Document Detail

Indirect reperfusion in the setting of symptomatic carotid occlusion by treatment of bilateral vertebral artery origin stenoses.
MedLine Citation:
PMID:  20434054     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Patients with total carotid occlusions can develop ischemic stroke as a result to hemodynamic impairment. Flow augmentation can be provided through a variety of surgical and endovascular techniques. We describe a patient treated with vertebral artery stent placement to augment indirect flow to the territory of an occluded carotid artery. METHODS: A 52-year-old man presented with ST elevation myocardial infarction and ischemic stroke manifesting with right-sided hemiparesis and aphasia. A computed tomography (CT) angiogram confirmed the presence of a left internal carotid artery total occlusion with prolongation of the mean transit time and reduced estimated cerebral blood flow on CT perfusion maps. The patient was taken for angiography and found to have bilateral vertebral artery ostial stenosis and a posterior communicating artery supplying the left hemisphere. RESULTS: The patient underwent successful stenting and angioplasty of both lesions with stabilization of neurologic symptoms. A follow-up CT perfusion study showed marked improvement in the estimated cerebral blood flow, and reduction of the mean transit time. CONCLUSIONS: Stenting and angioplasty of a stenosis of an artery providing indirect blood flow to the territory of an occluded ipsilateral vessel can stabilize neurologic decline and improve CT perfusion parameters.
Mark Bain; Muhammad Shazam Hussain; Vivek Gonugunta; Shaye Moskowitz; Ferdinand K Hui; Rishi Gupta
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association     Volume:  19     ISSN:  1532-8511     ISO Abbreviation:  J Stroke Cerebrovasc Dis     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-03     Completed Date:  2010-07-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9111633     Medline TA:  J Stroke Cerebrovasc Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  241-6     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2010 National Stroke Association. Published by Elsevier Inc. All rights reserved.
Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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MeSH Terms
Angiography, Digital Subtraction
Anti-Inflammatory Agents, Non-Steroidal / adverse effects
Carotid Stenosis / complications,  therapy*
Cerebral Angiography
Cerebrovascular Circulation / physiology
Femoral Artery / surgery
Magnetic Resonance Imaging
Middle Aged
Naproxen / adverse effects
Neurologic Examination
Paresis / etiology
Tomography, X-Ray Computed
Vertebrobasilar Insufficiency / complications,  therapy*
Reg. No./Substance:
0/Anti-Inflammatory Agents, Non-Steroidal; 22204-53-1/Naproxen

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