)
- Yigit Can Senol
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Bilkent City Hospital, Ankara, Turkey.
| | - Bige Sayin
- Department of Radiology, Bilkent City Hospital, Ankara, Turkey
| | - Zeynep Gence Oz
- Department of Neurologic Surgery, Bilkent City Hospital, Ankara, Turkey
| | - Idris Gurpinar
- Department of Neurologic Surgery, Bilkent City Hospital, Ankara, Turkey
| | - Batuhan Dereli
- Department of Neurologic Surgery, Bilkent City Hospital, Ankara, Turkey
| | - Musa Onur Ozbakir
- Department of Neurologic Surgery, Bilkent City Hospital, Ankara, Turkey
| | - Ilkay Akmangit
- Department of Radiology, Bilkent City Hospital, Ankara, Turkey
| | - Ergun Daglioglu
- Department of Neurologic Surgery, Bilkent City Hospital, Ankara, Turkey
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Shah P, Shrivastava M, Kale H, Mundada K. Interventions and imaging in patients with anatomic variations of cerebral circulation: a pictorial review. Acta Radiol 2023; 64:2455-2469. [PMID: 37143263 DOI: 10.1177/02841851231171687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The cerebral arterial system shows a wide spectrum of variations. Minor degrees of anatomic differences can be seen in almost all patients. Recognition of these anatomic variants is essential for the following: evaluating collateral circulation; some anatomic variants may mimic pathology; increased risk for aneurysm formation with some variants (e.g. fenestration, persistent trigeminal artery); dealing with pathologies that can arise with these variations; and for preoperative planning. The anterior and posterior groups of intracranial circulation show numerous anastomoses that play a major role in maintaining adequate blood supply to the cerebral parenchyma. This review focuses on the imaging features of these variants as seen on computed tomography and magnetic resonance imaging with relevant digital subtraction angiography imaging. We also present some case illustrations where understanding of these variants contributed to providing appropriate management.
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Affiliation(s)
- Pratik Shah
- Department of Neuro-interventional Radiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Manish Shrivastava
- Department of Neuro-interventional Radiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Hrishikesh Kale
- Department of Radiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Krishna Mundada
- Department of Radiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
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Narayan A, Sahdev R, Hosur B. Simple Coiling of Ruptured Duplicated Anterior Choroidal Artery Aneurysm: Not So Simple. Neurol India 2023; 71:845-846. [PMID: 37635552 DOI: 10.4103/0028-3886.383816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Ashok Narayan
- Department of Radiodiagnosis, Armed Forces Medical College, Pune, Maharashtra, India
| | - Ravinder Sahdev
- Department of Radiodiagnosis, Armed Forces Medical College, Pune, Maharashtra, India
| | - Bharat Hosur
- Department of Radiodiagnosis, Armed Forces Medical College, Pune, Maharashtra, India
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35
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Luisi CA, Amiri A, Büsen M, Sichermann T, Nikoubashman O, Wiesmann M, Steinseifer U, Müller M, Neidlin M. Investigation of Cerebral Hemodynamics During Endovascular Aspiration: Development of an Experimental and Numerical Setup. Cardiovasc Eng Technol 2023; 14:393-403. [PMID: 36814059 PMCID: PMC10412675 DOI: 10.1007/s13239-023-00660-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE Acute ischemic stroke is a life-threatening emergency caused by an occlusion of a cerebral artery through a blood clot. Aspiration thrombectomy is an endovascular therapy for the removal of vessel occlusions. However, open questions regarding the hemodynamics during the intervention remain, motivating investigations of blood flow within cerebral arteries. In this study, we present a combined experimental and numerical approach to analyze hemodynamics during endovascular aspiration. METHODS We have developed an in vitro setup for investigations of hemodynamic changes during endovascular aspiration within a compliant model of patient-specific cerebral arteries. Pressures, flows, and locally resolved velocities were obtained. In addition, we established a computational fluid dynamics (CFD) model and compared the simulations during physiological conditions and in two aspiration scenarios with different occlusions. RESULTS Flow redistribution within cerebral arteries after ischemic stroke is strongly dependent on the severity of the occlusion and on the volume flow extracted by endovascular aspiration. Numerical simulations exhibit an excellent correlation of R = 0.92 for flow rates and a good correlation of R = 0.73 for pressures. Further on, the local velocity field inside the basilar artery had a good agreement between CFD model and particle image velocimetry (PIV) data. CONCLUSION The presented setup allows for in vitro investigations of artery occlusions and endovascular aspiration techniques on arbitrary patient-specific cerebrovascular anatomies. The in silico model provides consistent predictions of flows and pressures in several aspiration scenarios.
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Affiliation(s)
- C A Luisi
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Pauwelsstr. 20, 52074, Aachen, Germany
| | - A Amiri
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Pauwelsstr. 20, 52074, Aachen, Germany
| | - M Büsen
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Pauwelsstr. 20, 52074, Aachen, Germany
| | - T Sichermann
- Clinic for Diagnostic and Interventional Neuroradiology, University Hospital Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - O Nikoubashman
- Clinic for Diagnostic and Interventional Neuroradiology, University Hospital Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - M Wiesmann
- Clinic for Diagnostic and Interventional Neuroradiology, University Hospital Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - U Steinseifer
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Pauwelsstr. 20, 52074, Aachen, Germany
| | - M Müller
- Clinic for Diagnostic and Interventional Neuroradiology, University Hospital Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - M Neidlin
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Pauwelsstr. 20, 52074, Aachen, Germany.
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Mysiewicz S, North KC, Moreira L, Odum SJ, Bukiya AN, Dopico AM. Interspecies and regional variability of alcohol action on large cerebral arteries: regulation by KCNMB1 proteins. Am J Physiol Regul Integr Comp Physiol 2023; 324:R480-R496. [PMID: 36717168 PMCID: PMC10027090 DOI: 10.1152/ajpregu.00103.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 02/01/2023]
Abstract
Alcohol intake leading to blood ethanol concentrations (BEC) ≥ legal intoxication modifies brain blood flow with increases in some regions and decreases in others. Brain regions receive blood from the Willis' circle branches: anterior, middle (MCA) and posterior cerebral (PCA), and basilar (BA) arteries. Rats and mice have been used to identify the targets mediating ethanol-induced effects on cerebral arteries, with conclusions being freely interchanged, albeit data were obtained in different species/arterial branches. We tested whether ethanol action on cerebral arteries differed between male rat and mouse and/or across different brain regions and identified the targets of alcohol action. In both species and all Willis' circle branches, ethanol evoked reversible and concentration-dependent constriction (EC50s ≈ 37-86 mM; below lethal BEC in alcohol-naïve humans). Although showing similar constriction to depolarization, both species displayed differential responses to ethanol: in mice, MCA constriction was highly sensitive to the presence/absence of the endothelium, whereas in rat PCA was significantly more sensitive to ethanol than its mouse counterpart. In the rat, but not the mouse, BA was more ethanol sensitive than other branches. Both interspecies and regional variability were ameliorated by endothelium. Selective large conductance (BK) channel block in de-endothelialized vessels demonstrated that these channels were the effectors of alcohol-induced cerebral artery constriction across regions and species. Variabilities in alcohol actions did not fully matched KCNMB1 expression across vessels. However, immunofluorescence data from KCNMB1-/- mouse arteries electroporated with KCNMB1-coding cDNA demonstrate that KCNMB1 proteins, which regulate smooth muscle (SM) BK channel function and vasodilation, regulate interspecies and regional variability of brain artery responses to alcohol.
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Affiliation(s)
- Steven Mysiewicz
- Department of Pharmacology, Addiction Science, and Toxicology, College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Kelsey C North
- Department of Pharmacology, Addiction Science, and Toxicology, College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Luiz Moreira
- Department of Pharmacology, Addiction Science, and Toxicology, College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Schyler J Odum
- Department of Pharmacology, Addiction Science, and Toxicology, College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Anna N Bukiya
- Department of Pharmacology, Addiction Science, and Toxicology, College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Alex M Dopico
- Department of Pharmacology, Addiction Science, and Toxicology, College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
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Fujimoto M, Tani S, Ogata H, Shimizu K, Yoshida S, Yamaguchi S, Hirata Y, Akiyama Y. Effective Mechanical Thrombectomy for Posterior Circulation Ischemia Using Magnetic Resonance Imaging-based Arterial Structures. Neurol Med Chir (Tokyo) 2023; 63:122-126. [PMID: 36682792 PMCID: PMC10072885 DOI: 10.2176/jns-nmc.2022-0246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
To improve the success of mechanical thrombectomy, three-dimensional turbo spin-echo (3D-TSE) sequences on T2WI can be employed to estimate the vascular structure of the posterior circulation. In addition to the short imaging time of 3D-TSE T2WI (33 sec), it can visualize the outer diameter of the main cerebral artery, including the occluded vessels. However, to date, the efficacy of mechanical thrombectomy in the posterior circulation remains unclear, and safer and more efficient mechanical thrombectomy procedures are required. Assessment of the anatomical variations in the posterior circulation using 3D-TSE T2WI is valuable for access decisions, device selection, and safe device guidance and retrieval techniques to the target vessel. Herein, we present representative cases of basilar artery and posterior cerebral artery occlusions in our institute and describe the utility of preoperative 3D-TSE T2WI in these patients.
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Kahle KT, Duran D, Smith ER. Increasing precision in the management of pediatric neurosurgical cerebrovascular diseases with molecular genetics. J Neurosurg Pediatr 2023; 31:228-237. [PMID: 36609371 DOI: 10.3171/2022.12.peds22332] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/05/2022] [Indexed: 01/09/2023]
Abstract
Recent next-generation DNA and RNA sequencing studies of congenital and pediatric cerebrovascular anomalies such as moyamoya disease, arteriovenous malformations, vein of Galen malformations, and cavernous malformations have shed new insight into the genetic regulation of human cerebrovascular development by implicating multiple novel disease genes and signaling pathways in the pathogenesis of these disorders. These diseases are now beginning to be categorized by molecular disruptions in canonical signaling pathways that impact the differentiation and proliferation of specific venous, capillary, or arterial cells during the hierarchical development of the cerebrovascular system. Here, the authors discuss how the continued study of these and other congenital cerebrovascular conditions has the potential to replace the current antiquated, anatomically based disease classification systems with a molecular taxonomy that has the potential to increase precision in genetic counseling, prognostication, and neurosurgical and endovascular treatment stratification. Importantly, the authors also discuss how molecular genetic data are already informing clinical trials and catalyzing the development of targeted therapies for these conditions historically considered as exclusively neurosurgical lesions.
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Affiliation(s)
- Kristopher T Kahle
- 1Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston
- 2Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston
- 3Division of Genetics and Genomics, Boston Children's Hospital, Boston
- 4Broad Institute of MIT and Harvard, Cambridge, Massachusetts; and
| | - Daniel Duran
- 5Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi
| | - Edward R Smith
- 2Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston
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Winder NR, Reeve EH, Kronquist EK, Khurana A, Lee B, Nguyen T, Henson GD, Walker AE. High pulse pressure impairs cerebral artery endothelial function in young, but not old, mice. Exp Gerontol 2023; 173:112101. [PMID: 36690049 PMCID: PMC9974894 DOI: 10.1016/j.exger.2023.112101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 01/09/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
One of the hallmarks of vascular aging is increased pulse pressure. This elevated pulse pressure is associated with deleterious effects on cerebral vascular function; however, it is unknown if age modulates the susceptibility to high pulse pressure. To examine the effects of age on the cerebral artery response to pulse pressure, we studied isolated cerebral arteries collected from young (6.1 ± 0.2 mo) and old (26.7 ± 0.5 mo) male C57BL/6 mice. Isolated cerebral arteries were exposed ex vivo to static pressure, low pulse pressure (25 mmHg), and high pulse pressure (50 mmHg). In cerebral arteries from young mice, endothelium-dependent dilation was similar between the static and low pulse pressure conditions. Exposure to high pulse pressure impaired endothelium-dependent dilation in cerebral arteries from young mice, mediated by less nitric oxide bioavailability and greater oxidative stress. Cerebral arteries from old mice had impaired cerebral artery endothelium-dependent dilation at static pressure compared with young cerebral arteries. However, exposure to low or high pulse pressure did not cause any further impairments to endothelium-dependent dilation in old cerebral arteries compared with static pressure. The old cerebral arteries had less distension during exposure to high pulse pressure and greater stiffness compared with young cerebral arteries. These results indicate that acute exposure to high pulse pressure impairs endothelium-dependent dilation in young, but not old, cerebral arteries. The greater stiffness of cerebral arteries from old mice potentially protects against the negative consequences of high pulse pressure.
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Affiliation(s)
- Nick R Winder
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
| | - Emily H Reeve
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
| | - Elise K Kronquist
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
| | - Aleena Khurana
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
| | - Byron Lee
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
| | - Thuan Nguyen
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
| | - Grant D Henson
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
| | - Ashley E Walker
- Department of Human Physiology, University of Oregon, Eugene, OR, USA.
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Reeve EH, Kronquist EK, Wolf JR, Lee B, Khurana A, Pham H, Cullen AE, Peterson JA, Meza A, Colton Bramwell R, Villasana L, Machin DR, Henson GD, Walker AE. Pyridoxamine treatment ameliorates large artery stiffening and cerebral artery endothelial dysfunction in old mice. J Cereb Blood Flow Metab 2023; 43:281-295. [PMID: 36189840 PMCID: PMC9903220 DOI: 10.1177/0271678x221130124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Age-related increases in large artery stiffness are associated with cerebrovascular dysfunction and cognitive impairment. Pyridoxamine treatment prevents large artery stiffening with advancing age, but the effects of pyridoxamine treatment on the cerebral vasculature or cognition is unknown. The purpose of this study was to investigate the effects of pyridoxamine on blood pressure, large artery stiffness, cerebral artery function, and cognitive function in old mice. Old male C57BL/6 mice consumed either pyridoxamine (2 g/L) or vehicle control in drinking water for ∼7.5 months and were compared with young male C57BL/6 mice. From pre- to post-treatment, systolic blood pressure increased in old control mice, but was maintained in pyridoxamine treated mice. Large artery stiffness decreased in pyridoxamine-treated mice but was unaffected in control mice. Pyridoxamine-treated mice had greater cerebral artery endothelium-dependent dilation compared with old control mice, and not different from young mice. Old control mice had impaired cognitive function; however, pyridoxamine only partially preserved cognitive function in old mice. In summary, pyridoxamine treatment in old mice prevented age-related increases in blood pressure, reduced large artery stiffness, preserved cerebral artery endothelial function, and partially preserved cognitive function. Taken together, these results suggest that pyridoxamine treatment may limit vascular aging.
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Affiliation(s)
- Emily H Reeve
- Department of Human Physiology, 3265, University of Oregon, Eugene, OR, USA
| | - Elise K Kronquist
- Department of Human Physiology, 3265, University of Oregon, Eugene, OR, USA
| | - Julia R Wolf
- Department of Human Physiology, 3265, University of Oregon, Eugene, OR, USA
| | - Byron Lee
- Department of Human Physiology, 3265, University of Oregon, Eugene, OR, USA
| | - Aleena Khurana
- Department of Human Physiology, 3265, University of Oregon, Eugene, OR, USA
| | - Hanson Pham
- Department of Human Physiology, 3265, University of Oregon, Eugene, OR, USA
| | - Abigail E Cullen
- Department of Human Physiology, 3265, University of Oregon, Eugene, OR, USA
| | - Jessica A Peterson
- Department of Human Physiology, 3265, University of Oregon, Eugene, OR, USA
| | - Antonio Meza
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - R Colton Bramwell
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | | | - Daniel R Machin
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
- Department of Nutrition and Integrative Physiology, 7823, Florida State University, Tallahassee, FL, USA
| | - Grant D Henson
- Department of Human Physiology, 3265, University of Oregon, Eugene, OR, USA
| | - Ashley E Walker
- Department of Human Physiology, 3265, University of Oregon, Eugene, OR, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
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Ota T, Komiyama M. Vascular supply of the hindbrain: Basic longitudinal and axial angioarchitecture. Interv Neuroradiol 2022; 28:756-764. [PMID: 34935534 PMCID: PMC9706269 DOI: 10.1177/15910199211063011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 11/15/2022] Open
Abstract
The basic pattern of arterial vascularization is highly conserved across vertebrates and develops under neuromeric rules. The hindbrain has an angioarchitecture that is homologous to that of the spinal cord, and the hindbrain vascular system can be analyzed at the longitudinal and axial structures. During development, there are two main longitudinal arteries: the longitudinal neural artery and primitive lateral basilovertebral anastomosis. This review discusses the basic pattern of the blood supply of the hindbrain, the development of vascularization, and the anatomical variations, with a special reference to the embryological point of view of two main longitudinal anastomoses (longitudinal neural artery and primitive lateral basilovertebral anastomosis). The formation of commonly observed variations, such as fenestration and duplication of the vertebrobasilar artery, or primitive trigeminal artery variant, can be explained by the partial persistence of the primitive lateral basilovertebral anastomosis. Understanding the pattern and the development of the blood supply of the hindbrain provides useful information of the various anomalies of the vertebrobasilar junction and cerebellar arteries.
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Affiliation(s)
- Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo,
Japan
| | - Masaki Komiyama
- Department of Neurointervention, Osaka City General Hospital, Osaka,
Japan
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42
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Delmas J, Cherier L, Sauvestre F, Chateil JF. Vertical course of fetal anterior cerebral artery as clue to prenatal diagnosis of syntelencephaly. Ultrasound Obstet Gynecol 2022; 60:813-814. [PMID: 35809245 DOI: 10.1002/uog.26028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Affiliation(s)
- J Delmas
- Service d'Imagerie Anténatale, de l'Enfant et de la Femme, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - L Cherier
- Service d'Imagerie Anténatale, de l'Enfant et de la Femme, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - F Sauvestre
- Unité de Fœtopathologie, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - J F Chateil
- Service d'Imagerie Anténatale, de l'Enfant et de la Femme, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
- University of Bordeaux/CNRS, CRMSB, UMR 5536, Bordeaux, France
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Rivera-Rivera LA, Kecskemeti S, Jen ML, Miller Z, Johnson SC, Eisenmenger L, Johnson KM. Motion-corrected 4D-Flow MRI for neurovascular applications. Neuroimage 2022; 264:119711. [PMID: 36307060 PMCID: PMC9801539 DOI: 10.1016/j.neuroimage.2022.119711] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
Neurovascular 4D-Flow MRI has emerged as a powerful tool for comprehensive cerebrovascular hemodynamic characterization. Clinical studies in at risk populations such as aging adults indicate hemodynamic markers can be confounded by motion-induced bias. This study develops and characterizes a high fidelity 3D self-navigation approach for retrospective rigid motion correction of neurovascular 4D-Flow data. A 3D radial trajectory with pseudorandom ordering was combined with a multi-resolution low rank regularization approach to enable high spatiotemporal resolution self-navigators from extremely undersampled data. Phantom and volunteer experiments were performed at 3.0T to evaluate the ability to correct for different amounts of induced motions. In addition, the approach was applied to clinical-research exams from ongoing aging studies to characterize performance in the clinical setting. Simulations, phantom and volunteer experiments with motion correction produced images with increased vessel conspicuity, reduced image blurring, and decreased variability in quantitative measures. Clinical exams revealed significant changes in hemodynamic parameters including blood flow rates, flow pulsatility index, and lumen areas after motion correction in probed cerebral arteries (Flow: P<0.001 Lt ICA, P=0.002 Rt ICA, P=0.004 Lt MCA, P=0.004 Rt MCA; Area: P<0.001 Lt ICA, P<0.001 Rt ICA, P=0.004 Lt MCA, P=0.004 Rt MCA; flow pulsatility index: P=0.042 Rt ICA, P=0.002 Lt MCA). Motion induced bias can lead to significant overestimation of hemodynamic markers in cerebral arteries. The proposed method reduces measurement bias from rigid motion in neurovascular 4D-Flow MRI in challenging populations such as aging adults.
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Affiliation(s)
- Leonardo A Rivera-Rivera
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Rm 1005, Madison, WI, 53705-2275, United States; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, United States
| | - Steve Kecskemeti
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Rm 1005, Madison, WI, 53705-2275, United States
| | - Mu-Lan Jen
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Rm 1005, Madison, WI, 53705-2275, United States
| | - Zachary Miller
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Rm 1005, Madison, WI, 53705-2275, United States
| | - Sterling C Johnson
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, United States
| | - Laura Eisenmenger
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, United States
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Ave, Rm 1005, Madison, WI, 53705-2275, United States; Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, United States.
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Yamada H, Akiyama T, Kamamoto D, Yoshida K, Fukumura M, Toda M. Combined transarterial and transvenous embolization of multi-hole pial arteriovenous fistula with large varix. Neuroradiol J 2022; 35:640-646. [PMID: 35477369 PMCID: PMC9513922 DOI: 10.1177/19714009221096829] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Pial arteriovenous fistula (AVF) is a vascular fistulous disease in which the cerebral pial artery and vein are directly connected without the intervening nidus within a sub-pial space. Multi-hole pial AVFs, wherein multiple feeders flow into one drainer, are usually formed with complex angioarchitecture and are difficult to treat. METHODS A rare case of an adult patient with hereditary hemorrhagic telangiectasia and multi-hole pial AVF was described. A 23-year-old woman was referred to our hospital. She was previously diagnosed with left cerebellar pial AVF with multiple feeders (bilateral superior cerebellar artery and common trunk of the left anterior inferior cerebellar artery and posterior inferior cerebellar) and large varix that had been untreated for 9 years. The enlargement of the large varix with the new second varix formation was revealed by angiography. Although asymptomatic, considered to be a risk for future hemorrhage was the continuous high hemodynamic stress. RESULTS Endovascular embolization was performed by securing safe transarterial n-butyl-2-cyanoacrylate injection by transarterial and transvenous coil placement to the shunt points and feeders, resulting in total occlusion of the fistula without any complications. Extensive transvenous coil placement inside the varix allowed safe embolization of the entire fistula with multiple high-flow feeders. Moreover, bidirectional (transarterial and transvenous) retrograde coil embolization enabled firm obliteration of the shunt points. CONCLUSIONS Performing combined transarterial and transvenous embolization in a well-balanced manner was considered to treat multi-hole pial AVF to provide a safe and effective embolization.
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Affiliation(s)
- Hiroki Yamada
- Department of Neurosurgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Takenori Akiyama
- Department of Neurosurgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Dai Kamamoto
- Department of Neurosurgery, Tokyo Dental College Ichikawa General
Hospital, Chiba, Japan
| | - Keisuke Yoshida
- Department of Neurosurgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Mariko Fukumura
- Department of Neurosurgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Deguchi I. [Cerebral Infarction with Diffuse and Severe Atherosclerosis of The Main Cerebral Artery and Recurrent Infarction Despite Multiple Antiplatelet Agents: Treatment Strategy for Patients with Recurrent Cerebral Infarction During Antiplatelet Therapy]. Brain Nerve 2022; 74:621-628. [PMID: 35589656 DOI: 10.11477/mf.1416202089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In real-world settings, many patients experience single or multiple recurrences of non-cardiogenic cerebral infarction, which is mainly caused by arteriosclerosis. These patients are treated according to set guidelines. While antiplatelet therapy is the standard treatment for preventing recurrence, this therapy alone is insufficient for full prevention of recurrence. Combining the administration of antiplatelet agents with the management of risk factors for recurrent cerebral infarction can maximize the preventive effects of these drugs.
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Affiliation(s)
- Ichiro Deguchi
- Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center
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46
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Suzuki K, Kimura K. [Cerebral Infarction with Diffuse and Severe Atherosclerosis of The Main Cerebral Artery and Recurrent Infarction Despite Multiple Antiplatelet Agents: Management for Acute Stroke Patients]. Brain Nerve 2022; 74:629-636. [PMID: 35589657 DOI: 10.11477/mf.1416202090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The recent approval of prasugrel will expand the choice of medical treatment. Prasugrel, as a platelet inhibitor, was approved for the management of cardiovascular events (including stent thrombosis) in patients with acute coronary syndrome in 2009. In 2021, it was also approved for use in patients with ischemic stroke. However, there have been cases of patients showing resistance to medical treatment and, therefore, worsening symptoms. It is important to approach treatment while considering the next step. Physicians should be aware of medical treatment choices, including the use of antiplatelet drugs, as well as the appropriate timing to shift to surgical treatment when necessary. In this paper, clinical practice options and guidelines will be considered.
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47
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Mugikura S, Mori N. Perforators of the posterior communicating artery and memory disturbance. Acta Neurochir (Wien) 2022; 164:1307-1308. [PMID: 35220461 DOI: 10.1007/s00701-022-05147-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Shunji Mugikura
- Department of Diagnostic Radiology, Graduate School of Medicine, Tohoku University, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
- Division of Image Statistics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
| | - Naoko Mori
- Department of Diagnostic Radiology, Graduate School of Medicine, Tohoku University, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
- Division of Image Statistics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
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Kim HS, Lee ES, Shin BS, Kang HG. Recurrent Cerebral Artery Dissection Associated with Seronegative Antiphospholipid Antibody Syndrome. Tomography 2022; 8:754-759. [PMID: 35314639 PMCID: PMC8938765 DOI: 10.3390/tomography8020062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022] Open
Abstract
Stroke in young patients requires thorough evaluation as they often lack risk factors. Antiphospholipid syndrome can cause arterial thrombosis and pregnancy loss; hence, differential diagnoses should include seronegative antiphospholipid syndrome. We report a case of recurrent ischemic stroke caused by recurrent dissection in a patient with a history of pregnancy loss. A 33-year-old woman was admitted with global aphasia and right hemiparesis. During intra-arterial thrombectomy, a left middle cerebral artery dissection was detected. After 5.5 years, she was re-admitted for dysarthria, left facial palsy, subtle left hemiparesis, and right middle cerebral artery dissection. She tested negative for autoimmune diseases and vasculitis. However, underlying pathologic conditions could not be excluded because of the unique disease course. Finally, she was diagnosed with seronegative antiphospholipid syndrome. The concept of seronegative antiphospholipid syndrome has been proposed for patients with clinical features suggestive of antiphospholipid syndrome but with negative titers. However, this syndrome can only be diagnosed by exclusion. Furthermore, arterial dissection should be considered to be its main pathology. Antiphospholipid syndrome itself can be a risk factor for arterial dissection because it weakens the vessel walls. Therefore, diagnosis is important to prevent future complications in young patients with recurrent cerebral artery dissection, especially those associated with pregnancy-related morbidities.
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Affiliation(s)
- Hee Sue Kim
- Jeonbuk National University Medical School, Jeonju 54907, Korea;
| | - Eun Su Lee
- Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Korea; (E.S.L.); (B.-S.S.)
| | - Byoung-Soo Shin
- Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Korea; (E.S.L.); (B.-S.S.)
- Biomedical Research Institute, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Korea
| | - Hyun Goo Kang
- Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Korea; (E.S.L.); (B.-S.S.)
- Biomedical Research Institute, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Korea
- Correspondence: ; Tel.: +82-63-250-1590
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Renú A, Millán M, San Román L, Blasco J, Martí-Fàbregas J, Terceño M, Amaro S, Serena J, Urra X, Laredo C, Barranco R, Camps-Renom P, Zarco F, Oleaga L, Cardona P, Castaño C, Macho J, Cuadrado-Godía E, Vivas E, López-Rueda A, Guimaraens L, Ramos-Pachón A, Roquer J, Muchada M, Tomasello A, Dávalos A, Torres F, Chamorro Á. Effect of Intra-arterial Alteplase vs Placebo Following Successful Thrombectomy on Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke: The CHOICE Randomized Clinical Trial. JAMA 2022; 327:826-835. [PMID: 35143603 PMCID: PMC8832304 DOI: 10.1001/jama.2022.1645] [Citation(s) in RCA: 112] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE It is estimated that only 27% of patients with acute ischemic stroke and large vessel occlusion who undergo successful reperfusion after mechanical thrombectomy are disability free at 90 days. An incomplete microcirculatory reperfusion might contribute to these suboptimal clinical benefits. OBJECTIVE To investigate whether treatment with adjunct intra-arterial alteplase after thrombectomy improves outcomes following reperfusion. DESIGN, SETTING, AND PARTICIPANTS Phase 2b randomized, double-blind, placebo-controlled trial performed from December 2018 through May 2021 in 7 stroke centers in Catalonia, Spain. The study included 121 patients with large vessel occlusion acute ischemic stroke treated with thrombectomy within 24 hours after stroke onset and with an expanded Treatment in Cerebral Ischemia angiographic score of 2b50 to 3. INTERVENTIONS Participants were randomized to receive intra-arterial alteplase (0.225 mg/kg; maximum dose, 22.5 mg) infused over 15 to 30 minutes (n = 61) or placebo (n = 52). MAIN OUTCOMES AND MEASURES The primary outcome was the difference in proportion of patients achieving a score of 0 or 1 on the 90-day modified Rankin Scale (range, 0 [no symptoms] to 6 [death]) in all patients treated as randomized. Safety outcomes included rate of symptomatic intracranial hemorrhage and death. RESULTS The study was terminated early for inability to maintain placebo availability and enrollment rate because of the COVID-19 pandemic. Of 1825 patients with acute ischemic stroke treated with thrombectomy at the 7 study sites, 748 (41%) patients fulfilled the angiographic criteria, 121 (7%) patients were randomized (mean age, 70.6 [SD, 13.7] years; 57 women [47%]), and 113 (6%) were treated as randomized. The proportion of participants with a modified Rankin Scale score of 0 or 1 at 90 days was 59.0% (36/61) with alteplase and 40.4% (21/52) with placebo (adjusted risk difference, 18.4%; 95% CI, 0.3%-36.4%; P = .047). The proportion of patients with symptomatic intracranial hemorrhage within 24 hours was 0% with alteplase and 3.8% with placebo (risk difference, -3.8%; 95% CI, -13.2% to 2.5%). Ninety-day mortality was 8% with alteplase and 15% with placebo (risk difference, -7.2%; 95% CI, -19.2% to 4.8%). CONCLUSIONS AND RELEVANCE Among patients with large vessel occlusion acute ischemic stroke and successful reperfusion following thrombectomy, the use of adjunct intra-arterial alteplase compared with placebo resulted in a greater likelihood of excellent neurological outcome at 90 days. However, because of study limitations, these findings should be interpreted as preliminary and require replication. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03876119; EudraCT Number: 2018-002195-40.
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Affiliation(s)
- Arturo Renú
- Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mónica Millán
- Stroke Unit, Department of Neuroscience, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Luis San Román
- Neuroradiology Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Jordi Blasco
- Neuroradiology Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Joan Martí-Fàbregas
- Department of Neurology, Stroke Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Mikel Terceño
- Neuroradiology Service, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Sergio Amaro
- Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
| | - Joaquín Serena
- Neurology Service, Stroke Unit, Institut d’Investigació Biomèdica de Girona (IDIBGI), Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Xabier Urra
- Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
| | - Carlos Laredo
- Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Roger Barranco
- Department of Interventional Neuroradiology, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - Pol Camps-Renom
- Department of Neurology, Stroke Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Federico Zarco
- Neuroradiology Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Laura Oleaga
- Neuroradiology Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Pere Cardona
- Department of Neurology, Bellvitge University Hospital, Barcelona, Spain
| | - Carlos Castaño
- Interventional Neuroradiology Unit, Department of Neuroscience, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Juan Macho
- Neuroradiology Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Elisa Cuadrado-Godía
- Department of Neurology, Institut Hospital del Mar d’Investigacions Mèdiques, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elio Vivas
- Department of Neuroradiology, Hospital del Mar, Barcelona, Spain
| | | | | | - Anna Ramos-Pachón
- Stroke Unit, Department of Neuroscience, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Jaume Roquer
- Department of Neurology, Institut Hospital del Mar d’Investigacions Mèdiques, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marian Muchada
- Stroke Unit, Department of Neurology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Alejandro Tomasello
- Department of Neuroradiology, Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Dávalos
- Stroke Unit, Department of Neuroscience, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Department of Neurology, Stroke Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ferran Torres
- Medical Statistics Core Facility, Clinical Pharmacology Service, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
- Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ángel Chamorro
- Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic of Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
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Li TF, Shi CC, Ma J, Fu PJ, Zhu M, Ren JZ, Han XW. Clinical Study of High-Resolution C-Arm CT in Mechanical Recanalization and Stent Implantation for Chronic Cerebral Artery Occlusion. Neurol India 2022; 70:694-698. [PMID: 35532641 DOI: 10.4103/0028-3886.344607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND In recent years, among patients with chronic cerebral artery occlusion, recanalization can be achieved by an endovascular operation. However, complications and restenosis rates remain high. OBJECTIVE To evaluate the utility of high-resolution C-arm CT (Dyna micro-CT) for stent placement in patients with chronic cerebral artery occlusion. METHODS AND MATERIALS We retrospectively reviewed the clinical data of 27 patients with chronic cerebral artery occlusion who underwent mechanical recanalization and stent implantation. Images were reconstructed using conventional C-arm CT (Dyna CT) and Dyna micro-CT. Whether the stent was fully expanded and image quality was evaluated. Follow-up assessments included clinical and angiographic outcomes and complications. RESULTS Twenty-two patients successfully underwent stenting (22 stents; 14 cases: Neuroform EZ; eight cases: Enterprise); stenting failed in five patients. Compared to Dyna CT, Dyna micro-CT afforded improved visualization of the stent structure, providing significantly improved image quality (P < 0.05). In seven patients, the stent under-expanded and dilatation was performed; thereafter, stent malapposition improved. One patient experienced sudden headache 22 hours after the procedure; CT showed intraparenchymal hemorrhage. The remaining 21 patients did not have acute thrombosis or bleeding complications and were followed up by imaging for 3-6 months. In three patients, digital subtraction angiography showed mild in-stent stenosis. CONCLUSIONS High-resolution C-arm CT can improve visualization of stent structures in chronic cerebral artery occlusion, making it easy to determine the extent of stent deployment and potentially reduce complications and stent restenosis.
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Affiliation(s)
- Teng-Fei Li
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University; Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Cheng-Cheng Shi
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University; Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Ji Ma
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University; Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Pei-Ji Fu
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University; Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Ming Zhu
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University; Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Jian-Zhuang Ren
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University; Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Xin-Wei Han
- Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University; Interventional Institute of Zhengzhou University, Zhengzhou, China
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