A thread of hope for successful revascularization for acute embolic basilar artery occlusion due to miserable vertebral artery stump syndrome. A technical report

Publication date: Available online 23 January 2020Source: Journal of Clinical NeuroscienceAuthor(s): Ryosuke Maeoka, Ichiro Nakagawa, Hiroyuki Ohnishi, Yoshihiro Kuga, Hiroyuki Nakase, Hideyuki OhnishiAbstractAcute basilar artery occlusion (BAO) is associated with major morbidities and a high mortality rate. The prevalence of acute BAO is 10.4% among patients treated with thrombectomy for acute large vessel occlusion. Vertebral artery stump syndrome (VASS) reportedly causes ischemic stroke with tandem occlusions as vertebral artery (VA) origin occlusion and BAO. The pathogenesis of ischemic stroke due to VASS can be attributed to thrombi or emboli. Acute embolic BAO due to VASS accounted for 2 of 25 cases (8.0%) of BAO treated using thrombectomy between April 2014 and May 2019 in our registry. VASS must be considered as one cause of BAO. With the initial Magnetic resonance angiography on arrival, it is difficult to distinguish between BAO due to simple cardiogenic embolus and due to embolus caused by VASS rapidly. In patients suffering from acute embolic BAO due to VASS, the presence of VA origin occlusion makes endovascular therapy (EVT) difficult to perform. Here, we report consecutive cases of thrombectomy for acute embolic BAO due to VASS, showing markedly different outcomes. VA origin occlusion severely limits the technical options for EVT. Visualization or conjecture of the origin of both or dominant VAs conceivably offers the possibility of successful EVT and may allow...
Source: Journal of Clinical Neuroscience - Category: Neuroscience Source Type: research

Related Links:

Publication date: Available online 20 February 2020Source: The LancetAuthor(s): Michael D Hill, Mayank Goyal, Bijoy K Menon, Raul G Nogueira, Ryan A McTaggart, Andrew M Demchuk, Alexandre Y Poppe, Brian H Buck, Thalia S Field, Dar Dowlatshahi, Brian A van Adel, Richard H Swartz, Ruchir A Shah, Eric Sauvageau, Charlotte Zerna, Johanna M Ospel, Manish Joshi, Mohammed A Almekhlafi, Karla J Ryckborst, Mark W LowerisonSummaryBackgroundNerinetide, an eicosapeptide that interferes with post-synaptic density protein 95, is a neuroprotectant that is effective in preclinical stroke models of ischaemia-reperfusion. In this trial, we ...
Source: The Lancet - Category: General Medicine Source Type: research
ConclusionImaging of thrombus can be used as an aseessment tool to predict the outcomes and it needs further studies in the future.
Source: Neurological Sciences - Category: Neurology Source Type: research
Publication date: Available online 19 February 2020Source: Journal of Clinical NeuroscienceAuthor(s): Bomi Kim, Yeon Mee Kim, Sung-cheol Jin, Jun-won Lee, Byung In Lee, Sung Eun Kim, Kyong Jin Shin, JinSe Park, Kang Min Park, Si Eun Kim, Seongho Park, Sam Yeol HaAbstractWe analyzed the histopathological findings of the clots obtained from patients with acute ischemic stroke by mechanical thrombectomy. We then developed a clinical scoring system for predicting pathogenic causes in patients with undetermined ischemic stroke using these histopathological and the angiographic findings during endovascular treatment. Only cases ...
Source: Journal of Clinical Neuroscience - Category: Neuroscience Source Type: research
This study supports the value of HR-MRI in non-invasive diagnosis of young adults with cervical artery dissections.
Source: The International Journal of Cardiovascular Imaging - Category: Radiology Source Type: research
CONCLUSIONS: This review provides evidence that TCD or TCCD, administered by professionals with adequate experience and skills, can provide useful diagnostic information for detecting stenosis or occlusion of intracranial vessels in people with acute ischaemic stroke, or guide the request for more invasive vascular neuroimaging, especially where CT or MR-based vascular imaging are not immediately available. More studies are needed to confirm or refute the results of this review in a larger sample of stroke patients, to verify the role of contrast medium and to evaluate the clinical advantage of the use of ultrasound. ...
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
Conclusion: To our knowledge, this is the first report in which an immediate thrombus formation on the carotid web was observed in a patient with congenital protein C deficiency. In a case of acute ischemic stroke with carotid web, especially when congenital coagulopathy such as protein C deficiency is suspected, careful follow-up with ultrasound imaging should be performed.
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Authors: Toyoda S, Tokoi S, Takekawa H, Matsumoto H, Inami S, Sakuma M, Arikawa T, Abe S, Nakajima T, Hirata K, Inoue T Abstract BACKGROUND: Although flow-mediated vasodilation (FMD) of brachial artery and carotid intima-media thickness (IMT) are important surrogate markers in the process of atherosclerosis, information about relationship between both markers is insufficient. In the present study, we assessed extensively the relationship in patients with coronary artery disease (CAD). METHODS: The values of brachial FMD and carotid ultrasonography findings in 159 patients (67±8 yr, 130 males) with angiog...
Source: International Angiology - Category: Cardiology Tags: Int Angiol Source Type: research
Posterior reversible encephalopathy syndrome (PRES) and reversible cerebral vasoconstriction syndrome (RCVS) are relatively uncommon neurological disorders, but their detection has been increasing mainly due to clinical awareness and spreading of magnetic resonance imaging (MRI). Because these syndromes share some common clinical and radiologic features and occasionally occur in the same patient, misdiagnosis may occur. PRES is characterized by varied neurological symptoms including headache, impaired visual acuity or visual field deficit, confusion, disorders of consciousness, seizures, and motor deficits often associated...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Objective: To explore the value of whole-brain perfusion parameters combined with multiphase computed tomography angiography (MP-CTA) in predicting the hemorrhagic transformation (HT) of ischemic stroke. Methods: A total of 64 patients with ischemic stroke who underwent noncontrast computed tomography, computed tomography perfusion imaging, and computed tomography angiography before treatment from August 2017 to June 2019 were included retrospectively. The perfusion parameters cerebral blood volume (CBV), cerebral blood flow (CBF), time to peak (TTP), mean transit time (MTT), time to maximum (Tmax), and permeability surfac...
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Source Type: research
The recent article from McCluskey et al “Radiological Eye Deviation as a Predictor of Large Vessel Occlusion in Acute Ischaemic Stroke” J of Stroke and Cerebrovasc Dis. 2019; 28:2318-23231 provides valuable information that may lead to early stroke intervention. They found that subjective visual detection of radiographic eye deviation on nonenhanced computed tomography (NECT) brain is strongly associated with large vessel occlusion (LVO). This compelling association may expedite patients for timely angiographic testing and endovascular therapy.
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Tags: Letter to the Editor Source Type: research
More News: Angiography | Brain | Cardiology | Heart | Ischemic Stroke | Neurology | Neuroscience | Stroke