Arterial perforation is a feared complication of acute stroke intervention. A high index of suspicion is important to recognize this complication and tailor patient management to prevent further deterioration in clinical outcome. This report describes the endovascular management of microcatheter arterial perforation in a 66-year-old woman with an acute left ...

BACKGROUND AND PURPOSE: Occlusion of the internal carotid artery (ICA) and stroke may be the consequence of either local thrombosis due to atherosclerosis or massive embolism. Up to date, there are only few reports of subsequent recanalization. METHODS: We report 12/76 cases of acute ICA occlusion leading to ischemic stroke, ...

Stroke is a leading cause of death and morbidity in Thailand. The purpose of this study was to look for prevalence of significant extracranial carotid stenosis (ECCS) in Thai ischemic stroke/transient ischemic attack (TIA) patients and baseline characteristics of this subgroup. METHODS: All acute/subacute ischemic stroke/TIA patients who were treated ...

Acute symptomatic occlusion of the cervical internal carotid artery (ICA) can be treated by intravenous administration of tissue plasminogen activator, percutaneous transluminal angioplasty, and carotid endarterectomy. Carotid artery stenting (CAS) is now indicated for cervical ICA stenosis, but the safety and the efficacy of urgent CAS have not been established. ...

We report a case of HIV-associated carotid vasculitis, causing cerebral infarction. Immediate corticosteroid treatment was followed by improvement, with radiological documentation of reversal of the vasculitic changes, preventing arterial occlusion. Vasculitis should be considered as a diagnosis in stroke in HIV and steroid treatment considered as a potentially life-saving intervention.

Ischemic stroke is a devastating disorder with limited treatment options. Arterial recanalization with thrombolysis or mechanical thrombectomy may be used to restore perfusion in only a subset of cases. Collateral therapeutic strategies such as partial aortic occlusion attempt to reverse ischemia, the principal detrimental element in stroke pathophysiology. This article ...

Traumatic carotid dissection is a well-known cause of ischemic stroke and although the treatment of the dissection itself has received some attention in recent years, the treatment of the concomitant stroke has been less investigated. We present a 43-year-old patient with blunt traumatic internal carotid artery dissection associated with subocclusive ...

The purpose of this case-control study was to determine whether an asymmetry of size of the intracranial internal carotid artery (ICA) on 3D time-of-flight MR angiography (MRA) is predictive of a high-grade cervical ICA stenosis. Ninety-six stroke/TIA consecutive patients were recruited for the study, of whom 32 had unilateral high-grade ...

The objective of the present study is to extract the representative features of the internal carotid arterial (ICA) Doppler ultrasound signals and to present the accurate classification model. This paper presented the usage of statistics over the set of the extracted features (Lyapunov exponents and the power levels of the ...

BACKGROUND AND PURPOSE: Although current guidelines state that carotid endarterectomy is probably recommended before or concomitant to coronary artery bypass grafting (CABG) in patients with carotid stenosis, significant controversies to this recommendation still persist. Carotid artery stenting has been recently introduced as an alternative revascularization modality in high-risk patients. The ...

<b>Background:</b> Stroke subtypes and etiology may differ between developing and developed countries. Infections are a relatively common cause of stroke in tropical regions. <b> Objective:</b> To review the main infectious diseases associated with stroke. <b> Discussion:</b> Prevalence of stroke in HIV patients is around 1&#x0025;. Pathogenic mechanisms include HIV vasculopathy, ...

People with a history of stroke or transient ischaemic attack are at high risk of all vascular events, such as myocardial infarction (MI), but are at particular risk of subsequent stroke (about 10% in the first year and about 5% each year thereafter). METHODS AND OUTCOMES: We conducted a systematic ...

BACKGROUND: Functional magnetic resonance imaging (fMRI) is a method usually used to identify cortical representations of cerebral functions. Some studies and case reports suggest that stenoses of the brain-supplying arteries influence the BOLD (blood-oxygenation-level-dependent) signal. The objective of this study was to find out whether the BOLD signal differs in ...

This article reviews the randomized control trials (RCT's) that were published in 2007 of emerging pharmacotherapies in patients with acute (</= 2 weeks), sub-acute (2 to 12 weeks) and chronic (>/= 12 weeks) stroke. A Medline search generated 22 RCT's in stroke in the year 2007 in the English language. ...

BACKGROUND: Tandem occlusion of the arteries at the extracranial and intracranial segments is a unique cause of ischemic stroke and is often associated with a poor prognosis. Although tandem occlusion is occasionally found during intra-arterial thrombolysis (IAT), as of yet no clear therapeutic strategy has been elucidated. METHODS: After identifying ...

AIM: To evaluate the influence that steno-occlusive arterial disease may have on the development of early neurological deterioration (END) in a large series of patients with acute ischemic stroke. METHODS: We studied a prospective cohort of 1,093 patients admitted to a single tertiary hospital with presence of neurological symptoms in ...

We report a patient with high grade internal carotid artery (ICA) stenosis who had frequent migrainous aura-like symptoms for a period of 3 weeks (Latin: status aurae migraenalis). This syndrome has been described previously but it was unclear whether ischaemic damage was associated with it. Using MRI, we demonstrated widely ...

BACKGROUND: Clinical characteristics of common carotid artery (CCA) stenosis have been reported relatively rarely, compared with those of internal carotid artery (ICA) stenosis. The current retrospective study aimed to clarify the symptomatology of CCA stenosis. METHODS: Summarized records of patients admitted were reviewed to identify patients with CCA stenosis or ...

The purpose of this study was to describe the technique used to safely identify the petrous carotid artery during expanded endonasal approaches to the skull base. A series of 20 cadaveric studies was undertaken to isolate the vidian artery and nerve and to use them as landmarks to the petrous ...

BACKGROUND: Investigating atherosclerosis of the coronary artery in ischemic stroke patients is clinically important because comorbidity is relatively common in such patients. We studied the relationship of atherosclerosis of the coronary artery to atherosclerosis of the intracranial cerebral artery and extracranial carotid artery. Further investigation was performed for determining the ...

This review on spontaneous dissection of the internal carotid artery (sICAD) will discuss in the first part stroke prevention and focus on vascular risk factors, antithrombotic therapy, and treatment of severe stenosis or occlusion, and dissecting aneurysm. The second part of the review will summarize the treatment of acute ischemic ...

BACKGROUND: Cerebral microbleeds (CMB) are now receiving considerable attention for their association with stroke recurrence and white matter lesions (WML). Pulse wave velocity (PWV), which is a measure of arterial stiffness, was found to be one of the predictors of cardiovascular disease and stroke in a large population-based study. The ...

BACKGROUND: We aimed to assess quality of life (QOL) and its predictors in stroke survivors after local intra-arterial thrombolysis (IAT) as well as to measure QOL according to the site of pretreatment vessel occlusion. METHODS: From January 2000 to April 2004, 175 consecutive patients underwent IAT for acute ischemic stroke. ...

BACKGROUND: We aimed to investigate whether baseline cerebrovascular reactivity could predict subsequent ischemic event after intervention and identify the patient group for more aggressive medical and interventional management paradigms. METHODS: Patients with more than 70% cervical carotid stenosis (from ultrasonography) were reviewed. Patients, who had baseline cerebrovascular reactivity test before ...

BACKGROUND: Mechanical clot extraction up to 8 hours after stroke onset is an alternative strategy for opening large vessels, especially for patients ineligible for intravenous thrombolysis. Safety beyond this therapeutic window is untested. METHODS: An 81-year-old woman presented 8 hours after she developed left-sided weakness and dysarthria with a National ...

With the advent of magnetic resonance imaging as a rapid and accurate way to diagnose arterial ischemic stroke, cerebrospinal fluid assessment is rarely performed, unless infectious or inflammatory processes are obvious. Recent advances in the understanding of the pathophysiology of childhood stroke have implicated a growing list of discrete or ...

BACKGROUND: In previous studies on unilateral internal carotid artery (ICA) occlusive disease, contralateral strokes have been ignored or excluded, probably because of their heterogeneity in etiology. The purpose of this study was to analyze the acute ischemic lesions contralateral to ICA occlusive disease and characterize the patterns and mechanisms of ...

BACKGROUND: Carotid artery angioplasty and stenting (CAS) is an evolving and increasingly common endovascular treatment for carotid artery stenosis. Risk factors associated with an increased incidence of adverse periprocedural neurologic outcomes are being recognized. The goal of this study was to determine if certain angiographic lesion characteristics were predictive of ...

BACKGROUND: Stroke is the third most common cause of death in the UK and the largest single cause of severe disability. Each year more than 110,000 people in England suffer from a stroke which costs the National Health Service (NHS) over GBP2.8 billion. Thus, it is imperative that patients at ...

BACKGROUND: Several studies have suggested that the specific stroke subtype may influence the presence of leukoaraiosis in patients with ischemic stroke. We investigated the association between stroke subtype and leukoaraiosis in Korean patients with ischemic stroke by MRI. METHODS: There were 594 patients included in this study that were classified ...

The cervical internal carotid artery (ICA) is susceptible to injury through various mechanisms, including dissection, which can lead to pseudoaneurysm formation. Pathological processes affecting the ICA, in association with an ipsilateral fetal posterior cerebral artery (PCA), resulting in parieto-occipital strokes are rarely reported. We present a patient with a left ...

BACKGROUND AND PURPOSE: In stroke attributable to spontaneous dissection of the internal carotid artery (sICAD), arterial patency may influence the pattern and extent of cerebral ischemia. METHODS: In 40 consecutive patients with stroke caused by sICAD, we compared the number, size and pattern of cerebral diffusion-weighted imaging lesions between patients ...

Mini-ischemia localized into a specific brain area has promoted understanding of the mechanisms underlying brain recovery in stroke. However, the conventional mini-stroke model adopted permanent arterial ligations but lacked controllable reperfusion, which is crucial for the outcome of delayed functional recovery. In this study, we devised a new rat mini-stroke ...

AIM: Intraoperative electroencephalography, somato-sensory evoked potentials and transcranial Doppler have been proposed to replace carotid artery stump pressure measurement (CASP) as the test of choice in the evaluation of cerebral tolerance during temporary carotid occlusion. CASP is a simple, inexpensive test that does not require an additional specialist in the ...

BACKGROUND AND PURPOSE: Atherosclerosis of the intracranial arteries is a well-recognized cause of ischemic stroke in Asians, and extracranial carotid artery disease is more often seen in western countries. The relationship of common carotid artery intima-media thickness (CCA-IMT), intracranial arteries stenosis (ICS) and vascular cognitive impairment (VCI) after ischemic stroke ...

Carotid duplex ultrasound testing provides a safe and accurate method to detect and grade the severity of atherosclerotic internal carotid artery stenosis both before and following carotid intervention. Testing after surgical endarterectomy or stent angioplasty allows assessment of the technical success by excluding residual stenosis. The focus of duplex surveillance ...

BACKGROUND AND PURPOSE: Gradation of high-grade intracranial internal carotid artery (ICA) stenosis poses a challenge to noninvasive neurovascular imaging, which seems critical for angioplasty in the ICA segments C1 and C5. We investigated cutoff values of intracranial ICA stenosis for transcranial color-coded sonography (TCCS) and compared this method with the ...

BACKGROUND AND PURPOSE: Carotid artery stenosis can be classified by magnetic resonance imaging (MRI) as lesion types I-VIII according to a modified histological scheme based on American Heart Association (AHA) guidelines. Lesion types IV-V and VI are regarded as high-risk plaques.We aimed to evaluate the clinical relevance of this classification ...

Transcranial Doppler sonography is a non-invasive, non-ionising, inexpensive, portable and safe technique that uses a pulsed Doppler transducer for assessment of intracerebral blood flow. This article deals with the principles and technique of transcranial Doppler sonography. It gives a brief overview of its use in evaluation of intracranial steno-occlusive disease, ...

This case study demonstrates the feasibility and diagnostic value of the oblique-plane arterial spin labeling method to visualize individual perfusion territories in a patient with embolic stroke. The perfusion territories obtained with this technique differed significantly from the standard anatomical situation. Imaging findings suggested that all acute embolic lesions in ...

Measurement of arterial stiffness is assuming an increasing role in the clinical assessment of patients. Indeed, arterial stiffness and wave reflections are now well accepted as the most important determinants of increasing systolic and pulse pressure in our aging community, and thus as the cause of cardiovascular (CV) complications and ...

OBJECTIVE: This study evaluated the perioperative and 3-year follow-up results of 103 consecutive carotid artery stenting (CAS) procedures done with a transcervical approach using carotid flow reversal for cerebral protection that were performed over a 28-month period in 97 patients. METHODS: The mean age of these patients was 72 years, ...

Stroke is the third leading cause of mortality in the United States; approximately every three minutes a person will die from a stroke. Extracranial internal carotid artery stenosis (EICAS) accounts for approximately 25% of ischemic strokes, with an incidence as high as 10% in people aged > 80 years. Clinically, ...

This study is to investigate the relationships between prevalent cardiovascular events (myocardial infarction, stroke and peripheral arterial disease) and carotid intima-media thickness (CIMT) in middle-aged and older adults; to assess which of the indexes, IMT in the common carotid artery (CCA), internal carotid artery (ICA) and carotid bifurcation (CB) separately ...

BACKGROUND: An occluded internal carotid artery (ICA) is considered a "safe artery" as it causes few symptoms. However, it has recently been suggested that spontaneous recanalisation of ICA occlusions may occur. AIM: To determine the incidence of ICA recanalisation among patients with a previously documented occluded ICA. METHODS: Patients with ...

BACKGROUND/AIMS: The aim of this study is to clarify the relationship between lesion detectability by diffusion-weighted magnetic resonance imaging (DWI) and the etiology of transient ischemic attacks (TIAs). METHODS: A retrospective study was performed on 72 patients with carotid TIAs who underwent DWI studies within 2 weeks after the last ...

Extracranial-intracranial bypass surgery has been shown to reverse hemodynamic insufficiency on the basis of steno-occlusive disease of the internal carotid artery (ICA) or middle cerebral artery. In contrast, chronic occlusion of the common carotid artery (CCA) without extracranial donor vessels affords alternative revascularization procedures as well as a more elaborate ...

A 52-year-old woman with a large left-hemispheric stroke was transferred to our hospital for possible endovascular treatment. The patient underwent a cerebral angiogram at 7 hours after symptom onset with intent to treat and was found to have occlusion of the proximal M1-segment of the left middle cerebral artery (MCA). ...

BACKGROUND: Stroke has emerged as an important complication of thoracic endovascular aortic repair (TEVAR). Identifying risk factors for stroke is important to define the risks of this procedure. METHODS: All neurologic complications were analyzed in a prospective database of patients in thoracic aortic stent graft trials from 1999 to 2006. ...

Arterial dissection is the underlying stroke mechanism in approximately 2.5% of all strokes and the second leading cause of stroke in patients younger than 45 years of age. Controversy exists regarding the medical management of carotid dissection. Both anticoagulants and antiplatelet agents have been used with no compelling data supporting ...