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Sample records for cerebral arterial occlusive

  1. Spontaneous recanalization of atherosclerotic middle cerebral artery occlusion: Case report.

    PubMed

    Mao, Ying; Huang, Yujing; Zhang, Li; Nan, Guangxian

    2017-07-01

    Intracranial vascular atherosclerotic occlusion is one of the most common causes of ischemic stroke world wide. The involvement of large intracranial vessels, in particular, the middle cerebral artery, is usually associated with unfavorable outcomes in patients. Spontaneous recanalization of atherosclerotic occlusion is relatively rare. The first patient was a 43-year-old male with slurred speech and left-sided weakness for a duration of 24 hours. The second was a 59-year-old male with left-sided weakness over a period of 13 hours. The last was a 49-year-old female patient presented with a 1-month history of right-sided headache. Atherosclerotic middle cerebral artery occlusion. In all cases, oral aspirin (100 mg; once daily), Plavix (75 mg; once daily), and Lipitor (40 mg; once daily) were used . Oral Plavix was stopped 3 months. Spontaneous recanalization occured in the three cases of atherosclerotic middle cerebral artery occlusion. Spontaneous recanalization may occur in both early and late stages of atherosclerotic middle cerebral artery occlusion. Clinicians should be aware of this particular condition, as it may represent a relatively favorable prognosis.

  2. Inadvertent Occlusion of the Anterior Choroidal Artery Explains Infarct Variability in the Middle Cerebral Artery Thread Occlusion Stroke Model

    PubMed Central

    McLeod, Damian D.; Beard, Daniel J.; Parsons, Mark W.; Levi, Christopher R.; Calford, Mike B.; Spratt, Neil J.

    2013-01-01

    Intraluminal occlusion of the middle cerebral artery (MCAo) in rodents is perhaps the most widely used model of stroke, however variability of infarct volume and the ramifications of this on sample sizes remains a problem, particularly for preclinical testing of potential therapeutics. Our data and that of others, has shown a dichotomous distribution of infarct volumes for which there had previously been no clear explanation. When studying perfusion computed tomography cerebral blood volume (CBV) maps obtained during intraluminal MCAo in rats, we observed inadvertent occlusion of the anterior choroidal artery (AChAo) in a subset of animals. We hypothesized that the combined occlusion of the MCA and AChA may be a predictor of larger infarct volume following stroke. Thus, we aimed to determine the correlation between AChAo and final infarct volume in rats with either temporary or permanent MCA occlusion (1 h, 2 h, or permanent MCAo). Outbred Wistar rats (n = 28) were imaged prior to and immediately following temporary or permanent middle cerebral artery occlusion. Presence of AChAo on CBV maps was shown to be a strong independent predictor of 24 h infarct volume (β = 0.732, p <0.001). This provides an explanation for the previously observed dichotomous distribution of infarct volumes. Interestingly, cortical infarct volumes were also larger in rats with AChAo, although the artery does not supply cortex. This suggests an important role for perfusion of the MCA territory beyond the proximal occlusion through AChA-MCA anastomotic collateral vessels in animals with a patent AChAo. Identification of combined MCAo and AChAo will allow other investigators to tailor their stroke model to reduce variability in infarct volumes, improve statistical power and reduce sample sizes in preclinical stroke research. PMID:24069448

  3. Multi-modal assessment of neurovascular coupling during cerebral ischaemia and reperfusion using remote middle cerebral artery occlusion.

    PubMed

    Sutherland, Brad A; Fordsmann, Jonas C; Martin, Chris; Neuhaus, Ain A; Witgen, Brent M; Piilgaard, Henning; Lønstrup, Micael; Couch, Yvonne; Sibson, Nicola R; Lauritzen, Martin; Buchan, Alastair M

    2017-07-01

    Hyperacute changes in cerebral blood flow during cerebral ischaemia and reperfusion are important determinants of injury. Cerebral blood flow is regulated by neurovascular coupling, and disruption of neurovascular coupling contributes to brain plasticity and repair problems. However, it is unknown how neurovascular coupling is affected hyperacutely during cerebral ischaemia and reperfusion. We have developed a remote middle cerebral artery occlusion model in the rat, which enables multi-modal assessment of neurovascular coupling immediately prior to, during and immediately following reperfusion. Male Wistar rats were subjected to remote middle cerebral artery occlusion, where a long filament was advanced intraluminally through a guide cannula in the common carotid artery. Transcallosal stimulation evoked increases in blood flow, tissue oxygenation and neuronal activity, which were diminished by middle cerebral artery occlusion and partially restored during reperfusion. These evoked responses were not affected by administration of the thrombolytic alteplase at clinically used doses. Evoked cerebral blood flow responses were fully restored at 24 h post-middle cerebral artery occlusion indicating that neurovascular dysfunction was not sustained. These data show for the first time that the rat remote middle cerebral artery occlusion model coupled with transcallosal stimulation provides a novel method for continuous assessment of hyperacute neurovascular coupling changes during ischaemia and reperfusion, and offers unique insight into hyperacute ischaemic pathophysiology.

  4. Cerebral arterial occlusion and intracranial venous thrombosis in a woman taking oral contraceptives.

    PubMed Central

    Montón, F.; Rebollo, M.; Quintana, F.; Berciano, J.

    1984-01-01

    Occlusion of the middle cerebral artery and thrombosis of the superior sagittal sinus are reported in a 30-year-old woman taking oral contraceptives (OC). The coexistence of arterial and venous cerebral pathology as a complication of OC use has only been previously reported in one case. The pathogenesis of this rare association is briefly discussed. Images Fig. 1 Fig. 2 PMID:6462985

  5. Endovascular revascularization of symptomatic chronic middle cerebral artery occlusions: Two case reports

    PubMed Central

    Wan, Yue; Lo, Wai-Ting; Liu, Yang-Xia

    2016-01-01

    For patients with chronic middle cerebral artery occlusions who have recurrent ischemic symptoms despite antiplatelet therapy and vascular risk factor control, treatment options are limited. Because of concerns about the safety of endovascular revascularization of these occlusions and the technical skills required, these procedures have not been widely performed. We report on two patients with successful endovascular revascularization of the chronic middle cerebral artery occlusion with impaired cerebral hemodynamics, with vessel patency maintained on follow-up imaging and no recurrence of stroke. A literature review of treatment options for such patients was performed. Revascularization is technically feasible and can be considered an option for carefully selected chronic middle cerebral artery occlusion patients with recurrent ischemic symptoms despite medical therapy. PMID:26647227

  6. Posterior cerebral artery laterality on magnetic resonance angiography predicts long-term functional outcome in middle cerebral artery occlusion.

    PubMed

    Ichijo, Masahiko; Miki, Kazunori; Ishibashi, Satoru; Tomita, Makoto; Kamata, Tomoyuki; Fujigasaki, Hiroto; Mizusawa, Hidehiro

    2013-02-01

    Prominent posterior cerebral artery (PCA) laterality upon 3-dimensional time-of-flight magnetic resonance angiography is often encountered in patients with middle cerebral artery occlusion. We hypothesized that this sign is correlated with improved functional outcome in patients with middle cerebral artery occlusion treated with intravenous recombinant tissue plasminogen activator. Fifty acute ischemic stroke patients with middle cerebral artery occlusion were treated with intravenous recombinant tissue plasminogen activator from April 2007 to October 2009. All patients routinely underwent initial (first 3 hours) magnetic resonance scans on admission, and additional follow-up (14-21 days after stroke onset) computed tomography scans. Two film readers blinded to all clinical information assessed the presence or absence of PCA laterality on magnetic resonance angiography. We retrospectively analyzed the clinical and radiologic data on all patients. Out of 50 patients, 20 showed PCA laterality on magnetic resonance angiography. National Institute of Health Stroke Scale score 7 days after stroke onset was significantly lower (P=0.007), and infarct volume on follow-up computed tomography was significantly smaller (P=0.009) in patients with PCA laterality than in patients without this sign. Multivariate logistic regression analyses showed an adjusted odds ratio of 8.49 for a favorable outcome (modified Rankin Scale score 0-1 at 6 months) in patients with PCA laterality (95% CI: 1.82 to 55.8, P=0.005). The presence of PCA laterality on magnetic resonance angiography before intravenous recombinant tissue plasminogen activator can be used as a predictor of favorable functional outcome in patients with middle cerebral artery occlusion, probably due to improvement of recanalization rate.

  7. Middle Cerebral Artery Occlusion with Moyamoya-Like Vessels and Aneurysms

    PubMed Central

    Rivera, Rodrigo; Sordo, Juan; Badilla, Lautaro; Bravo, Eduardo; Riveros, Rodrigo; Giacaman, Pablo

    2014-01-01

    Summary We describe two cases of aneurysmal rupture in moyamoya-like vessels in middle cerebral artery occlusion. This phenomenon was previously described in severe steno-occlusive disease and accounts for the hemorrhagic presentation. To our knowledge, these are the second and third clinical cases published in modern neuroradiological literature. PMID:24556306

  8. Cerebral Angiographic Findings of Cosmetic Facial Filler-related Ophthalmic and Retinal Artery Occlusion.

    PubMed

    Kim, Yong-Kyu; Jung, Cheolkyu; Woo, Se Joon; Park, Kyu Hyung

    2015-12-01

    Cosmetic facial filler-related ophthalmic artery occlusion is rare but is a devastating complication, while the exact pathophysiology is still elusive. Cerebral angiography provides more detailed information on blood flow of ophthalmic artery as well as surrounding orbital area which cannot be covered by fundus fluorescein angiography. This study aimed to evaluate cerebral angiographic features of cosmetic facial filler-related ophthalmic artery occlusion patients. We retrospectively reviewed cerebral angiography of 7 patients (4 hyaluronic acid [HA] and 3 autologous fat-injected cases) showing ophthalmic artery and its branches occlusion after cosmetic facial filler injections, and underwent intra-arterial thrombolysis. On selective ophthalmic artery angiograms, all fat-injected patients showed a large filling defect on the proximal ophthalmic artery, whereas the HA-injected patients showed occlusion of the distal branches of the ophthalmic artery. Three HA-injected patients revealed diminished distal runoff of the internal maxillary and facial arteries, which clinically corresponded with skin necrosis. However, all fat-injected patients and one HA-injected patient who were immediately treated with subcutaneous hyaluronidase injection showed preserved distal runoff of the internal maxillary and facial arteries and mild skin problems. The size difference between injected materials seems to be associated with different angiographic findings. Autologous fat is more prone to obstruct proximal part of ophthalmic artery, whereas HA obstructs distal branches. In addition, hydrophilic and volume-expansion property of HA might exacerbate blood flow on injected area, which is also related to skin necrosis. Intra-arterial thrombolysis has a limited role in reconstituting blood flow or regaining vision in cosmetic facial filler-associated ophthalmic artery occlusions.

  9. Cerebral Angiographic Findings of Cosmetic Facial Filler-related Ophthalmic and Retinal Artery Occlusion

    PubMed Central

    2015-01-01

    Cosmetic facial filler-related ophthalmic artery occlusion is rare but is a devastating complication, while the exact pathophysiology is still elusive. Cerebral angiography provides more detailed information on blood flow of ophthalmic artery as well as surrounding orbital area which cannot be covered by fundus fluorescein angiography. This study aimed to evaluate cerebral angiographic features of cosmetic facial filler-related ophthalmic artery occlusion patients. We retrospectively reviewed cerebral angiography of 7 patients (4 hyaluronic acid [HA] and 3 autologous fat-injected cases) showing ophthalmic artery and its branches occlusion after cosmetic facial filler injections, and underwent intra-arterial thrombolysis. On selective ophthalmic artery angiograms, all fat-injected patients showed a large filling defect on the proximal ophthalmic artery, whereas the HA-injected patients showed occlusion of the distal branches of the ophthalmic artery. Three HA-injected patients revealed diminished distal runoff of the internal maxillary and facial arteries, which clinically corresponded with skin necrosis. However, all fat-injected patients and one HA-injected patient who were immediately treated with subcutaneous hyaluronidase injection showed preserved distal runoff of the internal maxillary and facial arteries and mild skin problems. The size difference between injected materials seems to be associated with different angiographic findings. Autologous fat is more prone to obstruct proximal part of ophthalmic artery, whereas HA obstructs distal branches. In addition, hydrophilic and volume-expansion property of HA might exacerbate blood flow on injected area, which is also related to skin necrosis. Intra-arterial thrombolysis has a limited role in reconstituting blood flow or regaining vision in cosmetic facial filler-associated ophthalmic artery occlusions. PMID:26713062

  10. Cerebral blood flow response pattern during balloon test occlusion of the internal carotid artery

    SciTech Connect

    Witt, J.P.; Yonas, H.; Jungreis, C.

    1994-05-01

    To evaluate the risk of temporary or permanent internal carotid artery occlusion. In 156 patients intraarterial balloon test occlusion in combination with a stable xenon-enhanced CT cerebral blood flow study was performed before radiologic or surgical treatment. All 156 patients passed the clinical balloon test occlusion and underwent a xenon study in combination with a second balloon test. Quantitative flow data were analyzed for absolute changes as well as changes in symmetry. Fourteen patients exhibited reduced flow values between 20 and 30 mL/100 g per minute, an absolute decrease in flow, and significant asymmetry in the middle cerebral artery territory during balloon test occlusion. These patients would be considered at high risk for cerebral infarction if internal carotid artery occlusion were to be performed. With one exception they belonged to a group (class I) of 61 patients who showed bilateral or ipsilateral flow decrease and significant asymmetry with lower flow on the side of occlusion. The other 95 patients, who showed a variety of cerebral blood flow response patterns including ipsilateral or bilateral flow increase, were at moderate (class II) or low (class III) stroke risk. In contrast to these findings, exclusively qualitative flow analysis failed to identify the patients at high risk: a threshold with an asymmetry index of 10% revealed only 16% specificity whereas an asymmetry index of 45% showed only 61% sensitivity for detection of low flow areas (<30 mL/100 g per minute). For achieving a minimal hemodynamic related-stroke rate associated with permanent clinical internal carotid artery occlusion we suggest integration of a thorough analysis of quantitative cerebral blood flow data before and during balloon test occlusion. 68 refs., 5 figs., 2 tabs.

  11. Effects of CD11b/18 monoclonal antibody on rats with permanent middle cerebral artery occlusion.

    PubMed Central

    Garcia, J. H.; Liu, K. F.; Bree, M. P.

    1996-01-01

    The progression of a lesion from ischemic injury to infarct, after the permanent occlusion of a middle cerebral artery, may be influenced by the influx of leukocytes into the ischemic territory. We aimed to evaluate the effectiveness of treating rats that had permanent middle cerebral artery occlusion with a single dose of an anti-CD11b/18 monoclonal antibody injected 1 hour after the arterial occlusion. To mimic the clinical situation of patients with ischemic strokes who may be treated within 1 hour of the ischemic event, the artery remained occluded. Forty-one adult Wistar rats had permanent middle cerebral artery occlusion, and one was subjected to a sham operation. One hour later, 22 rats received CD11b/18 monoclonal antibody and an additional 20 were injected either with a nonspecific antibody (n = 10) or a buffer solution (n = 10). Experiments were terminated at intervals ranging 12 to 96 hours after the arterial occlusion. Endpoints included neurological testing, daily evaluation of body weight, counts of white blood cells in the peripheral blood, measurement of the area of pallor in the ischemic hemisphere, counts of necrotic neurons, and counts of leukocytes sequestered in the ischemic hemisphere. In experiments terminated 12 hours after the arterial occlusion (n = 4), there were fewer necrotic neurons in the group treated with the CD11b/18 monoclonal antibody compared with the two controls (P < .05), but this difference was not reflected in the neurological scores. Numbers of necrotic neurons in experiments terminated > 12 hours later were not different among the three subgroups. White blood cell counts in peripheral blood were lower in animals with arterial occlusion injected with the monoclonal antibody CD11b/18 (P < .05); numbers of leukocytes sequestered in the ischemic hemisphere were not different in the three groups. Neither changes in body weight nor in the volume of the area of pallor were significantly different among the three groups. Images

  12. Utilizing a cranial window to visualize the middle cerebral artery during endothelin-1 induced middle cerebral artery occlusion.

    PubMed

    Regenhardt, Robert W; Ansari, Saeed; Azari, Hassan; Caldwell, Kenneth J; Mecca, Adam P

    2013-02-22

    Creation of a cranial window is a method that allows direct visualization of structures on the cortical surface of the brain(1-3). This technique can be performed in many locations overlying the rat cerebrum, but is most easily carried out by creating a craniectomy over the readily accessible frontal or parietal bones. Most frequently, we have used this technique in combination with the endothelin-1 middle cerebral artery occlusion model of ischemic stroke to quantify the changes in middle cerebral artery vessel diameter that occur with injection of endothelin-1 into the brain parenchyma adjacent to the proximal MCA(4, 5). In order to visualize the proximal portion of the MCA during endothelin -1 induced MCAO, we use a technique to create a cranial window through the temporal bone on the lateral aspect of the rat skull (Figure 1). Cerebral arteries can be visualized either with the dura intact or with the dura incised and retracted. Most commonly, we leave the dura intact during visualization since endothelin-1 induced MCAO involves delivery of the vasoconstricting peptide into the brain parenchyma. This bypasses the need to incise the dura directly over the visualized vessels for drug delivery. This protocol will describe how to create a cranial window to visualize cerebral arteries in a step-wise fashion, as well as how to avoid many of the potential pitfalls pertaining to this method.

  13. Partial aortic occlusion and cerebral venous steal: venous effects of arterial manipulation in acute stroke.

    PubMed

    Pranevicius, Osvaldas; Pranevicius, Mindaugas; Liebeskind, David S

    2011-05-01

    Acute ischemic stroke therapy emphasizes early arterial clot lysis or removal. Partial aortic occlusion has recently emerged as an alternative hemodynamic approach to augment cerebral perfusion in acute ischemic stroke. The exact mechanism of cerebral flow augmentation with partial aortic occlusion remains unclear and may involve more than simple diversion of arterial blood flow from the lower body to cerebral collateral circulation. The cerebral venous steal hypothesis suggests that even a small increase in tissue pressure in the ischemic area will divert blood flow to surrounding regions with lesser tissue pressures. This may cause no-reflow (absence of flow after restoration of arterial patency) in the ischemic core and "luxury perfusion" in the surrounding regions. Such maldistribution may be reversed with increased venous pressure titrated to avoid changes in intracranial pressure. We propose that partial aortic occlusion enhances perfusion in the brain by offsetting cerebral venous steal. Partial aortic occlusion redistributes blood volume into the upper part of the body, manifested by an increase in central venous pressure. Increased venous pressure recruits the collapsed vascular network and, by eliminating cerebral venous steal, corrects perifocal perfusion maldistribution analogous to positive end-expiratory pressure recruitment of collapsed airways to decrease ventilation/perfusion mismatch in the lungs.

  14. Cerebral Arterial Calcification Is an Imaging Prognostic Marker for Revascularization Treatment of Acute Middle Cerebral Arterial Occlusion

    PubMed Central

    Lee, Seong-Joon; Hong, Ji Man; Lee, Manyong; Huh, Kyoon; Choi, Jin Wook

    2015-01-01

    Background and Purpose To study the significance of intracranial artery calcification as a prognostic marker for acute ischemic stroke patients undergoing revascularization treatment after middle cerebral artery (MCA) trunk occlusion. Methods Patients with acute MCA trunk occlusion, who underwent intravenous and/or intra-arterial revascularization treatment, were enrolled. Intracranial artery calcification scores were calculated by counting calcified intracranial arteries among major seven arteries on computed tomographic angiography. Patients were divided into high (HCB; score ≥3) or low calcification burden (LCB; score <3) groups. Demographic, imaging, and outcome data were compared, and whether HCB is a prognostic factor was evaluated. Grave prognosis was defined as modified Rankin Scale 5-6 for this study. Results Of 80 enrolled patients, the HCB group comprised 15 patients, who were older, and more commonly had diabetes than patients in the LCB group. Initial National Institutes of Health Stroke Scale (NIHSS) scores did not differ (HCB 13.3±2.7 vs. LCB 14.6±3.8) between groups. The final good reperfusion after revascularization treatment (thrombolysis in cerebral infarction score 2b-3, HCB 66.7% vs. LCB 69.2%) was similarly achieved in both groups. However, the HCB group had significantly higher NIHSS scores at discharge (16.0±12.3 vs. 7.9±8.3), and more frequent grave outcome at 3 months (57.1% vs. 22.0%) than the LCB group. HCB was proven as an independent predictor for grave outcome at 3 months when several confounding factors were adjusted (odds ratio 4.135, 95% confidence interval, 1.045-16.359, P=0.043). Conclusions Intracranial HCB was associated with grave prognosis in patients who have undergone revascularization for acute MCA trunk occlusion. PMID:25692109

  15. Stent-assisted mechanical recanalization for symptomatic subacute or chronic middle cerebral artery occlusion

    PubMed Central

    Guo, Dong; Ma, Ji; Li, Teng-Fei; Zhu, Ming; Han, Xin-Wei; Shui, Shao-Feng

    2015-01-01

    To assess the feasibility and short-term effects of treating patients with subacute or chronic middle cerebral artery (M1) occlusion by stent-assisted mechanical recanalization. Six patients with cerebral arteries occlusion underwent surgery. Six cerebral arteries occlusion in 5 patients were successfully recanalized. On postoperative day 1, four patients’ symptoms were relieved and two patients’ symptoms were exacerbated, of which one was significantly improved after 3 days, the other one’s symptoms were recovered to preoperative levels in 2 weeks. No patients died after surgery. No stroke or transient ischemic attack occurred. The average follow-up of was 4.2 months, no worsening of condition, recurrence or death occurred. The results indicate that for patients with subacute or chronic middle cerebral artery (M1) occlusion, mechanical recanalization was technically feasible under the premise of strict case screening. Mechanical recanalization is able to improve ischemic symptoms and promote dysfunction restoration. But its long-term effect remains to be evaluated by further large samples, long-term follow-up studies. PMID:26885148

  16. Efficacy of Early Superficial Temporal Artery-Middle Cerebral Artery Double Anastomoses for Atherosclerotic Occlusion in Patients with Progressing Stroke.

    PubMed

    Inoue, Akihiro; Kohno, Kanehisa; Iwata, Shinji; Ohue, Shiro; Ozaki, Saya; Ninomiya, Satoko; Tomita, Hitomi; Kamogawa, Kenji; Okamoto, Kensho; Fukumoto, Shinya; Ichikawa, Haruhisa; Onoue, Shinji; Nakamura, Yawara; Okuda, Bungo

    2017-04-01

    We investigated the efficacy of early superficial temporal artery-middle cerebral artery (STA-MCA) double anastomoses for patients with progressing stroke due to atherosclerotic occlusion. Nine consecutive patients who underwent early STA-MCA double anastomoses were enrolled. All patients presented with progressing stroke despite maximal medical treatment. Cerebral blood flow in 7 patients was analyzed by single-photon emission tomography. Clinical outcomes were investigated postoperatively, and we evaluated the utility of early STA-MCA double anastomoses. Nine patients in the present study included those with middle cerebral artery occlusion (n = 6) and internal carotid artery occlusion (n = 3). The mean age was 58.4 years. Subjects comprised 1 female (11.1%) and 8 males (88.9%). The cause was low perfusion ischemia due to atherosclerotic occlusion with a small infarct. The mean regional cerebral blood flow (rCBF) ratio in the middle cerebral artery territory compared to the normal side was 69.6 ± 5.3%. The duration from onset to surgery was 1-8 days (median, 3.11 days). All patients underwent early STA-MCA double anastomoses, and no reperfusion-induced hemorrhage occurred. All of them slowly achieved obvious remission compared to symptoms on admission and achieved a good functional outcome. Early STA-MCA double anastomoses were safe and effective, and early revascularization resulted in rapid neurological improvement. We recommend this procedure for patients with progressive ischemia due to main trunk artery occlusion, when the rCBF flow ratio with the normal side was 70 ± 10%, even at the subacute stage. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  17. Cerebral Hemodynamics and Vascular Reactivity in Mild and Severe Ischemic Rodent Middle Cerebral Artery Occlusion Stroke Models

    PubMed Central

    Sim, Jeongeun; Jo, Areum; Kang, Bok-Man; Lee, Sohee; Bang, Oh Young; Heo, Chaejeong; Jhon, Gil-Ja; Lee, Youngmi

    2016-01-01

    Ischemia can cause decreased cerebral neurovascular coupling, leading to a failure in the autoregulation of cerebral blood flow. This study aims to investigate the effect of varying degrees of ischemia on cerebral hemodynamic reactivity using in vivo real-time optical imaging. We utilized direct cortical stimulation to elicit hyper-excitable neuronal activation, which leads to induced hemodynamic changes in both the normal and middle cerebral artery occlusion (MCAO) ischemic stroke groups. Hemodynamic measurements from optical imaging accurately predict the severity of occlusion in mild and severe MCAO animals. There is neither an increase in cerebral blood volume nor in vessel reactivity in the ipsilateral hemisphere (I.H) of animals with severe MCAO. The pial artery in the contralateral hemisphere (C.H) of the severe MCAO group reacted more slowly than both hemispheres in the normal and mild MCAO groups. In addition, the arterial reactivity of the I.H in the mild MCAO animals was faster than the normal animals. Furthermore, artery reactivity is tightly correlated with histological and behavioral results in the MCAO ischemic group. Thus, in vivo optical imaging may offer a simple and useful tool to assess the degree of ischemia and to understand how cerebral hemodynamics and vascular reactivity are affected by ischemia. PMID:27358581

  18. [Diagnostic image (162) A woman with temporary hemiplegia. Temporary embolic occlusion of the left middle cerebral artery by a thrombus].

    PubMed

    Groeneveld, G J; van der Schaaf, I C

    2003-10-25

    A 48-year-old woman with right-sided hemiplegia by embolic occlusion of the left middle cerebral artery was treated with alteplase. A pre- and post-treatment CT angiography scan showed the vanishing blood clot.

  19. A protocol for characterizing the impact of collateral flow after distal middle cerebral artery occlusion

    PubMed Central

    DeFazio, R. Anthony; Levy, Sean; Morales, Carmen L.; Levy, Rebecca V.; Dave, Kunjan R.; Lin, Hung W.; Abaffy, Tatjana; Watson, Brant D.; Perez-Pinzon, Miguel A.; Ohanna, Victoria

    2010-01-01

    I. SUMMARY In humans and in animal models of stroke, collateral blood flow between territories of the major pial arteries has a profound impact on cortical infarct size. However, there is a gap in our understanding of the genetic determinants of collateral formation and flow, as well as the signaling pathways and neurovascular interactions regulating this flow. Previous studies have demonstrated that collateral flow between branches of the anterior cerebral artery (ACA) and the middle cerebral artery (MCA) can protect mouse cortex from infarction after middle cerebral artery occlusion. Because the number and diameter of collaterals varies among mouse strains and after transgenic manipulations, a combination of methods is required to control for these variations. Here, we report an inexpensive approach to characterizing the cerebrovascular anatomy, and in vivo monitoring of cerebral blood flow as well. Further, we introduce a new, minimally invasive method for the occlusion of distal MCA branches. These methods will permit a new generation of studies on the mechanisms regulating collateral remodeling and cortical blood flow after stroke. PMID:21593993

  20. Transneuronal Degeneration of Thalamic Nuclei following Middle Cerebral Artery Occlusion in Rats

    PubMed Central

    2016-01-01

    Objective. Postinfarction transneuronal degeneration refers to secondary neuronal death that occurs within a few days to weeks following the disruption of input or output to synapsed neurons sustaining ischemic insults. The thalamus receives its blood supply from the posterior circulation; however, infarctions of the middle cerebral arterial may cause secondary transneuronal degeneration in the thalamus. In this study, we presented the areas of ischemia and associated transneuronal degeneration following MCAo in a rat model. Materials and Methods. Eighteen 12-week-old male Sprague-Dawley rats were randomly assigned to receive middle cerebral artery occlusion surgery for 1, 7, and 14 days. Cerebral atrophy was assessed by 2,3,5-triphenyltetrazolium hydrochloride staining. Postural reflex and open field tests were performed prior to animal sacrifice to assess the effects of occlusion on behavior. Results. Myelin loss was observed at the lesion site following ischemia. Gliosis was also observed in thalamic regions 14 days following occlusion. Differential degrees of increased vascular endothelial growth factor expression were observed at each stage of infarction. Increases in myelin basic protein levels were also observed in the 14-day group. Conclusion. The present rat model of ischemia provides evidence of transneuronal degeneration within the first 14 days of occlusion. The observed changes in protein expression may be associated with self-repair mechanisms in the damaged brain. PMID:27597962

  1. Cerebral Perfusion After Repair of Congenital Diaphragmatic Hernia with Common Carotid Artery Occlusion After ECMO Therapy.

    PubMed

    Henzler, Claudia; Zöllner, Frank G; Weis, Meike; Zimmer, Fabian; Schoenberg, Stefan O; Zahn, Katrin; Schaible, Thomas; Neff, K Wolfgang

    2017-01-01

    To prospectively evaluate cerebral perfusion after repair of congenital diaphragmatic hernia (CDH) and right-common-carotid-artery (rCCA) occlusion after extracorporeal membrane oxygenation (ECMO) therapy. A total of 29 2-year-old-children with a history of CDH repair underwent cerebral magnetic resonance perfusion imaging. In 14 patients, the rCCA was occluded after ECMO therapy. Fifteen patients with CDH without ECMO served as controls. Regional cerebral-blood-flow (rCBF) was measured cortically and subcortically in both hemispheres and compared intra-individually and between both groups. Patients with rCCA-occlusion showed intra-individual side differences between hemispheres, with significantly lower subcortical perfusion of the right hemisphere and reduced cortical perfusion. In one-third of patients with rCCA-occlusion, rCBF of the right-hemisphere was reduced by more than 20% when compared to the left hemisphere. Despite intra-individual side differences, mean rCBF in patients with rCCA occlusion was not reduced compared to controls. Beside intra-individual side differences, overall right hemisphere perfusion is sufficient after rCCA-occlusion due to collateral blood supply. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  2. [A case of middle cerebral artery occlusion caused by dissecting aneurysm].

    PubMed

    Fu, Y; Komiyama, M; Inoue, T; Ohata, K; Matsuoka, Y; Hakuba, A

    1996-10-01

    We reported a case of middle cerebral artery occlusion caused by a dissecting aneurysm that was successfully treated by intra-arterial fibrinolysis. A 38-year-old man suddenly developed left hemiparesis and became confused. He was transferred to our hospital one hour and 27 minutes after the ictus. Right carotid angiogram (CAG) revealed aneurysmal dilatation of the horizontal portion of the middle cerebral artery and occlusion of the anterior trunk. Twelve million IU of tissue plasminogen activator was injected to fibrinolyze the thrombus of the occlusion site through a microcatheter. After this, the patient became alert and hemiparesis disappeared. It took three hours and 30 minutes to gain recanalization after the ictus. Right CAG obtained the next day demonstrated the patency of the anterior trunk and the characteristic finding of the dissecting aneurysm viz "double lumen" as a result of fibrinolysis of the thrombus in the false lumen. Right CAG obtained two weeks later demonstrated "string and pearl sign" instead of the "double lumen" as a result of partial thrombosis in the false lumen. Follow-up CAG obtained nine months after the ictus demonstrated marked reduction of the aneurysmal size as the result of progressing thrombosis of the false lumen. The characteristic angiographic findings of the dissecting aneurysm such as "double lumen" and "string and pearl sign" seemed to be mostly influenced by the status of the thrombus in the false lumen. In case of major cerebral arterial occlusion caused by the embolus or thrombus from the dissecting aneurysm, intra-arterial fibrinolysis seems to be a possible treatment modality, even though it is accompanied by the risk of giving rise to subarachnoid hemorrhage.

  3. Middle Cerebral Artery, Ophthalmic Artery, and Multibranch Retinal Vessel Occlusion After Cosmetic Autologous Fat Transfer to Forehead.

    PubMed

    Roshandel, Danial; Soheilian, Masoud; Pakravan, Mohammad; Aghayan, Sara; Peyman, Gholam A

    2015-05-01

    A 65-year-old woman with left hemiparesis and sudden loss of visual acuity in her right eye presented a few hours after cosmetic injection of autologous fat to her forehead. Right eye visual acuity was no light perception. Funduscopy revealed widespread retinal whitening and multibranch retinal vessel occlusion. Fluorescein angiography showed markedly delayed choroidal and retinal filling together with occlusion of multiple branches of retinal arteries and veins. On magnetic resonance imaging of the brain, multiple lesions compatible with recent infarction were detected. The authors diagnosed multibranch retinal artery and vein occlusion in the right ophthalmic and middle cerebral arteries due to fat emboli. This case emphasizes the need to reevaluate the safety of such aesthetic procedures, particularly in the facial zone to prevent devastating complications.

  4. Persistent middle cerebral artery occlusion associated with lower body temperature on admission.

    PubMed

    Kvistad, Christopher Elnan; Øygarden, Halvor; Thomassen, Lars; Waje-Andreassen, Ulrike; Naess, Halvor

    2013-01-01

    Low body temperature is considered neuroprotective in ischemic stroke, yet some studies suggest that low body temperature may also inhibit clot lysis and recanalization. We hypothesized that low body temperature was associated with persistent proximal middle cerebral artery (MCA) occlusion in patients with acute ischemic stroke presenting with symptoms of proximal MCA occlusion, suggesting a possible detrimental effect of low body temperature on recanalization. All patients with acute ischemic stroke admitted to our Stroke Unit between February 2006 and August 2012 were prospectively registered in a database. Computed tomography (CT) angiography was performed in patients admitted <6 hours after stroke onset. Based on presenting symptoms, patients were classified according to the Oxford Community Stroke Project classification (OCSP). Patients with symptomatic proximal MCA occlusion were compared to patients with total anterior circulation infarct (TACI) without MCA occlusion on CT angiography. During the study period, 384 patients with acute ischemic stroke were examined with CT angiography. A total of 79 patients had proximal MCA occlusion and 31 patients had TACI without MCA occlusion. Median admission body temperatures were lower in patients with MCA occlusion compared to patients without occlusion (36.3°C versus 36.7°C, P = 0.027). Admission body temperature <36.5°C was independently associated with persistent MCA occlusion when adjusted for confounders in multivariate analyses (odds ratio 3.7, P = 0.007). Our study showed that low body temperature on admission was associated with persistent proximal MCA occlusion. These results may support a possible detrimental effect of low body temperature on clot lysis and recanalization.

  5. Persistent middle cerebral artery occlusion associated with lower body temperature on admission

    PubMed Central

    Kvistad, Christopher Elnan; Øygarden, Halvor; Thomassen, Lars; Waje-Andreassen, Ulrike; Naess, Halvor

    2013-01-01

    Background Low body temperature is considered neuroprotective in ischemic stroke, yet some studies suggest that low body temperature may also inhibit clot lysis and recanalization. We hypothesized that low body temperature was associated with persistent proximal middle cerebral artery (MCA) occlusion in patients with acute ischemic stroke presenting with symptoms of proximal MCA occlusion, suggesting a possible detrimental effect of low body temperature on recanalization. Methods All patients with acute ischemic stroke admitted to our Stroke Unit between February 2006 and August 2012 were prospectively registered in a database. Computed tomography (CT) angiography was performed in patients admitted <6 hours after stroke onset. Based on presenting symptoms, patients were classified according to the Oxford Community Stroke Project classification (OCSP). Patients with symptomatic proximal MCA occlusion were compared to patients with total anterior circulation infarct (TACI) without MCA occlusion on CT angiography. Results During the study period, 384 patients with acute ischemic stroke were examined with CT angiography. A total of 79 patients had proximal MCA occlusion and 31 patients had TACI without MCA occlusion. Median admission body temperatures were lower in patients with MCA occlusion compared to patients without occlusion (36.3°C versus 36.7°C, P = 0.027). Admission body temperature <36.5°C was independently associated with persistent MCA occlusion when adjusted for confounders in multivariate analyses (odds ratio 3.7, P = 0.007). Conclusion Our study showed that low body temperature on admission was associated with persistent proximal MCA occlusion. These results may support a possible detrimental effect of low body temperature on clot lysis and recanalization. PMID:23807851

  6. Progression from ischemic injury to infarct following middle cerebral artery occlusion in the rat.

    PubMed Central

    Garcia, J. H.; Yoshida, Y.; Chen, H.; Li, Y.; Zhang, Z. G.; Lian, J.; Chen, S.; Chopp, M.

    1993-01-01

    Focal brain ischemia induced in rats by occlusion of an intracranial artery is a widely used paradigm of human brain infarct. Details of the structural changes that develop in either the human or the rat brain at various times after occlusion of an intracranial artery are incompletely characterized. We studied, in 48 adult Wistar rats, structural alterations involving the cerebral hemisphere ipsilateral to an arterial occlusion, at intervals ranging from 30 min to 7 days. Microscopic changes developed over time in separate areas of the corresponding cerebral hemisphere in a predictable pattern, appearing as small lesions in the preoptic area (30 minutes), enlarging to involve the striatum, and finally involving the cerebral cortex. Two types of neuronal responses were noted according to the time elapsed; acute changes (up to 6 hours) included scalloping, shrinkage, and swelling, whereas delayed changes (eosinophilia and karyolysis) appeared later (> or = 12 hours). Three types of astrocytic responses were noted. 1) Cytoplasmic disintegration occurred in the preoptic area at a time and in a place where neurons appeared minimally injured. 2) Nuclear and cytoplasmic swelling were prominent responses in the caudoputamen and cerebral cortex at a time when neurons showed minimal alterations. 3) Increased astrocytic glial fibrillary acidic protein reactivity was noted at the interface between the lesion and the surrounding brain tissue after 4 to 6 hours. The gross pattern of the brain lesion and the maturation of neuronal changes typical of a brain infarct have a predictable progression. Focal brain ischemia of up to 6-hour duration does not induce coagulation necrosis. Images Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 PMID:8434652

  7. [Mechanical thrombectomy using Solitaire AB stent for acute middle cerebral artery occlusion with atrial fibrillation].

    PubMed

    Zhu, Xucheng; Peng, Ya; Xuan, Jinggang; Chen, Ronghua; Shao, Huaming; Cao, Jie; Yang, Yilin

    2015-10-20

    To investigate the endovascular management strategy of mechanical thrombectomy using Solitaire AB stent for acute middle cerebral artery occlusion with atrial fibrillation and assess the safety and efficacy. From June 2012 to Dec 2013, 40 patients of acute middle cerebral artery occlusion with atrial fibrillation admitted to our institutes were treated by Solitaire AB stent.Clinical status was evaluated by the score of National Institute of Health Stroke Scale (NIHSS) before and 72 hours after treatment, immediate scale of thrombolysis in cerebral infarction (TICI) after thrombectomy, the 90 d score of Modified Rankin Scale (mRS).The patients were classified into good result group (mRS≤2) and bad result group (mRS>2) according to the mRS score. Out of 40 cases, there were 28 cases caused by cardiogenic embolism. Recanalization was successful (TICI score 2b or 3) in 37 out of 40 (92.5%). 90 d follow-up mRS was 0-2 in 19 of 40 patients (47.5%). 3-5 in 21 patients (52.5%). 5 patients died (12.5%).Symptomatic hemorrhagic transform developed in 6 patients (15%).No complications related to the Solitaire AB thrombectomy occurred.Mean time from symptom onset to recanalization (312±52 min vs 370±68 min, P<0.05) and initial NIHSS score (17.0±0.4 vs 18.6±0.4, P<0.05) were of significant difference between good result group and bad result group. These results confirm that mechanical thrombectomy using solitaire AB stent for acute middle cerebral artery occlusion with atrial fibrillation is safe and effective.

  8. Middle cerebral artery occlusion 25 years after cranial radiation therapy in acromegaly: a case report.

    PubMed

    Maffei, P; Albano, I; Martini, C; Barban, M; Manara, R; Meneghetti, G; Sicolo, N

    2009-10-01

    We report a case of ischemic stroke in a 43 year-old woman with no traditional cardiovascular risk factors and a history of cranial surgery and cranial radiation therapy (CRT) for a GH-secreting pituitary macroadenoma. The neurological work-up on this patient disclosed several cerebral ischemic lesions and demonstrated the occlusion of the right middle cerebral artery together with the narrowing of the right carotid artery; post-radiation brain damage was also visible by nuclear magnetic resonance. We postulate the existence in this patient of a radiation-induced vascular damage, which is a well recognized process thoroughly described in in vitro studies. We remark that life-long follow-up of acromegalic patients receiving CRT is essential so that early diagnosis of radiation-induced vascular injury can be made.

  9. Neuroprotective effects of progesterone after transient middle cerebral artery occlusion in rat.

    PubMed

    Chen, J; Chopp, M; Li, Y

    1999-12-01

    Treatment of focal cerebral ischemia in the rat with intraperitoneal administration of progesterone dissolved in dimethyl sulfoxide (DMSO) has demonstrated therapeutic efficacy. In the present study we test whether iv administration of water soluble progesterone 2 h after the onset of middle cerebral artery occlusion provides therapeutic benefit for the treatment of stroke. In addition, we perform a battery of functional tests: rotarod, adhesive-backed somatosensory, and neurological score, as well as a dose-response study. The data indicate that iv administration of progesterone at a dose of 8 mg/kg significantly reduces the volume of cerebral infarction and significantly improves outcome on the array of functional measures employed. Treatment with 4 mg/kg or 32 mg/kg of progesterone failed to provide any therapeutic benefit. Progesterone, a non toxic, clinically employed, pluripotent therapeutic agent which targets both neuroprotective as well as neuroregenerative strategies, may have important therapeutic benefits for the treatment of stroke.

  10. A Lumped Parameter Method to Calculate the Effect of Internal Carotid Artery Occlusion on Anterior Cerebral Artery Pressure Waveform.

    PubMed

    Abdi, M; Navidbakhsh, M; Razmkon, A

    2016-03-01

    Numerical modeling of biological structures would be very helpful tool to analyze hundreds of human body phenomena and also diseases diagnosis. One physiologic phenomenon is blood circulatory system and heart hemodynamic performance that can be simulated by utilizing lumped method. In this study, we can predict hemodynamic behavior of one artery of circulatory system (anterior cerebral artery) when disease such as internal carotid artery occlusion is occurred. Pressure-flow simulation is one the leading common approaches for modeling of circulatory system behavior and forecasts of hemodynamic in numerous physiological conditions. In this paper, by using lumped model (electrical analogy), CV system is simulated in MATLAB software (SIMULINK environment). The performance of healthy blood circulation and heart is modeled and the obtained results used for further analyses. The stenosis of internal carotid artery at different rates was, then, induced in the circuit and the effects are studied. In stenosis cases, the effects of internal carotid artery occlusion on  left anterior cerebral artery pressure waveform are investigated. The findings of this study may have implications not only for understanding the behavior of human biological system at healthy condition but also for diagnosis of diseases in circulatory and cardiovascular system of human body.

  11. Near-infrared spectroscopy and transcranial sonography to evaluate cerebral autoregulation in middle cerebral artery steno-occlusive disease.

    PubMed

    Oldag, Andreas; Neumann, Jens; Goertler, Michael; Hinrichs, Hermann; Heinze, Hans-Jochen; Kupsch, Andreas; Sweeney-Reed, Catherine M; Kopitzki, Klaus

    2016-11-01

    The measurement of autoregulatory delay by near-infrared spectroscopy (NIRS) has been proposed as an alternative technique to assess cerebral autoregulation, which is routinely assessed via transcranial Doppler sonography (TCD) in most centers. Comparitive studies of NIRS and TCD, however, are largely missing. We investigated whether cerebrovascular reserve (CVR), as assessed via TCD, correlates with the delay of the autoregulatory response to changes in arterial blood pressure (ABP) as assessed by NIRS, i.e., if impaired upstream vasomotor reactivity is reflected by downstream cortical autoregulation. Twenty patients with unilateral high-grade steno-occlusion of the middle cerebral artery (MCA) underwent bilateral multichannel NIRS of the cortical MCA distributions over a period of 6 min while breathing at a constant rate of 6 cycles/min to induce stable oscillations in ABP. The phase shift φ between ABP and cortical blood oxygenation was calculated as a measure of autoregulatory latency. In a subgroup of 13 patients, CO2 reactivity of the MCAs was determined by TCD to assess CVR in terms of normalized autoregulatory response (NAR). Mean phase shift between ABP and blood oxygenation was significantly increased over the hemisphere ipsilateral to the steno-occlusion (n = 20, p = 0.042). The interhemispheric difference Δφ in phase shift was significantly larger in patients with markedly diminished or exhausted CVR (NAR < 10) than in patients with normal NAR values (NAR ≥ 10) (p = 0.007). Within the MCA core distribution territory, a strong correlation existed between Δφ and CO2 reactivity of the affected MCA (n = 13, r = -0.78, p = 0.011). NIRS may provide an alternative or supplementary approach to evaluate cerebral autoregulation in risk assessment of ischemic events in steno-occlusive disease of cerebral arteries, especially in patients with insufficient bone windows for TCD.

  12. [Superficial temporal artery-middle cerebral artery anastomosis in a patient of temporal arteritis with internal carotid artery occlusion: a case report].

    PubMed

    Abiko, Masaru; Nakano, Shigeki; Nishizaki, Takafumi; Ikeda, Norio; Sakakura, Takanori; Okamura, Tomohiro; Abiko, Seisho

    2012-01-01

    Temporal arteritis is a rare systemic autoimmune disease and the arteritic process in this case of temporal arteritis involved large and medium-size arteries. Temporal arteritis with internal carotid artery (ICA) occlusion is very rare. We report a case of temporal arteritis with ICA occlusion following superficial temporal artery (STA) -middle cerebral artery (MCA) anastomosis, together with steroid therapy. A 73-year-old female presented with a headache, visual disturbance of left side, and suppression of activity. Left STA was inflammatory and overswelling. Magnetic resonance angiography (MRA) and angiography revealed occlusion of the left internal carotid artery (ICA) at the cervical portion and lowering of vascular reserve on PAO SPECT. Diagnosis as temporal arteritis was conclusive due to the clinical presentation, laboratory studies, and left temporal artery biopsy, so steroid pulse therapy was initiated. Inflammation of left STA disappeared after steroid therapy, but left ICA occlusion on angiography and lowering of vascular reserve on SPECT remained for 3 months afterwards. Because of this, STA-MCA anastomosis was performed. There were no complications after the operation and the donor artery has been patent for two years. Temporal arteritis with ICA occlusion that requires extracranial-intracranial bypass (EC-IC bypass) is very rare. STA-MCA anastomosis with steroid therapy is effective for the prevention of cerebral infarction.

  13. Severity of middle cerebral artery occlusion determines retinal deficits in rats

    PubMed Central

    Allen, Rachael S.; Sayeed, Iqbal; Cale, Heather A.; Morrison, Katherine C.; Boatright, Jeffrey H.; Pardue, Machelle T.; Stein, Donald G.

    2014-01-01

    Middle cerebral artery occlusion (MCAO) using the intraluminal suture technique is a common model used to study cerebral ischemia in rodents. Due to the proximity of the ophthalmic artery to the middle cerebral artery, MCAO blocks both arteries, causing both cerebral and retinal ischemia. While previous studies have shown retinal dysfunction at 48 hours post-MCAO, we investigated whether these retinal function deficits persist until 9 days and whether they correlate with central neurological deficits. Rats received 90 minutes of transient MCAO followed by electroretinography at 2 and 9 days to assess retinal function. Retinal damage was assessed with cresyl violet staining, immunohistochemistry for glial fibrillary acidic protein (GFAP) and glutamine synthetase, and TUNEL staining. Rats showed behavioral deficits as assessed with neuroscore that correlated with cerebral infarct size and retinal function at 2 days. Two days after surgery, rats with moderate MCAO (neuroscore < 5) exhibited delays in electroretinogram implicit time, while rats with severe MCAO (neuroscore ≥ 5) exhibited reductions in amplitude. Glutamine synthetase was upregulated in Müller cells 3 days after MCAO in both severe and moderate animals, however, retinal ganglion cell death was only observed in MCAO retinas from severe animals. By 9 days after MCAO, both glutamine synthetase labeling and electroretinograms had returned to normal levels in moderate animals. Early retinal function deficits correlated with behavioral deficits. However, retinal function decreases were transient and selective retinal cell loss was observed only with severe ischemia, suggesting that the retina is less susceptible to MCAO than the brain. Temporary retinal deficits caused by MCAO are likely due to ischemia-induced increases in extracellular glutamate that impair signal conduction, but resolve by 9 days after MCAO. PMID:24518488

  14. Effect of oral administration of Pheretima aspergillum (earthworm) in rats with cerebral infarction induced by middle-cerebral artery occlusion.

    PubMed

    Liu, Chung-Hsiang; Lin, Yi-Wen; Tang, Nou-Ying; Liu, Hsu-Jan; Huang, Chih-Yang; Hsieh, Ching-Liang

    2012-01-01

    We investigated the curative effect of Pheretima aspergillum (earthworm, PA) on rats with middle cerebral artery occlusion (MCAo). The MCAo-induced cerebral infarction was established and its underlying mechanisms by counting the infarction areas and evaluating the rats' neurological status. Immunostaining was used to test the expression of NeuN, and glial fibrillary acidic (GFAP), S100B, and brain-derived neurotrophic factor (BDNF) proteins. Our results showed that oral administration of PA for two weeks to rats with MCAo successfully reduced cerebral infarction areas in the cortex and striatum, and also reduced scores of neurological deficit. The PA-treated MCAo rats showed greatly decreased neuronal death, glial proliferation, and S100B proteins in the penumbra area of the cortex and in the ischemic core area of the cortex, but BDNF did not changed. These results demonstrated novel and detailed cellular mechanisms underlying the neuroprotective effects of PA in MCAo rats.

  15. Experience with A Direct Aspiration First Pass Technique (ADAPT) for Thrombectomy in Distal Cerebral Artery Occlusions Causing Acute Ischemic Stroke.

    PubMed

    Vargas, Jan; Spiotta, Alex M; Fargen, Kyle; Turner, Raymond D; Chaudry, Imran; Turk, Aquilla

    2017-03-01

    Thromboembolic occlusion of distal branches in anterior and posterior circulation may produce severe clinical deficits. A Direct Aspiration at first Pass Technique (ADAPT) is a simple, fast method for achieving good angiographic and clinical outcomes using large-bore catheters in large vessel occlusions. We present our results using ADAPT with distal cerebral artery occlusions. ADAPT was used to treat 35 patients (14 women, 21 men; average age 65.5 years ± 12.6) with acute ischemic stroke with thrombus in the distal middle cerebral artery, anterior cerebral artery, or posterior cerebral artery. Patients presented with a mean National Institutes of Health Stroke Scale score of 14.1 ± 6.9; 15 patients received intravenous tissue plasminogen activator. Mean time from onset to puncture was 7.1 hours ± 5.1. Of patients, 28 (80%) presented with isolated M2 segment occlusions, 1 (2.9%) presented with isolated A3 segment occlusion, and 6 (17.1%) presented with tandem occlusions. Mean time to recanalization was 35.7 minutes ± 26.4. A thrombolysis in cerebral infarction grade 2B or better was achieved in 34 patients (97.1%), with 15 achieving a thrombolysis in cerebral infarction 3. Aspiration alone was successful in 26 cases (77.1%), whereas 7 (20%) required additional techniques. A 90-day modified Rankin Scale score was available in 32 patients; 59.4% had a 90-day score of 0-2. No patients had a modified Rankin Scale score of 6. Acute distal anterior circulation thromboembolic occlusions may be treated safely with intraarterial thrombectomy. Prior studies have demonstrated the success of ADAPT in proximal large vessel occlusions. This series suggests that ADAPT is an effective, safe method for performing thrombectomy in distal branches of anterior and posterior circulation. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Protective effect of extract of Cordyceps sinensis in middle cerebral artery occlusion-induced focal cerebral ischemia in rats

    PubMed Central

    2010-01-01

    Background Ischemic hypoxic brain injury often causes irreversible brain damage. The lack of effective and widely applicable pharmacological treatments for ischemic stroke patients may explain a growing interest in traditional medicines. From the point of view of "self-medication" or "preventive medicine," Cordyceps sinensis was used in the prevention of cerebral ischemia in this paper. Methods The right middle cerebral artery occlusion model was used in the study. The effects of Cordyceps sinensis (Caterpillar fungus) extract on mortality rate, neurobehavior, grip strength, lactate dehydrogenase, glutathione content, Lipid Peroxidation, glutathione peroxidase activity, glutathione reductase activity, catalase activity, Na+K+ATPase activity and glutathione S transferase activity in a rat model were studied respectively. Results Cordyceps sinensis extract significantly improved the outcome in rats after cerebral ischemia and reperfusion in terms of neurobehavioral function. At the same time, supplementation of Cordyceps sinensis extract significantly boosted the defense mechanism against cerebral ischemia by increasing antioxidants activity related to lesion pathogenesis. Restoration of the antioxidant homeostasis in the brain after reperfusion may have helped the brain recover from ischemic injury. Conclusions These experimental results suggest that complement Cordyceps sinensis extract is protective after cerebral ischemia in specific way. The administration of Cordyceps sinensis extract significantly reduced focal cerebral ischemic/reperfusion injury. The defense mechanism against cerebral ischemia was by increasing antioxidants activity related to lesion pathogenesis. PMID:20955613

  17. Environmental reduplication in a patient with right middle cerebral artery occlusion.

    PubMed

    Likitcharoen, Yuthachai; Phanthumchinda, Kammant

    2004-12-01

    Environmental reduplication or reduplicative paramnesia is one of the content-specific delusions (CSD) which is characterized by reduplication of places. CSD has been reported in focal and diffuse cerebral disorders. A focal lesion such as frontal lobes and the right hemispheric lesion have been documented The authors describe a 66 year-old woman who had a delusion of misidentification for place one month after right middle cerebral artery occlusion. The patient did not have any history of schizophrenia or other psychiatric diseases. The patient believed that her car, furniture and house were duplicated. She also mentioned that her son and friends tried to takeover all of her properties and told everyone that she was insane. The prominent cortical signs were tactile and visual neglect. Neuropsychological assessments revealed poor attention but she had neither confusion nor dementia. Clock drawing and construction tests revealed visuospatial impairment which was compatible with non-dominant hemispheric abnormality. MRI showed evidence of cerebral infarction in the right middle cerebral artery territory. Only one similar patient who had an intracerbral hematoma of the right frontal lobe has been reported in the literature. The role of occipito-parietal and fronto-temporal lobes or their connections in environmental reduplication is proposed.

  18. Cerebral hemodynamics in patients with carotid artery occlusion and contralateral moderate or severe internal carotid artery stenosis.

    PubMed

    Vernieri, F; Pasqualetti, P; Diomedi, M; Giacomini, P; Rossini, P M; Caltagirone, C; Silvestrini, M

    2001-04-01

    The purpose of this study was to evaluate cerebral hemodynamics in patients suffering from occlusion of the carotid artery (CA) and contralateral CA stenosis. Using transcranial Doppler ultrasonography, the cerebrovascular reactivity to hypercapnia in the middle cerebral arteries was evaluated by calculating the breath-holding index (BHI) of 69 symptomatic patients suffering from internal CA (ICA) occlusion and moderate or severe contralateral ICA stenosis. To evaluate which variables influenced BHIs ipsilateral to the site of ICA occlusion, a multiple stepwise linear regression analysis was performed that included the following factors: patient age, percentage of contralateral ICA stenosis, contralateral BHI, number of collateral pathways, and presence of hypertension, diabetes, smoking, and hyperlipidemia. An analysis of variance was conducted to evaluate the impact of the type of collateral vessels on the BHI. A regression analysis showed that the BHI ipsilateral to the site of ICA occlusion could be accounted for by the contralateral BHI (which was entered at the first step of the analysis, p < 0.001) and by the number of collateral pathways (which was entered at the second step, p = 0.033). Neither the degree of contralateral ICA stenosis nor the other variables could be added to improve the model. The analysis demonstrated that the absence of collateral pathways and the presence of the anterior communicating artery (ACoA) alone were associated with lower BHI values than those found in the presence of two or three collateral vessels, regardless of the presence of an anterior collateral pathway. On the basis of these data one can infer that the cerebral hemodynamic status of patients with occlusive disease of the CA is influenced by individual anatomical and functional characteristics. Because improvement in contralateral hemodynamics after surgical correction of an ICA stenosis can only be expected in the presence of an ACoA, the planning of strategies for

  19. Intraoperative laser speckle contrast imaging improves the stability of rodent middle cerebral artery occlusion model

    NASA Astrophysics Data System (ADS)

    Yuan, Lu; Li, Yao; Li, Hangdao; Lu, Hongyang; Tong, Shanbao

    2015-09-01

    Rodent middle cerebral artery occlusion (MCAO) model is commonly used in stroke research. Creating a stable infarct volume has always been challenging for technicians due to the variances of animal anatomy and surgical operations. The depth of filament suture advancement strongly influences the infarct volume as well. We investigated the cerebral blood flow (CBF) changes in the affected cortex using laser speckle contrast imaging when advancing suture during MCAO surgery. The relative CBF drop area (CBF50, i.e., the percentage area with CBF less than 50% of the baseline) showed an increase from 20.9% to 69.1% when the insertion depth increased from 1.6 to 1.8 cm. Using the real-time CBF50 marker to guide suture insertion during the surgery, our animal experiments showed that intraoperative CBF-guided surgery could significantly improve the stability of MCAO with a more consistent infarct volume and less mortality.

  20. Allopurinol and dimethylthiourea reduce brain infarction following middle cerebral artery occlusion in rats.

    PubMed

    Martz, D; Rayos, G; Schielke, G P; Betz, A L

    1989-04-01

    Free radicals have been shown to play an important role in ischemia-reperfusion injury in several organ systems; however, the role of free radicals in central nervous system ischemia has been less well studied. Many potential free radical-generating systems exist. The primary products of these reactions, superoxide and hydrogen peroxide, may combine to produce hydroxyl radicals. Of the many potential sources of free radical generation, the enzyme xanthine oxidase has been shown to be important in ischemia in noncerebral tissue. We investigated the effect of the hydroxyl radical scavenger dimethylthiourea and the xanthine oxidase inhibitor allopurinol on infarct volume in a model of continuous partial ischemia. Male Sprague-Dawley rats were treated with dimethylthiourea or allopurinol before middle cerebral artery occlusion. Infarct volume was measured by triphenyltetrazolium chloride staining of brains removed 3 or 24 hours after occlusion. Stroke volume was reduced by 30% after dimethylthiourea treatment and by 32-35% after allopurinol treatment. At 24 hours after stroke, cortical tissue was more effectively protected than caudate tissue with both agents. Pretreatment with dimethylthiourea and allopurinol also significantly reduced cerebral edema formation and improved blood-brain barrier function as measured by fluorescein uptake. Our results imply that hydroxyl radicals are important in tissue injury secondary to partial cerebral ischemia and that xanthine oxidase may be the primary source of these radicals.

  1. Sequential neuronal and astrocytic changes after transient middle cerebral artery occlusion in the rat.

    PubMed

    Chen, H; Chopp, M; Schultz, L; Bodzin, G; Garcia, J H

    1993-09-01

    The temporal evolution and spatial distribution of ischemic cell injury was investigated after transient middle cerebral artery (MCA) occlusion. Male Wistar rats (n = 61) were subjected to 2 h of MCA occlusion induced by advancing a nylon monofilament into the right internal carotid artery. Animals were killed after different durations of reperfusion, ranging from 4 to 166 h (n = 6-11 for each group). Neuronal injury and astrocytic reaction were evaluated using hematoxylin and eosin (H & E) and glial fibrillary acidic protein (GFAP) immunohistochemistry, respectively. Eosinophilic neurons were detected at 4 h of reperfusion in the basal ganglia, and at 10 h of reperfusion in the cortex. Focal brain infarct developed by 46 h of reperfusion, both in the cortex and the basal ganglia, and the volume remained constant between 46 and 166 h of reperfusion. Significant differences in astrocytic reaction were detected between the lesion and the periphery of the lesion at reperfusion times from 46 to 166 h; GFAP staining decreased in the core of the lesion and increased in the peripheral areas. Our data suggest that, after 2 h of MCA occlusion, brain tissue progresses from isolated neuronal injury to infarct with a time course dependent on anatomical site; and astrocytic reactivity, expressed by GFAP staining, reflects the outcome of the ischemic injury.

  2. Protective effects of allicin against ischemic stroke in a rat model of middle cerebral artery occlusion.

    PubMed

    Zhang, Benping; Li, Feng; Zhao, Weijiang; Li, Jiebing; Li, Qingsong; Wang, Weizhi

    2015-09-01

    Allicin, a molecule predominantly responsible for the pungent odor and the antibiotic function of garlic, exhibits various pharmacological activities and has been suggested to be beneficial in the treatment of various disorders. The present study aimed to elucidate the effect of allicin in cerebral ischemia/reperfusion (I/R) injury in rats. Rats were subjected to 1.5 h of transient middle cerebral artery occlusion (MCAO), followed by 24 h of reperfusion. Rats were randomly assigned to the sham surgery group, the MCAO group and the MCAO + allicin group. Neurological score, cerebral infarct size, brain water content, neuronal apoptosis, serum tumor necrosis factor (TNF)‑α and myeloperoxidase (MPO) activity were measured. The results suggested that allicin reduced cerebral infarction area, brain water content, neuronal apoptosis, TNF‑α levels and MPO activity in the serum. The results of the present study indicated that allicin protects the brain from cerebral I/R injury, which may be ascribed to its anti‑apoptotic and anti‑inflammatory effects.

  3. Carvacrol Exerts Neuroprotective Effects Via Suppression of the Inflammatory Response in Middle Cerebral Artery Occlusion Rats.

    PubMed

    Li, Zhenlan; Hua, Cong; Pan, Xiaoqiang; Fu, Xijia; Wu, Wei

    2016-08-01

    Increasing evidence demonstrates that inflammation plays an important role in cerebral ischemia. Carvacrol, a monoterpenic phenol, is naturally occurring in various plants belonging to the family Lamiaceae and exerts protective effects in a mice model of focal cerebral ischemia/reperfusion injury by reducing infarct volume and decreasing the expression of cleaved caspase-3. However, the anti-inflammatory mechanisms by which carvacrol protect the brain have yet to be fully elucidated. We investigated the effects of carvacrol on inflammatory reaction and inflammatory mediators in middle cerebral artery occlusion rats. The results of the present study showed that carvacrol inhibited the levels of inflammatory cytokines and myeloperoxidase (MPO) activity, as well as the expression of iNOS and COX-2. It also increased SOD activity and decreased MDA level in ischemic cortical tissues. In addition, carvacrol treatment suppressed the ischemia/reperfusion-induced increase in the protein expression of nuclear NF-kB p65. In conclusion, we have shown that carvacrol inhibits the inflammatory response via inhibition of the NF-kB signaling pathway in a rat model of focal cerebral ischemia. Therefore, carvacrol may be a potential therapeutic agent for the treatment of cerebral ischemia injury.

  4. MR imaging of middle cerebral artery stenosis and occlusion: Value of MR angiography

    SciTech Connect

    Fujita, Norihiko; Sato, Tadayuki ); Hirabuki, Norio; Fujii, Keiko; Hashimoto, Tsutomu; Miura, Takashi; Kozuka, Takahiro )

    1994-02-01

    To investigate the effectiveness of MR angiography in conjunction with spin-echo imaging for evaluating vascular patency in patients with middle cerebral artery (MCA) stenosis or occlusion. Seven patients with MCA stenosis or occlusion, verified with contrast angiography in five and correlated with transcranial Doppler sonography in two, were examined using two-dimensional and/or three-dimensional time-of-flight MR angiographic techniques as well as conventional spin-echo imaging. Of the seven patients, six demonstrated basal ganglionic and/or cortical infarct in the MCA territory. Except one case with minimal stenosis immediately distal to the MCA origin, all six cases with either severe stenosis or occlusion of the main trunk of the MCA showed the absence of normal flow voids using spin-echo imaging in the sylvian fissure on the affected side. However, it was not possible to discriminate between stenosis and occlusion. Although different mechanisms (i.e., flow-induced spin dephasing for the 2-D technique and progressive spin saturation for the 3-D technique) were predominantly responsible for the loss of signal through the area of stenosis, both the 2-D and 3-D MR angiograms clearly depicted the compromised flow of the MCA: a focal discontinuity with decreased vessel caliber corresponded to stenosis, and nonvisualization of distal MCA branches represented occlusion. Either 2-D or 3-D time-of-flight MR angiography is a useful adjunct to conventional parenchymal spin-echo imaging for evaluating vascular patency in patients with MCA stenosis or occlusion, although it is important to recognize that each technique has a different basis for the loss of signal through the area of stenosis. 13 refs., 4 figs., 1 tab.

  5. Stroke outcomes of Japanese patients with major cerebral artery occlusion in the post-alteplase, pre-MERCI era.

    PubMed

    Endo, Kaoru; Koga, Masatoshi; Sakai, Nobuyuki; Yamagami, Hiroshi; Furui, Eisuke; Matsumoto, Yasushi; Shiokawa, Yoshiaki; Yoshimura, Shinichi; Okada, Yasushi; Nakagawara, Jyoji; Hyogo, Toshio; Hasegawa, Yasuhiro; Nagashima, Hisashi; Fujinaka, Toshiyuki; Hyodo, Akio; Terada, Tomoaki; Toyoda, Kazunori

    2013-08-01

    This study examined outcomes of patients with acute ischemic stroke (AIS) with major cerebral artery occlusion after the approval of intravenous recombinant tissue-type plasminogen activator (IV rt-PA) but before approval of the MERCI retriever. We retrospectively enrolled 1170 consecutive patients with AIS and major cerebral artery occlusion (496 women; mean age, 73.9 ± 12.3 years) who were admitted within 24 hours after the onset of symptoms to 12 Japanese stroke centers between October 2005 and June 2009. Cardioembolism was a leading cause of AIS in this group (68.2%). The occlusion sites of the major cerebral arteries included the common carotid artery and internal carotid artery (ICA; 29.6%), middle cerebral artery (52.2%), and basilar artery (7.6%). Recanalization therapy (RT) was performed in 32.0% of patients (IV rt-PA, 20.0%; neuroendovascular therapy, 9.4%; combined, 2.5%). Symptomatic intracerebral hemorrhage within 36 hours with a ≥ 1-point increase in the National Institutes of Health Stroke Scale score occurred in 5.3% of the patients. At 3 months (or at hospital discharge), 29.3% of the patients had a favorable outcome (based on a modified Rankin scale score of 0-2), 23.8% were bedridden, and 15.6% died. After multivariate adjustment, RT was positively associated with a favorable outcome and negatively associated with death, whereas age, baseline National Institutes of Health Stroke Scale score, and ICA occlusion were negatively associated with a favorable outcome and positively associated with death. One-third of the patients with AIS and major cerebral artery occlusion were treated with RT, which was independently associated with favorable outcomes and death. However, 40% of the patients became bedridden or died during the post-alteplase, pre-MERCI era in Japan.

  6. Validity of Laser Doppler Flowmetry in Predicting Outcome in Murine Intraluminal Middle Cerebral Artery Occlusion Stroke

    PubMed Central

    Hedna, Vishnumurthy Shushrutha; Ansari, Saeed; Shahjouei, Shima; Cai, Peter Y.; Ahmad, Abdullah Shafique; Mocco, J; Qureshi, Adnan I.

    2015-01-01

    Background Laser Doppler flowmetry (LDF) can reliably reflect brain perfusion in experimental stroke by monitoring both the degree and the duration of relative regional cerebral blood flow (rCBF). Variation in rCBF was continuously monitored in 68 mice undergoing middle cerebral artery occlusion (MCAO) and 25 mice undergoing sham-operation and documented as LDF (%). Transcranial LDF changes in the territory of right middle cerebral artery during MCAO procedure were correlated with corrected infarct volume (CIV) and neurological deficit score (NDS). Methods Ninety-three C57BL/6 mice (Harlan Laboratories, Indianapolis, IN) between 9 and 11 weeks old were randomly selected and assigned to either MCAO for 45 minutes (n = 68) or sham group (n = 25). Ischemia was induced using the transient intraluminal filament model of MCAO based on Koizumi’s method and transcranial LDF was used to measure CBF during the procedure. Neurological deficits were measured at 2 and 23 hours after MCA reperfusion with NDS and 2% triphenyltetrazolium chloride (TTC) staining of carefully dissected brains was performed at 23 hours after reperfusion to determine infarct area. Results After common carotid artery occlusion (CCAO), there was a negative association between LDF drop from base line and NDS at 2 hours (r = −0.43, P = 0.038) and 23 hours (r = −0.61, P = 0.003). Also, a negative correlation was noted between MCA reperfusion LDF and NDS at 23 hours (r = −0.53, P = 0.001). Moreover, post-MCA reperfusion LDF had a positive association with initial CCAO LDF (r = 0.761, P = 0.000) and MCA occlusion LDF (r = 0.31, P = 0.036) in predicting neurological outcome. NDS at 23 hours corresponded well with the infarct volume (r = 0.31, P = 0.005). Conclusions Greater augmentation of rCBF after MCA reperfusion was associated with improved neurological deficit scoring. Interestingly, greater reduction of regional cerebral blood flow after CCAO was also associated with improved neurological

  7. Intravenous administration of pravastatin immediately after middle cerebral artery occlusion reduces cerebral oedema in spontaneously hypertensive rats.

    PubMed

    Mariucci, Giuseppina; Taha, Elena; Tantucci, Michela; Spaccatini, Cristiano; Tozzi, Alessandro; Ambrosini, Maria Vittoria

    2011-06-25

    3-hydroxy-3-methyl-glutaryl-coenzyme-A (HMG-CoA) reductase inhibitors (statins) have been shown to protect against ischemic stroke by mechanisms that are independent of lowering serum cholesterol levels. In this study we investigated the potential neuroprotective effect of a single i.v. treatment with four increasing doses of pravastatin on permanent occlusion of middle cerebral artery (MCAo) in spontaneously hypertensive rats. Pravastatin was given 10 min after MCAo and its effect was determined 24 h later. Treatment results were evaluated in terms of infarct volume, homolateral hemisphere oedema, glial fibrillary acid (GFAP), vimentin (Vim) and endothelial NO synthase (eNOS) immunoreactivity and TUNEL positivity. Cerebral levels of eNOS were measured by western blot analysis. Pravastatin did not reduce cerebral infarct while it mitigated homolateral hemisphere oedema in a dose-dependent manner with respect to controls. No differences among groups were found regarding GFAP and Vim immunoreactivity and TUNEL positivity. Instead, pravastatin-treated animals presented a more marked cerebral eNOS immunoreactivity as compared with controls. In agreement with immunohistochemistry, immunoblot revealed dose-dependent increases in cerebral levels of eNOS in pravastatin rats. Our data confirm statin neuroprotection in cerebral ischemia. In particular, it is of great interest that a single i.v. Pravastatin administration reduced cerebral oedema by upregulating eNOS expression/activity. This, by increasing vascular NO bioavailability, could have produced proximal vasodilation and contributed to reducing perfusional deficit. It is worthy stressing how important the anti-oedema action is that pravastatin seems to exert. Indeed, cerebral oedema, when widespread and beyond limits of physiological compensation, causes endocranic hypertension and additional cerebral damage over time.

  8. Acute arterial occlusion - kidney

    MedlinePlus

    Acute renal arterial thrombosis; Renal artery embolism; Acute renal artery occlusion; Embolism - renal artery ... kidneys need a good blood supply. The main artery to the kidney is called the renal artery. ...

  9. Neuroprotective effects of argon in an in vivo model of transient middle cerebral artery occlusion in rats.

    PubMed

    Ryang, Yu-Mi; Fahlenkamp, Astrid V; Rossaint, Rolf; Wesp, Dominik; Loetscher, Philip D; Beyer, Cordian; Coburn, Mark

    2011-06-01

    The neuroprotective effects of the noble gas xenon are well known. Argon, in contrast to xenon, is abundant, inexpensive, and therefore widely applicable. In this study, we analyzed the possible neuroprotective role of argon in an in vivo rat model of acute focal cerebral ischemia. Controlled laboratory study. Academic research laboratory. Male adult Sprague-Dawley rats. Twenty-two rats underwent 2 hrs of transient middle cerebral artery occlusion using the endoluminal thread model. One hr after transient middle cerebral artery occlusion induction, spontaneously breathing rats received either 50 vol % argon/50 vol % O2 (argon group, n = 11) or 50 vol % N2/50 vol % O2 (control group, n = 11) for 1 hr through a face mask. Twenty-four hrs after reperfusion, rats were neurologically and behaviorally tested and euthanized. Rat brains were stained with 2,3,5-triphenyltetrazolium chloride and infarct volumes determined by planimetry. After 2 hrs of transient middle cerebral artery occlusion in the rat, we found in the argon group a significant reduction in the overall (p = .004) and after subdivision in the cortical (p = .007) and the basal ganglia (p = .02) infarct volumes. Argon treatment resulted in a significant improvement of the composite adverse outcome (p = .034). However, there was no advantage in acute survival 24 hrs after transient middle cerebral artery occlusion (p = .361). We were able to demonstrate argon's neuroprotective effects in an in vivo experimental rat model of acute focal cerebral ischemia. Animals breathing spontaneously 50 vol % argon 1 hr after induction of transient middle cerebral artery occlusion for 1 hr by face mask showed significantly reduced infarct volumes and composite adverse outcomes.

  10. Nylon filament coated with paraffin for intraluminal permanent middle cerebral artery occlusion in rats.

    PubMed

    Zuo, Xia-Lin; Wu, Ping; Ji, Ai-Min

    2012-06-21

    A variety of intraluminal nylon filament has been used in rat middle cerebral artery occlusion (MCAO) models. However the lesion extent and its reproducibility vary among laboratories. The properties of nylon filament play a part of reasons for these variations. In the present study, we used paraffin-coated nylon filament for rat MCAO model, tested the effects and advanced improvement for making the rat MCAO. Forty male Sprague-Dawley (SD) rats were randomized into two groups, MCAO with traditional uncoated nylon filament (uMCAO) and MCAO with paraffin-coated nylon filament (cMCAO), three rats as normal group and sham group respectively. Assessment included mortality rates, model success rates, neurological deficit evaluation, and infarct volume. The study showed two rats died in uMCAO group, no rat died in cMCAO group within the 12h. The model success rate of uMCAO was 100%, while the uMCAO group was 55% (n=20, two died within 12h, seven rats were excluded as the brain slices showed no TTC staining due to subarachanoid hemorrhage). Neurological evaluation demonstrated group cMCAO had more worse neurological outcomes than group uMCAO, and the difference was statistically signification (p<0.05). TTC staining cMCAO group had significantly larger infarct volumes than uMCAO group, and also showed statistically significant difference (p<0.05). The result demonstrated that the paraffin-coated nylon filament intraluminal occlusion provide better occlusion of middle cerebral artery than the uncoated nylon filament, improve the consistent of model, and raise the success rate to reduce the number of experimental animals. These positive results are much encouraging and interesting.

  11. Middle Cerebral Artery Occlusion Model of Stroke in Rodents: A Step-by-Step Approach

    PubMed Central

    Shahjouei, Shima; Cai, Peter Y.; Ansari, Saeed; Sharififar, Sharareh; Azari, Hassan; Ganji, Sarah; Zand, Ramin

    2016-01-01

    Stroke is one of the leading causes of morbidity and mortality in developed countries and an immense amount of medical care resources are devoted to combat the poststroke debilitating consequences. The key to develop effective and clinically applicable treatment methodologies is a better understanding of the pathophysiology of the disease, including the root causes and targets for pharmacology. Developing these foundations requires the use of standard animal models that mimic the physicochemical process of the diseases that can reliably replicate results in order to test and fine-tune therapeutic modalities. Middle cerebral artery occlusion (MCAO), endothelin-1-induced ischemic stroke, photothrombosis, devascularization, embolization, and spontaneous infarction using hemorrhage are some examples of different animal models. Reliability of MCAO has been proved and due to the ability to induce reperfusion similar to tissue plasminogen activator (tPA) therapy, this model is widely used in preclinical studies. Here, we describe a detailed methodology on how to develop MCAO stroke in rodents using intra-arterial insertion of filament to occlude the middle cerebral artery. This approach allows for the study of a wide array of basic pathophysiology mechanisms, regenerative medicine and rehabilitation therapy. PMID:26958146

  12. Cognitive impairment and neurovascular function in patients with severe steno-occlusive disease of a main cerebral artery.

    PubMed

    Ishikawa, Mami; Saito, Haruna; Yamaguro, Tomotaka; Ikoda, Masashi; Ebihara, Akira; Kusaka, Gen; Tanaka, Yuichi

    2016-02-15

    Patients with severe steno-occlusive disease of a main cerebral artery may demonstrate cognitive impairment without identification of causative lesions on magnetic resonance imaging. We investigated whether cognitive impairment in these patients is associated with regional cerebral blood flow (rCBF), leukoaraiosis, risk factors of atherosclerosis and cerebrovascular reserve (CVR), which shows so-called clinical neurovascular function. In 65 patients with severe steno-occlusive disease of an internal carotid artery or a middle cerebral artery (MCA) and no cerebral infarction (CI), we examined cognitive function with COGNISTAT, grades of leukoaraiosis, and CBF and CVR as calculated by iodine-123-N-isopropyl-p-iodoamphetamine single photon emission computed tomography and blood data. We compared such values of the left and right sided diseases. rCBF and CVR on the affected side were compared to other side. Logistic regression analysis revealed that CVR correlated with cognitive impairment. There was no significant difference in rCBF, CVR, or COGNISTAT score when comparing the left and right sided diseases. There were good correlations between CBF or CVR of the ipsilateral MCA area and ipsilateral and contralateral other areas. Cognitive impairment is associated with CVR in the whole brain. Nonselective widespread neurovascular mild dysfunction can be a reason for cognitive impairment in patients with severe steno-occlusive disease of a main cerebral artery and no CI. Copyright © 2015 Elsevier B.V. All rights reserved.

  13. Krypton laser-induced photothrombotic distal middle cerebral artery occlusion without craniectomy in mice.

    PubMed

    Sugimori, Hiroshi; Yao, Hiroshi; Ooboshi, Hiroaki; Ibayashi, Setsuro; Iida, Mitsuo

    2004-08-01

    Recent advances in genetical engineering of the mouse have highlighted the importance of reproducible and less invasive models of cerebral ischemia in mice. In this paper, we developed minimally invasive and reproducible model of distal middle cerebral artery (MCA) occlusion in mice using krypton (Kr) laser-induced photothrombosis. C57BL/6 or BALB mice (n=8 each) were anesthetized with halothane. The skin was cut, the temporal muscle was retracted, and the right distal MCA was observed through the skull. A Kr laser beam of wavelength 568 nm was focused onto the MCA over the intact skull. Upon laser irradiation, intravenous administration of a rose bengal solution was begun. After 4 min of irradiation, the laser beam was refocused on the MCA just proximal to the first spot, and another 4-min irradiation was performed. Then, the right common carotid artery (CCA) was ligated. Three days later, the brain was removed, and infarct volume was determined. Infarction confined almost solely to the cortical area was produced in each mouse. Mean infarct volume in C57BL/6 mice was 25.2+/-13.7 mm3. The BALB mice group showed significantly larger and more reproducible infarction (44.1+/-5.2 mm3; the coefficient of variation was 12%) than did C57BL/6 mice (P<0.005). Our photothrombosis model of stroke in mice can be performed without craniectomy, and its reproducibility is satisfactory when using BALB mice.

  14. Extracerebral Tissue Damage in the Intraluminal Filament Mouse Model of Middle Cerebral Artery Occlusion

    PubMed Central

    Vaas, Markus; Ni, Ruiqing; Rudin, Markus; Kipar, Anja; Klohs, Jan

    2017-01-01

    Middle cerebral artery occlusion is the most common model of focal cerebral ischemia in the mouse. In the surgical procedure, the external carotid artery (ECA) is ligated; however, its effect on the tissue supplied by the vessel has not been described so far. C57BL/6 mice underwent 1 h of transient MCAO (tMCAO) or sham surgery. Multi-spectral optoacoustic tomography was employed at 30 min after surgery to assess oxygenation in the temporal muscles. Microstructural changes were assessed with magnetic resonance imaging and histological examination at 24 h and 48 h after surgery. Ligation of the ECA resulted in decreased oxygenation of the left temporal muscle in most sham-operated and tMCAO animals. Susceptible mice of both groups exhibited increased T2 relaxation times in the affected muscle with histological evidence of myofibre degeneration, interstitial edema, and neutrophil influx. Ligatures had induced an extensive neutrophil-dominated inflammatory response. ECA ligation leads to distinct hypoxic degenerative changes in the tissue of the ECA territory and to ligature-induced inflammatory processes. An impact on outcome needs to be considered in this stroke model. PMID:28348545

  15. Malignant infarction in cats after prolonged middle cerebral artery occlusion: glutamate elevation related to decrease of cerebral perfusion pressure.

    PubMed

    Toyota, Shingo; Graf, Rudolf; Valentino, Mario; Yoshimine, Toshiki; Heiss, Wolf-Dieter

    2002-05-01

    To study the putative role and predictive significance of glutamate elevation in space-occupying ischemic stroke, we investigated the correlation between perfusional disturbances and glutamate alterations in a transient ischemia model in cats that is susceptible to secondary deterioration after reperfusion. In 10 halothane-anesthetized cats, the left middle cerebral artery was occluded for 3 hours, followed by 6 hours of reperfusion. Laser-Doppler flowmetry (LDF) probes, microdialysis/high-performance liquid chromatography, and pressure sensors measured simultaneously regional cerebral blood flow (CBF), extracellular amino acids, mean arterial blood pressure, and intracranial pressure, respectively. Cerebral perfusion pressure (CPP) was calculated. In complementary experiments (n=2), regional CBF was assessed by sequential positron emission tomography. Middle cerebral artery occlusion reduced LDF-measured CBF in all animals to <25% of control. In 5 of 10 cats, glutamate rose approximately 30-fold during ischemia. LDF-measured CBF and glutamate primarily recovered after reperfusion. Glutamate rose again in the late reperfusion phase, when CPP decreased to <60 mm Hg, and symptoms of transtentorial herniation were recognized. Positron emission tomography revealed ischemic thresholds of 15 to 20 mL/100 g per minute for secondary deterioration. In the other 5 cats, ischemic elevation of glutamate was significantly smaller, and signs of secondary deterioration were not recognized. Glutamate determinations during ischemia predict fatal outcome, as do intracranial pressure and CPP measurements during early reperfusion. Secondary amino acid elevation during reperfusion is presumably caused by a drastic decrease of CPP to <50 mm Hg in the final stage of space-occupying, malignant focal ischemia. At this stage, a further progression of injury due to increased glutamate may be irrelevant with respect to fatal outcome.

  16. Screen-imaging guidance using a modified portable video macroscope for middle cerebral artery occlusion.

    PubMed

    Zhu, Xingbao; Luo, Junli; Liu, Yun; Chen, Guolong; Liu, Song; Ruan, Qiangjin; Deng, Xunding; Wang, Dianchun; Fan, Quanshui; Pan, Xinghua

    2012-04-25

    The use of operating microscopes is limited by the focal length. Surgeons using these instruments cannot simultaneously view and access the surgical field and must choose one or the other. The longer focal length (more than 1 000 mm) of an operating telescope permits a position away from the operating field, above the surgeon and out of the field of view. This gives the telescope an advantage over an operating microscope. We developed a telescopic system using screen-imaging guidance and a modified portable video macroscope constructed from a Computar MLH-10 × macro lens, a DFK-21AU04 USB CCD Camera and a Dell laptop computer as monitor screen. This system was used to establish a middle cerebral artery occlusion model in rats. Results showed that magnification of the modified portable video macroscope was appropriate (5-20 ×) even though the Computar MLH-10 × macro lens was placed 800 mm away from the operating field rather than at the specified working distance of 152.4 mm with a zoom of 1-40 ×. The screen-imaging telescopic technique was clear, life-like, stereoscopic and matched the actual operation. Screen-imaging guidance led to an accurate, smooth, minimally invasive and comparatively easy surgical procedure. Success rate of the model establishment evaluated by neurological function using the modified neurological score system was 74.07%. There was no significant difference in model establishment time, sensorimotor deficit and infarct volume percentage. Our findings indicate that the telescopic lens is effective in the screen surgical operation mode referred to as "long distance observation and short distance operation" and that screen-imaging guidance using an modified portable video macroscope can be utilized for the establishment of a middle cerebral artery occlusion model and micro-neurosurgery.

  17. External carotid artery angioplasty and stenting to augment cerebral perfusion in the setting of subacute symptomatic ipsilateral internal carotid artery occlusion. Case report.

    PubMed

    Adel, Joseph G; Bendok, Bernard R; Hage, Ziad A; Naidech, Andrew M; Miller, Jeffery W; Batjer, H Hunt

    2007-12-01

    The authors performed external carotid artery (ECA) angioplasty and stenting in a 45-year-old man who had presented with right hemispheric crescendo ischemic symptoms stemming from acute right internal carotid artery occlusion (ICAO). This unique application of ECA angioplasty and stenting augmented cerebral perfusion and improved clinical symptoms. In certain situations, ECA stenting can increase cerebral perfusion in the setting of ICAO and ECA stenosis. The authors are the first to describe this approach in this context.

  18. Early retinal inflammatory biomarkers in the middle cerebral artery occlusion model of ischemic stroke.

    PubMed

    Ritzel, Rodney M; Pan, Sarah J; Verma, Rajkumar; Wizeman, John; Crapser, Joshua; Patel, Anita R; Lieberman, Richard; Mohan, Royce; McCullough, Louise D

    2016-01-01

    The transient middle cerebral artery occlusion (MCAO) model of stroke is one of the most commonly used models to study focal cerebral ischemia. This procedure also results in the simultaneous occlusion of the ophthalmic artery that supplies the retina. Retinal cell death is seen days after reperfusion and leads to functional deficits; however, the mechanism responsible for this injury has not been investigated. Given that the eye may have a unique ocular immune response to an ischemic challenge, this study examined the inflammatory response to retinal ischemia in the MCAO model. Young male C57B/6 mice were subjected to 90-min transient MCAO and were euthanized at several time points up to 7 days. Transcription of inflammatory cytokines was measured with quantitative real-time PCR, and immune cell activation (e.g., phagocytosis) and migration were assessed with ophthalmoscopy and flow cytometry. Observation of the affected eye revealed symptoms consistent with Horner's syndrome. Light ophthalmoscopy confirmed the reduced blood flow of the retinal arteries during occlusion. CX3CR1-GFP reporter mice were then employed to evaluate the extent of the ocular microglia and monocyte activation. A significant increase in green fluorescent protein (GFP)-positive macrophages was seen throughout the ischemic area compared to the sham and contralateral control eyes. RT-PCR revealed enhanced expression of the monocyte chemotactic molecule CCL2 early after reperfusion followed by a delayed increase in the proinflammatory cytokine TNF-α. Further analysis of peripheral leukocyte recruitment by flow cytometry determined that monocytes and neutrophils were the predominant immune cells to infiltrate at 72 h. A transient reduction in retinal microglia numbers was also observed, demonstrating the ischemic sensitivity of these cells. Blood-eye barrier permeability to small and large tracer molecules was increased by 72 h. Retinal microglia exhibited enhanced phagocytic activity following

  19. Early retinal inflammatory biomarkers in the middle cerebral artery occlusion model of ischemic stroke

    PubMed Central

    Ritzel, Rodney M.; Pan, Sarah J.; Verma, Rajkumar; Wizeman, John; Crapser, Joshua; Patel, Anita R.; Lieberman, Richard; Mohan, Royce

    2016-01-01

    Purpose The transient middle cerebral artery occlusion (MCAO) model of stroke is one of the most commonly used models to study focal cerebral ischemia. This procedure also results in the simultaneous occlusion of the ophthalmic artery that supplies the retina. Retinal cell death is seen days after reperfusion and leads to functional deficits; however, the mechanism responsible for this injury has not been investigated. Given that the eye may have a unique ocular immune response to an ischemic challenge, this study examined the inflammatory response to retinal ischemia in the MCAO model. Methods Young male C57B/6 mice were subjected to 90-min transient MCAO and were euthanized at several time points up to 7 days. Transcription of inflammatory cytokines was measured with quantitative real-time PCR, and immune cell activation (e.g., phagocytosis) and migration were assessed with ophthalmoscopy and flow cytometry. Results Observation of the affected eye revealed symptoms consistent with Horner’s syndrome. Light ophthalmoscopy confirmed the reduced blood flow of the retinal arteries during occlusion. CX3CR1-GFP reporter mice were then employed to evaluate the extent of the ocular microglia and monocyte activation. A significant increase in green fluorescent protein (GFP)-positive macrophages was seen throughout the ischemic area compared to the sham and contralateral control eyes. RT–PCR revealed enhanced expression of the monocyte chemotactic molecule CCL2 early after reperfusion followed by a delayed increase in the proinflammatory cytokine TNF-α. Further analysis of peripheral leukocyte recruitment by flow cytometry determined that monocytes and neutrophils were the predominant immune cells to infiltrate at 72 h. A transient reduction in retinal microglia numbers was also observed, demonstrating the ischemic sensitivity of these cells. Blood–eye barrier permeability to small and large tracer molecules was increased by 72 h. Retinal microglia exhibited enhanced

  20. Mapping the dynamics of brain perfusion using functional ultrasound in a rat model of transient middle cerebral artery occlusion.

    PubMed

    Brunner, Clément; Isabel, Clothilde; Martin, Abraham; Dussaux, Clara; Savoye, Anne; Emmrich, Julius; Montaldo, Gabriel; Mas, Jean-Louis; Baron, Jean-Claude; Urban, Alan

    2017-01-01

    Following middle cerebral artery occlusion, tissue outcome ranges from normal to infarcted depending on depth and duration of hypoperfusion as well as occurrence and efficiency of reperfusion. However, the precise time course of these changes in relation to tissue and behavioral outcome remains unsettled. To address these issues, a three-dimensional wide field-of-view and real-time quantitative functional imaging technique able to map perfusion in the rodent brain would be desirable. Here, we applied functional ultrasound imaging, a novel approach to map relative cerebral blood volume without contrast agent, in a rat model of brief proximal transient middle cerebral artery occlusion to assess perfusion in penetrating arterioles and venules acutely and over six days thanks to a thinned-skull preparation. Functional ultrasound imaging efficiently mapped the acute changes in relative cerebral blood volume during occlusion and following reperfusion with high spatial resolution (100 µm), notably documenting marked focal decreases during occlusion, and was able to chart the fine dynamics of tissue reperfusion (rate: one frame/5 s) in the individual rat. No behavioral and only mild post-mortem immunofluorescence changes were observed. Our study suggests functional ultrasound is a particularly well-adapted imaging technique to study cerebral perfusion in acute experimental stroke longitudinally from the hyper-acute up to the chronic stage in the same subject.

  1. A novel embolic middle cerebral artery occlusion model induced by thrombus formed in common carotid artery in rat.

    PubMed

    Ma, Yin-Zhong; Li, Li; Song, Jun-Ke; Niu, Zi-Ran; Liu, Hai-Feng; Zhou, Xiang-Shan; Xie, Fu-Sheng; Du, Guan-Hua

    2015-12-15

    Stroke is a major cause of death and disability worldwide. However, treatment options to date are very limited. To meet the need for validating the novel therapeutic approaches and understanding the physiopathology of the ischemic brain injury, experimental stroke models were critical for preclinical research. However, commonly used embolic stroke models are reluctant to mimic the clinical situation and not suitable for thrombolytic timing studies. In this paper, we established a standard method for producing a rat embolic stroke model with autologous thrombus formed within the common carotid artery (CCA) by constant galvanic stimulation. Then the thrombus was shattered and channeled into the origin of the MCA and small (lacunar) artery. To identify the success of MCA occlusion, regional cerebral blood flow was monitored, neurological deficits and infarct volumes were measured at 2, 4 and 6h postischemia. This model developed a predictable infarct volume (38.37 ± 2.88%) and gradually reduced blood flow (20% of preischemic baselines) within the middle cerebral artery (MCA) territory. The thrombus occluded in the MCA was able to be lysed by a tissue-type plasminogen activator (t-PA) within 4h postischemia. The techniques presented in this paper would help investigators to overcome technical problems for stroke research.

  2. Combined use of stent angioplasty and mechanical thrombectomy for acute tandem internal carotid and middle cerebral artery occlusion

    PubMed Central

    Gao, Feng; Joyce Lo, WaiTing; Sun, Xuan; Xu, XiaoTong

    2015-01-01

    Purpose Tandem internal carotid and middle cerebral artery occlusion carries a grave prognosis, with intravenous and intra-arterial thrombolytics having low efficacy. Currently, endovascular therapy is a promising means for treatment in which the proximal carotid lesion can be treated with angioplasty and stenting, whilst mechanical thrombectomy can be used for the treatment of the distal occlusion. Two approaches can be used – the antegrade (proximal-to-distal) approach or the retrograde (distal-to-proximal) approach, although there has not yet been any consensus on which is the better approach. Case report We present two patients with tandem occlusions, one treated using the antegrade and one using the retrograde approach, with different revascularization outcomes, despite having similar functional outcome on follow-up. Conclusion The combined use of stent angioplasty and mechanical thrombectomy can be used to treat tandem occlusions, and with procedural modifications, the antegrade approach may more easily achieve technical success. PMID:26246102

  3. Impaired motor activity and motor learning function in rat with middle cerebral artery occlusion.

    PubMed

    Ding, Yuchuan; Zhou, Yandong; Lai, Qin; Li, Jie; Park, Hun; Diaz, Fernando G

    2002-04-15

    The poor quality of life after a stroke is largely attributed to deficits in cognitive-motor functioning. The goals of this study were to detect if damaged motor learning function were attributed to motor deficits in rats following a transient middle cerebral artery (MCA) occlusion. Stroke was induced by a 2-h occlusion of the MCA using an intraluminal filament. Motor functions were evaluated from 5 up to 28 days after reperfusion in ischemic and control rats. Motor function was detected by a series of motor tests (runway traversing and beam balancing, as well as foot fault placing, parallel bar crossing, rope and ladder climbing), and motor learning behavior was determined by analyzing the rate of improvement of impaired function during performance of the motor tasks. Significant (P<0.001) motor deficits were detected in the stroke group (n=10) while performing motor tasks that involve extensive coordination, in comparison to the controls (n=12). Although motor behavior was improved with repeated behavior testing, unparalleled rate of improvement of motor performance on rope and ladder climbing tests was found between the two groups, suggesting an impaired motor learning function. Brain tissue damage was detected in the ischemic animals 28 days after surgery, demonstrated by 40% infarct volume of contralateral hemisphere. Both motor learning and motor function were impaired in ischemic rats. The motor tests used in this study are sensitive, semi-quantitative, and reproducible measurements of functional impairment in rats following an ischemic stroke.

  4. The transient intraluminal filament middle cerebral artery occlusion model as a model of endovascular thrombectomy in stroke.

    PubMed

    Sutherland, Brad A; Neuhaus, Ain A; Couch, Yvonne; Balami, Joyce S; DeLuca, Gabriele C; Hadley, Gina; Harris, Scarlett L; Grey, Adam N; Buchan, Alastair M

    2016-02-01

    The clinical relevance of the transient intraluminal filament model of middle cerebral artery occlusion (tMCAO) has been questioned due to distinct cerebral blood flow profiles upon reperfusion between tMCAO (abrupt reperfusion) and alteplase treatment (gradual reperfusion), resulting in differing pathophysiologies. Positive results from recent endovascular thrombectomy trials, where the occluding clot is mechanically removed, could revolutionize stroke treatment. The rapid cerebral blood flow restoration in both tMCAO and endovascular thrombectomy provides clinical relevance for this pre-clinical model. Any future clinical trials of neuroprotective agents as adjuncts to endovascular thrombectomy should consider tMCAO as the model of choice to determine pre-clinical efficacy.

  5. The Effect of Photoluminescence of Bioceramic Irradiation on Middle Cerebral Arterial Occlusion in Rats

    PubMed Central

    Zhang, Lei; Chan, Paul; Liu, Zhong-Min; Hwang, Ling-Ling; Lin, Kuo-Chi; Chan, Wing P.; Leung, Ting-Kai; Choy, Cheuk Sing

    2016-01-01

    The purpose of this study is to determine the possible effect of photoluminescence of bioceramic (PLB) on ischemic cerebral infarction (stroke), by using an animal model of transient middle cerebral artery occlusion (MCAO). Sprague-Dawley rats were used to induce MCAO to block the origin of the left MCAO; three months later, the positive chronic stroke rats were selected by running tunnel maze; the MCAO rats with significant chronic stroke and neurological defects were used for treadmill experiments with varying speed settings to test their capability for restoration after muscular fatigue under conditions of with and without PLB irradiation. As a result, PLB irradiation could improve exercise completion rate and average running speed during slow and fast treadmill settings. After PLB irradiation, the selected MCAO rats successfully completed all the second-round treadmill exercises at the maximum speed setting, and they had better restoration from muscular fatigue. An in vitro cell study on astrocytes of rats by bioceramic irradiation further demonstrated increased intracellular nitric oxide. To explain these results, we suggest that cortical brain stimulation of microcirculation and enhancement of peripheral muscular activity are the main causes of the improved exercise performance in MCAO rats by PLB. PMID:27375765

  6. The Effect of Photoluminescence of Bioceramic Irradiation on Middle Cerebral Arterial Occlusion in Rats.

    PubMed

    Zhang, Lei; Chan, Paul; Liu, Zhong-Min; Hwang, Ling-Ling; Lin, Kuo-Chi; Chan, Wing P; Leung, Ting-Kai; Choy, Cheuk Sing

    2016-01-01

    The purpose of this study is to determine the possible effect of photoluminescence of bioceramic (PLB) on ischemic cerebral infarction (stroke), by using an animal model of transient middle cerebral artery occlusion (MCAO). Sprague-Dawley rats were used to induce MCAO to block the origin of the left MCAO; three months later, the positive chronic stroke rats were selected by running tunnel maze; the MCAO rats with significant chronic stroke and neurological defects were used for treadmill experiments with varying speed settings to test their capability for restoration after muscular fatigue under conditions of with and without PLB irradiation. As a result, PLB irradiation could improve exercise completion rate and average running speed during slow and fast treadmill settings. After PLB irradiation, the selected MCAO rats successfully completed all the second-round treadmill exercises at the maximum speed setting, and they had better restoration from muscular fatigue. An in vitro cell study on astrocytes of rats by bioceramic irradiation further demonstrated increased intracellular nitric oxide. To explain these results, we suggest that cortical brain stimulation of microcirculation and enhancement of peripheral muscular activity are the main causes of the improved exercise performance in MCAO rats by PLB.

  7. Blockage of transient receptor potential vanilloid 4 inhibits brain edema in middle cerebral artery occlusion mice.

    PubMed

    Jie, Pinghui; Tian, Yujing; Hong, Zhiwen; Li, Lin; Zhou, Libin; Chen, Lei; Chen, Ling

    2015-01-01

    Brain edema is an important pathological process during stroke. Activation of transient receptor potential vanilloid 4 (TRPV4) causes an up-regulation of matrix metalloproteinases (MMPs) in lung tissue. MMP can digest the endothelial basal lamina to destroy blood brain barrier, leading to vasogenic brain edema. Herein, we tested whether TRPV4-blockage could inhibit brain edema through inhibiting MMPs in middle cerebral artery occlusion (MCAO) mice. We found that the brain water content and Evans blue extravasation at 48 h post-MCAO were reduced by a TRPV4 antagonist HC-067047. The increased MMP-2/9 protein expression in hippocampi of MCAO mice was attenuated by HC-067046, but only the increased MMP-9 activity was blocked by HC-067047. The loss of zonula occludens-1 (ZO-1) and occludin protein in MCAO mice was also attenuated by HC-067047. Moreover, MMP-2/9 protein expression increased in mice treated with a TRPV4 agonist GSK1016790A, but only MMP-9 activity was increased by GSK1016790A. Finally, ZO-1 and occludin protein expression was decreased by GSK1016790A, which was reversed by an MMP-9 inhibitor. We conclude that blockage of TRPV4 may inhibit brain edema in cerebral ischemia through inhibiting MMP-9 activation and the loss of tight junction protein.

  8. Lipocalin-2 deficiency attenuates neuroinflammation and brain injury after transient middle cerebral artery occlusion in mice.

    PubMed

    Jin, Myungwon; Kim, Jong-Heon; Jang, Eunha; Lee, Young Mi; Soo Han, Hyung; Woo, Dong Kyun; Park, Dong Ho; Kook, Hyun; Suk, Kyoungho

    2014-08-01

    Lipocalin-2 (LCN2) is a secreted protein of the lipocalin family, but little is known about the expression or the role of LCN2 in the central nervous system. Here, we investigated the role of LCN2 in ischemic stroke using a rodent model of transient cerebral ischemia. Lipocalin-2 expression was highly induced in the ischemic brain and peaked at 24 hours after reperfusion. After transient middle cerebral artery occlusion, LCN2 was predominantly expressed in astrocytes and endothelial cells, whereas its receptor (24p3R) was mainly detected in neurons, astrocytes, and endothelial cells. Brain infarct volumes, neurologic scores, blood-brain barrier (BBB) permeabilities, glial activation, and inflammatory mediator expression were significantly lower in LCN2-deficient mice than in wild-type animals. Lipocalin-2 deficiency also attenuated glial neurotoxicity in astrocyte/neuron cocultures after oxygen-glucose deprivation. Our results indicate LCN2 has a critical role in brain injury after ischemia/reperfusion, and that LCN2 may contribute to neuronal cell death in the ischemic brain by promoting neurotoxic glial activation, neuroinflammation, and BBB disruption.

  9. Effect of mastication on functional recoveries after permanent middle cerebral artery occlusion in rats.

    PubMed

    Kawanishi, Katsuya; Koshino, Hisashi; Toyoshita, Yoshifumi; Tanaka, Maki; Hirai, Toshihiro

    2010-01-01

    We evaluated whether solid feed is more effective for functional recoveries than liquid feed in rats with ischemic brain injury after permanent middle cerebral artery occlusion (MCAO). A total of 36 male Wistar/ST rats were subjected to MCAO or sham surgery. After MCAO or sham surgery, all rats were provided liquid feed for 14 days. Then, all rats were divided into 3 groups: the solid feeding group, the liquid feeding group, and the solid feeding group of sham. Effect of mastication on functional recoveries after permanent MCAO in rats was evaluated by the limb placement test and Morris water maze (MWM) task. After surgery, limb placement test scores were equal in both MCAO groups. In the acquisition trials of MWM task, statistically significant differences in escape latency were observed between the liquid feeding group and sham groups at all days, and between the solid feeding group and sham groups at days 3 and 4 of the trials. In the probe trial, statistically significant differences in time spent were observed between the liquid feeding group and sham group. On day 5 of acquisition trials, the time spent in the periphery of the pool in MWM task was significantly different among the 3 groups. This study suggested that solid diet mastication could be effective for the rehabilitation of sensorimotor and learning/memory dysfunction induced by cerebral infarction. Copyright (c) 2010 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  10. Tirofiban combined with urokinase selective intra-arterial thrombolysis for the treatment of middle cerebral artery occlusion

    PubMed Central

    FENG, LEI; LIU, JUN; LIU, YUNZHEN; CHEN, JIAN; SU, CHUNHAI; LV, CHUANFENG; WEI, YUZHEN

    2016-01-01

    The aims of the present study were to establish a model of embolic stroke in rabbits and to evaluate the efficacy and safety of intra-arterially administered tirofiban combined with urokinase thrombolysis. The middle cerebral artery occlusion model (MCAO) of embolic stroke was established in New Zealand rabbits via an autologous clot. The model rabbits were allocated at random into four groups: Tirofiban group (T group), urokinase group (UK group), tirofiban and urokinase group (T + UK group) and the control group (C group). The recanalization rate, relative-apparent diffusion coefficient (rADC) and neurological function deficit score (NFDS) values were compared among the four groups. The recanalization rate, rADC and NFDS values were improved in the T + UK group compared with the other groups. In summary, the intra-arterial administration of tirofiban combined with urokinase thrombolysis was a more effective intervention in an MCAO model compared with intra-arterial urokinase alone, and may promote reperfusion and reduce infarct volume. PMID:26998029

  11. Cerebral ischemia symptoms in carotid artery occlusion: role of hemodynamic factors.

    PubMed

    Norrving, B; Nilsson, B; Cronquist, S

    1981-01-01

    The acute outcome in 59 patients with carotid artery occlusion was studied and related to the angiographic pattern of collateral flow. No patient with TIA only had retrograde ophthalmic artery flow, although such a pattern was found in 50 percent of patients with stroke. In a follow-up study (mean 48 months), the same distribution of the collateral pattern was found on ultrasonic Doppler examination. The absence of substantial retrograde ophthalmic flow was associated with an increased contralateral carotid flow. The findings show that the efficiency of the collateral pathways, mainly the contralateral carotid artery and the circle of Willis, largely determines the outcome of carotid artery occlusion.

  12. Hemodynamic changes in a rat parietal cortex after endothelin-1-induced middle cerebral artery occlusion monitored by optical coherence tomography

    NASA Astrophysics Data System (ADS)

    Liu, Jian; Ma, Yushu; Dou, Shidan; Wang, Yi; La, Dongsheng; Liu, Jianghong; Ma, Zhenhe

    2016-07-01

    A blockage of the middle cerebral artery (MCA) on the cortical branch will seriously affect the blood supply of the cerebral cortex. Real-time monitoring of MCA hemodynamic parameters is critical for therapy and rehabilitation. Optical coherence tomography (OCT) is a powerful imaging modality that can produce not only structural images but also functional information on the tissue. We use OCT to detect hemodynamic changes after MCA branch occlusion. We injected a selected dose of endothelin-1 (ET-1) at a depth of 1 mm near the MCA and let the blood vessels follow a process first of occlusion and then of slow reperfusion as realistically as possible to simulate local cerebral ischemia. During this period, we used optical microangiography and Doppler OCT to obtain multiple hemodynamic MCA parameters. The change trend of these parameters from before to after ET-1 injection clearly reflects the dynamic regularity of the MCA. These results show the mechanism of the cerebral ischemia-reperfusion process after a transient middle cerebral artery occlusion and confirm that OCT can be used to monitor hemodynamic parameters.

  13. Neuroprotection by pyrroloquinoline quinone (PQQ) in reversible middle cerebral artery occlusion in the adult rat.

    PubMed

    Zhang, Yonghua; Feustel, Paul J; Kimelberg, Harold K

    2006-06-13

    Pyrroloquinoline quinone (PQQ) is a naturally occurring redox cofactor that acts as an essential nutrient, antioxidant, and redox modulator. It has previously been reported to reduce infarct size in 7-day-old rat pups with an in vivo cerebral hypoxia/ischemia model (Jensen et al., 1994). In this study, we tested whether improvement is found in both behavioral measures of protection and by histological measures of infarcted tissue at 72 h after reversible middle cerebral artery occlusion (rMCAo) in adult rats. Two-hour rMCAo was induced in adult rats using the intraluminal suture technique. PQQ (10, 3, and 1 mg/kg) was given once by intravenous injection at the initiation, or 3 h after the initiation, of 2 h rMCAo. Neurobehavioral deficits were evaluated daily for 3 days followed by infarct volumes measurements by 2,3,5-triphenyltetrazolium chloride (TTC) staining. PQQ at 10 mg/kg infused at the initiation, or 3 h after the initiation, of rMCAo was effective in reducing cerebral infarct volumes measured 72 h later. At 3 h after ischemia, a dose of 3 mg/kg significantly reduced infarct volume compared to vehicle-treated animals, but 1 mg/kg was ineffective. Neurobehavioral scores were also significantly better in the PQQ-treated group compared to the vehicle controls when PQQ was given at 10 and 3 mg/kg, but not at 1 mg/kg. Thus, PQQ is neuroprotective when given as a single administration at least 3 h after initiation of rMCAo. These data indicate that PQQ may be a useful neuroprotectant in stroke therapy.

  14. Emergency Extracranial-to-Intracranial Bypass after Thromboembolic Occlusion of the Middle Cerebral Artery Following GDC Embolization of a Ruptured ACoA Aneurysm

    PubMed Central

    Standhardt, H.; Gruber, A.; Ferraz-Leite, H.; Bavinzski, G.

    2004-01-01

    Summary We report a case of thromboembolic occlusion of the middle cerebral artery after endovascular treatment of a ruptured anterior communicating artery aneurysm. When fibrinolytic therapy failed to recanalize the occluded vessel, an emergency extracranial-to-intracranial bypass was performed. This intervention rescued our patient from cerebral infarction. This case demonstrates the importance of the offering this procedure at neurointerventional centers. PMID:20587239

  15. Repeated edaravone treatment reduces oxidative cell damage in rat brain induced by middle cerebral artery occlusion.

    PubMed

    Yamamoto, Yorihiro; Yanagisawa, Makoto; Tak, Nyou Wei; Watanabe, Kazutoshi; Takahashi, Chizuko; Fujisawa, Akio; Kashiba, Misato; Tanaka, Masahiko

    2009-01-01

    The free radical scavenger 3-methyl-1-phenyl-2-pyrazolin-5-one (edaravone) has been used to treat acute brain infarction in Japan since 2001. To obtain direct evidence that edaravone serves as an antioxidant in vivo, four groups of rats were prepared: (i) an ischemia/reperfusion (I/R) group receiving 2 h occlusion-reperfusion of the middle cerebral artery; (ii) a single administration group treated by intravenous infusion of edaravone (3 mg/kg) immediately after I/R; (iii) a repeated treatment group receiving twice daily edaravone administration for 14 days; and (iv) a sham operation group without occlusion. Repeated treatment with edaravone significantly improved the neurological symptoms and impairment of motor function as compared to the I/R group, while single administration demonstrated limited efficacy. No significant differences in plasma antioxidants such as ascorbate, urate, and vitamin E, or in redox status of coenzyme Q(9) were observed among the four groups. In contrast, the plasma content of oleic acid in the total free fatty acids (percentage 18:1) was significantly increased in the I/R group for 7 days as compared to the sham operation group. Oleic acid was produced from stearic acid by the action of stearoyl-CoA desaturase to compensate for the oxidative loss of polyunsaturated fatty acids. The above results suggest that cellular oxidative damage in the rat brain is evident for at least 7 days after I/R. Repeated treatment suppressed the percentage 18:1 increment, while the single administration did not, which is consistent with the limited efficacy of single administration.

  16. Cerebroprotective Effect of Moringa oleifera against Focal Ischemic Stroke Induced by Middle Cerebral Artery Occlusion

    PubMed Central

    Wattanathorn, Jintanaporn; Tong-Un, Terdthai; Muchimapura, Supaporn; Wannanon, Panakaporn; Jittiwat, Jinatta

    2013-01-01

    The protection against ischemic stroke is still required due to the limitation of therapeutic efficacy. Based on the role of oxidative stress in stroke pathophysiology, we determined whether Moringa oleifera, a plant possessing potent antioxidant activity, protected against brain damage and oxidative stress in animal model of focal stroke. M. oleifera leaves extract at doses of 100, 200 and 400 mg·kg−1 was orally given to male Wistar rats (300–350 g) once daily at a period of 2 weeks before the occlusion of right middle cerebral artery (Rt.MCAO) and 3 weeks after Rt.MCAO. The determinations of neurological score and temperature sensation were performed every 7 days throughout the study period, while the determinations of brain infarction volume, MDA level, and the activities of SOD, CAT, and GSH-Px were performed 24 hr after Rt.MCAO. The results showed that all doses of extract decreased infarction volume in both cortex and subcortex. The protective effect of medium and low doses of extract in all areas occurred mainly via the decreased oxidative stress. The protective effect of the high dose extract in striatum and hippocampus occurred via the same mechanism, whereas other mechanisms might play a crucial role in cortex. The detailed mechanism required further exploration. PMID:24367723

  17. Neurological sequelae and long-term behavioural assessment of rats with transient middle cerebral artery occlusion.

    PubMed

    Modo, M; Stroemer, R P; Tang, E; Veizovic, T; Sowniski, P; Hodges, H

    2000-12-15

    Animal models of stroke, notably transient middle cerebral artery occlusion (MCAo), are used to assess the efficacy of pharmacological and transplant treatments. Long-term studies (>1 month) of the functional effects of treatments in animal models are required to predict treatments likely to improve dysfunctions associated with stroke damage. These pre-clinical studies require (1) optimum post-operative care to ensure long-term survival, (2) methods for assignment of rats to groups with equivalent impairments to reduce variability and enhance detection of treatment effects, and (3) behavioural tests that detect long-term stable deficits. For long-term functional assessment, a battery of behavioural tests sensitive to a range of deficits observed after MCAo was developed. The bilateral asymmetry test evaluated the time course of sensory neglect. Deficits of motor integration were examined in the footfault test, and motor bias was assessed by pharmacological stimulation of rotation. The water maze was used to detect long-term deficits in spatial information processing. Long-term differences between control and MCAo animals in this battery of tests indicate that the protocol provides an efficient assessment suitable for evaluating treatment outcomes in pre-clinical studies of stroke, and that the post-operative care procedure and method of assignment to groups were effective.

  18. Accumulation of exogenous 45Ca after middle cerebral artery occlusion in rats.

    PubMed

    Tomabechi, M; Sako, K; Yonemasu, Y

    1994-02-01

    The distribution of exogenous 45Ca in the focal ischemia rat model (middle cerebral artery occlusion) was studied using 45Ca autoradiography. High 45Ca accumulations were observed in the frontal cortex and caudate-putamen corresponding with morphological damage shown by HE staining. Regional 45Ca concentrations were calculated from the optical density on the 45Ca autoradiograms. Rapid uptake of 45Ca in the ischemic brain occurred during the first 5 hours, and continued more slowly between 5 and 24 hours after ischemia. The area of 45Ca accumulation was also expanded between 5 and 24 hours. An area of low 45Ca concentration around the area of high accumulation developed 5 hours after ischemia, which presumably accumulated 45Ca between 5 and 24 hours after ischemia. The lower concentration of 45Ca in the periphery of ischemia may result from: 1) a decrease in the total amount of calcium due to narrowing of extracellular space accompanied by cytotoxic edema, and 2) delayed accumulation of exogenous 45Ca due to reduced clearance of extracellular fluid.

  19. Cerebroprotective effect of Moringa oleifera against focal ischemic stroke induced by middle cerebral artery occlusion.

    PubMed

    Kirisattayakul, Woranan; Wattanathorn, Jintanaporn; Tong-Un, Terdthai; Muchimapura, Supaporn; Wannanon, Panakaporn; Jittiwat, Jinatta

    2013-01-01

    The protection against ischemic stroke is still required due to the limitation of therapeutic efficacy. Based on the role of oxidative stress in stroke pathophysiology, we determined whether Moringa oleifera, a plant possessing potent antioxidant activity, protected against brain damage and oxidative stress in animal model of focal stroke. M. oleifera leaves extract at doses of 100, 200 and 400 mg·kg(-1) was orally given to male Wistar rats (300-350 g) once daily at a period of 2 weeks before the occlusion of right middle cerebral artery (Rt.MCAO) and 3 weeks after Rt.MCAO. The determinations of neurological score and temperature sensation were performed every 7 days throughout the study period, while the determinations of brain infarction volume, MDA level, and the activities of SOD, CAT, and GSH-Px were performed 24 hr after Rt.MCAO. The results showed that all doses of extract decreased infarction volume in both cortex and subcortex. The protective effect of medium and low doses of extract in all areas occurred mainly via the decreased oxidative stress. The protective effect of the high dose extract in striatum and hippocampus occurred via the same mechanism, whereas other mechanisms might play a crucial role in cortex. The detailed mechanism required further exploration.

  20. Mildronate treatment improves functional recovery following middle cerebral artery occlusion in rats.

    PubMed

    Svalbe, Baiba; Zvejniece, Liga; Vavers, Edijs; Pugovics, Osvalds; Muceniece, Ruta; Liepinsh, Edgars; Dambrova, Maija

    2011-09-12

    Mildronate (3-(2,2,2-trimethylhydrazinium) propionate) is an inhibitor of l-carnitine biosynthesis and an anti-ischemic drug. In the present study, we investigated the effects of mildronate in rats following focal cerebral ischemia. Male Wistar rats were subjected to transient occlusion of the middle cerebral artery (MCAO) for 90min, followed by the intraperitoneal administration of mildronate at doses of 100 and 200mg/kg 2h after reperfusion and then daily for an additional 14days. The beam-walking, rota-rod and cylinder tests were used to assess sensorimotor function, and vibrissae-evoked forelimb-placing and limb-placing tests examined responses to tactile and proprioceptive stimulation. Following behavioural testing, the infarct volume was measured. The cerebellar concentrations of l-carnitine, γ-butyrobetaine (GBB) and mildronate were also measured. The results showed that saline-treated MCAO rats had minor or no spontaneous recovery in sensorimotor and proprioceptive function up to 14days post-stroke. Treatment with mildronate at a dose of 200mg/kg was found to accelerate recovery of motor and proprioceptive deficits in limb-placing, cylinder and beam-walking tests. Analysis of rat cerebellar tissue extracts revealed that l-carnitine and GBB concentrations changed with mildronate treatment; the concentration of l-carnitine was significantly decreased by mildronate treatment, whereas the concentration of GBB was significantly increased. Cerebellar concentrations of mildronate also increased in a dose-dependent manner following systemic administration. Infarct size did not differ among the experimental groups on post-stroke day 14. The present study suggests that mildronate treatment improves the functional outcome in MCAO rats without influencing infarct size.

  1. The Kringle-2 domain of tissue plasminogen activator significantly reduces mortality and brain infarction in middle cerebral artery occlusion rats.

    PubMed

    Zhang, Haitao; Bi, Feng; Xiao, Chunlan; Liu, Jianxia; Wang, Zhixia; Liu, Jian-Ning; Zhang, Jing

    2010-08-01

    Tissue plasminogen activator (TPA) showed brain-protective activity within the first 15 min after cerebral ischemia in rats. To understand its molecular mechanism, TPA derivates were intracerebroventricularly administered at 15 min before, and 15, 90, 120 min after middle cerebral artery occlusion (MCAO) in rats. The reduction in mortality and cerebral infarction at 24 h was seen only with TPA administered at 15 min after MCAO. The down-regulation of endogenous TPA by the intracerebroventricular injection of TPA was found to be responsible for the protective effect on the integrity of blood-brain barrier after MCAO, as well as for the reduction in mortality and cerebral infarction. Moreover, for the first time we have found that the Kringle-2 domain is essential for the brain-protective activity of TPA.

  2. [Cerebral sequelae of stenosing and occlusive diseases of the internal carotid artery. Importance of Doppler transcranial examination. Part 2].

    PubMed

    Rohr-Le Floch, J

    1991-01-01

    The author reports 57 stenosis or occlusions of the internal carotid artery, 13 dissections and 44 atheromatous lesions. She studies the correlation between intracranial collateralisation detected by transcranial Doppler sonography (TCD) and clinical symptoms as well as lesions seen on cerebral CT-scan. Two types of ischaemic lesions are described: border-zone infarcts, probably haemodynamic in origin and territorial infarcts, probably thromboembolic. TCD lets suppose that strokes in this series have a thromboembolic origin. On the other hand it is possible that collateralisation depending on both anterior and posterior communicating arteries is not sufficient, because such a collateralisation is found above all in the 2 most severe symptomatic groups and in many territorial infarcts. In the atheromatous group, occlusions are often asymptomatic and territorial infarcts less extended, whereas in the dissections group all occlusions determined a territorial infarct, often very important. TCD alone doesn't allow to definitely conclude about pathogeny of ischaemic lesions nor on collateralisation value. The adjunction of CO2 reactivity tests in middle cerebral artery will perhaps give the clues of these problems.

  3. Atorvastatin Modulates Regulatory T Cells and Attenuates Cerebral Damage in a Model of Transient Middle Cerebral Artery Occlusion in Rats.

    PubMed

    Rodríguez-Perea, Ana Lucía; Gutierrez-Vargas, Johanna; Cardona-Gómez, Gloria Patricia; Guarin, Carlos Julio Montoya; Rojas, Mauricio; Hernández, Paula Andrea Velilla

    2017-03-01

    Regulatory T cells (Tregs) inhibit the activation of the immune response which could down-regulate the systemic and focal activation observed during ischemic stroke. In fact, in animal models, Tregs infiltrate the infarcted brain and reduce the pro-inflammatory cytokine production and infarct volume, mainly in late stages of ischemia. Recently, an expansion and greater suppressive capacity of circulating Tregs after treatment with statins was observed, in addition to their cardio- and neuroprotective actions demonstrated previously. Thus, to determine whether Treg modulation mediated by statins can also be beneficial during stroke, cerebral ischemia was artificially induced in Wistar rats by transient middle cerebral artery occlusion (tMCAO) during 60 minutes with subsequent reperfusion for 7 days. Six hours after surgery, some animals were treated with atorvastatin (ATV, 10 mg/kg) or carboxymethylcellulose as vehicle at the same concentration every other day during 7 days. Some animals were sham operated as control group of surgery. Interestingly, ATV treatment prevented the development of infarct volume, reduced the neurological deficits, and the circulating and cervical lymph node CD25(+)FoxP3(+) Treg population. Moreover, there was a reduction of glial cell activation, which correlated with decreased circulating Tregs. Remarkably, treatment with ATV induced an increase in the frequency of CD4(+)CD25(+) T cells, in particular of those expressing CTLA-4, in brain samples. Together, these results suggest that ATV can modulate Tregs in peripheral tissue and favor their accumulation in the brain, where they can exert neuroprotective actions maybe by the reduction of glial cell activation.

  4. Fluid-Attenuated Inversion Recovery Vascular Hyperintensity Topography, Novel Imaging Marker for Revascularization in Middle Cerebral Artery Occlusion.

    PubMed

    Liu, Dezhi; Scalzo, Fabien; Rao, Neal M; Hinman, Jason D; Kim, Doojin; Ali, Latisha K; Saver, Jeffrey L; Sun, Wen; Dai, Qiliang; Liu, Xinfeng; Liebeskind, David S

    2016-11-01

    In acute arterial occlusion, fluid-attenuated inversion recovery vascular hyperintensity (FVH) has been linked to slow flow in leptomeningeal collaterals and cerebral hypoperfusion, but the impact on clinical outcome is still controversial. In this study, we aimed to investigate the association between FVH topography or FVH-Alberta Stroke Program Early CT Score (ASPECTS) pattern and outcome in acute M1-middle cerebral artery occlusion patients with endovascular treatment. We included acute M1-middle cerebral artery occlusion patients treated with endovascular therapy (ET). All patients had diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery before ET. Distal FVH-ASPECTS was evaluated according to distal middle cerebral artery-ASPECT area (M1-M6) and acute DWI lesion was also reviewed. The presence of FVH inside and outside DWI-positive lesions was separately analyzed. Clinical outcome after ET was analyzed with respect to different distal FVH-ASPECTS topography. Among 101 patients who met inclusion criteria for the study, mean age was 66.2±17.8 years and median National Institutes of Health Stroke Scale was 17.0 (interquartile range, 12.0-21.0). FVH-ASPECTS measured outside of the DWI lesion was significantly higher in patients with good outcome (modified Rankin Scale [mRS] score of 0-2; 8.0 versus 4.0, P<0.001). Logistic regression demonstrated that FVH-ASPECTS outside of the DWI lesion was independently associated with clinical outcome of these patients (odds ratio, 1.3; 95% confidence interval, 1.06-1.68; P=0.013). FVH-ASPECTS inside the DWI lesion was associated with hemorrhagic transformation (odds ratio, 1.3; 95% confidence interval, 1.04-1.51; P=0.019). Higher FVH-ASPECTS measured outside the DWI lesion is associated with good clinical outcomes in patients undergoing ET. FVH-ASPECTS measured inside the DWI lesion was predictive of hemorrhagic transformation. The FVH pattern, not number, can serve as an imaging selection marker for ET in

  5. Reversible occlusion of donor vessel caused by mouth opening after superficial temporal artery-middle cerebral artery anastomosis in adult moyamoya patients.

    PubMed

    Katsuta, Toshiro; Abe, Hiroshi; Miki, Koichi; Inoue, Tooru

    2015-09-01

    The authors experienced an intriguing phenomenon in 2 adult patients with moyamoya disease. Mouth opening caused reversible occlusion of the donor superficial temporal artery (STA), and the patients exhibited transient cerebral ischemic symptoms. The aim of this study was to assess the incidence of such occlusion and the mechanism of this phenomenon. Twelve consecutive adult patients with moyamoya disease (15 affected sides) who underwent STA-middle cerebral artery anastomosis were included in this study. Ultrasound examination was performed more than 3 months postoperatively to determine whether mouth opening affected blood flow of the donor STA and led to any ischemic symptoms within 1 minute. Computed tomography angiography was performed during both mouth opening and mouth closing, when blood flow changes of the donor STA were recognized. Under wide mouth opening, steno-occlusion of the donor STA occurred in 5 of 15 sides (33.3%). On 1 side (6.7%), complete occlusion induced ischemic symptoms. Steno-occlusion occurred by at least 2 mechanisms: either the stretched temporalis muscle pushed the donor STA against the edge of the bone window, or the redundant donor STA kinked when the muscle was stretched. Even with temporary occlusion of the donor STA, ischemic symptoms seem to rarely occur. However, to avoid the "big bite ischemic phenomenon," the authors recommend securing a sufficient distance between the donor STA and the edge of the bone window and avoiding a redundant course of the donor STA within the muscle layer.

  6. Interleukin-1 receptor antagonist decreases the number of necrotic neurons in rats with middle cerebral artery occlusion.

    PubMed Central

    Garcia, J. H.; Liu, K. F.; Relton, J. K.

    1995-01-01

    Marked increases in the brain expression of interleukin (IL)-1 have been reported in rats after permanent occlusion of a large cerebral artery. Interactions between endothelial cells and leukocytes have been implicated in the pathogenesis of several types of ischemic injury to the myocardium and other organs. In this study we asked whether inhibiting the effects of IL-1 would affect the outcome of an experimental brain infarct. Adult male Wistar rats (n = 13) with permanent occlusion of the middle cerebral artery were given IL-1 receptor antagonist. A second group (n = 13) with the same type of brain injury was given a placebo. A third group, subjected to a sham operation, was given either IL-1 receptor antagonist (n = 2) or a placebo (n = 2). Experiments were terminated after either 24 hours or 7 days. Compared with the control group, animals treated with IL-1 receptor antagonist improved their neurological score (P < 0.05), experienced less pronounced changes in body weight (P < 0.05), and had fewer necrotic neurons (P < 0.001) and fewer leukocytes in the ischemic hemisphere (P < 0.001) as well as a smaller area of pallor (P < 0.05) in the ischemis hemisphere. The results suggest that inhibiting the proinflammatory effects of IL-1 with a receptor antagonist is an effective way of influencing the leukocyte responses elicited by an arterial occlusion. Such leukocyte inhibition seemingly attenuates the number of necrotic neurons resulting from the occlusion of a large brain artery. Images Figure 4 Figure 6 Figure 8 PMID:7485410

  7. Performing Permanent Distal Middle Cerebral with Common Carotid Artery Occlusion in Aged Rats to Study Cortical Ischemia with Sustained Disability

    PubMed Central

    Roy, Lisa A.; Haenzi, Barbara; Tsai, Shi-Yen; Kartje, Gwendolyn; Beech, John S.; Cash, Diana; Moon, Lawrence

    2016-01-01

    Stroke typically occurs in elderly people with a range of comorbidities including carotid (or other arterial) atherosclerosis, high blood pressure, obesity and diabetes. Accordingly, when evaluating therapies for stroke in animals, it is important to select a model with excellent face validity. Ischemic stroke accounts for 80% of all strokes, and the majority of these occur in the territory of the middle cerebral artery (MCA), often inducing infarcts that affect the sensorimotor cortex, causing persistent plegia or paresis on the contralateral side of the body. We demonstrate in this video a method for producing ischemic stroke in elderly rats, which causes sustained sensorimotor disability and substantial cortical infarcts. Specifically, we induce permanent distal middle cerebral artery occlusion (MCAO) in elderly female rats by using diathermy forceps to occlude a short segment of this artery. The carotid artery on the ipsilateral side to the lesion was then permanently occluded and the contralateral carotid artery was transiently occluded for 60 min. We measure the infarct size using structural T2-weighted magnetic resonance imaging (MRI) at 24 hr and 8 weeks after stroke. In this study, the mean infarct volume was 4.5% ± 2.0% (standard deviation) of the ipsilateral hemisphere at 24 hr (corrected for brain swelling using Gerriet’s equation, n = 5). This model is feasible and clinically relevant as it permits the induction of sustained sensorimotor deficits, which is important for the elucidation of pathophysiological mechanisms and novel treatments. PMID:26967269

  8. Performing Permanent Distal Middle Cerebral with Common Carotid Artery Occlusion in Aged Rats to Study Cortical Ischemia with Sustained Disability.

    PubMed

    Wayman, Christina; Duricki, Denise A; Roy, Lisa A; Haenzi, Barbara; Tsai, Shi-Yen; Kartje, Gwendolyn; Beech, John S; Cash, Diana; Moon, Lawrence

    2016-02-23

    Stroke typically occurs in elderly people with a range of comorbidities including carotid (or other arterial) atherosclerosis, high blood pressure, obesity and diabetes. Accordingly, when evaluating therapies for stroke in animals, it is important to select a model with excellent face validity. Ischemic stroke accounts for 80% of all strokes, and the majority of these occur in the territory of the middle cerebral artery (MCA), often inducing infarcts that affect the sensorimotor cortex, causing persistent plegia or paresis on the contralateral side of the body. We demonstrate in this video a method for producing ischemic stroke in elderly rats, which causes sustained sensorimotor disability and substantial cortical infarcts. Specifically, we induce permanent distal middle cerebral artery occlusion (MCAO) in elderly female rats by using diathermy forceps to occlude a short segment of this artery. The carotid artery on the ipsilateral side to the lesion was then permanently occluded and the contralateral carotid artery was transiently occluded for 60 min. We measure the infarct size using structural T2-weighted magnetic resonance imaging (MRI) at 24 hr and 8 weeks after stroke. In this study, the mean infarct volume was 4.5% ± 2.0% (standard deviation) of the ipsilateral hemisphere at 24 hr (corrected for brain swelling using Gerriet's equation, n = 5). This model is feasible and clinically relevant as it permits the induction of sustained sensorimotor deficits, which is important for the elucidation of pathophysiological mechanisms and novel treatments.

  9. Therapeutic effects of different durations of acupuncture on rats with middle cerebral artery occlusion

    PubMed Central

    Zhang, Chao; Wen, Yan; Fan, Xiao-nong; Tian, Guang; Zhou, Xue-yi; Deng, Shi-zhe; Meng, Zhi-hong

    2015-01-01

    Acupuncture is regarded as an effective therapy for cerebral ischemia. Different acupuncture manipulations and durations may result in different therapeutic effects. In the present study, the Neiguan (PC6) acupoint of rats with occluded middle cerebral arteries was needled at a fixed frequency (3 Hz) with different durations, i.e., 5, 60 and 180 seconds under a twisting-rotating acupuncture method. Results showed that different durations of acupuncture had different therapeutic effects, with 60 seconds yielding a better therapeutic effect than the other two groups. This duration of treatment demonstrated rapid cerebral blood flow, encouraging recovery of neurological function, and small cerebral infarct volume. Experimental findings indicated that under 3 Hz frequency, the treatment of needling Neiguan for 60 seconds is effective for ischemic stroke. PMID:25788938

  10. Internal carotid artery pseudo occlusion with embolic cerebral ischemia and low flow in the central retinal artery: a diagnostic challenge.

    PubMed

    Röhrer, Christoph; Ertl, Michael; Altmann, Mathias; Kasprzak, Piotr; Bogdahn, Ulrich; Schuierer, Gerhard; Schlachetzki, Felix

    2011-07-01

    We present a rare case of internal carotid artery pseudoocclusion (ICAPO) in a 60-year-old male Caucasian patient who experienced a reversible sudden loss of vision of the right eye for 10 min followed by recurrent blurring of vision as well as dysarthria and numbness in the left face. The referring ophthalmologist admitted the patient for suspicious occlusion of the internal carotid artery causing anterior ischemic optic neuropathy (AION).

  11. Curcumin attenuates the middle cerebral artery occlusion-induced reduction in γ-enolase expression in an animal model

    PubMed Central

    Gim, Sang-Ah; Lee, So-Ra; Shah, Fawad-Ali

    2015-01-01

    Curcumin exerts a protective effect in cerebral ischemia through its anti-oxidant and anti-inflammatory activities. γ-enolase is a glycolytic enzyme expressed in neurons that is known to exerts a neuroprotective effect. We investigated whether curcumin regulates γ-enolase expression in focal cerebral ischemic injury in rats. Middle cerebral artery occlusion (MCAO) was performed to induce focal cerebral ischemia. Adult male rats were injected intraperitoneally with either vehicle or curcumin (50 mg/kg) 1 h after MCAO and cerebral cortex tissues were isolated 24 h after MCAO. We found that MCAO-induced injury resulted in a reduction in γ-enolase expression in vehicle-treated animals using a proteomics approach. However, this reduction was attenuated in animals with MCAO treated with curcumin. Reverse-transcription PCR and Western blot analyses also showed that curcumin treatment prevented the MCAO injury-induced reduction in γ-enolase expression. The results of this study suggest that curcumin exerts its neuroprotective function in focal cerebral ischemia by regulating the expression of γ-enolase. PMID:26755923

  12. A Rare Cause of Stroke in Young Adults: Occlusion of the Middle Cerebral Artery by a Meningioma Postpartum

    PubMed Central

    Mathis, Stéphane; Bataille, Benoît; Boucebci, Samy; Jeantet, Marion; Ciron, Jonathan; Vandamme, Laurène; Neau, Jean-Philippe

    2013-01-01

    Meningioma is the most common nonglial intracranial primary tumor. It is a slowly growing tumor and presents clinically by causing seizures along with neurological or neuropsychological deficit. However, acute presentation of meningioma is possible. We are reporting a case of cerebral infarction due to a sphenoid wing meningothelial meningioma (with progesterone receptor positivity) leading to an occlusion of the middle cerebral artery (MCA) in a 30-year-old right-handed woman (1 month after childbirth). After surgery, no new neurological event occurred, and she recovered most of her neurological functions. Strokes due to meningioma are a highly rare clinical occurrence but should be given serious consideration, particularly in young patients. PMID:24198989

  13. Direct aspiration first pass technique for a middle cerebral artery occlusion with a hidden aneurysm

    PubMed Central

    Nakamura, Hajime; Sakaguchi, Manabu; Kawano, Tomohiro; Ozaki, Tomohiko; Ima, Hiroyuki; Kidani, Tomoki; Kadono, Yoshinori; Murakami, Tomoaki; Yoshimine, Toshiki

    2015-01-01

    Hidden aneurysms within occluded vessels present a challenge for interventionists because vessel perforation can lead to life-threatening complications. We present a case of middle cerebral artery ischemic stroke, refractory to thrombolysis. A direct aspiration first pass technique (ADAPT) was employed for revascularization. Following thrombectomy, an aneurysm of the occluded vessel was revealed. Despite this, the patient recovered without hemorrhagic complication. ADAPT permits the minimal insertion of endovascular devices and might be a safe procedure when hidden aneurysms are suspected. PMID:26472636

  14. Combination of blood flow asymmetry in the cerebral and cerebellar hemispheres on brain perfusion SPECT predicts 5-year outcome in patients with symptomatic unilateral major cerebral artery occlusion.

    PubMed

    Nomura, Jun-ichi; Ogasawara, Kuniaki; Saito, Hideo; Terasaki, Kazunori; Matsumoto, Yoshiyasu; Takahashi, Yoshihiro; Ogasawara, Yasushi; Saura, Hiroaki; Yoshida, Koji; Sato, Yuiko; Kubo, Yoshitaka; Ogawa, Akira

    2014-03-01

    Misery perfusion increases the risk of stroke recurrence in patients with symptomatic major cerebral artery occlusion. The ratio of brain perfusion contralateral-to-affected asymmetry in the cerebellar hemisphere to brain perfusion affected-to-contralateral asymmetry in the cerebral hemisphere (CblPR/CbrPR) indicates affected-to-contralateral asymmetry of oxygen extraction fraction (OEF) in the cerebral hemisphere. The purpose of the present study was to determine whether the CblPR/CbrPR on brain perfusion single-photon emission computed tomography (SPECT) predicts 5-year outcomes in patients with symptomatic unilateral occlusion of the middle cerebral artery (MCA) or internal carotid artery (ICA). Brain perfusion was assessed using N-isopropyl-p-[123I]-iodoamphetamine (123I-IMP) SPECT in 70 patients. A region of interest (ROI) was manually placed in the bilateral MCA territories and in the bilateral cerebellar hemispheres, and the CblPR/CbrPR was calculated. All patients were prospectively followed for 5 years. The primary end points were stroke recurrence or death. A total of 17 patients exhibited the primary end points, 11 of whom experienced subsequent ipsilateral strokes. Multivariate analysis revealed that only high CblPR/CbrPR was significantly associated with the development of the primary end point or subsequent ipsilateral strokes (95% confidential limits [CIs], 1.130-3.145; P  =  0.0114 or 95% CIs, 2.558-5.140; P  =  0.0045, respectively). The CblPR/CbrPR provided 65% (11/17) or 91% (10/11) sensitivity and 88% (47/53) or 88% (52/59) specificity in predicting the primary end point or subsequent ipsilateral strokes, respectively. The CblPR/CbrPR on brain perfusion SPECT predicts 5-year outcomes in patients with symptomatic unilateral occlusion of the MCA or ICA.

  15. Duplicated middle cerebral artery.

    PubMed

    Perez, Jesus; Machado, Calixto; Scherle, Claudio; Hierro, Daniel

    2009-01-01

    Duplicated middle cerebral artery (DMCA) is an anomalous vessel arising from the internal carotid artery. The incidence DMCA is relatively law, and an association between this anomaly and cerebral aneurysms has been documented. There is a controversy whether DMCA may have perforating arteries. This is an important fact to consider in aneurysm surgery. We report the case of a 34-year-old black woman who suffered a subarachnoid hemorrhage and the angiography a left DMCA, and an aneurysm in an inferior branch of the main MCA. The DMCA and the MCA had perforating arteries. The aneurysm was clipped without complications. The observation of perforating arteries in our patient confirms that the DMCA may have perforating arteries. This is very important to be considered in cerebral aneurysms surgery. Moreover, the DMCA may potentially serve as a collateral blood supply to the MCA territory in cases of MCA occlusion.

  16. Role of Multimodal Evaluation of Cerebral Hemodynamics in Selecting Patients with Symptomatic Carotid or Middle Cerebral Artery Steno-occlusive Disease for Revascularization

    PubMed Central

    Sharma, Vijay K; Tsivgoulis, Georgios; Ning, Chou; Teoh, Hock L; Bairaktaris, Chrisostomos; Chong, Vincent FH; Ong, Benjamin KC; Chan, Bernard PL; Sinha, Arvind K

    2008-01-01

    Background: The circle of Willis provides collateral pathways to perfuse the affected vascular territories in patients with severe stenoocclusive disease of major arteries. The collateral perfusion may become insufficient in certain physiological circumstances due to failed vasodilatory reserve and intracranial steal phenomenon, so-called ‘Reversed-Robinhood syndrome’. We evaluated cerebral hemodynamics and vasodilatory reserve in patients with symptomatic distal internal carotid (ICA) or middle cerebral artery (MCA) severe steno-occlusive disease. Methods: Diagnostic transcranial Doppler (TCD) and TCD-monitoring with voluntary breath-holding according to a standard scanning protocol were performed in patients with severe ICA or MCA steno-occlusive disease. The steal phenomenon was detected as transient, spontaneous, or vasodilatory stimuli-induced velocity reductions in affected arteries at the time of velocity increase in normal vessels. Patients with exhausted vasomotor reactivity and intracranial steal phenomenon during breath-holding were further evaluated by 99technetiumm-hexamethyl propylene amine oxime single photon emission computed tomography (HMPAO-SPECT) with acetazolamide challenge. Results: Sixteen patients (age 27–74 years, 11 men) fulfilled our TCD criteria for exhausted vasomotor reactivity and intracranial steal phenomenon during the standard vasomotor testing by breath holding. Acetazolamide-challenged HMPAO-SPECT demonstrated significant hypoperfusion in 12 patients in affected arterial territories, suggestive of failed vasodilatory reserve. A breath-holding index of ≤0.3 on TCD was associated with an abnormal HMPAO-SPECT with acetazolamide challenge. TCD findings of a breath holding index of ≤0.3 and intracranial steal during the procedure were determinants of a significant abnormality on HMPAO-SPECT with acetazolamide challenge. Conclusion: Multimodal evaluation of cerebral hemodynamics in symptomatic patients with severe steno-occlusive

  17. Role of Multimodal Evaluation of Cerebral Hemodynamics in Selecting Patients with Symptomatic Carotid or Middle Cerebral Artery Steno-occlusive Disease for Revascularization.

    PubMed

    Sharma, Vijay K; Tsivgoulis, Georgios; Ning, Chou; Teoh, Hock L; Bairaktaris, Chrisostomos; Chong, Vincent Fh; Ong, Benjamin Kc; Chan, Bernard Pl; Sinha, Arvind K

    2008-10-01

    The circle of Willis provides collateral pathways to perfuse the affected vascular territories in patients with severe stenoocclusive disease of major arteries. The collateral perfusion may become insufficient in certain physiological circumstances due to failed vasodilatory reserve and intracranial steal phenomenon, so-called 'Reversed-Robinhood syndrome'. We evaluated cerebral hemodynamics and vasodilatory reserve in patients with symptomatic distal internal carotid (ICA) or middle cerebral artery (MCA) severe steno-occlusive disease. Diagnostic transcranial Doppler (TCD) and TCD-monitoring with voluntary breath-holding according to a standard scanning protocol were performed in patients with severe ICA or MCA steno-occlusive disease. The steal phenomenon was detected as transient, spontaneous, or vasodilatory stimuli-induced velocity reductions in affected arteries at the time of velocity increase in normal vessels. Patients with exhausted vasomotor reactivity and intracranial steal phenomenon during breath-holding were further evaluated by (99)technetium(m)-hexamethyl propylene amine oxime single photon emission computed tomography (HMPAO-SPECT) with acetazolamide challenge. Sixteen patients (age 27-74 years, 11 men) fulfilled our TCD criteria for exhausted vasomotor reactivity and intracranial steal phenomenon during the standard vasomotor testing by breath holding. Acetazolamide-challenged HMPAO-SPECT demonstrated significant hypoperfusion in 12 patients in affected arterial territories, suggestive of failed vasodilatory reserve. A breath-holding index of ≤0.3 on TCD was associated with an abnormal HMPAO-SPECT with acetazolamide challenge. TCD findings of a breath holding index of ≤0.3 and intracranial steal during the procedure were determinants of a significant abnormality on HMPAO-SPECT with acetazolamide challenge. Multimodal evaluation of cerebral hemodynamics in symptomatic patients with severe steno-occlusive disease of the ICA or MCA is helpful in

  18. Distance to thrombus in acute middle cerebral artery occlusion: a predictor of outcome after intravenous thrombolysis for acute ischemic stroke.

    PubMed

    Friedrich, Benjamin; Gawlitza, Matthias; Schob, Stefan; Hobohm, Carsten; Raviolo, Mariana; Hoffmann, Karl-Titus; Lobsien, Donald

    2015-03-01

    In patients with acute middle cerebral artery (MCA) stroke, therapeutic decisions are influenced by the location of the occlusion. This study aimed to analyze clinical outcomes in patients with acute ischemic MCA stroke treated with systemic intravenous thrombolysis (IVT) using recombinant tissue plasminogen activator, according to the location of the occlusion. Of 621 patients screened, 136 with acute stroke and MCA occlusion confirmed by CT angiography were retrospectively included in this study. The distance from the carotid T to the thrombus (DT) on coronal maximum intensity projection images and the thrombus length were measured. The correlation between DT and the modified Rankin Scale score at 90 days was analyzed. DT was an independent predictor of clinical outcome in stroke patients treated with IVT. A long DT was significantly correlated with a good clinical outcome (modified Rankin Scale score at 90 days ≤2). A poor clinical outcome was exponentially more likely than a good outcome when the DT was <16 mm (P<0.001). The thrombus length was not correlated with the modified Rankin Scale score at 90 days. A long thrombus (>8 mm) occurred significantly more often in the proximal MCA than the distal MCA (P<0.001). DT is an independent predictor of clinical outcome in patients with acute MCA occlusion treated with IVT. In acute stroke with MCA occlusion confirmed by CT angiography and DT <16 mm, the likelihood of a good clinical outcome after treatment with IVT was exponentially <50%. This might warrant the evaluation of other therapy forms than IVT in patients with proximal MCA occlusion. © 2015 American Heart Association, Inc.

  19. Bilateral Superior Cerebellar Artery Embolic Occlusion with a Fetal-Type Posterior Cerebral Artery Providing Collateral Circulation

    PubMed Central

    Bergman, Taylor J.; Saporito, Rachael C.; Hope, Thomas

    2016-01-01

    Bilateral infarction of the superior cerebellar arteries with sparing of the rest of the posterior circulation, particularly the posterior cerebral arteries, is an uncommon finding in neurological practice. Most commonly, the deficits of the superior cerebellar arteries and posterior cerebral arteries occur together due to the close proximity of their origins at the top of the basilar artery. A patient was transferred to the neurological intensive care unit with a history of recent-onset falls from standing, profound hypertension, dizziness, and headaches. The neurological exam revealed cerebellar signs, including dysmetria of the right upper extremity and a decreased level of consciousness. Computed tomography of the head and neck revealed decreased attenuation throughout most of the cerebellar hemispheres suggestive of ischemic injury with sparing of the rest of the brain. Further investigation with a computed tomography angiogram revealed a fetal-type posterior cerebral artery on the right side that was providing collateral circulation to the posterior brain. Due to this embryological anomaly, the patient was spared significant morbidity and mortality that would have likely occurred had the circulation been more typical of an adult male. PMID:28203181

  20. Bilateral Superior Cerebellar Artery Embolic Occlusion with a Fetal-Type Posterior Cerebral Artery Providing Collateral Circulation.

    PubMed

    Bergman, Taylor J; Saporito, Rachael C; Hope, Thomas

    2016-01-01

    Bilateral infarction of the superior cerebellar arteries with sparing of the rest of the posterior circulation, particularly the posterior cerebral arteries, is an uncommon finding in neurological practice. Most commonly, the deficits of the superior cerebellar arteries and posterior cerebral arteries occur together due to the close proximity of their origins at the top of the basilar artery. A patient was transferred to the neurological intensive care unit with a history of recent-onset falls from standing, profound hypertension, dizziness, and headaches. The neurological exam revealed cerebellar signs, including dysmetria of the right upper extremity and a decreased level of consciousness. Computed tomography of the head and neck revealed decreased attenuation throughout most of the cerebellar hemispheres suggestive of ischemic injury with sparing of the rest of the brain. Further investigation with a computed tomography angiogram revealed a fetal-type posterior cerebral artery on the right side that was providing collateral circulation to the posterior brain. Due to this embryological anomaly, the patient was spared significant morbidity and mortality that would have likely occurred had the circulation been more typical of an adult male.

  1. Calibrated MRI to evaluate cerebral hemodynamics in patients with an internal carotid artery occlusion

    PubMed Central

    De Vis, Jill B; Petersen, Esben T; Bhogal, Alex; Hartkamp, Nolan S; Klijn, Catharina JM; Kappelle, L J; Hendrikse, J

    2015-01-01

    The purpose of this study was to assess whether calibrated magnetic resonance imaging (MRI) can identify regional variances in cerebral hemodynamics caused by vascular disease. For this, arterial spin labeling (ASL)/blood oxygen level-dependent (BOLD) MRI was performed in 11 patients (65±7 years) and 14 controls (66±4 years). Cerebral blood flow (CBF), ASL cerebrovascular reactivity (CVR), BOLD CVR, oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen (CMRO2) were evaluated. The CBF was 34±5 and 36±11 mL/100 g per minute in the ipsilateral middle cerebral artery (MCA) territory of the patients and the controls. Arterial spin labeling CVR was 44±20 and 53±10% per 10 mm Hg ▵EtCO2 in patients and controls. The BOLD CVR was lower in the patients compared with the controls (1.3±0.8 versus 2.2±0.4% per 10 mm Hg ▵EtCO2, P<0.01). The OEF was 41±8% and 38±6%, and the CMRO2 was 116±39 and 111±40 μmol/100 g per minute in the patients and the controls. The BOLD CVR was lower in the ipsilateral than in the contralateral MCA territory of the patients (1.2±0.6 versus 1.6±0.5% per 10 mmHg ▵EtCO2, P<0.01). Analysis was hampered in three patients due to delayed arrival time. Thus, regional hemodynamic impairment was identified with calibrated MRI. Delayed arrival artifacts limited the interpretation of the images in some patients. PMID:25712500

  2. Long-term beneficial effects of BW619C89 on neurological deficit, cognitive deficit and brain damage after middle cerebral artery occlusion in the rat.

    PubMed

    Smith, S E; Hodges, H; Sowinski, P; Man, C M; Leach, M J; Sinden, J D; Gray, J A; Meldrum, B S

    1997-04-01

    4-Amino-2-(4-methyl-1-piperazinyl)-5-(2,3,5-trichlorophenyl)pyrimidine (BW619C89) is a sodium channel antagonist which when administered parenterally reduces neurological deficit and infarct volume after middle cerebral artery occlusion in rats. We have investigated whether BW619C89 administered orally before middle cerebral artery occlusion is cerebroprotective when rats are assessed at one day after stroke, and whether cerebroprotection is long lasting and related to functional recovery. A cerebroprotective oral dose of BW619C89 (20 mg/kg) was used to determine whether reduction in infarct volume is long lasting and can be enhanced with continued therapy, and whether behavioural deficits occurring after middle cerebral artery occlusion such as disturbances in cognition and motor coordination are ameliorated by treatment with BW619C89. Rats received sham surgery or middle cerebral artery occlusion with a single treatment of BW619C89 (20 mg/kg) 1 h before middle cerebral artery occlusion, a double treatment group receiving 20 mg/kg BW619C89 1 h before and 10 mg/kg 5 h after middle cerebral artery occlusion, or continued treatment with BW619C89 for up to five days. Neurological deficit, assessed from days 1 to 21, and at 70 days after middle cerebral artery occlusion, was reduced to a similar extent in all three groups of rats treated with BW619C89, compared with vehicle-treated controls. At 70 days after middle cerebral artery occlusion, all groups performed at control level. Vehicle-treated rats were impaired in the Morris water maze and step-through passive avoidance paradigm five to eight weeks after middle cerebral artery occlusion, when neurological deficit was minimal. These deficits were partially alleviated, to a similar extent, by all of the three treatments with BW619C89. Total volumes of brain damage, assessed at 70 days after middle cerebral artery occlusion in Luxol Fast Blue- and Cresyl Violet-stained coronal sections, were reduced in all three groups

  3. Sesamin attenuates behavioral, biochemical and histological alterations induced by reversible middle cerebral artery occlusion in the rats.

    PubMed

    Khan, Mohd Moshahid; Ishrat, Tauheed; Ahmad, Ajmal; Hoda, Md Nasrul; Khan, M Badruzzaman; Khuwaja, Gulrana; Srivastava, Pallavi; Raza, Syed Shadab; Islam, Fakhrul; Ahmad, Saif

    2010-01-05

    Restoration of blood flow to an ischemic brain region is associated with generation of reactive oxygen species (ROS) with consequent reperfusion injury. ROS cause lipid peroxidation, protein oxidation, and DNA damage, all of which are deleterious to cells. So diminishing the production of free radicals and scavenging them may be a successful therapeutic strategy for the protection of brain tissue in cerebral stroke. The present study investigated the neuroprotective effect of sesamin (Sn) to reduce brain injury after middle cerebral artery occlusion (MCAO). The middle cerebral artery (MCA) of adult male Wistar rat was occluded for 2h and reperfused for 22h. Sesamin is the most abundant lignan in sesame seed oil is a potent antioxidant. Sesamin (30 mg/kg) was given orally twice, 30 min before the onset of ischemia and 12h after reperfusion. The initial investigations revealed that sesamin reduced the neurological deficits in terms of behavior and reduced the level of thiobarbituric acid reactive species (TBARS), and protein carbonyl (PC) in the different areas of the brain when compared with the MCAO group. A significantly depleted level of glutathione and its dependent enzymes (glutathione peroxidase [GPx] and glutathione reductase [GR]) in MCAO group were protected significantly in MCAO group treated with sesamin. The present study suggests that sesamin may be able to attenuate the ischemic cell death and plays a crucial role as a neuroprotectant in regulating levels of reactive oxygen species in the rat brain. Thus, sesamin may be a potential compound in stroke therapy.

  4. Spatiotemporal characterization of brain infarction by sequential multimodal MR imaging following transient focal ischemia in a Rat model of intra-arterial middle cerebral artery occlusion.

    PubMed

    Gory, Benjamin; Chauveau, Fabien; Bolbos, Radu; Langlois, Jean-Baptiste; Labeyrie, Paul-Emile; Signorelli, Francesco; Turjman, Alexis; Turjman, Francis

    2016-12-01

    To assess spatiotemporal brain infarction evolution by sequential multimodal magnetic resonance (MR) imaging in an endovascular model of acute stroke in rats. A microwire was selectively placed in the middle cerebral artery (MCA) in 16 consecutives rats during 90 minutes occlusion. Longitudinal 7-T MR imaging, including angiography, diffusion, and perfusion was performed during ischemia, immediately after reperfusion, 3 h and 24 h after subsequent reperfusion. MCA occlusion was complete in 75 % and partial in 18.7 %. Hypoperfusion (mean ± SD) was observed in all animals during ischemia (-59 ± 18 % of contralateral hemisphere, area 31 ± 5 mm(2)). Infarction volume (mean ± SD) was 90 ± 64 mm(3) during ischemia and 57 ± 67 mm(3) at 24 h. Brain infarction was fronto-parietal cortical in five animals (31 %), striatal in four animals (25 %), and cortico-striatal in seven animals (44 %) at 24 h. All rats survived at 24 h. This model is suitable to neuroprotection studies because of possible acute and close characterization of spatiotemporal evolution of brain infarction by MR imaging techniques, and evidence of ischemic penumbra, the target of neuroprotection agents. However, optimization of the brain infarct reproducibility needs further technical and neurointerventional tools improvements. • Nitinol microwire is MRI compatible allowing spatiotemporal characterization of brain infarction in rats. • Microwire selective placement in middle cerebral artery allows complete artery occlusion in 75 %. • A diffusion/perfusion mismatch during arterial occlusion is observed in 77 % of rats.

  5. Evaluation of the middle cerebral artery occlusion techniques in the rat by in-vitro 3-dimensional micro- and nano computed tomography

    PubMed Central

    2010-01-01

    Background Animal models of focal cerebral ischemia are widely used in stroke research. The purpose of our study was to evaluate and compare the cerebral macro- and microvascular architecture of rats in two different models of permanent middle cerebral artery occlusion using an innovative quantitative micro- and nano-CT imaging technique. Methods 4h of middle cerebral artery occlusion was performed in rats using the macrosphere method or the suture technique. After contrast perfusion, brains were isolated and scanned en-bloc using micro-CT (8 μm)3 or nano-CT at 500 nm3 voxel size to generate 3D images of the cerebral vasculature. The arterial vascular volume fraction and gray scale attenuation was determined and the significance of differences in measurements was tested with analysis of variance [ANOVA]. Results Micro-CT provided quantitative information on vascular morphology. Micro- and nano-CT proved to visualize and differentiate vascular occlusion territories performed in both models of cerebral ischemia. The suture technique leads to a remarkable decrease in the intravascular volume fraction of the middle cerebral artery perfusion territory. Blocking the medial cerebral artery with macrospheres, the vascular volume fraction of the involved hemisphere decreased significantly (p < 0.001), independently of the number of macrospheres, and was comparable to the suture method. We established gray scale measurements by which focal cerebral ischemia could be radiographically categorized (p < 0.001). Nano-CT imaging demonstrates collateral perfusion related to different occluded vessel territories after macrosphere perfusion. Conclusion Micro- and Nano-CT imaging is feasible for analysis and differentiation of different models of focal cerebral ischemia in rats. PMID:20509884

  6. Quantitative electroencephalographic changes due to middle cerebral artery occlusion by endothelin 1 in conscious rats.

    PubMed

    Moyanova, S; Kortenska, L; Kirov, R; Iliev, I

    1998-12-01

    The powerful vasoconstrictor peptide endothelin-1 (ET1) has been shown to reduce local cerebral blood flow in brain areas supplied by the middle cerebral artery (MCA) to a pathologically low level upon intracerebral injection adjacent to the MCA. This reduction manifests itself as an ischemic infarct, that is fully developed within 3 days after ET1 injection. The aim of the present study is to examine the effect of ET1 on electroencephalographic (EEG) activity. ET1 was microinjected unilaterally at a dose of 60 pmol in 3 microl of saline to the MCA in conscious rats. EEG signals were recorded from the frontoparietal cortical area, supplied by MCA, from the first up to the fourteenth day after ET1 injection. EEG activity was analyzed by the fast Fourier transformation. A significant shift to a lower EEG frequency, i.e., augmentation of slow waves and a reduction of alpha-like and faster EEG waves was found post-ET1. This effect was maximal after 3-7 days when the most severe destruction of neurons in this cortical area occurs, as has been previously demonstrated. The results suggest that the quantitative EEG analysis may provide useful additional information about the functional disturbances associated with focal cerebral ischemia.

  7. A modification of intraluminal middle cerebral artery occlusion/reperfusion model for ischemic stroke with laser Doppler flowmetry guidance in mice

    PubMed Central

    Cai, Qiang; Xu, Gang; Liu, Junhui; Wang, Long; Deng, Gang; Liu, Jun; Chen, Zhibiao

    2016-01-01

    Stroke is one of the common causes of death and disability in the world. The intraluminal middle cerebral artery occlusion/reperfusion (MCAO/R) model is a “gold standard” in surgical ischemic stroke models. Here, we optimized the procedure of this model by ligating on external carotid artery (ECA) stump and two ligatures prepared on internal carotid artery, which could improve the success and survival rate in mice. The results show that ECA approach was superior to common carotid artery approach. Meanwhile, we found that the exposure of pterygopalatine artery was not an essential step for MCAO/R model in mice. PMID:27843320

  8. Treatment of Acute Cerebral Artery Occlusion Using the Penumbra System: Our Early Experience

    PubMed Central

    SHINDO, Atsushi; KAWANISHI, Masahiko; KAWAKITA, Kenya; OKAUCHI, Masanobu; KAWAI, Nobuyuki; HAYASHI, Naoki; OSAKA, Naohiro; TAMIYA, Takashi

    2014-01-01

    Intravenous recombinant tissue-type plasminogen activator (rt-PA) therapy is highly recommended to patients who are diagnosed with ischemic stroke within 4.5 hours after the onset while mechanical clot retrieval can be attempted in patients who are not indicated for or cannot effectively receive intravenous rt-PA therapy. In this article, we report early treatment outcomes and discuss the usefulness of mechanical clot retrieval using the Penumbra system (Penumbra Inc., Alameda, California, USA), especially in terms of technical cautions during the procedure and adaptability to elderly and high National Institutes of Health Stroke Scale (NIHSS) patients. We included 7 patients with thromboembolic occlusion. Pre-treatment NIHSS score ranged from 11 to 36 (mean: 24.9). All patients achieved good recanalization [thrombolysis in cerebral infarction (TICI) grade 2a or greater] without complications. The NIHSS score at 30 days after the treatment ranged between 0 and 28 (mean: 12.4), and improved more than 10 points in 4 of the 7 patients (57.1%). To obtain good recanalization without complications, selection of suitable reperfusion catheter and careful manipulation of separator prefiguring the occluded distal vessels are essential. The improved NIHSS score at 30 days after the treatment may have led to favorable results, such as an increased participation in available rehabilitation programs and the alleviation of the burden of care. Our findings suggest that the Penumbra system might be effective for treatment in elderly patients or patients with high NIHSS score wherein rt-PA therapy is inadvisable or ineffective in ischemic stroke secondary to large vessel occlusion. Recanalization can improve their quality of life on condition that the procedure is performed successfully without serious complications. PMID:24759097

  9. Apparent diffusion coefficient evaluation for secondary changes in the cerebellum of rats after middle cerebral artery occlusion

    PubMed Central

    Yang, Yunjun; Gao, Lingyun; Fu, Jun; Zhang, Jun; Li, Yuxin; Yin, Bo; Chen, Weijian; Geng, Daoying

    2013-01-01

    Supratentorial cerebral infarction can cause functional inhibition of remote regions such as the cerebellum, which may be relevant to diaschisis. This phenomenon is often analyzed using positron emission tomography and single photon emission CT. However, these methods are expensive and radioactive. Thus, the present study quantified the changes of infarction core and remote regions after unilateral middle cerebral artery occlusion using apparent diffusion coefficient values. Diffusion-weighted imaging showed that the area of infarction core gradually increased to involve the cerebral cortex with increasing infarction time. Diffusion weighted imaging signals were initially increased and then stabilized by 24 hours. With increasing infarction time, the apparent diffusion coefficient value in the infarction core and remote bilateral cerebellum both gradually decreased, and then slightly increased 3–24 hours after infarction. Apparent diffusion coefficient values at remote regions (cerebellum) varied along with the change of supratentorial infarction core, suggesting that the phenomenon of diaschisis existed at the remote regions. Thus, apparent diffusion coefficient values and diffusion weighted imaging can be used to detect early diaschisis. PMID:25206615

  10. Apparent diffusion coefficient evaluation for secondary changes in the cerebellum of rats after middle cerebral artery occlusion.

    PubMed

    Yang, Yunjun; Gao, Lingyun; Fu, Jun; Zhang, Jun; Li, Yuxin; Yin, Bo; Chen, Weijian; Geng, Daoying

    2013-11-05

    Supratentorial cerebral infarction can cause functional inhibition of remote regions such as the cerebellum, which may be relevant to diaschisis. This phenomenon is often analyzed using positron emission tomography and single photon emission CT. However, these methods are expensive and radioactive. Thus, the present study quantified the changes of infarction core and remote regions after unilateral middle cerebral artery occlusion using apparent diffusion coefficient values. Diffusion-weighted imaging showed that the area of infarction core gradually increased to involve the cerebral cortex with increasing infarction time. Diffusion weighted imaging signals were initially increased and then stabilized by 24 hours. With increasing infarction time, the apparent diffusion coefficient value in the infarction core and remote bilateral cerebellum both gradually decreased, and then slightly increased 3-24 hours after infarction. Apparent diffusion coefficient values at remote regions (cerebellum) varied along with the change of supratentorial infarction core, suggesting that the phenomenon of diaschisis existed at the remote regions. Thus, apparent diffusion coefficient values and diffusion weighted imaging can be used to detect early diaschisis.

  11. Therapeutic effects of oral dimethyl fumarate on stroke induced by middle cerebral artery occlusion: An animal experimental study.

    PubMed

    Safari, Anahid; Fazeli, Mehdi; Namavar, Mohammad Reza; Tanideh, Nader; Jafari, Peyman; Borhani-Haghighi, Afshin

    2017-01-01

    Dimethyl fumarate (DMF) has immune-modulatory and neuro-protective characteristics that can be used for treatment of acute ischemic stroke. To investigate the therapeutic effects of DMF on histological and functional recovery of rats after transient middle cerebral artery (MCA) occlusion. 22 Sprague-Dawley male rats weighing 275-300 g were randomized into three groups by block randomization. In the sham group (n = 7), the neck was opened, but neither MCA was occluded, nor any drug was administered.The control group (n = 7) was treated with vehicle (methocel) by gavage for 14 days after MCA occlusion. In the DMF-treated group (n = 8), treatment was performed with 15 mg/kg body weight dimethyl fumarate twice a day for 14 days after MCA occlusion. Transient occlusion of the right MCA was performed by intraluminal thread method in the DMF-treated and the control group. Neurological deficit score (NDS), pole test, and adhesive removal test were performed before the surgery, and on post-operative Days 0, 3, 5, 7, 10, and 14. After the final behaviour test, the animals' brains were perfused and removed. Brains were frozen and sectioned serially and coronally using a cryostat. Infract volume and brain volume were estimated by stereology. The percentage of infarct volume was significantly lower in DMF-treated animals (5.76%) than in the control group (22.39%) (P < 0.0001). Regarding behavioural tests, the DMF-treated group showed better function in NDS on Days 7 (P = 0.041) and 10 (P = 0.046), but not in pole and adhesive removal tests. There was no significant correlation between behavioural tests and histological results. Dimethyl fumarate could be beneficial as a potential neuroprotective agent in the treatment of stroke.

  12. Distal hyperintense vessels alleviate insula infarction in proximal middle cerebral artery occlusion.

    PubMed

    Song, Jiacheng; Ma, Zhanlong; Meng, Huan; Yu, Jing; Li, Yan; Hong, Xunning; Shi, Haibin

    2016-11-01

    Insula involvement in acute cerebral ischemia more likely causes penumbral loss and poor clinical outcome than infarct-sparing insula. Our objective was to prove the hypothesis that abundant collateral circulation represented by distal hyperintense vessels (HV) on MRI alleviates insula infarction and facilitates prognosis. One hundred and fourteen stroke cases with M1 totally occlusion on MR angiography were documented consecutively from 2012 to 2014. The degree of HV was graded as absent, subtle or prominent. Clinical data were recorded retrospectively by reviewing the medical records. The infarct volume on diffusion-weighted image, along with National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS), was used to evaluate the clinical severity and prognosis. The degree of HV was more abundant in insula-uninvolved stroke compared with stroke involving insula infarction (p = 0.026). Insula-involved stroke patients were older (p = 0.039) with a higher percentage of atrial fibrillation history (p = 0.042). Univariate analysis revealed that insula infarction, age, infarct volume and NIHSS predicted unfavorable prognosis of stroke, whereas HV had a favorable effect. The protective effect of HV was confirmed by multivariate analysis. HV is a protective barrier between insula infarction and severity of clinical symptoms among stroke patients.

  13. Transarterial regional hypothermia provides robust neuroprotection in a rat model of permanent middle cerebral artery occlusion with transient collateral hypoperfusion.

    PubMed

    Kurisu, Kota; Abumiya, Takeo; Ito, Masaki; Gekka, Masayuki; Osanai, Toshiya; Shichinohe, Hideo; Nakayama, Naoki; Kazumata, Ken; Houkin, Kiyohiro

    2016-11-15

    The robust neuroprotective effects of transarterial regional hypothermia have been demonstrated in the typical transient middle cerebral artery occlusion (tMCAO) model, but have not yet been tested in other ischemic stroke models, even though clinical ischemic conditions are diverse. In order to clarify these effects in a different ischemic stroke model, we employed a rat model of permanent MCAO (pMCAO) with transient collateral hypoperfusion (tCHP), which was achieved by direct MCA ligation through craniotomy and 1-h bilateral common carotid artery occlusion at the beginning of pMCAO. The infusion of 20ml/kg of 4°C cold saline (CS) or 37°C warm saline (WS) into the ipsilateral internal carotid artery (ICA) was performed for 15min in intra- or post-tCHP. Neurological scores, infarct/edema volumes, and neuronal apoptosis and reactive gliosis were compared between the CS and WS groups and a non-infusion control group after 48h of reperfusion. Although brain temperatures were only reduced by 2-3°C for 15min, the CS group had significantly better neurological scores, smaller infarct/edema volumes, and less penumbral neuronal apoptosis and reactive gliosis than the control and WS groups. The post-tCHP CS group exhibited prominent neuroprotective effects, even though infarct volumes and neuronal apoptosis were reduced less than those in the intra-tCHP CS group. In conclusion, we demonstrated the neuroprotective effects of transarterial regional hypothermia in an ischemic model of pMCAO with tCHP. Even though MCAO is persistent, cold infusion via the ICA is neuroprotective for the penumbra, suggesting the wider therapeutic application of this therapy.

  14. Does Preinterventional Flat-Panel Computer Tomography Pooled Blood Volume Mapping Predict Final Infarct Volume After Mechanical Thrombectomy in Acute Cerebral Artery Occlusion?

    SciTech Connect

    Wagner, Marlies; Kyriakou, Yiannis; Mesnil de Rochemont, Richard du; Singer, Oliver C.; Berkefeld, Joachim

    2013-08-01

    PurposeDecreased cerebral blood volume is known to be a predictor for final infarct volume in acute cerebral artery occlusion. To evaluate the predictability of final infarct volume in patients with acute occlusion of the middle cerebral artery (MCA) or the distal internal carotid artery (ICA) and successful endovascular recanalization, pooled blood volume (PBV) was measured using flat-panel detector computed tomography (FPD CT).Materials and MethodsTwenty patients with acute unilateral occlusion of the MCA or distal ACI without demarcated infarction, as proven by CT at admission, and successful Thrombolysis in cerebral infarction score (TICI 2b or 3) endovascular thrombectomy were included. Cerebral PBV maps were acquired from each patient immediately before endovascular thrombectomy. Twenty-four hours after recanalization, each patient underwent multislice CT to visualize final infarct volume. Extent of the areas of decreased PBV was compared with the final infarct volume proven by follow-up CT the next day.ResultsIn 15 of 20 patients, areas of distinct PBV decrease corresponded to final infarct volume. In 5 patients, areas of decreased PBV overestimated final extension of ischemia probably due to inappropriate timing of data acquisition and misery perfusion.ConclusionPBV mapping using FPD CT is a promising tool to predict areas of irrecoverable brain parenchyma in acute thromboembolic stroke. Further validation is necessary before routine use for decision making for interventional thrombectomy.

  15. Multimodal Neuroprotection Induced by PACAP38 in Oxygen–Glucose Deprivation and Middle Cerebral Artery Occlusion Stroke Models

    PubMed Central

    Cohen, Gadi; Arien-Zakay, Hadar; Chen, Jieli; Zhang, Chunling; Chopp, Michael; Jiang, Hao

    2014-01-01

    Pituitary adenylate cyclase activating peptide (PACAP), a potent neuropeptide which crosses the blood–brain barrier, is known to provide neuroprotection in rat stroke models of middle cerebral artery occlusion (MCAO) by mechanism(s) which deserve clarification. We confirmed that following i.v. injection of 30 ng/kg of PACAP38 in rats exposed to 2 h of MCAO focal cerebral ischemia and 48 h reoxygenation, 50 % neuroprotection was measured by reduced caspase-3 activity and volume of cerebral infarction. Similar neuroprotective effects were measured upon PACAP38 treatment of oxygen–glucose deprivation and reoxygenation of brain cortical neurons. The neuroprotection was temporally associated with increased expression of brain-derived neurotrophic factor, phosphorylation of its receptor—tropomyosin-related kinase receptor type B (trkB), activation of phosphoinositide 3-kinase and Akt, and reduction of extracellular signal-regulated kinases 1/2 phosphorylation. PACAP38 increased expression of neuronal markers beta-tubulin III, microtubule-associated protein-2, and growth-associated protein-43. PACAP38 induced stimulation of Rac and suppression of Rho GTPase activities. PACAP38 down-regulated the nerve growth factor receptor (p75NTR) and associated Nogo-(Neurite outgrowth-A) receptor. Collectively, these in vitro and in vivo results propose that PACAP exhibits neuroprotective effects in cerebral ischemia by three mechanisms: a direct one, mediated by PACAP receptors, and two indirect, induced by neurotrophin release, activation of the trkB receptors and attenuation of neuronal growth inhibitory signaling molecules p75NTR and Nogo receptor. PMID:22678884

  16. Multimodal neuroprotection induced by PACAP38 in oxygen-glucose deprivation and middle cerebral artery occlusion stroke models.

    PubMed

    Lazarovici, Philip; Cohen, Gadi; Arien-Zakay, Hadar; Chen, Jieli; Zhang, Chunling; Chopp, Michael; Jiang, Hao

    2012-11-01

    Pituitary adenylate cyclase activating peptide (PACAP), a potent neuropeptide which crosses the blood-brain barrier, is known to provide neuroprotection in rat stroke models of middle cerebral artery occlusion (MCAO) by mechanism(s) which deserve clarification. We confirmed that following i.v. injection of 30 ng/kg of PACAP38 in rats exposed to 2 h of MCAO focal cerebral ischemia and 48 h reoxygenation, 50 % neuroprotection was measured by reduced caspase-3 activity and volume of cerebral infarction. Similar neuroprotective effects were measured upon PACAP38 treatment of oxygen-glucose deprivation and reoxygenation of brain cortical neurons. The neuroprotection was temporally associated with increased expression of brain-derived neurotrophic factor, phosphorylation of its receptor-tropomyosin-related kinase receptor type B (trkB), activation of phosphoinositide 3-kinase and Akt, and reduction of extracellular signal-regulated kinases 1/2 phosphorylation. PACAP38 increased expression of neuronal markers beta-tubulin III, microtubule-associated protein-2, and growth-associated protein-43. PACAP38 induced stimulation of Rac and suppression of Rho GTPase activities. PACAP38 downregulated the nerve growth factor receptor (p75(NTR)) and associated Nogo-(Neurite outgrowth-A) receptor. Collectively, these in vitro and in vivo results propose that PACAP exhibits neuroprotective effects in cerebral ischemia by three mechanisms: a direct one, mediated by PACAP receptors, and two indirect, induced by neurotrophin release, activation of the trkB receptors and attenuation of neuronal growth inhibitory signaling molecules p75(NTR) and Nogo receptor.

  17. The flavonoid fisetin attenuates postischemic immune cell infiltration, activation and infarct size after transient cerebral middle artery occlusion in mice

    PubMed Central

    Gelderblom, Mathias; Leypoldt, Frank; Lewerenz, Jan; Birkenmayer, Gabriel; Orozco, Denise; Ludewig, Peter; Thundyil, John; Arumugam, Thiruma V; Gerloff, Christian; Tolosa, Eva; Maher, Pamela; Magnus, Tim

    2012-01-01

    The development of the brain tissue damage in ischemic stroke is composed of an immediate component followed by an inflammatory response with secondary tissue damage after reperfusion. Fisetin, a flavonoid, has multiple biological effects, including neuroprotective and antiinflammatory properties. We analyzed the effects of fisetin on infarct size and the inflammatory response in a mouse model of stroke, temporary middle cerebral artery occlusion, and on the activation of immune cells, murine primary and N9 microglial and Raw264.7 macrophage cells and human macrophages, in an in vitro model of inflammatory immune cell activation by lipopolysaccharide (LPS). Fisetin not only protected brain tissue against ischemic reperfusion injury when given before ischemia but also when applied 3 hours after ischemia. Fisetin also prominently inhibited the infiltration of macrophages and dendritic cells into the ischemic hemisphere and suppressed the intracerebral immune cell activation as measured by intracellular tumor necrosis factor α (TNFα) production. Fisetin also inhibited LPS-induced TNFα production and neurotoxicity of macrophages and microglia in vitro by suppressing nuclear factor κB activation and JNK/Jun phosphorylation. Our findings strongly suggest that the fisetin-mediated inhibition of the inflammatory response after stroke is part of the mechanism through which fisetin is neuroprotective in cerebral ischemia. PMID:22234339

  18. Canine model of ischemic stroke with permanent middle cerebral artery occlusion: clinical features, magnetic resonance imaging, histopathology, and immunohistochemistry.

    PubMed

    Jeon, Joon-Hyeok; Jung, Hae-Won; Jang, Hyo-Mi; Moon, Jong-Hyun; Park, Ki-Tae; Lee, Hee-Chun; Lim, Ha-Young; Sur, Jung-Hyang; Kang, Byeong-Teck; Ha, Jeongim; Jung, Dong-In

    2015-01-01

    The purpose of this study was to identify time-related changes in clinical, MRI, histopathologic, and immunohistochemical findings associated with ischemic stroke in dogs. Additionally, the association of cerebrospinal fluid (CSF) and tissue levels of interleukin (IL)-6 with clinical prognosis was assessed. Ischemic stroke was induced by permanent middle cerebral artery occlusion (MCAO) in nine healthy experimental dogs. The dogs were divided into three groups according to survival time and duration of the experimental period: group A (survived only 1 day), group B (1-week experimental period), and group C (2-week experimental period). Neurologic status was evaluated daily. Magnetic resonance imaging (MRI) was performed according to a predetermined schedule. Concentration of IL-6 in CSF was measured serially after ischemic stroke. Postmortem examination was performed for all experimental dogs. During histopathological examination, variable degrees of cavitation and necrosis due to neuronal cytopathic effects, such as pyknotic nuclei and cytoplasmic shrinkage, were observed on the affected side of the cerebral cortex in all dogs. Immunohistochemistry specific for IL-6 showed increased expression in the ischemic lesions. CSF IL-6 concentrations and ischemic lesion volumes 1 day after ischemic stroke were significantly higher in group A compared to groups B and C.

  19. Multi-unit activity suppression and sensorimotor deficits after endothelin-1-induced middle cerebral artery occlusion in conscious rats.

    PubMed

    Moyanova, Slavianka; Kirov, Roumen; Kortenska, Lidia

    2003-08-15

    Conscious Wistar rats with stereotaxically and unilaterally implanted cannula just above the middle cerebral artery (MCA) were injected with the powerful vasoconstrictor peptide endothelin-1 (ET1, 60 pmol in 3 microl). The purpose was to examine the long-term (from the 1st to the 14th day) changes in neuronal bioelectrical activity together with sensorimotor deficits after ET1-induced MCA occlusion (MCAO). Extracellular multi-unit activity (MUA) recorded from the ipsilateral fronto-parietal cortical area (supplied by MCA) and sensorimotor behavior (one postural reflex test and six limb placing tests) were examined. A significant suppression of the multi-unit activity was observed until the 14th day post-ET1. The rats exhibited significant unilateral sensorimotor deficits with a maximum at the 3-7 days after ET1 and a spontaneous partial recovery by days 11-14. A significant correlation was found between the suppression of the multi-unit activity and the sensorimotor deficits between the 3rd and the 10th day post-ET1. The results suggest that studying the bioelectrical activity in combination with the behavioral sensorimotor functions may be of use to assess the functional disturbances associated with focal cerebral ischemia and would help to examine the therapeutic benefits of various cerebroprotective treatments before initiating human clinical trials.

  20. Low-speed treadmill running exercise improves memory function after transient middle cerebral artery occlusion in rats.

    PubMed

    Shimada, Haruka; Hamakawa, Michiru; Ishida, Akimasa; Tamakoshi, Keigo; Nakashima, Hiroki; Ishida, Kazuto

    2013-04-15

    Physical exercise may enhance the recovery of impaired memory function in stroke rats. However the appropriate conditions of exercise and the mechanisms underlying these beneficial effects are not yet known. Therefore, the purpose of this study was to investigate the effect exercise intensity on memory function after cerebral infarction in rats. The animals were subjected to middle cerebral artery occlusion (MCAO) for 90 min to induce stroke and were randomly assigned to four groups; Low-Ex, High-Ex, Non-Ex and Sham. On the fourth day after surgery, rats in the Low-Ex and High-Ex groups were forced to exercise using a treadmill for 30 min every day for four weeks. Memory functions were examined during the last 5 days of the experiment (27-32 days after MCAO) by three types of tests: an object recognition test, an object location test and a passive avoidance test. After the final memory test, the infarct volume, number of neurons and microtubule-associated protein 2 (MAP2) immunoreactivity in the hippocampus were analyzed by histochemistry. Memory functions in the Low-Ex group were improved in all tests. In the High-Ex group, only the passive avoidance test improved, but not the object recognition or object location tests. Both the Low-Ex and High-Ex groups had reduced infarct volumes. Although the number of neurons in the hippocampal dentate gyrus of the Low-Ex and High-Ex groups was increased, the number for the Low-Ex group increased more than that for the High-Ex group. Moreover hippocampal MAP2 immunoreactivity in the High-Ex group was reduced compared to that in the Low-Ex group. These data suggest that the effects of exercise on memory impairment after cerebral infarction depend on exercise intensity.

  1. Piperine suppresses cerebral ischemia-reperfusion-induced inflammation through the repression of COX-2, NOS-2, and NF-κB in middle cerebral artery occlusion rat model.

    PubMed

    Vaibhav, Kumar; Shrivastava, Pallavi; Javed, Hayate; Khan, Andleeb; Ahmed, Md Ejaz; Tabassum, Rizwana; Khan, Mohd Moshahid; Khuwaja, Gulrana; Islam, Farah; Siddiqui, M Saeed; Safhi, Mohammed M; Islam, Fakhrul

    2012-08-01

    The pathophysiological mechanisms leading to neuronal injury in middle cerebral artery occlusion (MCAO) model of cerebral stroke are complex and multifactorial that form the bases of behavioral deficits and inflammation mediated damage. The present study demonstrates the effect of piperine pretreatment (10 mg/kg b wt, once daily p.o. for 15 days) on cerebral ischemia-induced inflammation in male Wistar rats. The right middle cerebral artery was occluded for 2 h followed by reperfusion for 22 h. A maximum infarct volume (57.80 %) was observed in ischemic MCAO group. However, piperine administration prior to ischemia showed a significant reduction in infarct volume (28.29 %; p < 0.05) and neuronal loss (12.72 %; p < 0.01). As a result of piperine pretreatment, a significant improvement in behavioral outputs of MCAO rats (p < 0.05-0.01) was observed. Piperine successfully reduced the level of proinflammatory cytokines IL-1β, IL-6 and TNF-α, in ischemic group (p < 0.01). Ischemic group brain has shown edematous morphology with vacuolated architecture and pyknotic nuclei in H & E staining which was successfully ameliorated by piperine administration. Moreover, piperine also succeeded in lowering the expression of COX-2, NOS-2, and NF-κB (p < 0.01). Both cytosolic and nuclear NF-κB were down-regulated in ischemic group pre-administered with piperine (p < 0.01). The present study suggests that piperine is able to salvage the ischemic penumbral zone neurons by virtue of its anti-inflammatory property, thereby limiting ischemic cell death.

  2. Main Trunk and Division Middle Cerebral Artery Occlusions: Differences in Recanalization Times, Number of Stent Retriever Passes and Clinical Outcomes: A Single-Center Experience

    PubMed Central

    Qureshi, Ihtesham A.; Maud, Alberto; Cruz-Flores, Salvador; Rodriguez, Gustavo J.

    2016-01-01

    Background and Purpose In this article, we present our experience with the recanalization of the middle cerebral artery (MCA), we hypothesize that there are higher rates of recanalization with fewer stent retriever passes and better clinical outcomes in patients with division MCA occlusions. A more complex anatomy at the bifurcation may prevent a faster recanalization in main trunk MCA occlusions. Methods We retrospectively identified consecutive patients admitted with MCA occlusions who underwent mechanical thrombectomy using stent retrievers. We categorized patients into division MCA and main trunk MCA occlusions based on angiography. Variables were compared between the groups. We further analyzed patients with trunk MCA occlusions to identify reasons for delays in recanalization. Results There were 32 MCA occlusions that underwent mechanical thrombectomy and eligible for the analysis during the study period. Of those, 11 were main trunk MCA occlusions. Univariate analysis disclosed a trend toward a lower GP-to-recanalization time (p = 0.05) and a lower number of passes required for recanalization in division MCA occlusions. However, there was a significantly better outcome in patients with division MCA occlusion after multivariate analysis. Analyzing main trunk MCA occlusion data, we found that the need for more than one pass to achieve recanalization led to a trend toward a longer GP-to-recanalization time and a worse outcome. When the stent was placed in the dominant division, the chances of recanalization were significantly higher. Conclusions Division MCA occlusions have higher recanalization rates with fewer stent retriever passes and better clinical outcomes than main trunk MCA occlusions, likely due to a more favorable anatomy. Measures like placing the stent retriever in the dominant division may decrease recanalization times and improve clinical outcomes in main trunk MCA occlusions. PMID:27051403

  3. Ischemic brain injury decreases dynamin-like protein 1 expression in a middle cerebral artery occlusion animal model and glutamate-exposed HT22 cells

    PubMed Central

    Jang, Ah-Ram

    2016-01-01

    Dynamin-like protein I (DLP-1) is an important mitochondrial fission and fusion protein that is associated with apoptotic cell death in neurodegenerative diseases. In this study, we investigated DLP-1 expression in a focal cerebral ischemia animal model and glutamate-exposed hippocampal-derived cell line. Middle cerebral artery occlusion (MCAO) was surgically induced in adult male rats to induce focal cerebral ischemic injury. Brain tissues were collected 24 hours after the onset of MCAO. MCAO induces an increase in infarct volume and histopathological changes in the cerebral cortex. We identified a decrease in DLP-1 in the cerebral cortices of MCAO-injured animals using a proteomic approach and Western blot analysis. Moreover, glutamate treatment significantly decreased DLP-1 expression in a hippocampal-derived cell line. The decrease in DLP-1 indicates mitochondrial dysfunction. Thus, these results suggest that neuronal cell injury induces a decrease in DLP-1 levels and consequently leads to neuronal cell death. PMID:28053612

  4. [Comparative analysis of action of beta-phenyl derivatives of glutamic and gamma-aminobutyric acid on cerebral blood flow and cerebrovascular endothelium after irreversible occlusion of the common carotid artery].

    PubMed

    Volotova, E V; Kurkin, D V; Mazina, N V; Berestovitskaia, V M; Vasil'eva, O S

    2013-01-01

    A comparative analysis of the effect of phenyl derivatives of glutamic (RGPU-135) and gamma-aminobutyric acid (Phenibut) on cerebral blood flow, vasodilatory endothelial function and the number of circulating endothelial cells desquamated in animals after irreversible occlusion of the common carotid arteries. It was found that animals treated prophylactically by RGPU-135, after occlusion of the common carotid arteries have higher cerebral blood flow and lower the severity of endothelial dysfunction than in animals treated with Phenibut.

  5. Thrombotic distal middle cerebral artery occlusion produced by topical FeCl3 application: a novel model suitable for intravital microscopy and thrombolysis studies

    PubMed Central

    Karatas, Hulya; Erdener, Sefik Evren; Gursoy-Ozdemir, Yasemin; Gurer, Gunfer; Soylemezoglu, Figen; Dunn, Andrew K; Dalkara, Turgay

    2011-01-01

    Intravital or multiphoton microscopy and laser-speckle imaging have become popular because they allow live monitoring of several processes during cerebral ischemia. Available rodent models have limitations for these experiments; e.g., filament occlusion of the proximal middle cerebral artery (MCA) is difficult to perform under a microscope, whereas distal occlusion methods may damage the MCA and the peri-arterial cortex. We found that placement of a 10% FeCl3-soaked filter paper strip (0.3 × 1 mm2) on the duramater over the trunk of the distal MCA through a cranial window for 3 minutes induced intraarterial thrombus without damaging the peri-arterial cortex in the mouse. This caused a rapid regional cerebral blood flow decrease within 10 minutes and total occlusion of the MCA segment under the filter paper in 17±2 minutes, which resulted in a typical cortical infarct of 27±4 mm3 at 24 hours and moderate sensorimotor deficits. There was no significant hemispheric swelling or hemorrhage or mortality at 24 hours. Reperfusion was obtained in half of the mice with tissue plasminogen activator, which allowed live monitoring of clot lysis along with restoration of tissue perfusion and MCA flow. In conclusion, this relatively simple and noninvasive stroke model is easy to perform under a microscope, making it suitable for live imaging and thrombolysis studies. PMID:21326267

  6. Galectin-3 causes enteric neuronal loss in mice after left sided permanent middle cerebral artery occlusion, a model of stroke

    PubMed Central

    Cheng, Xiaowen; Boza-Serrano, Antonio; Turesson, Michelle Foldschak; Deierborg, Tomas; Ekblad, Eva; Voss, Ulrikke

    2016-01-01

    In addition to brain injury stroke patients often suffer gastrointestinal complications. Neuroimmune interactions involving galectin-3, released from microglia in the brain, mediates the post-stroke pro-inflammatory response. We investigated possible consequences of stroke on the enteric nervous system and the involvement of galectin-3. We show that permanent middle cerebral artery occlusion (pMCAO) induces loss of enteric neurons in ileum and colon in galectin-3+/+, but not in galectin-3−/−, mice. In vitro we show that serum from galectin-3+/+, but not from galectin-3−/−, mice subjected to pMCAO, caused loss of C57BL/6J myenteric neurons, while myenteric neurons derived from TLR4−/− mice were unaffected. Further purified galectin-3 (10−6 M) caused loss of cultured C57BL/6J myenteric neurons. Inhibitors of transforming growth factor β-activated kinase 1 (TAK1) or AMP activated kinase (AMPK) counteracted both the purified galectin-3 and the galectin-3+/+ pMCAO serum-induced loss in vitro. Combined we show that stroke (pMCAO) triggers central and peripheral galectin-3 release causing enteric neuronal loss through a TLR4 mediated mechanism involving TAK1 and AMPK. Galectin-3 is suggested a target for treatment of post-stroke complications. PMID:27612206

  7. Coaccumulation of calcium and beta-amyloid in the thalamus after transient middle cerebral artery occlusion in rats.

    PubMed

    Mäkinen, Susanna; van Groen, Thomas; Clarke, Jared; Thornell, Anders; Corbett, Dale; Hiltunen, Mikko; Soininen, Hilkka; Jolkkonen, Jukka

    2008-02-01

    Transient occlusion of the middle cerebral artery (MCAO) in rats leads to abnormal accumulation of beta-amyloid (Abeta) peptides in the thalamus. This study investigated the chemical composition of these deposits. Adult male human beta-amyloid precursor protein (APP) overexpressing (hAPP695) rats and their wild-type littermates were subjected to transient MCAO for 2 h or sham operation. After 26-week survival time, histological examination revealed an overlapping distribution pattern for rodent and human Abeta in the thalamus of hAPP695 rats subjected to MCAO. X-ray microanalysis showed that the deposits did not contain significant amount of iron, zinc, or copper typical to senile plaques. In contrast, the deposit both in hAPP695 and non-transgenic rats contained calcium and phosphorus in a ratio (1.28+/-0.15) characteristic to hydroxyapatites. Alizarin red staining confirmed that calcium coaccumulated in these Abeta deposits. It is suggested that APP expression is induced by ischemic insult in cortical neurons adjacent to infarct, which in turn is reflected as increased release of Abeta peptides by their corticothalamic axon endings. This together with insufficient clearance or atypical degradation of Abeta peptides lead to dysregulation of calcium homeostatis and coaccumulation in the thalamus.

  8. Solulin reduces infarct volume and regulates gene-expression in transient middle cerebral artery occlusion in rats.

    PubMed

    Ryang, Yu-Mi; Dang, Jon; Kipp, Markus; Petersen, Karl-Uwe; Fahlenkamp, Astrid V; Gempt, Jens; Wesp, Dominik; Rossaint, Rolf; Beyer, Cordian; Coburn, Mark

    2011-11-14

    Thrombolysis after acute ischemic stroke has only proven to be beneficial in a subset of patients. The soluble recombinant analogue of human thrombomodulin, Solulin, was studied in an in vivo rat model of acute ischemic stroke. Male SD rats were subjected to 2 hrs of transient middle cerebral artery occlusion (tMCAO). Rats treated with Solulin intravenously shortly before reperfusion were compared to rats receiving normal saline i.v. with respect to infarct volumes, neurological deficits and mortality. Gene expression of IL-6, IL-1β, TNF-α, MMP-9, CD11B and GFAP were semiquantitatively analyzed by rtPCR of the penumbra. 24 hrs after reperfusion, rats were neurologically tested, euthanized and infarct volumes determined. Solulin significantly reduced mean total (p=0.001), cortical (p=0.002), and basal ganglia (p=0.036) infarct volumes. Hippocampal infarct volumes (p=0.191) were not significantly affected. Solulin significantly downregulated the expression of IL-1β (79%; p<0.001), TNF-α (59%; p=0.001), IL-6 (47%; p=0.04), and CD11B (49%; p=0.001) in the infarcted cortex compared to controls. Solulin reduced mean total, cortical and basal ganglia infarct volumes and regulated a subset of cytokines and proteases after tMCAO suggesting the potency of this compound for therapeutic interventions.

  9. Solulin reduces infarct volume and regulates gene-expression in transient middle cerebral artery occlusion in rats

    PubMed Central

    2011-01-01

    Background Thrombolysis after acute ischemic stroke has only proven to be beneficial in a subset of patients. The soluble recombinant analogue of human thrombomodulin, Solulin, was studied in an in vivo rat model of acute ischemic stroke. Methods Male SD rats were subjected to 2 hrs of transient middle cerebral artery occlusion (tMCAO). Rats treated with Solulin intravenously shortly before reperfusion were compared to rats receiving normal saline i.v. with respect to infarct volumes, neurological deficits and mortality. Gene expression of IL-6, IL-1β, TNF-α, MMP-9, CD11B and GFAP were semiquantitatively analyzed by rtPCR of the penumbra. Results 24 hrs after reperfusion, rats were neurologically tested, euthanized and infarct volumes determined. Solulin significantly reduced mean total (p = 0.001), cortical (p = 0.002), and basal ganglia (p = 0.036) infarct volumes. Hippocampal infarct volumes (p = 0.191) were not significantly affected. Solulin significantly downregulated the expression of IL-1β (79%; p < 0.001), TNF-α (59%; p = 0.001), IL-6 (47%; p = 0.04), and CD11B (49%; p = 0.001) in the infarcted cortex compared to controls. Conclusions Solulin reduced mean total, cortical and basal ganglia infarct volumes and regulated a subset of cytokines and proteases after tMCAO suggesting the potency of this compound for therapeutic interventions. PMID:22082476

  10. Monocytes are Essential for the Neuroprotective Effect of Human Cord Blood Cells Following Middle Cerebral Artery Occlusion in Rat

    PubMed Central

    Womble, T. A.; Green, S.; Shahaduzzaman, M.; Grieco, J.; Sanberg, P. R.; Pennypacker, K. R.; Willing, A. E.

    2014-01-01

    Systemic administration of human umbilical cord blood (HUCB) mononuclear cells (MNC) following middle cerebral artery occlusion (MCAO) in the rat reduces infarct size and, more importantly, restores motor function. The HUCB cell preparation is composed of immature T-cells, B-cells, monocytes and stem cells. In this study we examined whether the beneficial effects of HUCB injection were attributable to one of these cell types. Male Sprague Dawley rats underwent permanent MCAO followed 48 hours later by intravenous administration of HUCB MNC preparations depleted of either CD14+ monocytes, CD133+ stem cells, CD2+ T-cells or CD19+ B cells. Motor function was measured prior to MCAO and 30 days post-stroke. When CD14+ monocytes were depleted from the HUCB MNC, activity and motor asymmetry were similar to the MCAO only treated animals. Monocyte depletion prevented HUCB cell treatment from reducing infarct size while monocyte enrichment was sufficient to reduce infarct size. Administration of monocyte-depleted HUCB cells did not suppress Iba1 labeling of microglia in the infarcted area relative to treatment with the whole HUCB preparation. These data demonstrate that the HUCB monocytes provide the majority of the efficacy in reducing infarct volume and promoting functional recovery. PMID:24472845

  11. Role of the NMDA receptor and iron on free radical production and brain damage following transient middle cerebral artery occlusion.

    PubMed

    Im, Doo Soon; Jeon, Jeong Wook; Lee, Jin Soo; Won, Seok Joon; Cho, Sung Ig; Lee, Yong Beom; Gwag, Byoung Joo

    2012-05-21

    Excess activation of ionotropic glutamate receptors and iron is believed to contribute to free radical production and neuronal death following hypoxic ischemia. We examined the possibility that both NMDA receptor activation and iron overload determine spatial and temporal patterns of free radical production after transient middle cerebral artery occlusion (tMCAO) in male Sprague-Dawley rats. Mitochondrial free radical (MFR) levels were maximally increased in neurons in the core at 1 h and 24 h after tMCAO. Early MFR production was blocked by administration of MK-801, an NMDA receptor antagonist, but not deferoxamine, an iron chelator. Neither MK-801 nor deferoxamine attenuated late MFR production in the core. Increased MFRs were observed in penumbral neurons within 6 h and gradually increased over 24 h after tMCAO. Slowly-evolving MFRs in the core and penumbra were accompanied by iron overload. Deferoxamine blocked iron overload but reduced MFR production only in the penumbra. Combined MK-801/deferoxamine reduced late MFR production in both core and penumbra in an additive manner. Combination therapy significantly ameliorated infarction compared with monotherapy. These findings suggest that the NMDA receptor activation and iron overload mediate late MFR production and infarction after tMCAO. Copyright © 2012 Elsevier B.V. All rights reserved.

  12. Post-ischemic helium provides neuroprotection in rats subjected to middle cerebral artery occlusion-induced ischemia by producing hypothermia.

    PubMed

    David, Hélène N; Haelewyn, Benoît; Chazalviel, Laurent; Lecocq, Myriam; Degoulet, Mickael; Risso, Jean-Jacques; Abraini, Jacques H

    2009-06-01

    During the past decade, studies on the manipulation of various inhaled inert gases during ischemia and/or reperfusion have led to the conclusion that inert gases may be promising agents for treating acute ischemic stroke and perinatal hypoxia-ischemia insults. Although there is a general consensus that among these gases xenon is a golden standard, the possible widespread clinical use of xenon experiences major obstacles, namely its availability and cost of production. Interestingly, recent findings have shown that helium, which is a cost-efficient inert gas with no anesthetic properties, can provide neuroprotection against acute ischemic stroke in vivo when administered during ischemia and early reperfusion. We have investigated whether helium provides neuroprotection in rats subjected to middle cerebral artery occlusion (MCAO) when administered after reperfusion, a condition prerequisite for the therapeutic viability and possible clinical use of helium. In this study, we show that helium at 75 vol% produces neuroprotection and improvement of neurologic outcome in rats subjected to transient MCAO by producing hypothermia on account of its high specific heat as compared with air.

  13. Keep warm and get success: the role of postischemic temperature in the mouse middle cerebral artery occlusion model.

    PubMed

    Wu, Li; Xu, Lili; Xu, Xiaohui; Fan, Xinying; Xie, Yi; Yang, Lian; Lan, Wenya; Zhu, Juehua; Xu, Gelin; Dai, Jianwu; Jiang, Yongjun; Liu, Xinfeng

    2014-02-01

    Intraluminal suture middle cerebral artery occlusion (MCAO) model is the most frequently used model for ischemic stroke. However, the success rate of this model is variable among different research studies. This study aimed to investigate the effect of postischemic temperature on the success rate. A total of 100 C57BL/6 mice were randomized into two groups: control group (n=50), body temperature was allowed to self-regulate after MCAO; temperature-controlled group (n=50), mice were kept warm in an incubator for 12 h after MCAO. The body temperature of animals was measured before, during, and for 12 h after MCAO. Neurological deficits and infarct volumes were measured at 24 h after MCAO. There was significant difference (P<0.05) of the body temperature between the two groups from 0.5 h to 3.5 h post ischemia. Moreover, there was obvious difference between the success rates of the two groups (control group: 52%, temperature-controlled group: 84%, P<0.05). In the successful models, infarct volume was significantly (P<0.05) higher in temperature-controlled group (53.44%±9.83%, n=42) than control group (45.63%±10.24%, n=26). There was significant difference of the modified neurological severity scores (P<0.05), left adhesive tests (P<0.05) between the two groups. Our data demonstrated that postischemic warming contributed to the success of mouse MCAO model. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. Transient middle cerebral artery occlusion in mice induces neuronal expression of RNF213, a susceptibility gene for moyamoya disease.

    PubMed

    Sato-Maeda, Mika; Fujimura, Miki; Kanoke, Atsushi; Morita-Fujimura, Yuiko; Niizuma, Kuniyasu; Tominaga, Teiji

    2016-01-01

    Although recent genome-wide and locus-specific association studies revealed that the RING finger protein 213 (RNF213) gene is an important susceptibility gene for moyamoya disease (MMD), the exact mechanism by which the genetic alteration of RNF213 contributes to the development of MMD has not yet been elucidated. A quantitative reverse transcription polymerase chain reaction (PCR) analysis revealed that the constitutive expression of the RNF213 gene was very low in adult and embryonic brain tissue. However, information regarding the temporal and spatial expression patterns of the RNF213 gene under the condition of cerebral ischemia, which is one of characteristic pathologies associated with MMD, is currently limited. In order to address this critical issue, Rnf213 mRNA expression was investigated in mouse brains subjected to 60 min of transient middle cerebral artery occlusion (tMCAO). Male C57BL6/j mice underwent tMCAO through the intraluminal blockade of MCA. Expression of the Rnf213 gene in the tMCAO brain was investigated with in situ RNA hybridization and a real-time PCR analysis from 1 to 72 h after tMCAO. In situ RNA hybridization revealed a significant increase in Rnf213 mRNA levels in the cerebral cortex supplied by the affected MCA, especially at the penumbra area, as early as 6h after tMCAO, and these levels had increased further by 24 h. Rnf213 gene expression remained unchanged in the non-ischemic hemisphere or control specimens. Double staining of Rnf213 mRNA with NeuN immunohistochemistry revealed Rnf213 hybridization signal expression mostly in neurons. The real-time PCR analysis confirmed induction of the Rnf213 gene after tMCAO. Therefore, the Rnf213 gene was up-regulated in the ischemic brain, especially at the penumbra area, 6 h after tMCAO. Early increases in RNF213 gene expression in neurons after tMCAO indicate its involvement in cerebral ischemia, which is an underlying pathology of MMD. Further investigation is required to clarify its

  15. Transcriptomics and proteomics analyses of the PACAP38 influenced ischemic brain in permanent middle cerebral artery occlusion model mice

    PubMed Central

    2012-01-01

    Introduction The neuropeptide pituitary adenylate cyclase-activating polypeptide (PACAP) is considered to be a potential therapeutic agent for prevention of cerebral ischemia. Ischemia is a most common cause of death after heart attack and cancer causing major negative social and economic consequences. This study was designed to investigate the effect of PACAP38 injection intracerebroventrically in a mouse model of permanent middle cerebral artery occlusion (PMCAO) along with corresponding SHAM control that used 0.9% saline injection. Methods Ischemic and non-ischemic brain tissues were sampled at 6 and 24 hours post-treatment. Following behavioral analyses to confirm whether the ischemia has occurred, we investigated the genome-wide changes in gene and protein expression using DNA microarray chip (4x44K, Agilent) and two-dimensional gel electrophoresis (2-DGE) coupled with matrix assisted laser desorption/ionization-time of flight-mass spectrometry (MALDI-TOF-MS), respectively. Western blotting and immunofluorescent staining were also used to further examine the identified protein factor. Results Our results revealed numerous changes in the transcriptome of ischemic hemisphere (ipsilateral) treated with PACAP38 compared to the saline-injected SHAM control hemisphere (contralateral). Previously known (such as the interleukin family) and novel (Gabra6, Crtam) genes were identified under PACAP influence. In parallel, 2-DGE analysis revealed a highly expressed protein spot in the ischemic hemisphere that was identified as dihydropyrimidinase-related protein 2 (DPYL2). The DPYL2, also known as Crmp2, is a marker for the axonal growth and nerve development. Interestingly, PACAP treatment slightly increased its abundance (by 2-DGE and immunostaining) at 6 h but not at 24 h in the ischemic hemisphere, suggesting PACAP activates neuronal defense mechanism early on. Conclusions This study provides a detailed inventory of PACAP influenced gene expressions and protein targets

  16. Bryostatin extends tPA time window to 6 hours following middle cerebral artery occlusion in aged female rats

    PubMed Central

    Tan, Zhenjun; Lucke-Wold, Brandon P.; Logsdon, Aric F.; Turner, Ryan C.; Tan, Cong; Li, Xinlan; Hongpaison, Jarin; Alkon, Daniel L.; Simpkins, James W.; Rosen, Charles L.; Huber, Jason D.

    2015-01-01

    Background and Purpose Blood-brain barrier (BBB) disruption and hemorrhagic transformation (HT) following ischemic/reperfusion injury contributes to post-stroke morbidity and mortality. Bryostatin, a potent protein kinase C (PKC) modulator, has shown promise in treating neurological injury. In the present study, we tested the hypothesis that administration of bryostatin would reduce BBB disruption and HT following acute ischemic stroke; thus, prolonging the time window for administering recombinant tissue plasminogen activator (r-tPA). Methods Acute cerebral ischemia was produced by reversible occlusion of the right middle cerebral artery (MCAO) in 18–20-month-old female rats using an autologous blood clot with delayed r-tPA reperfusion. Bryostatin (or vehicle) was administered at 2 hours post-MCAO and r-tPA was administered at 6 hours post-MCAO. Functional assessment, lesion volume, and hemispheric swelling measurements were performed at 24 hours post-MCAO. Assessment of BBB permeability, measurement of hemoglobin, assessment of matrix metalloproteinase (MMP) levels by gel zymography, and measurement of PKCε, PKCα, PKCδ expression by western blot were conducted at 24 hours post-MCAO. Results Rats treated with bryostatin prior to r-tPA administration had decreased mortality and hemispheric swelling when compared with rats treated with r-tPA alone. Administration of bryostatin also limited BBB disruption and HT and down-regulated MMP-9 expression while up-regulating PKCε expression at 24 hours post-MCAO. Conclusions Bryostatin administration ameliorates BBB disruption and reduces the risk of HT by down-regulating MMP-9 activation and up-regulating PKCε. In this proof-of-concept study, bryostatin treatment lengthened the time-to-treatment window and enhanced the efficacy and safety of thrombolytic therapy. PMID:26189021

  17. Bryostatin extends tPA time window to 6 h following middle cerebral artery occlusion in aged female rats.

    PubMed

    Tan, Zhenjun; Lucke-Wold, Brandon P; Logsdon, Aric F; Turner, Ryan C; Tan, Cong; Li, Xinlan; Hongpaison, Jarin; Alkon, Daniel L; Simpkins, James W; Rosen, Charles L; Huber, Jason D

    2015-10-05

    Blood-brain barrier (BBB) disruption and hemorrhagic transformation (HT) following ischemic/reperfusion injury contributes to post-stroke morbidity and mortality. Bryostatin, a potent protein kinase C (PKC) modulator, has shown promise in treating neurological injury. In the present study, we tested the hypothesis that administration of bryostatin would reduce BBB disruption and HT following acute ischemic stroke; thus, prolonging the time window for administering recombinant tissue plasminogen activator (r-tPA). Acute cerebral ischemia was produced by reversible occlusion of the right middle cerebral artery (MCAO) in 18-20-month-old female rats using an autologous blood clot with delayed r-tPA reperfusion. Bryostatin (or vehicle) was administered at 2 h post-MCAO and r-tPA was administered at 6 h post-MCAO. Functional assessment, lesion volume, and hemispheric swelling measurements were performed at 24 h post-MCAO. Assessment of BBB permeability, measurement of hemoglobin, assessment of matrix metalloproteinase (MMP) levels by gel zymography, and measurement of PKCε, PKCα, PKCδ expression by western blot were conducted at 24 h post-MCAO. Rats treated with bryostatin prior to r-tPA administration had decreased mortality and hemispheric swelling when compared with rats treated with r-tPA alone. Administration of bryostatin also limited BBB disruption and HT and down-regulated MMP-9 expression while up-regulating PKCε expression at 24 h post-MCAO. Bryostatin administration ameliorates BBB disruption and reduces the risk of HT by down-regulating MMP-9 activation and up-regulating PKCε. In this proof-of-concept study, bryostatin treatment lengthened the time-to-treatment window and enhanced the efficacy and safety of thrombolytic therapy. Copyright © 2015 Elsevier B.V. All rights reserved.

  18. Optical inhibition of striatal neurons promotes focal neurogenesis and neurobehavioral recovery in mice after middle cerebral artery occlusion.

    PubMed

    He, Xiaosong; Lu, Yifan; Lin, Xiaojie; Jiang, Lu; Tang, Yaohui; Tang, Guanghui; Chen, Xiaoyan; Zhang, Zhijun; Wang, Yongting; Yang, Guo-Yuan

    2017-03-01

    Striatal neurons regulate the activity of neural progenitor cells in the subventricular zone, but the effect of striatal neuronal activity on neurogenesis after ischemic stroke is unclear. In this study, we used optogenetic tools to investigate the impact of striatal neuronal activity on the neurogenesis and functional recovery after cerebral ischemia. We transfected striatal neurons with channelrhodopsin-2 or halorhodopsin from Natronomonas so that they can be excited by 473 nm laser or inhibited by 594 nm laser, respectively. Neural inhibition but not excitation at 4-7 days after middle cerebral artery occlusion resulted in reduced atrophy volume (6.8 ± 0.7 vs 8.5 ± 1.2 mm(3), p < 0.05) and better performance represented by longer sustaining time on rotarod (99.3 ± 9 vs 80.1 ± 11 s, p < 0.01) and faster moving speed (7.7 ± 2 vs 5.7 ± 1.1 cm/s, p < 0.05) in open field tests. Furthermore, neural inhibition increased the number of nestin(+), BrdU(+)/doublecortin(+) and BrdU(+)/NeuN(+) cells ( p < 0.001) in the subventricular zone and peri-focal region, and the expression level of axon guidance factor Netrin-1 (0.39 ± 0.16 vs 0.16 ± 0.02, p < 0.05) in the peri-focal region. These data suggest that striatal neuronal activity plays an important role in regulating neurogenesis and neural-behavioral outcomes, and that inhibiting striatal neurons by optogenetics promotes the recovery after ischemic stroke in mice.

  19. Endovascular thrombolysis and stenting of a middle cerebral artery occlusion beyond 6 hours post-attack: special reference to the usefulness of diffusion-perfusion MRI.

    PubMed

    Ahn, Jung Yong; Han, In Bo; Chung, Sang Sup; Chung, Young Sun; Kim, Sang Heum; Yoon, Pyeong Ho

    2006-12-01

    Intra-arterial thrombolysis and percutaneous angioplasty is feasible in patients with acute middle cerebral artery (MCA) occlusion limited to 6 hours post-ictus, but there are some limitations such as reocclusion or hemorrhagic complications. In this report, we describe a stent placement in the treatment of a refractory artherothrombotic MCA occlusion beyond 6 hours of symptom onset. A 57-year-old man presented with a progressive left-sided weakness and verbal disturbance resulting from an acute thrombotic occlusion of the right MCA superimposed on severe proximal atheromatous stenosis. Diffusion-perfusion magnetic resonance imaging (MRI) demonstrated the significant diffusion-perfusion mismatch. After chemical and mechanical thrombolysis of the clot, balloon angioplasty of the underlying MCA stenosis was performed 2 days post-attack, without significant angiographic improvement. Percutaneous endovascular deployment of a stent (Driver 2.5 x 12 mm, MTI, Irvine, CA) was subsequently performed, with excellent angiographic results. Follow-up diffusion-perfusion MRI showed improved perfusion in the hypoperfused area. The patient's National Institutes of Health Stroke Scale (NIHSS) score was increased from 12 to 3. Clot thrombolysis and subsequent stenting in patients with refractory proximal MCA occlusion is feasible and allows for a significant reduction in the amount of thrombolytic drug required. In selective patients with acute MCA occlusion, the therapeutic window for recanalization procedures can be safely and effectively extended beyond the 'traditional 6 hours'. Diffusion-perfusion MRI in acute MCA occlusion is important for indication of therapy.

  20. Electroacupuncture Attenuates Cerebral Ischemia and Reperfusion Injury in Middle Cerebral Artery Occlusion of Rat via Modulation of Apoptosis, Inflammation, Oxidative Stress, and Excitotoxicity

    PubMed Central

    Shen, Mei-hong; Zhang, Chun-bing; Zhang, Jia-hui; Li, Peng-fei

    2016-01-01

    Electroacupuncture (EA) has several properties such as antioxidant, antiapoptosis, and anti-inflammatory properties. The current study was to investigate the effects of EA on the prevention and treatment of cerebral ischemia-reperfusion (I/R) injury and to elucidate possible molecular mechanisms. Sprague-Dawley rats were subjected to middle cerebral artery occlusion (MCAO) for 2 h followed by reperfusion for 24 h. EA stimulation was applied to both Baihui and Dazhui acupoints for 30 min in each rat per day for 5 successive days before MCAO (pretreatment) or when the reperfusion was initiated (treatment). Neurologic deficit scores, infarction volumes, brain water content, and neuronal apoptosis were evaluated. The expressions of related inflammatory cytokines, apoptotic molecules, antioxidant systems, and excitotoxic receptors in the brain were also investigated. Results showed that both EA pretreatment and treatment significantly reduced infarct volumes, decreased brain water content, and alleviated neuronal injury in MCAO rats. Notably, EA exerts neuroprotection against I/R injury through improving neurological function, attenuating the inflammation cytokines, upregulating antioxidant systems, and reducing the excitotoxicity. This study provides a better understanding of the molecular mechanism underlying the traditional use of EA. PMID:27123035

  1. Progressive cerebral occlusive disease after radiation therapy.

    PubMed

    Bitzer, M; Topka, H

    1995-01-01

    A case of progressive irradiation-induced cerebral vasculopathy with abnormal netlike vessels and transdural anastomoses (moyamoya syndrome) is presented. Radiological findings in an additional 40 cases reported in the literature are analyzed, and their clinical relevance is discussed. A 19-year-old woman presented with recurrent ischemic brain lesions after radiation therapy for treatment of a craniopharyngioma during childhood. Cerebral angiography 6 and 12 years after completion of radiation therapy revealed progressive cerebral arterial occlusive disease involving the internal carotid artery on either side of the circle of Willis, with abnormal netlike vessels and transdural anastomoses (moyamoya syndrome). Extensive similarities between irradiation-induced cerebral vasculopathy and primary moyamoya syndrome (Nishimoto's disease) support the notion that both disorders share common pathophysiological mechanisms. The occurrence of moyamoya-like vascular changes may not depend on specific trigger mechanisms but may rather represent a nonspecific response of the developing vascular system to a number of various noxious events.

  2. [Neuroprotective activity of the proline-containing dipeptide noopept on the model of brain ischemia induced by the middle cerebral artery occlusion].

    PubMed

    Gavrilova, S A; Us, K S; Ostrovskaia, R U; Koshelev, V B

    2006-01-01

    The influence of noopept (N-phenylacetyl-L-prolylglycine ethyl ester, GVS-111) on the extent of ischemic cortical stroke was investigated in experiments on white mongrel male rats with ischemia induced by a combination of the middle cerebral artery occlusion with ipsilateral common carotid artery ligation. Animals were treated with noopept (0.5 mg/kg, i.p.) according to the following schedule: 15 min and 2, 24, and 48 h after the occlusion. Test rats were decapitated 72 h after occlusion, brains were extracted and frozen, and thin brain slices were stained with 2,3,5-triphenyltetrazolium chloride. The slices were scanned and processed using Auc 1 computer program, which estimates the percentage of damaged area relative to that of the whole ipsilateral hemisphere. The conditions of coagulation the distal segment of middle cerebral artery were selected, which caused necrosis localized in the fronto-parietal and dorso-lateral regions of the brain cortex without any damage of subcortical structures. The extent of the brain damage in control group (treated by saline) was 18.6%, while that in the group treated with noopept was 12.2%, thus demonstrating a decrease in the infarction area by 34.5% (p < 05). The data on noopept efficacy on the model of the extensive ischemic injury of brain cortex show that this drug has good prospects for use in the neuroprotective treatment of stroke.

  3. [Acute popliteal arterial occlusion during extracorporeal circulation].

    PubMed

    Mizuno, Ju; Senda, Masahiro; Asahara, Miho; Yamada, Yoshitsugu; Arita, Hideko; Hanaoka, Kazuo

    2006-11-01

    A 79-year-old man underwent aortic arch replacement for thoracic aortic aneurysm. He had a history of smoking, coronary stenting for ischemic heart disease and replacement with artificial blood vessel for abdominal aortic aneurysm. Anesthesia was induced and maintained with midazolam, fentanyl, sevoflurane, and vecuronium. A 20 gage catheter was placed in the right radial artery and a 22 gage catheter in the left posterior tibial artery. Total circulatory arrest under profound hypothermia and retrograde cerebral perfusion were performed using extracorporeal circulation. After finishing anastomosis with artificial blood vessel, he was weaned from extracorporeal circulation. The pressure in the left posterior tibial artery was maintained at 15 mmHg, although the blood pressure in the right radial artery increased gradually. Then, the pressure in the left femoral artery in the operative field was the same as the pressure in the right radial artery. Therefore, we suspected the arterial line occlusion of the left posterior tibial artery. After the operation, we found the left leg and foot pale and cold with no pulsation on the left popliteal, dorsal pedis, and posterior tibial arteries. Further, acute left popliteal arterial occlusion was assessed by means of Doppler and left lower extremity angiography. We immediately performed the balloon-catheter embolectomy. However, as he developed compartment syndrome on the left lower limb due to reperfusion injury postoperatively, fascitomy was performed. On the 58th postoperative day, he was discharged from our hospital. Measurement by Doppler is useful for the early diagnosis of the lower leg arterial occlusion.

  4. Reduction of ischemic brain injury by administration of palmitoylethanolamide after transient middle cerebral artery occlusion in rats.

    PubMed

    Ahmad, Akbar; Genovese, Tiziana; Impellizzeri, Daniela; Crupi, Rosalia; Velardi, Enrico; Marino, Angela; Esposito, Emanuela; Cuzzocrea, Salvatore

    2012-10-05

    Stroke is the third leading cause of death and the leading cause of long-term disability in adults. Current therapeutic strategies for stroke, including thrombolytic drugs, such as tissue plasminogen activator offer great promise for the treatment, but complimentary neuroprotective treatments are likely to provide a better outcome. To counteract the ischemic brain injury in mice, a new therapeutic approach has been employed by using palmitoylethanolamide (PEA). PEA is one of the members of N-acyl-ethanolamine family maintain not only redox balance but also inhibit the mechanisms of secondary injury on ischemic brain injury. Treatment of the middle cerebral artery occlusion (MCAo)-induced animals with PEA reduced edema and brain infractions as evidenced by decreased 2,3,5-triphenyltetrazolium chloride (TTC) staining across brain sections. PEA-mediated improvements in tissues histology shown by reduction of lesion size and improvement in apoptosis level (assayed by Bax and Bcl-2) further support the efficacy of PEA therapy. We demonstrated that PEA treatment blocked infiltration of astrocytes and restored MCAo-mediated reduced expression of PAR, nitrotyrosine, iNOS, chymase, tryptase, growth factors (BDNF and GDNF) and GFAP. PEA also inhibited the MCAo-mediated increased expression of pJNK, NF-κB, and degradation of IκB-α. PEA-treated injured animals improved neurobehavioral functions as evaluated by motor deficits. Based on these findings we propose that PEA would be useful in lowering the risk of damage or improving function in ischemia-reperfusion brain injury-related disorders.

  5. Asynchronization in Changes of Electrophysiology and Pathology of Spinal Cord Motor Neurons in Rats Following Middle Cerebral Artery Occlusion.

    PubMed

    Lin, Nan; Liu, Ming-Sheng; Fan, Si-Yuan; Guan, Yu-Zhou; Cui, Li-Ying

    2015-11-05

    Motor dysfunction is common in stroke patients. Clinical electrophysiological studies suggest that transsynaptic degeneration occurred in the lower motor neurons, while pathological evidence is lacked. This study aimed to combine the electrophysiological and pathological results to prove the existence of transsynaptic degeneration in the motor system after stroke. Modified neurologic severity score, electrophysiological, and pathological assessments were evaluated in rats before middle cerebral artery occlusion (MCAO), and at 24 hours, 7 days, and 14 days after MCAO. Paired and independent-sample t-tests were applied to assess the changes of electrophysiological and pathological data. Compound motor action potential amplitude in the paretic side was significantly lower than the nonparetic side at both 24 hours (61.9 ± 10.4 vs. 66.6 ± 8.9, P < 0.05) and 7 days (60.9 ± 8.4 vs. 67.3 ± 9.6, P < 0.05) after MCAO. Motor unit number estimation of the paretic side was significantly less than the nonparetic side (379.0 ± 84.6 vs. 445.0 ± 89.5, P < 0.05) at 7 days after MCAO. Until 14 days after stroke, the pathological loss of motor neurons was detected. Motor neurons in 14-day MCAO group were significantly decreased, compared with control group (5.3 ± 0.7 vs. 7.3 ± 1.8, P < 0.05). Both electrophysiological and pathological studies showed transsynaptic degeneration after stroke. This study identified the asynchronization in changes of electrophysiology and pathology. The abnormal physiological changes and function impairment can be detected in the early stage and recovered quickly, while the pathological loss of motor neuron can be detected only in a later stage.

  6. ChAT-positive neurons participate in subventricular zone neurogenesis after middle cerebral artery occlusion in mice.

    PubMed

    Wang, Jianping; Fu, Xiaojie; Zhang, Di; Yu, Lie; Li, Nan; Lu, Zhengfang; Gao, Yufeng; Wang, Menghan; Liu, Xi; Zhou, Chenguang; Han, Wei; Yan, Bo; Wang, Jian

    2017-01-01

    The mechanisms of post-stroke neurogenesis in the subventricular zone (SVZ) are unclear. However, neural stem cell-intrinsic and neurogenic niche mechanisms, as well as neurotransmitters, have been shown to play important roles in SVZ neurogenesis. Recently, a previously unknown population of choline acetyltransferase (ChAT)(+) neurons residing in rodent SVZ were identified to have direct control over neural stem cell proliferation by indirectly activating fibroblast growth factor receptor (FGFR). This finding revealed possible neuronal control over SVZ neurogenesis. In this study, we assessed whether these ChAT(+) neurons also participate in stroke-induced neurogenesis. We used a permanent middle cerebral artery occlusion (MCAO) model produced by transcranial electrocoagulation in mice, atropine (muscarinic cholinergic receptor [mAchR] antagonist), and donepezil (acetylcholinesterase inhibitor) to investigate the role of ChAT(+) neurons in stroke-induced neurogenesis. We found that mAchRs, phosphorylated protein kinase C (p-PKC), and p-38 levels in the SVZ were upregulated in mice on day 7 after MCAO. MCAO also significantly increased the number of BrdU/doublecortin-positive cells and protein levels of phosphorylated-neural cell adhesion molecule and mammalian achaete scute homolog-1. FGFR was activated in the SVZ, and doublecortin-positive cells increased in the peri-infarction region. These post-stroke neurogenic effects were enhanced by donepezil and partially decreased by atropine. Neither atropine nor donepezil affected peri-infarct microglial activation or serum concentrations of TNF-α, IFN-γ, or TGF-β on day 7 after MCAO. We conclude that ChAT(+) neurons in the SVZ may participate in stroke-induced neurogenesis, suggesting a new mechanism for neurogenesis after stroke.

  7. Biphasic Functional Regulation in Hippocampus of Rat with Chronic Cerebral Hypoperfusion Induced by Permanent Occlusion of Bilateral Common Carotid Artery

    PubMed Central

    Lee, In Sun; Han, Jung-Soo; Kim, Bu-Yeo

    2013-01-01

    Background Chronic cerebral hypoperfusion induced by permanent occlusion of the bilateral common carotid artery (BCCAO) in rats has been commonly used for the study of Alzheimer’s disease and vascular dementia. Despite the apparent cognitive dysfunction in rats with BCCAO, the molecular markers or pathways involved in the pathological alternation have not been clearly identified. Methods Temporal changes (sham, 21, 35, 45, 55 and 70 days) in gene expression in the hippocampus of rats after BCCAO were measured using time-course microarray analysis. Gene Ontology (GO) and pathway analyses were performed to identify the functional involvement of temporally regulated genes in BCCAO. Results Two major gene expression patterns were observed in the hippocampus of rats after BCCAO. One pattern, which was composed of 341 early up-regulated genes after the surgical procedure, was dominantly involved in immune-related biological functions (false discovery rate [FDR]<0.01). Another pattern composed of 182 temporally delayed down-regulated genes was involved in sensory perception such as olfactory and cognition functions (FDR<0.01). In addition to the two gene expression patterns, the temporal change of GO and the pathway activities using all differentially expressed genes also confirmed that an immune response was the main early change, whereas sensory functions were delayed responses. Moreover, we identified FADD and SOCS3 as possible core genes in the sensory function loss process using text-based mining and interaction network analysis. Conclusions The biphasic regulatory mechanism first reported here could provide molecular evidence of BCCAO-induced impaired memory in rats as well as mechanism of the development of vascular dementia. PMID:23936146

  8. Intra-carotid cold magnesium sulfate infusion induces selective cerebral hypothermia and neuroprotection in rats with transient middle cerebral artery occlusion.

    PubMed

    Song, Wei; Wu, Yong-Ming; Ji, Zhong; Ji, Ya-Bin; Wang, Sheng-Nan; Pan, Su-Yue

    2013-04-01

    Local hypothermia induced by intra-arterial infusion of cold saline reduces brain injury in ischemic stroke. Administration of magnesium sulfate through the internal carotid artery is also known to reduce ischemic brain damage. The neuroprotective effects of combination therapy with local endovascular hypothermia and intra-carotid magnesium sulfate infusion has not been evaluated. The aim of the study was to determine whether infusion of intra-carotid cold magnesium offers neuroprotective efficacy superior to cold saline infusion alone. Sixty-eight Sprague-Dawley rats were subjected to 3 h of middle cerebral artery occlusion and were randomly divided into six groups: sham-operated group; stroke control group; local cold magnesium infusion group; local cold saline infusion group; local normothermic magnesium infusion group; and local normothermic saline infusion group. Before reperfusion, ischemic rats received local infusion or no treatment. Infarct volume, neurological deficit, and brain water content were evaluated at 48 h after reperfusion. Selective brain hypothermia (33-34 °C) was successfully induced by intra-carotid cold infusion. Local cold saline infusion and local cold magnesium infusion reduced the infarct volumes by 48 % (p < 0.001) and 65 % (p < 0.001), respectively, compared with stroke controls. Brain water content was decreased significantly in animals treated with local cold magnesium infusion. Furthermore, the rats given a local cold magnesium infusion had the best neurological outcome. Local normothermic infusion failed to improve ischemic brain damage. These data suggest that local hypothermia induced by intra-carotid administration of cold magnesium is more effective in reducing acute ischemic damage than infusion of cold saline alone.

  9. Sequential metabolic changes in rat brain following middle cerebral artery occlusion: A 2-deoxyglucose study

    SciTech Connect

    Shiraishi, K.; Sharp, F.R.; Simon, R.P. )

    1989-12-01

    The distribution and time course of altered cerebral metabolism following permanent focal ischemia was studied in rat using the 2-deoxyglucose (2DG) technique. Increased 2DG uptake preceded decreased 2DG uptake and infarction in the caudate putamen and cortex. Decreased 2DG uptake without infarction was observed for 72 h in thalamus and for 24 h in hippocampus (areas remote from the ischemic zones). This study supports the concept of cell excitation as a pathophysiologic process in permanent focal ischemia. The time course of increased metabolism may demarcate the time window of opportunity for the previously demonstrated attenuation of stroke size with inhibition of cell excitation by pharmacologic blockade of excitatory amino acid neurotransmission.

  10. Regulation of brain-derived neurotrophic factor gene expression after transient middle cerebral artery occlusion with and without brain damage.

    PubMed

    Kokaia, Z; Zhao, Q; Kokaia, M; Elmér, E; Metsis, M; Smith, M L; Siesjö, B K; Lindvall, O

    1995-11-01

    Levels of mRNA for c-fos, nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), TrkB, and TrkC were studied using in situ hybridization in the rat brain at different reperfusion times after unilateral middle cerebral artery occlusion (MCAO). Short-term (15 min) MCAO, which does not cause neuronal death, induced elevated BDNF mRNA expression confined to ipsilateral frontal and cingulate cortices outside the ischemic area. With a longer duration of MCAO (2 h), which leads to cortical infarction, the increase was more marked and elevated BDNF mRNA levels were also detected bilaterally in dentate granule cells and CA1 and CA3 pyramidal neurons. Maximum expression was found after 2 h of reperfusion. At 24 h BDNF mRNA expression had returned to control values. In the ischemic core of the parietal cortex only scattered neurons were expressing high levels of BDNF mRNA after 15 min and 2 h of MCAO. Analysis of different BDNF transcripts showed that MCAO induced a marked increase of exon III mRNA but only small increases of exon I and II mRNAs in cortex and hippocampus. In contrast to BDNF mRNA, elevated expression of c-fos mRNA was observed in the entire ipsilateral cerebral cortex, including the ischemic core, after both 15 min and 2 h of MCAO. Two hours of MCAO also induced transient, bilateral increases of NGF and TrkB mRNA levels and a decrease of NT-3 mRNA expression, confined to dentate granule cells. The upregulation of BDNF mRNA expression in cortical neurons after MCAO is probably triggered by glutamate through a spreading depression-like mechanism. The lack of response of the BDNF gene in the ischemic core may be due to suppression of signal transduction or transcription factor synthesis caused by the ischemia. The observed pattern of gene expression after MCAO agrees well with a neuroprotective role of BDNF in cortical neurons. However, elevated levels of NGF and BDNF protein could also increase synaptic efficacy in the

  11. Parecoxib is neuroprotective in spontaneously hypertensive rats after transient middle cerebral artery occlusion: a divided treatment response?

    PubMed Central

    Kelsen, Jesper; Kjær, Katrine; Chen, Gang; Pedersen, Michael; Røhl, Lisbeth; Frøkiær, Jørgen; Nielsen, Søren; Nyengaard, Jens R; Rønn, Lars Christian B

    2006-01-01

    Background Anti-inflammatory treatment affects ischemic damage and neurogenesis in rodent models of cerebral ischemia. We investigated the potential benefit of COX-2 inhibition with parecoxib in spontaneously hypertensive rats (SHRs) subjected to transient middle cerebral artery occlusion (tMCAo). Methods Sixty-four male SHRs were randomized to 90 min of intraluminal tMCAo or sham surgery. Parecoxib (10 mg/kg) or isotonic saline was administered intraperitoneally (IP) during the procedure, and twice daily thereafter. Nineteen animals were euthanized after 24 hours, and each hemisphere was examined for mRNA expression of pro-inflammatory cytokines and COX enzymes by quantitative RT-PCR. Twenty-three tMCAo animals were studied with diffusion and T2 weighted MRI within the first 24 hours, and ten of the SHRs underwent follow-up MRI six days later. Thirty-three SHRs were given 5-bromo-2'-deoxy-uridine (BrdU) twice daily on Day 4 to 7 after tMCAo. Animals were euthanized on Day 8 and the brains were studied with free-floating immunohistochemistry for activated microglia (ED-1), hippocampal granule cell BrdU incorporation, and neuronal nuclei (NeuN). Infarct volume estimation was done using the 2D nucleator and Cavalieri principle on NeuN-stained coronal brain sections. The total number of BrdU+ cells in the dentate gyrus (DG) of the hippocampus was estimated using the optical fractionator. Results We found a significant reduction in infarct volume in parecoxib treated animals one week after tMCAo (p < 0.03). Cortical ADC values in the parecoxib group were markedly less increased on Day 8 (p < 0.01). Interestingly, the parecoxib treated rats were segregated into two subgroups, suggesting a responder vs. non-responder phenomenon. We found indications of mRNA up-regulation of IL-1β, IL-6, TNF-α and COX-2, whereas COX-1 remained unaffected. Hippocampal granule cell BrdU incorporation was not affected by parecoxib treatment. Presence of ED-1+ activated microglia in the

  12. Neurological impairment in rats after transient middle cerebral artery occlusion: a comparative study under various treatment paradigms.

    PubMed

    Zausinger, S; Hungerhuber, E; Baethmann, A; Reulen, H; Schmid-Elsaesser, R

    2000-04-28

    The assessment of the functional outcome - in addition to the conventional endpoints as histomorphometry of the ischemic brain damage - for the evaluation of cerebroprotective therapies is increasingly recommended, although there is little consensus on appropriate procedures. We evaluated a battery of sensorimotor tasks in rats after transient middle cerebral artery occlusion (MCAO) to select those with the highest potential to discriminate between various degrees of neuronal damage. A total of 40 Sprague-Dawley rats were subjected to 90 min of MCAO and assigned to one of four treatment arms: (1) sham-operated controls, (2) vehicle-treated controls, (3) moderately effective neuroprotection by 2x100 mg/kg alpha-phenyl-N-tert-butyl nitrone (PBN), (4) highly effective neuroprotection by mild hypothermia (33 degrees C). Functional deficits were daily quantified using the beam balance task (1.5 cm, 2.5 cm diameter rectangular and 2.5 cm diameter cylindrical beam), the prehensile traction task, the rotarod, and a six-point neuro-score. Infarction of cerebral cortex and basal ganglia was assessed one week after ischemia. Treatment with PBN significantly reduced cortical infarction (-31%), while treatment with hypothermia resulted in a significantly smaller infarct volume of cortex (-94%) and basal ganglia (-27%). Beam balance, prehensile traction and rotarod failed to demonstrate any difference in motor performance. The six-point neuro-score showed a significant correlation with cortical infarction from day 2 and with total infarct volume from day 3. The smaller the reduction of infarct volume, the later the corresponding difference in neuro-score became apparent. Functional outcome after MCAO in rats can be assessed by a relatively simple measurement of neurological deficit. The slope of functional recovery is closely related with the degree of the morphological, particularly cortical damage. If expected treatment effects are small, an observation period of at least 3

  13. The effects of Tanshinone IIA on blood-brain barrier and brain edema after transient middle cerebral artery occlusion in rats.

    PubMed

    Tang, Chao; Xue, Hongli; Bai, Changlin; Fu, Rong; Wu, Anhua

    2010-12-01

    Disruption of blood-brain barrier (BBB) and edema formation play a key role in the development of neurological dysfunction after cerebral ischemia. In this study, the effects of Tanshinone IIA (Tan IIA), one of the active ingredients of Salvia miltiorrhiza root, on the BBB and brain edema after transient middle cerebral artery occlusion in rats were examined. Our study demonstrated that Tan IIA reduced brain infarct area, water content in the ischemic hemisphere. Furthermore, Tan IIA significantly decreased BBB permeability to Evans blue, suppressed the expression of intercellular adhesion molecule-1 (ICAM-1), matrix metalloproteinase-9 (MMP-9), inhibited the degradation of tight junction proteins zonula occludens-1 (ZO-1) and Occludin. These results demonstrated that Tan IIA was effective for attenuating the extent of brain edema formation in response to ischemia injury in rats, partly by Tan IIA's protective effect on the BBB. Our results may have implications in the treatment of brain edema in cerebral ischemia.

  14. Prediction of infarct volume and neurologic outcome by using automated multiparametric perfusion-weighted magnetic resonance imaging in a primate model of permanent middle cerebral artery occlusion.

    PubMed

    Sasaki, Makoto; Kudo, Kohsuke; Honjo, Kaneyoshi; Hu, Jin-Qing; Wang, Hai-Bin; Shintaku, Katsuya

    2011-02-01

    By optimizing thresholds, we identified the perfusion-weighted magnetic resonance imaging (PWI) parameters that accurately predict final infarct volume and neurologic outcome in a primate model of permanent middle cerebral artery (MCA) occlusion. Ten cynomolgus monkeys underwent PWI and diffusion-weighted imaging (DWI) at 3 and 47 hours, respectively, after right MCA occlusion using platinum coils, and were killed at 48 hours. Volumes of the hypoperfused areas on PWI were automatically measured using different thresholds and 11 parametric maps to determine the optimum threshold (at which least difference was found between the average volumes on PWI and those determined using specimens or DWI). In the case of arrival time (AT), cerebral blood volume (CBV), time to peak (TTP), time to maximum (T(max)), and cerebral blood flow (CBF) determined using deconvolution techniques, the volume of the hypoperfused area significantly correlated with the infarct volumes and the neurologic deficit scores with small variations, whereas in the case of mean transit time and nondeconvolution CBF, relatively poor correlations with large variations were seen. At optimum threshold, AT, CBV, TTP, T(max), and deconvolution CBF can accurately predict the final infarct volume and neurologic outcome in monkeys with permanent MCA occlusion.

  15. Endothelin-1 overexpression leads to further water accumulation and brain edema after middle cerebral artery occlusion via aquaporin 4 expression in astrocytic end-feet.

    PubMed

    Lo, Amy C Y; Chen, Ann Y S; Hung, Victor K L; Yaw, Lai Ping; Fung, Maggie K L; Ho, Maggie C Y; Tsang, Margaret C S; Chung, Stephen S M; Chung, Sookja K

    2005-08-01

    Stroke patients have increased levels of endothelin-1 (ET-1), a strong vasoconstrictor, in their plasma or cerebrospinal fluid. Previously, we showed high level of ET-1 mRNA expression in astrocytes after hypoxia/ischemia. It is unclear whether the contribution of ET-1 induction in astrocytes is protective or destructive in cerebral ischemia. Here, we generated a transgenic mouse model that overexpress ET-1 in astrocytes (GET-1) using the glial fibrillary acidic protein promoter to examine the role of astrocytic ET-1 in ischemic stroke by challenging these mice with transient middle cerebral artery occlusion (MCAO). Under normal condition, GET-1 mice showed no abnormality in brain morphology, cerebrovasculature, absolute cerebral blood flow, blood-brain barrier (BBB) integrity, and mean arterial blood pressure. Yet, GET-1 mice subjected to transient MCAO showed more severe neurologic deficits and increased infarct, which were partially normalized by administration of ABT-627 (ET(A) antagonist) 5 mins after MCAO. In addition, GET-1 brains exhibited more Evans blue extravasation and showed decreased endothelial occludin expression after MCAO, correlating with higher brain water content and increased cerebral edema. Aquaporin 4 expression was also more pronounced in astrocytic end-feet on blood vessels in GET-1 ipsilateral brains. Our current data suggest that astrocytic ET-1 has deleterious effects on water homeostasis, cerebral edema and BBB integrity, which contribute to more severe ischemic brain injury.

  16. Efficacy of extracranial-intracranial bypass for progressive middle cerebral artery occlusion associated with active Sjögren's syndrome: case report.

    PubMed

    Sakata, Hiroyuki; Fujimura, Miki; Sato, Kenichi; Shimizu, Hiroaki; Tominaga, Teiji

    2014-09-01

    Sjögren syndrome affecting the major cerebral arteries is rare, and an optimal therapeutic strategy to counteract such a lesion has not yet been established. We herein report a case of a 39-year-old woman with a history of primary Sjögren syndrome, which had previously been treated with immunosuppressive therapy, manifesting with a crescendo transient ischemic attack because of left middle cerebral artery stenosis. Despite the administration of high doses of prednisolone and azathioprine for active Sjögren syndrome, the frequency of crescendo transient ischemic attacks increased with the progression of stenosis and magnetic resonance imaging showed the development of subacute cerebral infarction. Single-photon emission computed tomography with N-isopropyl[(123)I]-p-iodoamphetamine revealed apparent hemodynamic compromise in the affected cerebral hemisphere. In light of the increased risk of further progression of cerebral infarction, we decided to perform surgical revascularization in spite of her active inflammatory condition. The patient underwent extracranial-intracranial bypass without complications and was treated with intensive immunosuppressive therapy during the perioperative period. Based on our findings, we recommend surgical revascularization for occlusive cerebrovascular disease with hemodynamic compromise in combination with intensive immunosuppressive therapy, even in the active inflammatory state of autoimmune diseases, if ischemic symptoms are medically uncontrollable. Copyright © 2014 National Stroke Association. All rights reserved.

  17. A temporal MRI assessment of neuropathology after transient middle cerebral artery occlusion in the rat: correlations with behavior.

    PubMed

    Virley, D; Beech, J S; Smart, S C; Williams, S C; Hodges, H; Hunter, A J

    2000-03-01

    The purpose of this study was to evaluate the temporal and spatial pathological alterations within ischemic tissue using serial magnetic resonance imaging (MRI) and to determine the extent and duration of functional impairment using objective behavioral tests after transient middle cerebral artery occlusion (tMCAO) in the rat. MRI signatures derived from specific anatomical regions of interest (ROI) were then appropriately correlated to the behavioral measures over the time course of the study (up to 28 days post-tMCAO). Sprague-Dawley rats (n = 12) were initially trained on the following behavioral tasks before surgery: bilateral sticky label test (for contralateral neglect); beam walking (for hindlimb coordination); staircase test (for skilled forelimb paw-reaching). Rats were then randomly assigned to receive either tMCAO (90 minutes, n = 6), by means of the intraluminal thread technique, or sham-control surgery (n = 6). Proton density, T2- and T2-diffusion-weighted MR images were acquired at 1, 7, 14, and 28 days post-tMCAO that were then smoothed into respective proton density, T2 relaxation, and apparent diffusion coefficient (ADC) maps. Apparent percent total lesion volume was assessed using T2W imaging. MR signatures were evaluated using the tissue maps by defining ROI for MCAO and sham-control groups, which corresponded to the caudate-putamen, forelimb, hindlimb, and lower parietal cortices both ipsilateral and contralateral to the occlusion site. Behavioral tests were undertaken daily from 1 to 28 days post-tMCAO. Results demonstrate that apparent percent lesion volume reduced from 1 to 7 days (P < 0.05) but then remained constant up to 28 days for the MCAO group. Pathological changes in the temporal profile of T2 and ADC tissue signatures were significantly altered in specific ROI across the time course of the study (P < 0.05 to <0.001), reflecting the progression of edema to necrosis and cavitation. Both T2 and ADC measures of ischemic pathology

  18. The free radical spin-trap alpha-PBN attenuates periinfarct depolarizations following permanent middle cerebral artery occlusion in rats without reducing infarct volume.

    PubMed

    Christensen, Thomas; Bruhn, Torben; Diemer, Nils Henrik

    2003-11-14

    The effect of the free radical spin-trap alpha-phenyl-butyl-tert-nitrone (alpha-PBN) in permanent focal cerebral ischemia in rats was examined in two series of experiments. In the first, rats were subjected to permanent occlusion of the middle cerebral artery (MCAO) and treated 1 h after occlusion with a single dose of alpha-PBN (100 mg/kg) or saline. Body temperature was measured and controlled for the first 24 h to obtain identical temperature curves in the two groups. Cortical infarct volumes were determined on histological sections 7 days later. alpha-PBN did not significantly reduce infarct volume (control: 28.3+/-16.3 mm3 vs. alpha-PBN 23.7+/-7.4 mm3). In the second series of experiments, periinfarct depolarizations (PIDs) were recorded with an extracellular DC electrode at two locations in the ischemic penumbra for the initial 3 h following MCAO. alpha-PBN (100 mg/kg, single dose in conjunction with occlusion) significantly reduced the total number (median value of 3 PIDs in the control groups vs. 1 PID in alpha-PBN groups, p<0.001) and total duration of the PIDs (median value 662 s in the control groups vs. 162 s in the alpha-PBN groups, p<0.006). In spite of this, cortical infarct volumes determined 7 days later in the same rats were not smaller in alpha-PBN-treated rats. The study thus demonstrates that attenuation of PIDs does not always lead to smaller infarcts if permanent arterial occlusion is followed by long survival time and does not support the hypothesis that PIDs per se are critical determinants of infarct size in this situation.

  19. Bilateral atherosclerotic internal carotid artery occlusion and recurrent ischaemic stroke.

    PubMed

    Amin, Osama S M

    2015-06-08

    Bilateral internal carotid artery occlusion (BICAO) is a rare disease that carries a gloomy prognosis. We report a case of a 52-year-old man who developed ischaemic infarction at the region of the right middle cerebral artery; he was found to have atherosclerotic occlusion of both internal carotid arteries on Doppler-duplex examination. He received medical treatment only. After 1 year, he developed a new infarction at the region of the left middle cerebral artery. Conventional angiography revealed bilateral occlusion of internal carotid arteries at their origin, approximately 50% stenosis of the common carotid bulbs and mild stenosis of the origin of external carotid arteries. The patient did not undergo any form of surgical revascularisation procedures and died of severe aspiration pneumonia approximately 2 months after the second stroke. BICAO portends a poor outcome and carries a risk of recurrent ischaemic events. The best management strategy for this vascular occlusion remains unclear.

  20. Hemodynamic study of internal carotid artery stenosis and occlusion: value of combined isotopic measurements of regional cerebral blood flow and blood volume

    SciTech Connect

    Derlon, J.M.; Bouvard, G.; Lechevalier, B.; Dupuy, B.; Maiza, D.; Hubert, P.; Courtheoux, P.; Peres, J.C.; Houtteville, J.P.

    1986-05-01

    The assessment of the intracranial hemodynamic consequences of obstructive lesions of the carotid artery by measuring resting rCBF is inadequate because cerebral blood flow may remain constant in spite of significant drops in the intraluminal pressure due to autoregulation. Moreover, flow may be permanently decreased following cerebral infarction, even if the arterial anatomical conditions have resumed their normal state because of the decreased metabolic demand of an infarcted area. Measurement of the regional cerebral blood volume (rCBV) helps with the hemodynamic assessment of these conditions, since there is a linear and inverse relationship between intraarterial pressure and intracranial blood volume. In 24 patients exhibiting various carotid and ischemic brain lesions we studied both rCBF and rCBV. The latter is a comparative measure between hemispheres obtained by single photon emission tomography after autotransfusion of 99mTechnetium labeled erythrocytes. There was no correlation between rCBF and clinical status, CT scan or arterial lesions. There was no correlation between rCBV and clinical status or CT scan. There was, however, an interesting correlation between rCBV and the severity of the arterial lesion. The rCBV was symmetrical in all patients with normal or moderately stenotic carotid arteries before and after operation. In some patients with severe unilateral stenosis or occlusion, there was a significant relative increase of rCBV in the hemisphere downstream from the lesion, which disappeared after surgery (endarterectomy or extra-intracranial bypass). In some patients with severe and bilateral carotid lesions, we noted an asymmetry in rCBV that disappeared after a unilateral operation. Other patients with similar lesions develop asymmetry only after an operation that resulted in a relative increase in rCBV in the hemisphere supplied by the non-operated artery.

  1. Retinal artery occlusion

    MedlinePlus

    ... These blockages are more likely if there is hardening of the arteries ( atherosclerosis ) in the eye. Clots ... Blindness and vision loss Blood clots Diabetes Glaucoma Hardening of the arteries High blood cholesterol levels High ...

  2. Transient middle cerebral artery occlusion causes different structural, mechanical, and myogenic alterations in normotensive and hypertensive rats.

    PubMed

    Jiménez-Altayó, Francesc; Martín, Abraham; Rojas, Santiago; Justicia, Carles; Briones, Ana M; Giraldo, Jesús; Planas, Anna M; Vila, Elisabet

    2007-07-01

    Transient focal cerebral ischemia in the rat alters vessel properties, and spontaneously hypertensive rats (SHR) show a poorer outcome after ischemia. In the present study we examined the role of hypertension on vessel properties after ischemia-reperfusion. The right middle cerebral artery (MCA) was occluded (90 min) and reperfused (24 h) in SHR (n = 12) and Wistar-Kyoto rats (WKY; n = 11). Sham-operated rats (SHR, n = 10; WKY, n = 10) were used as controls. The structural, mechanical, and myogenic properties of the MCA were assessed by pressure myography. Nuclei distribution and elastin content and organization were analyzed by confocal microscopy. Infarct volume was larger in SHR than in WKY rats. Ischemia-reperfusion induced adventitial hypertrophy associated with an increase in the total number of adventitial cells. In addition, fenestrae area and arterial distensibility increased and myogenic tone decreased in the MCA of WKY rats after ischemia-reperfusion. Hypertension per se induced hypertrophic inward remodeling. Ischemia-reperfusion decreased the cross-sectional area of the MCA in SHR, without significant changes in distensibility, despite an increase in fenestrae area. In addition, MCA myogenic properties were not altered after ischemia-reperfusion in SHR. Our results indicate that in normotensive rats, MCA develops a compensatory mechanism (i.e., enhanced distensibility and decreased myogenic tone) that counteracts the effect of ischemia-reperfusion and ensures correct cerebral irrigation. These compensatory mechanisms are lost in hypertension, thereby explaining, at least in part, the greater infarct volume observed in SHR.

  3. Thrombosis of the Azygos Anterior Cerebral Artery

    PubMed Central

    Avelino, Marcelo Coelho; Bastos, Breno Braga; Moreira de Sousa, Rafael Soares

    2017-01-01

    The azygos anterior cerebral artery is a rare variant, characterized by the absence of the anterior communicating artery and the union of two proximal segments of the anterior cerebral artery, forming a single trunk and ascending through the interhemispheric fissure. The incidence in the population varies from 0.3 to 2%. The presence of occlusion for this vessel causes bifrontal infarcts, with potentially devastating functional consequences, hence the importance of recognizing this anatomical variation in imaging exams. PMID:28299225

  4. Near-infrared diffuse reflectance imaging of infarct core and peri-infarct depolarization in a rat middle cerebral artery occlusion model

    NASA Astrophysics Data System (ADS)

    Kawauchi, Satoko; Nishidate, Izumi; Nawashiro, Hiroshi; Sato, Shunichi

    2014-03-01

    To understand the pathophysiology of ischemic stroke, in vivo imaging of the brain tissue viability and related spreading depolarization is crucial. In the infarct core, impairment of energy metabolism causes anoxic depolarization (AD), which considerably increases energy consumption, accelerating irreversible neuronal damage. In the peri-infarct penumbra region, where tissue is still reversible despite limited blood flow, peri-infarct depolarization (PID) occurs, exacerbating energy deficit and hence expanding the infarct area. We previously showed that light-scattering signal, which is sensitive to cellular/subcellular structural integrity, was correlated with AD and brain tissue viability in a rat hypoxia-reoxygenation model. In the present study, we performed transcranial NIR diffuse reflectance imaging of the rat brain during middle cerebral artery (MCA) occlusion and examined whether the infarct core and PIDs can be detected. Immediately after occluding the left MCA, light scattering started to increase focally in the occlusion site and a bright region was generated near the occlusion site and spread over the left entire cortex, which was followed by a dark region, showing the occurrence of PID. The PID was generated repetitively and the number of times of occurrence in a rat ranged from four to ten within 1 hour after occlusion (n=4). The scattering increase in the occlusion site was irreversible and the area with increased scattering expanded with increasing the number of PIDs, indicating an expansion of the infarct core. These results suggest the usefulness of NIR diffuse reflectance signal to visualize spatiotemporal changes in the infarct area and PIDs.

  5. Isolated supraclinoid occlusive disease of the internal carotid artery.

    PubMed

    Lagrèze, H L; Hartmann, A; Ries, F; Wappenschmidt, J; Hanisch, E

    1987-01-01

    Isolated supraclinoid occlusive disease of the internal carotid artery is a rare cause of cerebral ischemia. The authors of the only review of this subject concluded that it is caused predominantly by factors other than atherosclerosis. We examined 6 patients with isolated supraclinoid occlusive lesions. Five of them had one or more risk factors for atherosclerosis. Thus, the isolated stenosis of that part of the internal carotid artery does not seem to represent a particular pathologic entity.

  6. A Comparative Study of Variables Influencing Ischemic Injury in the Longa and Koizumi Methods of Intraluminal Filament Middle Cerebral Artery Occlusion in Mice

    PubMed Central

    Morris, Gary P.; Gladbach, Amadeus; Ittner, Lars M.; Vissel, Bryce

    2016-01-01

    The intraluminal filament model of middle cerebral artery occlusion (MCAO) in mice and rats has been plagued by inconsistency, owing in part to the multitude of variables requiring control. In this study we investigated the impact of several major variables on survival rate, lesion volume, neurological scores, cerebral blood flow (CBF) and body weight including filament width, time after reperfusion, occlusion time and the choice of surgical method. Using the Koizumi method, we found ischemic injury can be detected as early as 30 min after reperfusion, to a degree that is not statistically different from 24 h post-perfusion, using 2,3,5-Triphenyltetrazolium chloride (TTC) staining. We also found a distinct increase in total lesion volume with increasing occlusion time, with 30–45 min a critical time for the development of large, reproducible lesions. Furthermore, although we found no significant difference in total lesion volume generated by the Koizumi and Longa methods of MCAO, nor were survival rates appreciably different between the two at 4 h after reperfusion, the Longa method produces significantly greater reperfusion. Finally, we found no statistical evidence to support the exclusion of data from animals experiencing a CBF reduction of <70% in the MCA territory following MCAO, using laser-Doppler flowmetry. Instead we suggest the main usefulness of laser-Doppler flowmetry is for guiding filament placement and the identification of subarachnoid haemorrhages and premature reperfusion. In summary, this study provides detailed evaluation of the Koizumi method of intraluminal filament MCAO in mice and a direct comparison to the Longa method. PMID:26870954

  7. Overactivation of NR2B-containing NMDA receptors through entorhinal-hippocampal connection initiates accumulation of hyperphosphorylated tau in rat hippocampus after transient middle cerebral artery occlusion.

    PubMed

    Xu, Cheng-Shi; Liu, An-Chun; Chen, Juan; Pan, Zhi-Yong; Wan, Qi; Li, Zhi-Qiang; Wang, Ze-Fen

    2015-08-01

    Middle cerebral artery occlusion (MCAO) induces secondary damages in the hippocampus that is remote from primary ischemic regions. Tau hyperphosphorylation is an important risk for neurodegenerative diseases. Increased tau phosphorylation has been identified in ischemic cortex, but little is known regarding the changes in the hippocampus. We showed that unilateral transient MCAO induced accumulation of hyperphosphorylated tau and concurrent dephosphorylation of glycogen synthase kinase-3β at Ser 9 in the ipsilateral hippocampus. These MCAO-induced changes were not reproduced when glutamatergic inputs from the entorhinal cortex to the hippocampus were transected; however, the changes were mimicked by intrahippocampal N-methyl-d-aspartate (NMDA) administration. Inhibition of NMDA receptor (NMDAR) subunit NR2B, but not NR2A activity in the hippocampus attenuated the accumulation of hyperphosphorylated tau and spatial cognitive impairment in MCAO rats. Together, our data suggest that overactivation of NR2B-containing NMDARs through entorhinal-hippocampal connection plays an important role in the accumulation of hyperphosphorylated tau in the hippocampus following MCAO. Glycogen synthase kinase-3β is an important protein kinase involved in NMDARs-mediated tau hyperphosphorylation. This study indicates that early inhibition of NR2B-containing NMDARs may represent a potential strategy to prevent or delay the occurrence of post-stroke dementia. Middle cerebral artery occlusion induces secondary damage in the hippocampus that is remote from primary ischemic regions. We propose that excessive activation of NR2B-containing NMDA receptors through entorhinal-hippocampal connection initiated the accumulation of hyperphosphorylated tau in the hippocampus, which subsequently induced cognitive deficit. This study provides new insights into the prospects of NR2B inhibition in stoke therapy.

  8. Effect of nitrous oxide use on long-term neurologic and neuropsychological outcome in patients who received temporary proximal artery occlusion during cerebral aneurysm clipping surgery.

    PubMed

    Pasternak, Jeffrey J; McGregor, Diana G; Lanier, William L; Schroeder, Darrell R; Rusy, Deborah A; Hindman, Bradley; Clarke, William; Torner, James; Todd, Michael M

    2009-03-01

    The authors explored the relationship between nitrous oxide use and neurologic and neuropsychological outcome in a population of patients likely to experience intraoperative cerebral ischemia: those who had temporary cerebral arterial occlusion during aneurysm clipping surgery. A post hoc analysis of a subset of the data from the Intraoperative Hypothermia for Aneurysm Surgery Trial was conducted. Only subjects who had temporary arterial occlusion during surgery were included in the analysis. Metrics of short-term and long-term (i.e., 3 months after surgery) outcome were evaluated via both univariate and multivariate logistic regression analysis. An odds ratio (OR) greater than 1.0 denotes a worse outcome in patients receiving nitrous oxide. The authors evaluated 441 patients, of which 199 received nitrous oxide. Patients receiving nitrous oxide had a greater risk of delayed ischemic neurologic deficits (i.e., the clinical manifestation of vasospasm) (OR, 1.78, 95% confidence interval [CI], 1.08-2.95; P = 0.025). However, at 3 months after surgery, there was no difference in any metric of gross neurologic outcome: Glasgow Outcome Score (OR, 0.67; CI, 0.44-1.03; P = 0.065), Rankin Score (OR, 0.74; CI, 0.47-1.16; P = 0.192), National Institutes of Health Stroke Scale (OR, 1.02; CI, 0.66-1.56; P = 0.937), or Barthel Index (OR, 0.69; CI, 0.38-1.25; P = 0.22). The risk of impairment on at least one test of neuropsychological function was reduced in those who received nitrous oxide (OR, 0.56; CI, 0.36-0.89; P = 0.013). In this patient population, use of nitrous oxide was associated with an increased risk for the development of delayed ischemic neurologic deficits; however, there was no evidence of detriment to long-term gross neurologic or neuropsychological outcome.

  9. Acute Middle Cerebral Artery Occlusion Treated by Thrombectomy in a Patient with Myelodysplastic Syndrome and Severe Thrombocytopenia

    PubMed Central

    Onder, Halil; Murat Arsava, E.; Arat, Anıl; Akif Topcuoglu, M.

    2015-01-01

    Objective Experience on thrombolysis and/or thrombectomy for acute major ischemic strokes in the setting of deep (less than 40,000/mm3) thrombocytopenia is limited. Methods Case report and review of the literature. Results A 63-year-old female with myelodysplastic syndrome presented with left middle cerebral artery stroke within 2 hours of symptom onset. Severe thrombocytopenia (10.000/mm3) precluded systemic thrombolysis. However, endovascular thrombectomy provided successful recanalization and dramatic clinical recovery with NIHSS score decreasing from 20 to 2 soon after the procedure. Her modified Rankin scale was 1 at the end of the third month. Conclusion This exceptional case highlights that neurothrombectomy could be feasible and of justifiable merit even in the setting of critically low thrombocytopenia if a meticulous procedure is followed in subjects with severe acute stroke. PMID:26576212

  10. Assessment of functional impairment following permanent middle cerebral artery occlusion in a non-human primate species.

    PubMed

    Marshall, J W; Ridley, R M

    1996-09-01

    The purpose of the present study was to examine and quantify the functional consequence of a focal cerebral ischaemic lesion in a primate species, the marmoset. Following craniotomy and retraction of the frontal and temporal lobes, the middle cerebral artery was permanently occluded by means of electrocoagulation. Three and eight weeks after surgery, various behavioural tests were used to give a quantifiable measure to the neurological deficits produced. These tests required the monkeys to reach into tubes for foodbits, retrieve rewards from the steps of two designs of 'staircases', respond to one of two simultaneously presented rewarded tubes, remove adhesive labels attached to their feet, and respond to sensory stimuli. Unilateral motor impairment of the contralateral forelimb and neglect of contralateral tactile stimuli were seen in all subjects, and spatial neglect was also present in some monkeys. Subsequent histological analysis revealed unilateral cortical damage in all subjects with varying amounts of injury to the caudate and the putamen in some animals. These results demonstrate the potential for the use of this species in future investigations to examine the effect of neuroprotective treatment on functional outcome after a focal ischaemic insult.

  11. Neuroprotective Effects of Bone Marrow Mesenchymal Stem Cells on Bilateral Common Carotid Arteries Occlusion Model of Cerebral Ischemia in Rat

    PubMed Central

    Pourheydar, Bagher; Azimzadeh, Mostafa; Rezaei Moghadam, Adel; Marzban, Asghar

    2016-01-01

    Cell therapy is the most advanced treatment of the cerebral ischemia, nowadays. Herein, we discuss the neuroprotective effects of bone marrow mesenchymal stem cells (BMSCs) on rat hippocampal cells following intravenous injection of these cells in an ischemia-reperfusion model. Adult male Wistar rats were divided into 5 groups: control, sham (surgery without blockage of common carotid arteries), ischemia (common carotid arteries were blocked for 30 min prior to reperfusion), vehicle (7 days after ischemia PBS was injected via the tail vein), and treatment (injections of BMSC into the tail veins 7 days after ischemia). We performed neuromuscular and vestibulomotor function tests to assess behavioral function and, finally, brains were subjected to hematoxylin and eosin (H&E), anti-Brdu immunohistochemistry, and TUNEL staining. The ischemia group had severe apoptosis. The group treated with BMSCs had a lower mortality rate and also had significant improvement in functional recovery (P < 0.001). Ischemia-reperfusion for 30 min causes damage and extensive neuronal death in the hippocampus, especially in CA1 and CA3 regions, leading to several functional and neurological deficits. In conclusion, intravenous injection of BMSCs can significantly decrease the number of apoptotic neurons and significantly improve functional recovery, which may be a beneficial treatment method for ischemic injuries. PMID:27847404

  12. ACUTE RETINAL ARTERIAL OCCLUSIVE DISORDERS

    PubMed Central

    Hayreh, Sohan Singh

    2011-01-01

    The initial section deals with basic sciences; among the various topics briefly discussed are the anatomical features of ophthalmic, central retinal and cilioretinal arteries which may play a role in acute retinal arterial ischemic disorders. Crucial information required in the management of central retinal artery occlusion (CRAO) is the length of time the retina can survive following that. An experimental study shows that CRAO for 97 minutes produces no detectable permanent retinal damage but there is a progressive ischemic damage thereafter, and by 4 hours the retina has suffered irreversible damage. In the clinical section, I discuss at length various controversies on acute retinal arterial ischemic disorders. Classification of acute retinal arterial ischemic disorders These are of 4 types: CRAO, branch retinal artery occlusion (BRAO), cotton wools spots and amaurosis fugax. Both CRAO and BRAO further comprise multiple clinical entities. Contrary to the universal belief, pathogenetically, clinically and for management, CRAO is not one clinical entity but 4 distinct clinical entities – non-arteritic CRAO, non-arteritic CRAO with cilioretinal artery sparing, arteritic CRAO associated with giant cell arteritis (GCA) and transient non-arteritic CRAO. Similarly, BRAO comprises permanent BRAO, transient BRAO and cilioretinal artery occlusion (CLRAO), and the latter further consists of 3 distinct clinical entities - non-arteritic CLRAO alone, non-arteritic CLRAO associated with central retinal vein occlusion and arteritic CLRAO associated with GCA. Understanding these classifications is essential to comprehend fully various aspects of these disorders. Central retinal artery occlusion The pathogeneses, clinical features and management of the various types of CRAO are discussed in detail. Contrary to the prevalent belief, spontaneous improvement in both visual acuity and visual fields does occur, mainly during the first 7 days. The incidence of spontaneous visual

  13. Estradiol reduces activity of the blood-brain barrier Na-K-Cl cotransporter and decreases edema formation in permanent middle cerebral artery occlusion.

    PubMed

    O'Donnell, Martha E; Lam, Tina I; Tran, Lien Q; Foroutan, Shahin; Anderson, Steven E

    2006-10-01

    Estrogen has been shown to protect against stroke-induced brain damage, yet the mechanism is unknown. During the early hours of stroke, cerebral edema forms as increased transport of Na and Cl from blood into brain occurs across an intact blood-brain barrier (BBB). We showed previously that a luminal BBB Na-K-Cl cotransporter is stimulated by hypoxia and arginine vasopressin (AVP), factors present during cerebral ischemia, and that inhibition of the cotransporter by intravenous bumetanide greatly reduces edema in rats subjected to permanent middle cerebral artery occlusion (MCAO). The present study was conducted to determine whether estrogen protects in stroke at least in part by reducing activity of the BBB cotransporter, thereby decreasing edema formation. Ovariectomized rats were subjected to 210 mins of permanent MCAO after 7-day or 30-min pretreatment with 17beta-estradiol and then brain swelling and 2,3,5-triphenyltetrazolium chloride staining were assessed as measures of brain edema and lesion volume, respectively. Diffusion-weighed imaging was used to monitor permanent MCAO-induced decreases in apparent diffusion coefficient (ADC) values, an index of changes in brain water distribution and mobility. Na-K-Cl cotransporter activity of cerebral microvascular endothelial cells (CMECs) was assessed as bumetanide-sensitive K influx and cotransporter abundance by Western blot analysis after estradiol treatment. Estradiol significantly decreased brain swelling and lesion volume and attenuated the decrease in ADC values during permanent MCAO. Estradiol also abolished CMEC cotransporter stimulation by chemical hypoxia or AVP and decreased cotransporter abundance. These findings support the hypothesis that estrogen attenuates stimulation of BBB Na-K-Cl cotransporter activity, reducing edema formation during stroke.

  14. Diabetic microangiopathy: impact of impaired cerebral vasoreactivity and delayed angiogenesis after permanent middle cerebral artery occlusion on stroke damage and cerebral repair in mice.

    PubMed

    Poittevin, Marine; Bonnin, Philippe; Pimpie, Cynthia; Rivière, Léa; Sebrié, Catherine; Dohan, Anthony; Pocard, Marc; Charriaut-Marlangue, Christiane; Kubis, Nathalie

    2015-03-01

    Diabetes increases the risk of stroke by three, increases related mortality, and delays recovery. We aimed to characterize functional and structural alterations in cerebral microvasculature before and after experimental cerebral ischemia in a mouse model of type 1 diabetes. We hypothesized that preexisting brain microvascular disease in patients with diabetes might partly explain increased stroke severity and impact on outcome. Diabetes was induced in 4-week-old C57Bl/6J mice by intraperitoneal injections of streptozotocin (60 mg/kg). After 8 weeks of diabetes, the vasoreactivity of the neurovascular network to CO2 was abolished and was not reversed by nitric oxide (NO) donor administration; endothelial NO synthase (eNOS) and neuronal NO synthase (nNOS) mRNA, phospho-eNOS protein, nNOS, and phospho-nNOS protein were significantly decreased; angiogenic and vessel maturation factors (vascular endothelial growth factor a [VEGFa], angiopoietin 1 (Ang1), Ang2, transforming growth factor-β [TGF-β], and platelet-derived growth factor-β [PDGF-β]) and blood-brain barrier (BBB) occludin and zona occludens 1 (ZO-1) expression were significantly decreased; and microvessel density was increased without changes in ultrastructural imaging. After permanent focal cerebral ischemia induction, infarct volume and neurological deficit were significantly increased at D1 and D7, and neuronal death (TUNEL+ / NeuN+ cells) and BBB permeability (extravasation of Evans blue) at D1. At D7, CD31+ / Ki67+ double-immunolabeled cells and VEGFa and Ang2 expression were significantly increased, indicating delayed angiogenesis. We show that cerebral microangiopathy thus partly explains stroke severity in diabetes.

  15. Assessment of Blood-Brain Barrier Permeability by Dynamic Contrast-Enhanced MRI in Transient Middle Cerebral Artery Occlusion Model after Localized Brain Cooling in Rats

    PubMed Central

    Kim, Eun Soo; Kwon, Mi Jung; Lee, Phil Hye; Ju, Young-Su; Yoon, Dae Young; Kim, Hye Jeong; Lee, Kwan Seop

    2016-01-01

    Objective The purpose of this study was to evaluate the effects of localized brain cooling on blood-brain barrier (BBB) permeability following transient middle cerebral artery occlusion (tMCAO) in rats, by using dynamic contrast-enhanced (DCE)-MRI. Materials and Methods Thirty rats were divided into 3 groups of 10 rats each: control group, localized cold-saline (20℃) infusion group, and localized warm-saline (37℃) infusion group. The left middle cerebral artery (MCA) was occluded for 1 hour in anesthetized rats, followed by 3 hours of reperfusion. In the localized saline infusion group, 6 mL of cold or warm saline was infused through the hollow filament for 10 minutes after MCA occlusion. DCE-MRI investigations were performed after 3 hours and 24 hours of reperfusion. Pharmacokinetic parameters of the extended Tofts-Kety model were calculated for each DCE-MRI. In addition, rotarod testing was performed before tMCAO, and on days 1-9 after tMCAO. Myeloperoxidase (MPO) immunohisto-chemistry was performed to identify infiltrating neutrophils associated with the inflammatory response in the rat brain. Results Permeability parameters showed no statistical significance between cold and warm saline infusion groups after 3-hour reperfusion 0.09 ± 0.01 min-1 vs. 0.07 ± 0.02 min-1, p = 0.661 for Ktrans; 0.30 ± 0.05 min-1 vs. 0.37 ± 0.11 min-1, p = 0.394 for kep, respectively. Behavioral testing revealed no significant difference among the three groups. However, the percentage of MPO-positive cells in the cold-saline group was significantly lower than those in the control and warm-saline groups (p < 0.05). Conclusion Localized brain cooling (20℃) does not confer a benefit to inhibit the increase in BBB permeability that follows transient cerebral ischemia and reperfusion in an animal model, as compared with localized warm-saline (37℃) infusion group. PMID:27587960

  16. Predictive Value of Pooled Cerebral Blood Volume Mapping for Final Infarct Volume in Patients with Major Artery Occlusions. A Retrospective Analysis.

    PubMed

    Ava, Lauma; Berkefeld, Joachim; Lauer, Arne; Seiler, Alexander; Pfeilschifter, Waltraud; Müller-Eschner, Monika; You, Se-Jong; Weidauer, Stefan; Pilatus, Ulrich; Wagner, Marlies

    2017-03-13

    Detection of ischemic core and collateral status is helpful to predict clinical success of thrombectomy in acute cerebral artery occlusion. Angiographic flat panel detector computed tomography (CT) with pooled blood volume (PBV) data acquisition was described to be helpful to estimate ischemic core in stroke patients prior to thrombectomy and to depict cerebral vessels. We therefore retrospectively evaluated preinterventional PBV data of a large collective of ischemic stroke patients prior to thrombectomy to test its predictive value on final infarct considering PBV maps and collateral status. We used PBV data from 101 patients with acute cerebral artery occlusion prior to successful thrombectomy to reconstruct PBV maps and collateral status maps. Suspected ischemic core and collateral status were correlated to final infarct on follow-up multislice CT. Furthermore, the influence of time window and patient age was taken into consideration. In 75.2% (95% confidence interval CI 66-82%), suspected ischemic core (PBV) matched with final infarct and in 24.8% (95% CI 17-34%) final infarct was overestimated. In all patients, collateral status could be evaluated, and the better the collateral status, the smaller the final infarct (p = 0.016). Although not statistically significant, poor collaterals seem to be a risk factor for overestimation of final infarct on PBV maps. In patients >80 years old predictive value of PBV and collateral status is better than in patients ≤80 years old (p = 0.04). Increasing time window did not have significant impact on predictive value of PBV and collateral status. The PBV data are useful to expeditiously exclude infarct growth and estimate collateral status prior to thrombectomy after a longer interval between initial multislice CT magnetic resonance imaging (MRI) and intervention. However, because of overestimating final infarct in 25% of patients, PBV data presuming large infarct should not be used as the only basis for excluding

  17. Assessment of Blood-Brain Barrier Permeability by Dynamic Contrast-Enhanced MRI in Transient Middle Cerebral Artery Occlusion Model after Localized Brain Cooling in Rats.

    PubMed

    Kim, Eun Soo; Lee, Seung-Koo; Kwon, Mi Jung; Lee, Phil Hye; Ju, Young-Su; Yoon, Dae Young; Kim, Hye Jeong; Lee, Kwan Seop

    2016-01-01

    The purpose of this study was to evaluate the effects of localized brain cooling on blood-brain barrier (BBB) permeability following transient middle cerebral artery occlusion (tMCAO) in rats, by using dynamic contrast-enhanced (DCE)-MRI. Thirty rats were divided into 3 groups of 10 rats each: control group, localized cold-saline (20℃) infusion group, and localized warm-saline (37℃) infusion group. The left middle cerebral artery (MCA) was occluded for 1 hour in anesthetized rats, followed by 3 hours of reperfusion. In the localized saline infusion group, 6 mL of cold or warm saline was infused through the hollow filament for 10 minutes after MCA occlusion. DCE-MRI investigations were performed after 3 hours and 24 hours of reperfusion. Pharmacokinetic parameters of the extended Tofts-Kety model were calculated for each DCE-MRI. In addition, rotarod testing was performed before tMCAO, and on days 1-9 after tMCAO. Myeloperoxidase (MPO) immunohisto-chemistry was performed to identify infiltrating neutrophils associated with the inflammatory response in the rat brain. Permeability parameters showed no statistical significance between cold and warm saline infusion groups after 3-hour reperfusion 0.09 ± 0.01 min(-1) vs. 0.07 ± 0.02 min(-1), p = 0.661 for K(trans); 0.30 ± 0.05 min(-1) vs. 0.37 ± 0.11 min(-1), p = 0.394 for kep, respectively. Behavioral testing revealed no significant difference among the three groups. However, the percentage of MPO-positive cells in the cold-saline group was significantly lower than those in the control and warm-saline groups (p < 0.05). Localized brain cooling (20℃) does not confer a benefit to inhibit the increase in BBB permeability that follows transient cerebral ischemia and reperfusion in an animal model, as compared with localized warm-saline (37℃) infusion group.

  18. Anti-inflammation and antioxidant effect of Cordymin, a peptide purified from the medicinal mushroom Cordyceps sinensis, in middle cerebral artery occlusion-induced focal cerebral ischemia in rats.

    PubMed

    Wang, Jie; Liu, Yong-Mei; Cao, Wei; Yao, Kui-Wu; Liu, Zhen-Quan; Guo, Jian-You

    2012-06-01

    Cordymin is a peptide purified from the medicinal mushroom Cordyceps sinensis. The present study investigated the effects of Cordymin in prevention of focal cerebral ischemic/reperfusion (IR) injury. The right middle cerebral artery occlusion model was used in the study. The effects of Cordymin on mortality rate, neurobehavior, grip strength, glutathione content, lipid Peroxidation, glutathione peroxidase activity, glutathione reductase activity, catalase activity, Na(+)K(+)ATPase activity glutathione S transferase activity and on the regulation of C3 and C4 protein level, polymorphonuclear cells, interleukin-1β and tumor necrosis factor-α in a rat model were studied respectively. Treatment (orally) of Cordymin significantly boosted the defense mechanism against cerebral ischemia by increasing antioxidants activity related to lesion pathogenesis. Restoration of the antioxidant homeostasis in the brain after reperfusion may have helped the brain recover from ischemic injury. Moreover, Cordymin significantly inhibited infiltration of polymorphonuclear cells and IR-induced up-regulation of the brain production of C3 protein level, interleukin-1β and tumor necrosis factor-α. Cordymin significantly improved the outcome in rats after cerebral ischemia and reperfusion in terms of neurobehavioral function. Our findings suggest that cordymin have a neuroprotective effect in the ischemic brain, which is due to the inhibition of inflammation and increase of antioxidants activity related to lesion pathogenesis. Cordymin can be used as potential preventive agent against cerebral ischemia-reperfusion injury.

  19. Transient middle cerebral artery occlusion and reperfusion alters inducible NOS expression within the ventrolateral medulla and modulates cardiovascular function during static exercise.

    PubMed

    Ally, Ahmmed; Maher, Timothy J

    2011-09-01

    A major cause of stroke is cerebral ischemia in regions supplied by the middle cerebral artery (MCA). In this study, we hypothesized that compromised cardiovascular function during static exercise may involve altered expression of inducible NOS (iNOS) protein within the rostral ventrolateral medulla (RVLM) and caudal ventrolateral medulla (CVLM). We compared cardiovascular responses and iNOS protein expression within the left and right sides of both RVLM and CVLM in sham-operated rats and in rats with a 90 min left-sided MCA occlusion (MCAO) followed by 24 h of reperfusion. Increases in blood pressure during a static muscle contraction were attenuated in MCAO rats compared with sham-operated rats. Also, iNOS expression within the left RVLM was augmented compared with the right RVLM in MCAO rats and compared with both RVLM quadrants in sham-operated rats. In contrast, compared with sham-operated rats and the right CVLM of MCAO rats, iNOS expression was attenuated in the left CVLM in left-sided MCAO rats. These data suggest that the attenuation of pressor responses during static exercise in MCAO rats involves overexpression of iNOS within the ipsilateral RVLM and attenuation in iNOS within the ipsilateral CVLM. Differential expression of iNOS within the medulla plays a role in mediating cardiovascular responses during static exercise following stroke.

  20. Hyperforin attenuates brain damage induced by transient middle cerebral artery occlusion (MCAO) in rats via inhibition of TRPC6 channels degradation.

    PubMed

    Lin, Yun; Zhang, Jian-Cheng; Fu, Jun; Chen, Fang; Wang, Jie; Wu, Zhi-Lin; Yuan, Shi-Ying

    2013-02-01

    Hyperforin, a lipophilic constituent of medicinal herb St John's wort, has been identified as the main active ingredient of St John's wort extract for antidepressant action by experimental and clinical studies. Hyperforin is currently known to activate transient receptor potential canonical (subtype) 6 (TRPC6) channel, increase the phosphorylated CREB (p-CREB), and has N-methyl-D-aspartate receptor-antagonistic effect that convert potential neuroprotective effects in vitro. However, the protective effects of hyperforin on ischemic stroke in vivo remain controversial and its neuroprotective mechanisms are still unclear. This study was designed to examine the effects of intracerebroventricular (i.c.v.) injection of hyperforin on transient focal cerebral ischemia in rats. Hyperforin, when applied immediately after middle cerebral artery occlusion (MCAO) onset, significantly reduced infarct volumes and apoptotic cells, and also increased neurologic scores at 24 hours after reperfusion accompanied by elevated TRPC6 and p-CREB activity and decreased SBDP145 activity. When MEK or CaMKIV activity was specifically inhibited, the neuroprotective effect of hyperforin was attenuated, and we observed a correlated decrease in CREB activity. In conclusion, our results clearly showed that i.c.v. injection of hyperforin immediately after MCAO onset blocked calpain-mediated TRPC6 channels degradation, and then to stimulate the Ras/MEK/ERK and CaMKIV pathways that converge on CREB activation, contributed to neuroprotection.

  1. Effect of treadmill exercise on 5-HT, 5-HT1A receptor and brain derived neurophic factor in rats after permanent middle cerebral artery occlusion.

    PubMed

    Lan, Xiaofang; Zhang, Meng; Yang, Wan; Zheng, Zongju; Wu, Yuan; Zeng, Qian; Liu, Shudong; Liu, Ke; Li, Guangqin

    2014-05-01

    It has been well documented that exercise promotes neurological rehabilitation in patients with cerebral ischemia. However, the exact mechanisms have not been fully elucidated. This study aimed to discuss the effect of treadmill exercise on expression levels of 5-HT, 5-HT1A receptor (5-HT1AR) and brain derived neurophic factor (BDNF) in rat brains after permanent middle cerebral artery occlusion (pMCAO). A total of 55 rats were randomly divided into 3 groups: pMCAO group, pMCAO and treadmill exercise (pMCAO + Ex) group, and sham-operated group. Rats in pMCAO + Ex group underwent treadmill exercise for 16 days. Neurological function was evaluated by modified Neurological Severity Scores (mNSS). High-performance liquid chromatography-electrochemical detection system was used to determine the content of 5-HT in cortex tissues. The protein levels of 5-HT1AR, BDNF and synaptophysin were measured by Western blot. The mNSS in pMCAO + Ex group was lower than that in pMCAO group on day 19 post-MCAO (p < 0.001). The content of 5-HT dropped to 3.81 ± 1.86 ng/ml in pMCAO group (43.84 ± 2.05 ng/ml in sham-operated group), but increased in pMCAO + Ex group (10.06 ± 1.80 ng/ml). The protein expressions levels of synaptophysin, 5-HT1AR and BDNF were downregulated after cerebral ischemia (p < 0.05), and upregulated after treadmill exercise (p < 0.05). These results indicate that treadmill exercise improves neurologic function, enhances neuronal plasticity and upregulates the levels of 5-HT, 5-HT1AR and BDNF in rats with pMCAO.

  2. Adenovirus-mediated brain-derived neurotrophic factor expression regulated by hypoxia response element protects brain from injury of transient middle cerebral artery occlusion in mice.

    PubMed

    Shi, Qindong; Zhang, Pengbo; Zhang, Junfeng; Chen, Xinlin; Lu, Haixia; Tian, Yumei; Parker, T L; Liu, Yong

    2009-11-20

    Some gene expression may be regulated by hypoxia-responsive element (HRE) that is bound by hypoxia-inducible factor-1 (HIF-1) which is up-regulated during cerebral ischemia. To explore ischemia/hypoxia-controlled expression and the neuroprotective effects of brain-derived neurotrophic factor (BDNF) after ischemic brain injury, an adenoviral vector using five copies of hypoxia response element (HRE) in the vascular endothelial growth factor gene to regulate the expression of BDNF gene (Ad5HRE:BDNF) was constructed, and its efficacy was verified for driving BDNF expression in cultured Hela cells under hypoxic condition by ELISA. We found that the concentration of BDNF in the Ad5HRE:BDNF-transfected culture media was 28-fold greater in a hypoxic condition than under normoxia. To examine the effect of Ad5HRE:BDNF on ischemic brain injury in vivo, Ad5HRE:BDNF was injected into right caudate putamen of adult mice 7 days prior to 60 min transient middle cerebral artery occlusion (MCAO). It was found that exogenous BDNF expression was increased in the Ad5HRE-BDNF-treated group and infarct volume of the Ad5HRE:BDNF-treated group at 3 days after MCAO was significantly smaller than that of vehicle- or AdNull-treated groups. Moreover, Ad5HRE:BDNF injection resulted in significantly improved sensorimotor scores 7 days after MCAO and induced a reduction in the number of Fluoro-Jade B-positive neurons and TUNEL-positive cells, compared with vehicle- or AdNull-injection. Our findings suggest that BDNF expression could be regulated in hypoxia/ischemia condition with five copies of HRE and ameliorates ischemic brain injury in a mouse focal cerebral ischemia model.

  3. Time course, distribution and cell types of induction of transforming growth factor betas following middle cerebral artery occlusion in the rat brain.

    PubMed

    Pál, Gabriella; Vincze, Csilla; Renner, Éva; Wappler, Edina A; Nagy, Zoltán; Lovas, Gábor; Dobolyi, Arpád

    2012-01-01

    Transforming growth factor-βs (TGF-β1-3) are cytokines that regulate the proliferation, differentiation, and survival of various cell types. The present study describes the induction of TGF-β1-3 in the rat after focal ischemia at 3 h, 24 h, 72 h and 1 month after transient (1 h) or permanent (24 h) middle cerebral artery occlusion (MCAO) using in situ hybridization histochemistry and quantitative analysis. Double labeling with different markers was used to identify the localization of TGF-β mRNA relative to the penumbra and glial scar, and the types of cells expressing TGF-βs. TGF-β1 expression increased 3 h after MCAO in the penumbra and was further elevated 24 h after MCAO. TGF-β1 was present mostly in microglial cells but also in some astrocytes. By 72 h and 1 month after the occlusion, TGF-β1 mRNA-expressing cells also appeared in microglia within the ischemic core and in the glial scar. In contrast, TGF-β2 mRNA level was increased in neurons but not in astrocytes or microglial cells in layers II, III, and V of the ipsilateral cerebral cortex 24 h after MCAO. TGF-β3 was not induced in cells around the penumbra. Its expression increased in only a few cells in layer II of the cerebral cortex 24 h after MCAO. The levels of TGF-β2 and -β3 decreased at subsequent time points. Permanent MCAO further elevated the levels of all 3 subtypes of TGF-βs suggesting that reperfusion is not a major factor in their induction. TGF-β1 did not co-localize with either Fos or ATF-3, while the co-localization of TGF-β2 with Fos but not with ATF-3 suggests that cortical spreading depolarization, but not damage to neural processes, might be the mechanism of induction for TGF-β2. The results imply that endogenous TGF-βs are induced by different mechanisms following an ischemic attack in the brain suggesting that they are involved in distinct spatially and temporally regulated inflammatory and neuroprotective processes.

  4. [Cilioretinal artery occlusion in hemochromatosis].

    PubMed

    Peral, M J; Reche, A; Crespo, M J; Carpio, R; Gutierrez, O; Espino, A; Toledano, N

    2015-05-01

    We report a case of a 31 year-old woman with a sudden visual loss due to a cilioretinal artery occlusion. The physical examinination showed hepatomegaly. Serum iron and ferritin and transferrin saturation were unusually high. The doppler scan of carotid arteries showed no relevant signs of atheromatous disease. Dilated cardiomiopaty was revealed in the B-scan with subendocardial calcium deposits. Genetic tests were positive for hemochromatosis. Subendocardial calcification due to hemochromatosis could be the embolic source in our patient. This embolic ocular disease is the first presentation of hemochromatosis in this patient. Copyright © 2012 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  5. Fish oil supplementation associated with decreased cellular degeneration and increased cellular proliferation 6 weeks after middle cerebral artery occlusion in the rat.

    PubMed

    Pascoe, Michaela C; Howells, David W; Crewther, David P; Carey, Leeanne M; Crewther, Sheila G

    2015-01-01

    Anti-inflammatory long-chain omega-3 polyunsaturated fatty acids (n-3-LC-PUFAs) are both neuroprotective and have antidepressive effects. However the influence of dietary supplemented n-3-LC-PUFAs on inflammation-related cell death and proliferation after middle cerebral artery occlusion (MCAo)-induced stroke is unknown. We have previously demonstrated that anxiety-like and hyperactive locomotor behaviors are reduced in n-3-LC-PUFA-fed MCAo animals. Thus in the present study, male hooded Wistar rats were exposed to MCAo or sham surgeries and examined behaviorally 6 weeks later, prior to euthanasia and examination of lesion size, cell death and proliferation in the dentate gyrus, cornu ammonis region of the hippocampus of the ipsilesional hemispheres, and the thalamus of the ipsilesional and contralesional hemispheres. Markers of cell genesis and cell degeneration in the hippocampus or thalamus of the ipsilesional hemisphere did not differ between surgery and diet groups 6 weeks post MCAo. Dietary supplementation with n-3-LC-PUFA decreased cell degeneration and increased cell proliferation in the thalamic region of the contralesional hemisphere. MCAo-associated cell degeneration in the hippocampus and thalamus positively correlated with anxiety-like and hyperactive locomotor behaviors previously reported in these animals. These results suggest that anti-inflammatory n-3-LC-PUFA supplementation appears to have cellular protective effects after MCAo in the rat, which may affect behavioral outcomes.

  6. Combined use of spatial restraint stress and middle cerebral artery occlusion is a novel model of post-stroke depression in mice

    PubMed Central

    Zhang, Gaocai; Chen, Li; Yang, Lingli; Hua, Xiaodong; Zhou, Beiqun; Miao, Zhigang; Li, Jizhen; Hu, Hua; Namaka, Michael; Kong, Jiming; Xu, Xingshun

    2015-01-01

    Post stroke depression (PSD) is one of the most common complications of ischemic stroke. At present, the underlying mechanisms are unclear, largely because there are no reliable, valid and reproducible animal models of PSD. Here we report a novel animal model of PSD that displays consistent and reliable clinical features of hemiplegic stroke. The animal model encompasses a combination of the middle cerebral artery occlusion (MCAO) and spatial restraint stress. We found that a 60-minute MCAO followed by spatial restraint stress for 2 h daily for 2 to 4 weeks from the fourth day after MCAO induced PSD-like depressive phenotypes in mice. Importantly, the mice showed exacerbated deficits of neurological functions and decreased body weights, which were accompanied with reduced levels of brain derived neurotrophic factor and neurotransmitters including serotonin and dopamine. In addition, we identified increased levels of serum cortisol in our PSD mice. Finally, we found that mice with PSD were responsive to the tri-cyclic antidepressant imipramine as evidenced by their attenuated depressive behaviors, increased body weights, recovered brain serotonin levels, and decreased serum cortisol levels. This mouse model replicates multiple features of human post-stroke depression and thus provides a new model for the investigation of PSD. PMID:26572587

  7. Neutrophil infiltration increases matrix metalloproteinase-9 in the ischemic brain after occlusion/reperfusion of the middle cerebral artery in rats.

    PubMed

    Justicia, Carles; Panés, Julián; Solé, Sònia; Cervera, Alvaro; Deulofeu, Ramon; Chamorro, Angel; Planas, Anna M

    2003-12-01

    Matrix metalloproteinase-9 (MMP-9) activity increases in the brain during the first day after focal ischemia and might be involved in the pathogenesis of tissue damage. We previously showed MMP-9 in the extracellular space of brain parenchyma along with neutrophil recruitment after ischemia. In the present study, we tested whether neutrophils were a direct source of enhanced MMP-9 in the ischemic brain. Neutrophil infiltration was prevented either by injecting an antibody against ICAM-1, which abrogates neutrophil adhesion to the endothelial vessel wall, or by inducing neutropenia. One-hour intraluminal middle cerebral artery occlusion with reperfusion was induced, and studies were performed at 24 hours. Circulating neutrophils expressed 95-kDa MMP-9 and dimers, and infiltrated neutrophils stained positive for MMP-9. The expression of MMP-9 (mainly 95-kDa proform and dimers and, to a lesser extent, 88-kDa form) increased in brain after ischemia/reperfusion. Treatments preventing neutrophil infiltration failed to preclude the ischemia-induced increase in 88-kDa MMP-9 form and gelatinase activity in neurons and blood vessels. However, these treatments prevented the major increase in 95-kDa MMP-9 form and dimers. We conclude that neutrophil infiltration highly contributes to enhanced MMP-9 in the ischemic brain by releasing MMP-9 proform, which might participate in the tissular inflammatory reaction.

  8. PACAP38 Differentially Effects Genes and CRMP2 Protein Expression in Ischemic Core and Penumbra Regions of Permanent Middle Cerebral Artery Occlusion Model Mice Brain

    PubMed Central

    Hori, Motohide; Nakamachi, Tomoya; Shibato, Junko; Rakwal, Randeep; Tsuchida, Masachi; Shioda, Seiji; Numazawa, Satoshi

    2014-01-01

    Pituitary adenylate-cyclase activating polypeptide (PACAP) has neuroprotective and axonal guidance functions, but the mechanisms behind such actions remain unclear. Previously we examined effects of PACAP (PACAP38, 1 pmol) injection intracerebroventrically in a mouse model of permanent middle cerebral artery occlusion (PMCAO) along with control saline (0.9% NaCl) injection. Transcriptomic and proteomic approaches using ischemic (ipsilateral) brain hemisphere revealed differentially regulated genes and proteins by PACAP38 at 6 and 24 h post-treatment. However, as the ischemic hemisphere consisted of infarct core, penumbra, and non-ischemic regions, specificity of expression and localization of these identified molecular factors remained incomplete. This led us to devise a new experimental strategy wherein, ischemic core and penumbra were carefully sampled and compared to the corresponding contralateral (healthy) core and penumbra regions at 6 and 24 h post PACAP38 or saline injections. Both reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting were used to examine targeted gene expressions and the collapsin response mediator protein 2 (CRMP2) protein profiles, respectively. Clear differences in expression of genes and CRMP2 protein abundance and degradation product/short isoform was observed between ischemic core and penumbra and also compared to the contralateral healthy tissues after PACAP38 or saline treatment. Results indicate the importance of region-specific analyses to further identify, localize and functionally analyse target molecular factors for clarifying the neuroprotective function of PACAP38. PMID:25257527

  9. Combined contrast-enhanced ultrasound and rt-PA treatment is safe and improves impaired microcirculation after reperfusion of middle cerebral artery occlusion

    PubMed Central

    Nedelmann, Max; Ritschel, Nouha; Doenges, Simone; Langheinrich, Alexander C; Acker, Till; Reuter, Peter; Yeniguen, Mesut; Pukropski, Jan; Kaps, Manfred; Mueller, Clemens; Bachmann, Georg; Gerriets, Tibo

    2010-01-01

    In monitoring of recanalization and in sonothrombolysis, contrast-enhanced ultrasound (CEUS) is applied in extended time protocols. As extended use may increase the probability of unwanted effects, careful safety evaluation is required. We investigated the safety profile and beneficial effects of CEUS in a reperfusion model. Wistar rats were subjected to filament occlusion of the right middle cerebral artery (MCA). Reperfusion was established after 90 minutes, followed by recombinant tissue-type plasminogen activator (rt-PA) treatment and randomization to additional CEUS (contrast agent: SonoVue; 60 minutes). Blinded outcome evaluation consisted of magnetic resonance imaging (MRI), neurologic assessment, and histology and, in separate experiments, quantitative 3D nano-computed tomography (CT) angiography (900 nm3 voxel size). Nano-CT revealed severely compromised microcirculation in untreated animals after MCA reperfusion. The rt-PA partially improved hemispheric perfusion. Impairment was completely reversed in animals receiving rt-PA and CEUS. This combination was more effective than treatment with either CEUS without rt-PA or rt-PA and ultrasound or ultrasound alone. In MRI experiments, CEUS and rt-PA treatment resulted in a significantly reduced ischemic lesion volume and edema formation. No unwanted effects were detected on MRI, histology, and intracranial temperature assessment. This study shows that CEUS and rt-PA is safe in the situation of reperfusion and displays beneficial effects on the level of the microvasculature. PMID:20531462

  10. The Antiepileptic Drug Levetiracetam Suppresses Non-Convulsive Seizure Activity and Reduces Ischemic Brain Damage in Rats Subjected to Permanent Middle Cerebral Artery Occlusion

    PubMed Central

    Cuomo, Ornella; Rispoli, Vincenzo; Leo, Antonio; Politi, Giovanni Bosco; Vinciguerra, Antonio; di Renzo, Gianfranco; Cataldi, Mauro

    2013-01-01

    The antiepileptic drug Levetiracetam (Lev) has neuroprotective properties in experimental stroke, cerebral hemorrhage and neurotrauma. In these conditions, non-convulsive seizures (NCSs) propagate from the core of the focal lesion into perilesional tissue, enlarging the damaged area and promoting epileptogenesis. Here, we explore whether Lev neuroprotective effect is accompanied by changes in NCS generation or propagation. In particular, we performed continuous EEG recordings before and after the permanent occlusion of the middle cerebral artery (pMCAO) in rats that received Lev (100 mg/kg) or its vehicle immediately before surgery. Both in Lev-treated and in control rats, EEG activity was suppressed after pMCAO. In control but not in Lev-treated rats, EEG activity reappeared approximately 30-45 min after pMCAO. It initially consisted in single spikes and, then, evolved into spike-and-wave and polyspike-and-wave discharges. In Lev-treated rats, only rare spike events were observed and the EEG power was significantly smaller than in controls. Approximately 24 hours after pMCAO, EEG activity increased in Lev-treated rats because of the appearance of polyspike events whose power was, however, significantly smaller than in controls. In rats sacrificed 24 hours after pMCAO, the ischemic lesion was approximately 50% smaller in Lev-treated than in control rats. A similar neuroprotection was observed in rats sacrificed 72 hours after pMCAO. In conclusion, in rats subjected to pMCAO, a single Lev injection suppresses NCS occurrence for at least 24 hours. This electrophysiological effect could explain the long lasting reduction of ischemic brain damage caused by this drug. PMID:24236205

  11. Certain forms of matrix metalloproteinase-9 accumulate in the extracellular space after microdialysis probe implantation and middle cerebral artery occlusion/reperfusion.

    PubMed

    Planas, Anna M; Justicia, Carles; Solé, Sònia; Friguls, Bibiana; Cervera, Alvaro; Adell, Albert; Chamorro, Angel

    2002-08-01

    Matrix metalloproteinases (MMPs) are activated in focal cerebral ischemia. The activation of MMP-9 is involved in blood-brain barrier breakdown and tissue remodeling. The MMPs are released to the extracellular space, but the form and fate of secreted enzymes in brain are unknown. Using microdialysis in vivo, the authors studied whether ischemia-induced MMP-9 in brain tissue was related to free MMP-9 in the extracellular fluid. A microdialysis probe was placed into the right striatum and microdialysis was initiated 24 hours later in controls (n = 7). One hour prior to microdialysis, a group of rats (n = 7) was subjected to 1-hour occlusion of the right middle cerebral artery, followed by reperfusion. Dialysates were collected at discrete time points up to 24 hours, and subjected to zymography and Western blot analysis. The MMP-9 was released after ischemia and accumulated in the extracellular space at 24 hours (P < 0.05). Free MMP-9 forms include mainly the 95-kd proform, and, to a lesser extent, dimers and cleaved active forms (70 kd), but not the 88-kd form found in tissue. Probe implantation and microdialysis increased free MMP-9 in the dialysate. This increase was concomitant with neutrophil infiltration after the mechanical lesion, as myeloperoxidase was found by means of Western blot analysis in the brain hemisphere subjected to microdialysis (P < 0.005), and immunohistochemistry revealed the presence of myeloperoxidase stain surrounding the site of probe implantation. The results suggest that certain forms of MMP-9 are released and accumulate in the extracellular space after brain injury, and that vascular alterations and neutrophil recruitment elicit MMP-9 activation in the brain after focal ischemia and trauma.

  12. Telmisartan reduces progressive oxidative stress and phosphorylated α-synuclein accumulation in stroke-resistant spontaneously hypertensive rats after transient middle cerebral artery occlusion.

    PubMed

    Sato, Kota; Yamashita, Toru; Kurata, Tomoko; Lukic, Violeta; Fukui, Yusuke; Hishikawa, Nozomi; Deguchi, Kentaro; Abe, Koji

    2014-07-01

    Telmisartan is an angiotensin receptor blocker with high lipid solubility, also called metabosartan, which exerts a special protective effect on both acute brain damage and chronic neurodegeneration. We examined the effects of telmisartan on oxidative stress by advanced glycation end product (AGE) and 4-hydroxynonenal (4-HNE) assays and the accumulation of phosphorylated α-synuclein (pSyn) in the brain of stroke-resistant spontaneously hypertensive rats (SHR-SR). At the age of 12 weeks, SHR-SR received transient middle cerebral artery occlusion (tMCAO) for 90 minutes and were divided into the following 3 groups: the vehicle group, the low-dose telmisartan group (.3 mg/kg/day), and the high-dose telmisartan group (3 mg/kg/day, postoperatively). Immunohistologic analysis was performed when rats were 6, 12, and 18 months old. AGE, 4-HNE, and pSyn-positive cells (per square millimeter) increased with age in the cerebral cortex and hippocampus of the vehicle group, in the low-dose telmisartan group, these parameters decreased without lowering blood pressure (BP), and in the high-dose telmisartan group, these parameters increased with lowering BP. The present study suggests that a persistent hypertension after tMCAO caused a progressive oxidative stress with the abnormal accumulation of pSyn, and that telmisartan reduced oxidative stress and the accumulation of pSyn without lowering BP (low dose) or improved these conditions with a reduction in BP (high dose) via its pleiotropic effects through a potential peroxisome proliferator-activated receptor gamma stimulation in the brain of SHR-SR. Copyright © 2014. Published by Elsevier Inc.

  13. Disruption of NMDAR-CRMP-2 signaling protects against focal cerebral ischemic damage in the rat middle cerebral artery occlusion model.

    PubMed

    Brittain, Joel M; Pan, Rui; You, Haitao; Brustovetsky, Tatiana; Brustovetsky, Nickolay; Zamponi, Gerald W; Lee, Wei-Hua; Khanna, Rajesh

    2012-01-01

    Collapsin response mediator protein 2 (CRMP-2), traditionally viewed as an axon/dendrite specification and axonal growth protein, has emerged as nidus in regulation of both pre- and post-synaptic Ca ( 2+) channels. Building on our discovery of the interaction and regulation of Ca ( 2+) channels by CRMP-2, we recently identified a short sequence in CRMP-2 which, when appended to the transduction domain of HIV TAT protein, suppressed acute, inflammatory and neuropathic pain in vivo by functionally uncoupling CRMP-2 from the Ca ( 2+) channel. Remarkably, we also found that this region attenuated Ca ( 2+) influx via N-methylD-Aspartate receptors (NMDARs) and reduced neuronal death in a moderate controlled cortical impact model of traumatic brain injury (TBI). Here, we sought to extend these findings by examining additional neuroprotective effects of this peptide (TAT-CBD3) and exploring the biochemical mechanisms by which TAT-CBD3 targets NMDARs. We observed that an intraperitoneal injection of TAT-CBD3 peptide significantly reduced infarct volume in an animal model of focal cerebral ischemia. Neuroprotection was observed when TAT-CBD3 peptide was given either prior to or after occlusion but just prior to reperfusion. Surprisingly, a direct biochemical complex was not resolvable between the NMDAR subunit NR2B and CRMP-2. Intracellular application of TAT-CBD3 failed to inhibit NMDAR current. NR2B interactions with the post synaptic density protein 95 (PSD-95) remained intact and were not disrupted by TAT-CBD3. Peptide tiling of intracellular regions of NR2B revealed two 15-mer sequences, in the carboxyl-terminus of NR2B, that may confer binding between NR2B and CRMP-2 which supports CRMP-2's role in excitotoxicity and neuroprotection.

  14. Melorheostosis with occlusion of dorsalis pedis artery.

    PubMed

    Ishibe, Motomi; Inoue, Masayuki; Saitou, Katsutoshi

    2002-02-01

    Melorheostosis is an unusual sclerotic dysplasia of bone. The case of a 51-year-old female patient with melorheostosis and occlusion of the dorsalis pedis artery is described. Although numerous vascular anomalies have been noted in patients with melorheostosis, occlusion of the dorsalis pedis artery has not been reported previously.

  15. [Surgical treatment of the internal carotid artery atherosclerotic occlusion].

    PubMed

    Galkin, P V; Gushcha, A O; Antonov, G I

    2014-01-01

    Internal carotid artery occlusion is the cause of carotid territory transient ischemic attacks or infarction approximately in 15% of patients. Extracranial-lntracranial (EC-IC) Bypass Study and Carotid Occlusion Surgery Study (COSS) failed to show a benefit of EC-IC bypass over medical therapy in patients with symptomatic carotid artery occlusion. Weak sides of COSS were investigators reliance on post hoc analysis, use of specific thresholds in the definition of impaired cerebral hemodynamics and high perioperative morbidity. In selected subset of patients with medically refractory ischemic symptoms, EC-IC bypass, can provide benefit from surgery performed with sufficiently low perioperative morbidity. The potential of functional and cognitive improvement after cerebral revascularization needs further investigation.

  16. Intra-arterial Thrombolysis for Central Retinal Artery Occlusion after the Coil Embolization of Paraclinoid Aneurysm

    PubMed Central

    Yoo, Minwook; Kim, Hae Yu; Choi, Byeong-Sam

    2016-01-01

    The most common complication of coil embolization for cerebral aneurysms is thrombo-embolic stroke; in rare cases, these strokes, can present with central retinal artery occlusion. At our institution, a 53-year-old woman underwent stent-assisted coiling of the aneurysm. The patient's vision was improved immediately after intra-arterial thrombolysis and had further improved 8 months later. This report describes our experience of a rare case of central retinal artery occlusion after coil embolization that was successfully treated by intra-arterial thrombolysis. PMID:28184347

  17. Relationships between high oxygen extraction fraction in the acute stage and final infarction in reversible middle cerebral artery occlusion: an investigation in anesthetized baboons with positron emission tomography.

    PubMed

    Young, A R; Sette, G; Touzani, O; Rioux, P; Derlon, J M; MacKenzie, E T; Baron, J C

    1996-11-01

    Studies in humans suggest that regions that show maximal increases in brain oxygen extraction fraction (OEF) in the hours following an ischemic episode are those most vulnerable for infarction and are often, although not always, associated with the final site of infarction. To clarify this issue, we followed the hemodynamic and metabolic characteristics of regions with an initially maximally increased OEF and compared them with the ultimately infarcted region in an experimental stroke model. Positron emission tomography (PET) was used to obtain functional images of the brain prior to and following reversible unilateral middle cerebral artery occlusion (MCAO) in 11 anesthetized baboons. To model early reperfusion, the clips were removed 6 h after occlusion. Successive measurements of regional CBF (rCBF), regional CMRO2 (rCMRO2), regional cerebral blood volume, and regional OEF (rOEF) were performed during the acute (up to 2 days) and chronic (> 15 days) stage. Late magnetic resonance imaging (MRI) scans (co-registered with PET) were obtained to identify infarction. Reversible MCAO produced an MRI-measurable infarction in 6 of 11 baboons; the others had no evidence of ischemic damage. Histological analysis confirmed the results of the MRI investigation but failed to show any evidence of cortical ischemic damage. The lesion was restricted to the head of the caudate nucleus, internal capsule, and putamen. The infarct volume obtained was 0.58 +/- 0.31 cm3. The infarcts were situated in the deep MCA territory, while the area of initially maximally increased OEF was within the cortical mantle. The mean absolute rCBF value in the infarct region of interest (ROI) was not significantly lower than in the highest-OEF ROI until 1-2 days post-MCAO. Cerebral metabolism in the deep MCA territory was always significantly lower than that of the cortical mantle; decreases in CMRO2 in the former region were evident as early as 1 h post-MCAO. In the cortical mantle, the rOEF was

  18. Comparisons between Garcia, Modo, and Longa rodent stroke scales: Optimizing resource allocation in rat models of focal middle cerebral artery occlusion.

    PubMed

    Bachour, Salam P; Hevesi, Mario; Bachour, Ornina; Sweis, Brian M; Mahmoudi, Javad; Brekke, Julia A; Divani, Afshin A

    2016-05-15

    The use of rodent stroke models allow for the understanding of stroke pathophysiology. There is currently no gold standard neurological assessment to measure deficits and recovery from stroke in rodent models. Agreement on a universal preclinical stroke scale allows for comparison of the outcomes among conducted studies. The present study aimed to compare three routinely used neurological assessments in rodent studies (i.e., Garcia, Modo, and Longa) to determine which is most effective for accurately and consistently quantifying neurological deficits in the context of focal middle cerebral artery occlusion (MCAo) in rats. Focal MCAo was induced in 22 male Wistar rats using a novel transfemoral approach. Rodents were assessed for neurological deficit pre-injury as well as 3 and 24h post-injury. Data was analyzed to determine Pearson correlation coefficients in addition to McNemar's χ(2) values between each pair of neurological assessments. All three stroke scales, Garcia, Modo, and Longa, showed statistically significant changes between the baseline and the 3-hour neurological assessments. A trend towards neurological recovery was observed in all three stroke scales between the 3 and 24-hour endpoints. The three scales were highly correlated with each other, with Garcia and Modo having the strongest correlation. Of the three pairwise analyses, the comparison between the Garcia and Longa tests demonstrated the highest McNemar's χ(2) value, indicating least marginal homogeneity between these two tests. The combination of high correlation between Garcia and Modo tests along with greatest marginal heterogeneity observed between the Garcia and Longa test lead us to recommend the use of Garcia and Longa neurological scales when researchers are hoping to capture the broadest range of neurological factors using only two stroke scales.

  19. TTC, fluoro-Jade B and NeuN staining confirm evolving phases of infarction induced by middle cerebral artery occlusion.

    PubMed

    Liu, Fudong; Schafer, Dorothy P; McCullough, Louise D

    2009-04-30

    Considerable debate exists in the literature on how best to measure infarct damage and at what point after middle cerebral artery occlusion (MCAO) infarct is histologically complete. As many researchers are focusing on more chronic endpoints in neuroprotection studies it is important to evaluate histological damage at later time points to ensure that standard methods of tissue injury measurement are accurate. To compare tissue viability at both acute and sub-acute time points, we used 2,3,5-triphenyltetrazolium chloride (TTC), Fluoro-Jade B, and NeuN staining to examine the evolving phases of infarction induced by a 90-min MCAO in mice. Stroke outcomes were examined at 1.5h, 6h, 12h, 24h, 3d, and 7d after MCAO. There was a time-dependent increase in infarct volume from 1.5h to 24h in the cortex, followed by a plateau from 24h to 7d after stroke. Striatal infarcts were complete by 12h. Fluoro-Jade B staining peaked at 24h and was minimal by 7d. Our results indicated that histological damage as measured by TTC and Fluoro-Jade B reaches its peak by 24h after stroke in a reperfusion model of MCAO in mice. TTC staining can be accurately performed as late as 7d after stroke. Neurological deficits do not correlate with the structural lesion but rather transient impairment of function. As the infarct is complete by 24h and even earlier in the striatum, even the most efficacious neuroprotective therapies are unlikely to show any efficacy if given after this point.

  20. In Vitro Differentiation of Bone Marrow Mesenchymal Stem Cells into Neuron-Like Cells by Cerebrospinal Fluid Improves Motor Function of Middle Cerebral Artery Occlusion Rats

    PubMed Central

    Ye, Ying; Peng, Yi-ran; Hu, Shu-qun; Yan, Xian-liang; Chen, Juan; Xu, Tie

    2016-01-01

    Bone marrow mesenchymal stem cells (BMSCs) represent a promising tool for stem cell-based therapies. However, the majority of BMSC transplants only allow for limited recovery of the lost functions. We previously found that human cerebrospinal fluid (hCSF) is more potent than growth factors in differentiating human BMSCs into neuron-like cells in vitro. In this study, we studied the effect of transplantation of rat BMSC-derived neuron-like cells (BMSC-Ns) induced by hCSF into rat brain with middle cerebral artery occlusion (MCAO). The survival and differentiation of the transplanted cells were determined using immunofluorescence staining of bromodeoxyuridine. The recovery of neurological function were observed by the modified neurological severity score (modified NSS) at 4, 15, and 32 days after cell transplantation, HE staining for determination of the infarct volume at day 32 after cell transplantation. Transplantation of BMSC-Ns or BMSCs significantly improved indexes of neurological function and reduced infarct size in rats previously subjected to MCAO compared with those in the control group. Remarkably, 32 days after transplantation, rats treated with BMSC-Ns presented a smaller infarct size, higher number of neuron-specific, enolase-positive, and BrdU-positive cells, and improved neurological function compared with BMSC group. Our results demonstrate that transplantation of hCSF-treated BMSC-Ns significantly improves neurological function and reduces infarct size in rats subjected to MCAO. This study may pave a new avenue for the treatment of MCAO. PMID:27833584

  1. TTC, Fluoro-Jade B and NeuN staining confirm evolving phases of infarction induced by Middle Cerebral Artery Occlusion

    PubMed Central

    Liu, Fudong; Schafer, Dorothy P.; McCullough, Louise D.

    2009-01-01

    Considerable debate exists in the literature on how best to measure infarct damage and at what point after middle cerebral artery occlusion (MCAO) infarct is histologically complete. As many researchers are focusing on more chronic endpoints in neuroprotection studies it is important to evaluate histological damage at later time points to ensure that standard methods of tissue injury measurement are accurate. To compare tissue viability at both acute and sub-acute time points, we used 2,3,5-Triphenyltetrazolium chloride (TTC), Fluoro-Jade B, and NeuN staining to examine the evolving phases of infarction induced by a 90-minute MCAO in mice. Stroke outcomes were examined at 1.5h, 6h, 12h, 24h, 3d, and 7d after MCAO. There was a time-dependent increase in infarct volume from 1.5h to 24 h in the cortex, followed by a plateau from 24h to 7d after stroke. Striatal infarcts were complete by 12h. Fluoro-Jade B staining peaked at 24 hours and was minimal by 7 days. Our results indicated that histological damage as measured by TTC and Fluoro-Jade B reaches its peak by 24h after stroke in a reperfusion model of MCAO in mice. TTC staining can be accurately performed as late as 7 days after stroke. Neurological deficits do not correlate with the structural lesion but rather transient impairment of function. As the infarct is complete by 24 hours and even earlier in the striatum, even the most efficacious neuroprotective therapies are unlikely to show any efficacy if given after this point. PMID:19167427

  2. The effect of adipose tissue-derived stem cells in a middle cerebral artery occlusion stroke model depends on their engraftment rate.

    PubMed

    Grudzenski, Saskia; Baier, Sebastian; Ebert, Anne; Pullens, Pim; Lemke, Andreas; Bieback, Karen; Dijkhuizen, Rick M; Schad, Lothar R; Alonso, Angelika; Hennerici, Michael G; Fatar, Marc

    2017-04-26

    In the field of experimental stem cell therapy, intra-arterial (IA) delivery yields the best results concerning, for example, migrated cell number at the targeted site. However, IA application also appears to be associated with increased mortality rates and infarction. Since many rodent studies systemically apply 1 × 10(6) cells, this could also be a consequence of engrafted cell number. The aim of this study was therefore to investigate the effect of different doses of adipose tissue-derived stem cells (ASCs) on engraftment rates and stroke outcome measured in vivo using 9.4-T high-field magnetic resonance imaging (MRI). Male Wistar rats (n = 43) underwent a middle cerebral artery occlusion (MCAo) for 45 or 90 min, followed by IA delivery of either saline or 1 × 10(6), 3 × 10(5), or 5 × 10(4) ASCs pre-labelled with very small superparamagnetic iron oxide particles (VSOPs). MRI (9.4-T) analysis was performed 48 h and 9 days post-MCAo. Lesion volumes were assessed by analysis of T2-weighted images and cell signal tracking showing cell engraftment and active cell migration by an improved T2*-analysis. The ASC-derived signal intensity increased in the affected hemisphere 48 h post MCAo with injected cell number (p < 0.05). The analysis of stroke volumes revealed an increased infarction after injection of 1 × 10(6) ASCs compared to controls or application of 5 × 10(4) ASCs (p < 0.05). At 9 days post-MCAo, injection of 3 × 10(5) ASCs resulted in reduced infarct volumes (p < 0.05). Correspondingly, MRI analysis revealed no changes in cell numbers between both MRI examinations but showed active ASC migration to the site of infarction. Our results confirm that IA injection is an efficient way of targeting damaged brain tissue but its usefulness strongly depends on the right dose of delivered stem cells since this factor has a strong influence on migration rate and infarct volume, with better results for doses below 1

  3. Stenting in Acute Lower Limb Arterial Occlusions

    SciTech Connect

    Raja, Jowad; Munneke, Graham; Morgan, Robert; Belli, Anna-Maria

    2008-07-15

    Management of critical limb ischemia of acute onset includes surgical embolectomy, bypass grafting, aspiration thrombectomy, thrombolysis, and mechanical thrombectomy followed by treatment of the underlying cause. We present our experience with the use of stents to treat acute embolic/thrombotic occlusions in one iliac and three femoropopliteal arteries. Although this is a small case series, excellent immediate and midterm results suggest that stenting of acute occlusions of the iliac, superficial femoral, and popliteal arteries is a safe and effective treatment option.

  4. Ophthalmic Artery Occlusion Following Transconjunctival Orbitotomy.

    PubMed

    Ganguly, Anasua; Pappuru, Rajeev Reddy; Ali, Mohammad Javed; Mishra, Dilip Kumar; Naik, Milind N

    Postoperative blindness after orbital surgery is an extremely rare and a disastrous complication. Ophthalmic artery occlusion as a cause of such unexpected vision loss has not been documented in literature. The authors report a case of a middle aged man who developed sudden vision loss due to ophthalmic artery occlusion following transconjunctival excision of orbital schwanomma. The possible mechanisms contributing to the loss of vision are discussed and preventive strategies are suggested to reduce the incidence of this complication.

  5. Deaths from occlusive arterial disease in renal allograft recipients.

    PubMed

    Ibels, L S; Stewart, J H; Mahony, J F; Sheil, A G

    1974-08-31

    In a series of 325 recipients of cadaveric renal transplants sudden occlusive arterial disease was found to be responsible for 12% of deaths. Acute myocardial infarction (9%) occurred 25 times more than expected in the normal population and cerebral thrombosis (3%) 300 times more. The greatest loss was in the initial three-month period after transplantation. Patients with renal failure due to essential hypertension were especially at risk, accounting for six of the 12 deaths.

  6. Unraveling the Specific Ischemic Core and Penumbra Transcriptome in the Permanent Middle Cerebral Artery Occlusion Mouse Model Brain Treated with the Neuropeptide PACAP38

    PubMed Central

    Hori, Motohide; Nakamachi, Tomoya; Shibato, Junko; Rakwal, Randeep; Shioda, Seiji; Numazawa, Satoshi

    2015-01-01

    Our group has been systematically investigating the effects of the neuropeptide pituitary adenylate-cyclase activating polypeptide (PACAP) on the ischemic brain. To do so, we have established and utilized the permanent middle cerebral artery occlusion (PMCAO) mouse model, in which PACAP38 (1 pmol) injection is given intracerebroventrically and compared to a control saline (0.9% sodium chloride, NaCl) injection, to unravel genome-wide gene expression changes using a high-throughput DNA microarray analysis approach. In our previous studies, we have accumulated a large volume of data (gene inventory) from the whole brain (ipsilateral and contralateral hemispheres) after both PMCAO and post-PACAP38 injection. In our latest research, we have targeted specifically infarct or ischemic core (hereafter abbreviated IC) and penumbra (hereafter abbreviated P) post-PACAP38 injections in order to re-examine the transcriptome at 6 and 24 h post injection. The current study aims to delineate the specificity of expression and localization of differentially expressed molecular factors influenced by PACAP38 in the IC and P regions. Utilizing the mouse 4 × 44 K whole genome DNA chip we show numerous changes (≧/≦ 1.5/0.75-fold) at both 6 h (654 and 456, and 522 and 449 up- and down-regulated genes for IC and P, respectively) and 24 h (2568 and 2684, and 1947 and 1592 up- and down-regulated genes for IC and P, respectively) after PACAP38 treatment. Among the gene inventories obtained here, two genes, brain-derived neurotrophic factor (Bdnf) and transthyretin (Ttr) were found to be induced by PACAP38 treatment, which we had not been able to identify previously using the whole hemisphere transcriptome analysis. Using bioinformatics analysis by pathway- or specific-disease-state focused gene classifications and Ingenuity Pathway Analysis (IPA) the differentially expressed genes are functionally classified and discussed. Among these, we specifically discuss some novel and previously

  7. Acute arterial occlusion after total knee arthroplasty.

    PubMed

    Gregory, Patricia C; Rogic, Roselyn; Eddington, Carolyn

    2006-11-01

    There are a number of complications associated with total knee-joint arthroplasty. These include deep venous thromboses, peroneal palsy, infection, anemia, and Ogilvie's syndrome. An uncommon but potentially limb-threatening complication is acute arterial occlusion. Approximately 35 cases have been reported in the orthopedic literature. Prompt recognition and treatment intervention are the keys to successful outcome. We describe the case of one patient who had mild peroneal palsy and developed acute arterial occlusion 9 days postoperatively while on the inpatient rehabilitation service. Prompt aggressive management restored arterial circulation to the lower limb. Careful management of patients after total knee arthroplasty requires an understanding that arterial occlusion is a rare limb-threatening complication of surgery, but that it is treatable with prompt, deliberate management. Physiatrists should be aware that this condition exists in postoperative knee-joint arthroplasty patients. They should pay careful attention to any patient with a history of peripheral vascular disease or postoperative peroneal palsy.

  8. Elevated brain derived neurotrophic factor (BDNF) levels in plasma but not serum reflect in vivo functional viability of infused mesenchymal stem cells after middle cerebral artery occlusion in rat.

    PubMed

    Nakamura, Hideyuki; Sasaki, Yuichi; Sasaki, Masanori; Kataoka-Sasaki, Yuko; Oka, Shinichi; Nakazaki, Masahito; Namioka, Takahiro; Namioka, Ai; Onodera, Rie; Suzuki, Junpei; Nagahama, Hiroshi; Mikami, Takeshi; Wanibuchi, Masahiko; Kocsis, Jeffery D; Honmou, Osamu

    2017-02-08

    Intravenous infusion of mesenchymal stem cells (MSCs) derived from adult bone marrow elicits functional recovery in rat stroke models and clinical studies in patients are ongoing. Brain derived neurotrophic factor (BDNF) is a neurotrophic factor produced by MSCs and may contribute to their therapeutic efficacy. The purpose of the current study was to determine if BDNF is elevated in infarcted brain and in which compartment of blood (plasma or serum) after intravenous MSC infusion in a middle cerebral artery occlusion (MCAO) model in the rat. In rats, a permanent middle cerebral artery occlusion (MCAO) was induced by intraluminal vascular occlusion with a microfilament and MSCs were intravenously administered 6 h after right MCAO induction. Enzyme-linked immunosorbent assay (ELISA) analysis of brain, serum and plasma BDNF were performed after the MSC infusion following the MCAO induction. Lesion volume was assessed using magnetic resonance imaging. Functional outcome was assessed using the Limb Placement Test. Infused MSCs reduced lesion volume and elicited functional improvement compared to the vehicle infused group. ELISA analysis of the MSC treated group revealed an increase BDNF levels in the infarcted hemisphere of the brain and plasma, but not in serum. The MSC group showed a greater increase in BDNF levels than sham control. In the MSC group, the expression of increased plasma BDNF levels correlated with increased brain BDNF levels. These results support the hypothesis that BDNF levels in plasma, but not serum, may be more appropriate to detect circulating BDNF in vivo following MSC infusion in a cerebral infarction rat model of ischemic stroke. Further, plasma BDNF might reflect in vivo functional viability of infused MSCs after stroke.

  9. Cerebral Arterial Fenestrations

    PubMed Central

    Cooke, Daniel L; Stout, Charles E; Kim, Warren T; Kansagra, Akash P; Yu, John Paul; Gu, Amy; Jewell, Nicholas P; Hetts, Steven W; Higashida, Randall T; Dowd, Christopher F; Halbach, Van V

    2014-01-01

    Summary Arterial fenestrations are an anatomic variant with indeterminate significance. Given the controversy surrounding fenestrations we sought their prevalence within our practice along with their association with other cerebrovascular anomalies. We retrospectively reviewed 10,927 patients undergoing digital subtraction angiography between 1992 and 2011. Dictated reports were searched for the terms “fenestration” or “fenestrated” with images reviewed for relevance, yielding 228 unique cases. A Medline database search from February 1964 to January 2013 generated 304 citations, 127 cases of which were selected for analysis. Cerebral arterial fenestrations were identified in 228 patients (2.1%). At least one aneurysm was noted in 60.5% of patients, with an aneurysm arising from the fenestration in 19.6% of patients. Aneurysmal subarachnoid hemorrhage or non-aneurysmal subarachnoid hemorrhage were present in 60.1% and 15.8%, respectively. For the subset of patients with an aneurysm arising directly from a fenestration relative to those patients with an aneurysm not immediately associated with a fenestration, the prevalence of aneurysmal subarachnoid hemorrhage was 66.7% vs. 58.6% (p = 0.58). Fenestrations were more often within the posterior circulation (73.2%) than the anterior circulation (24.6%), though there was no difference in the prevalence of aneurysms within these groups (61.1% vs. 60.7%, p = 1.0). Cerebral arterial fenestrations are an anatomic variant more often manifesting at the anterior communicating arterial complex and basilar artery and with no definite pathological relationship with aneurysms. PMID:24976087

  10. No evidence that severity of stroke in internal carotid occlusion is related to collateral arteries

    PubMed Central

    Mead, G E; Wardlaw, J M; Lewis, S C; Dennis, M S

    2006-01-01

    Background/Aim The neurological effects of internal carotid artery (ICA) occlusion vary between patients. The authors investigated whether the severity of symptoms in a large group of patients with ipsilateral or/and contralateral ICA occlusion at presentation with ocular or cerebral ischaemic symptoms could be explained by patency of other extra or intracranial arteries to act as collateral pathways. Methods The authors prospectively identified all patients (n = 2881) with stroke, cerebral transient ischaemic attack (TIA), retinal artery occlusion (RAO), and amaurosis fugax (AFx) presenting to our hospital over five years, obtained detailed history and examination, and examined the intra and extracranial arteries with carotid and colour‐power transcranial Doppler ultrasound. For this analysis, all those with intracranial haemorrhage on brain imaging and cerebral events without brain imaging were excluded. Results Among 2228/2397 patients with brain imaging (1713 ischaemic strokes, 401 cerebral TIAs, 193 AFx, and 90 RAO) who underwent carotid Doppler, 195 (9%) had ICA occlusion. Among those patients with cortical events, disease in potential collateral arteries (contralateral ICA, external carotid, ipsilateral or contralateral vertebral or intracranial arteries) was equally distributed among patients with severe and mild ischaemic presenting symptoms. Conclusion The authors found no evidence that the clinical presentation associated with an ICA occlusion was related to patency of other extra or intracranial arteries to act as collateral pathways. Further work is required to investigate what determines the clinical effects of ICA occlusion. PMID:16488923

  11. [Effect of occlusal reconstruction on cerebral blood flow and cerebral oxygen saturation in patients with malocclusion].

    PubMed

    Lu, Xiao-Hui; Xie, Guang-Ping; Gu, Xin-Hua; Lu, Dong-Min

    2015-01-01

    To investigate the effect of occlusal reconstruction on blood flow velocity and cerebral oxygen saturation in patients with malocclusion. Thirty-three patients with malocclusion treated with occlusal reconstruction in Department of Stomatology, Medical School of Huzhou Normal College from Feb 2011 to Oct 2013 were enrolled in the study. The systolic peak flow velocity (vs), end-diastolic peak flow (vd) , mean peak flow velocity (vm) of middle cerebral artery and the oxygen saturation (rScO2) in the brain were detected at rest or chewing status by using transcranial Doppler color ultrasonography and near-infrared spectroscopy, respectively. In rest state, vm was significantly increased on 3 months after treatment, while vs and vd were significantly increased on 6 months after treatment and rScO2 were increased on 12 months after treatment (P<0.05). In chewing state, vs, vm, and rScO2 were increased on 3 months after treatment, and vd was increased on 6 months after treatment (P<0.05). Occlusal reconstruction can increase blood flow velocity of middle cerebral artery and cerebral oxygen saturation and improve oxygen supply of the brain in patients with malocclusion.

  12. Pituitary apoplexy causing internal carotid artery occlusion--case report.

    PubMed

    Chokyu, Isao; Tsuyuguchi, Naohiro; Goto, Takeo; Chokyu, Kimihiko; Chokyu, Masahiro; Ohata, Kenji

    2011-01-01

    A 50-year-old man presented with pituitary apoplexy resulting in internal carotid artery occlusion manifesting as sudden onset of severe headache, right ptosis, and left hemiparesis, associated with visual impairment. Computed tomography showed a nodular mass, located in the sellar and suprasellar regions with early signs of acute cerebral ischemia. Magnetic resonance (MR) imaging indicated that the mass compressed the bilateral cavernous sinuses, resulting in obliteration of the cavernous portion of the right internal carotid artery. Right middle cerebral artery territory infarction was also found. Conservative therapy with steroids was given in the acute stage and repeated MR imaging showed recanalization of the internal carotid artery with reduction of the tumor size. The tumor was removed through the transsphenoidal approach to obtain a definitive diagnosis in the chronic stage. The histological diagnosis was consistent with non-functioning pituitary adenoma. Eye movement of this patient showed full recovery after the operation. Pituitary apoplexy resulting in internal carotid artery occlusion is rare. Surgical decompression through the transsphenoidal approach is appropriate, but the optimal timing should consider severe disturbance of visual acuity and visual field in the acute stage.

  13. Inferior pancreaticoduodenal artery aneurysm associated with common hepatic artery occlusion.

    PubMed

    Bracale, G; Porcellini, M; Bernardo, B; Selvetella, L; Renda, A

    1996-12-01

    A unique case of true inferior pancreaticoduodenal artery aneurysm (IPDA) associated with occlusion of common hepatic artery is reported. Radiological and MRI findings are described. Because of high risk of visceral ischemia that contraindicated a percutaneous transluminal embolization, a successful tangential resection of aneurysm was performed.

  14. rLj-RGD3, a Novel Recombinant Toxin Protein from Lampetra japonica, Protects against Cerebral Reperfusion Injury Following Middle Cerebral Artery Occlusion Involving the Integrin-PI3K/Akt Pathway in Rats

    PubMed Central

    Jiang, Junshu; Wang, Shengnan; Jia, Qilan; Wang, Yue; Li, Weiping; Zhou, Qin; Lv, Li; Li, Qingwei

    2016-01-01

    Background The RGD-toxin protein Lj-RGD3 is a naturally occurring 118 amino acid peptide that can be obtained from the salivary gland of the Lampetra japonica fish. This unique peptide contains 3 RGD (Arg-Gly-Asp) motifs in its primary structure. Lj-RGD3 is available in recombinant form (rLj-RGD3) and can be produced in large quantities using DNA recombination techniques. The pharmacology of the three RGD motif-containing peptides has not been studied. This study investigated the protective effects of rLj-RGD3, a novel polypeptide, against ischemia/reperfusion-induced damage to the brain caused by middle cerebral artery occlusion (MCAO) in a rat stroke model. We also explored the mechanism by which rLj-RGD3 acts by measuring protein and mRNA expression levels, with an emphasis on the FAK and integrin-PI3K/Akt anti-apoptosis pathways. Methods rLj-RGD3 was obtained from the buccal secretions of Lampetra japonica using gene recombination technology. Sprague Dawley (SD) rats were randomly divided into the following seven groups: a sham group; a vehicle-treated (VT) group; 100.0 μg·kg-1, 50.0 μg·kg-1 and 25.0 μg·kg-1 dose rLj-RGD3 groups; and two positive controls, including 1.5 mg·kg-1 Edaravone (ED) and 100.0 μg·kg-1 Eptifibatide (EP). MCAO was induced using a model consisting of 2 h of ischemia and 24 h of reperfusion. Behavioral changes were observed in the normal and operation groups after focal cerebral ischemia/reperfusion was applied. In addition, behavioral scores were evaluated at 4 and 24 h after reperfusion. Brain infarct volumes were determined based on 2,3,5-triphenyltetrazolium chloride (TTC) staining. Pathological changes in brain tissues were observed using hematoxylin and eosin (H&E) staining. Moreover, neuronal apoptosis was detected using terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling (TUNEL) assays. We determined the expression levels of focal adhesion kinase (FAK), phosphatidyl inositol 3-kinase (PI3K

  15. Intravenous HOE-642 reduces brain edema and Na uptake in the rat permanent middle cerebral artery occlusion model of stroke: evidence for participation of the blood-brain barrier Na/H exchanger.

    PubMed

    O'Donnell, Martha E; Chen, Yi-Je; Lam, Tina I; Taylor, Kelleen C; Walton, Jeffrey H; Anderson, Steven E

    2013-02-01

    Cerebral edema forms in the early hours of ischemic stroke by processes involving increased transport of Na and Cl from blood into brain across an intact blood-brain barrier (BBB). Our previous studies provided evidence that the BBB Na-K-Cl cotransporter is stimulated by the ischemic factors hypoxia, aglycemia, and arginine vasopressin (AVP), and that inhibition of the cotransporter by intravenous bumetanide greatly reduces edema and infarct in rats subjected to permanent middle cerebral artery occlusion (pMCAO). More recently, we showed that BBB Na/H exchanger activity is also stimulated by hypoxia, aglycemia, and AVP. The present study was conducted to further investigate the possibility that a BBB Na/H exchanger also participates in edema formation during ischemic stroke. Sprague-Dawley rats were subjected to pMCAO and then brain edema and Na content assessed by magnetic resonance imaging diffusion-weighed imaging and magnetic resonance spectroscopy Na spectroscopy, respectively, for up to 210 minutes. We found that intravenous administration of the specific Na/H exchange inhibitor HOE-642 significantly decreased brain Na uptake and reduced cerebral edema, brain swelling, and infarct volume. These findings support the hypothesis that edema formation and brain Na uptake during the early hours of cerebral ischemia involve BBB Na/H exchanger activity as well as Na-K-Cl cotransporter activity.

  16. Paradoxical cerebral air embolism causing large vessel occlusion treated with endovascular aspiration.

    PubMed

    Belton, Patrick J; Nanda, Ashish; Alqadri, Syeda L; Khakh, Gurpreet S; Chandrasekaran, Premkumar Nattanmai; Newey, Christopher; Humphries, William E

    2017-04-01

    Cerebral air embolism is a dreaded complication of invasive medical procedures. The mainstay of therapy for patients with cerebral air embolism has been hyperbaric oxygen therapy, high flow oxygen therapy, and anticonvulsants. We present a novel therapeutic approach for treatment of cerebral air embolism causing large vessel occlusion, using endovascular aspiration. Our patient developed a cerebral air embolism following sclerotherapy for varicose veins. This caused near total occlusion of the superior division of the M2 segment of the right middle cerebral artery. Symptoms included unilateral paralysis, unintelligible speech, and hemianopia; National Institutes of Health Stroke Scale (NIHSS) on presentation was 16. The air embolism was treated using a distal aspiration technique. Angiography following aspiration showed Thrombolysis in Cerebral Infarction 2B reperfusion. Following aspiration, the patient was re-examined; NIHSS at that time was 4. At 1 month follow-up, the modified Rankin Scale score was 1 and NIHSS was 1. Treatment of cerebral air embolism is discussed.

  17. Middle Cerebral Artery Calcification

    PubMed Central

    Kao, Hung-Wen; Liou, Michelle; Chung, Hsiao-Wen; Liu, Hua-Shan; Tsai, Ping-Huei; Chiang, Shih-Wei; Chou, Ming-Chung; Peng, Giia-Sheun; Huang, Guo-Shu; Hsu, Hsian-He; Chen, Cheng-Yu

    2015-01-01

    Abstract Calcification of the middle cerebral artery (MCA) is uncommon in the healthy elderly. Whether calcification of the MCA is associated with cerebral ischemic stroke remains undetermined. We intended to investigate the association using Agatston calcium scoring of the MCA. This study retrospectively included 354 subjects with ischemic stroke in the MCA territory and 1518 control subjects who underwent computed tomography (CT) of the brain. We recorded major known risk factors for ischemic stroke, including age, gender, hypertension, diabetes mellitus, smoking, hyperlipidemia, and obesity, along with the MCA calcium burden, measured with the Agatston calcium scoring method. Univariate and modified logistic regression analyses were performed to examine the association between the MCA calcification and ischemic stroke. The univariate analyses showed significant associations of ischemic stroke with age, hypertension, diabetes mellitus, smoking, total MCA Agatston score, and the presence of calcification on both or either side of the MCA. Subjects with the presence of MCA calcification on both or either side of the MCA were 8.46 times (95% confidence interval, 4.93–14.53; P < 0.001) more likely to have a cerebral infarct than subjects without MCA calcification after adjustment for the major known risk factors, including age, hypertension, diabetes mellitus, and smoking. However, a higher degree of MCA calcification reflected by the Agatston score was not associated with higher risk of MCA ischemic stroke after adjustment for the confounding factors and presence of MCA calcification. These results suggest that MCA calcification is associated with ischemic stroke in the MCA territory. Further prospective studies are required to verify the clinical implications of the MCA calcification. PMID:26683969

  18. Robust and enduring atorvastatin-mediated memory recovery following the 4-vessel occlusion/internal carotid artery model of chronic cerebral hypoperfusion in middle-aged rats.

    PubMed

    Zaghi, Gislene Gonçalves Dias; Godinho, Jacqueline; Ferreira, Emilene Dias Fiuza; Ribeiro, Matheus Henrique Dal Molin; Previdelli, Isolde Santos; de Oliveira, Rúbia Maria Weffort; Milani, Humberto

    2016-02-04

    Chronic cerebral hypoperfusion (CCH) is a common condition associated with the development and/or worsening of age-related dementia.We previously reported persistent memory loss and neurodegeneration after CCH in middle-aged rats. Statin-mediated neuroprotection has been reported after acute cerebral ischemia. Unknown, however, is whether statins can alleviate the outcome of CCH. The present study investigated whether atorvastatin attenuates the cognitive and neurohistological outcome of CCH. Rats (12–15 months old) were trained in a non-food-rewarded radial maze, and then subjected to CCH. Atorvastatin (10 mg/kg, p.o.) was administered for 42 days or 15 days, beginning 5 h after the first occlusion stage. Retrograde memory performance was assessed at 7, 14, 21, 28, and 35 days of CCH, and expressed by “latency,” “number of reference memory errors” and “number of working memory errors.” Neurodegeneration was then examined at the hippocampus and cerebral cortex. Compared to sham, CCH caused profound and persistent memory loss in the vehicle-treated groups, as indicated by increased latency (91.2% to 107.3%) and number of errors (123.5% to 2508.2%), effects from which the animals did not spontaneously recover across time. This CCH-induced retrograde amnesia was completely prevented by atorvastatin (latency: −4.3% to 3.3%; reference/working errors: −2.5% to 45.7%), regardless of the treatment duration. This effect was sustained during the entire behavioral testing period (5 weeks), even after discontinuing treatment. This robust and sustained memory-protective effect of atorvastatin occurred in the absence of neuronal rescue (39.58% to 56.45% cell loss). We suggest that atorvastatin may be promising for the treatment of cognitive sequelae associated with CCH.

  19. Endovascular Treatment of Tandem Common Carotid Artery Origin and Distal Intracranial Occlusion in Acute Ischemic Stroke.

    PubMed

    Weiner, Gregory M; Feroze, Rafey; Panczykowski, David M; Aghaebrahim, Amin; Ares, William; Agarwal, Nitin; Enis, John; Zhu, Xiao; Ducruet, Andrew F

    2017-01-01

    Tandem occlusion resulting in acute ischemic stroke is associated with high morbidity and mortality and a poor response to thrombolytic therapy. The use of endovascular strategies for tandem stroke cases results in an improved outcome for this subgroup of patients. We present 2 cases with a pattern of tandem occlusion consisting of proximal obstruction at the origin of the common carotid artery (CCA) with concomitant intracranial occlusion treated by endovascular techniques. The 2 patients presented each with occlusion at the left CCA origin and ipsilateral intracranial vessel (left middle cerebral artery and carotid terminus, respectively). A transfemoral anterograde approach was used to deliver a balloon-mounted stent across the proximal CCA origin occlusion to gain access to the distal cerebral vasculature. Subsequently, a stent retriever assisted mechanical aspiration thrombectomy was used to revascularize the intracranial occlusion. Complete revascularization with Thrombolysis in Cerebral Infarction scores of 2b and improvement in neurologic deficits occurred in both cases. Good clinical outcome was achieved for both patients at 3-month follow-up. An anterograde transfemoral approach should be considered in cases of tandem occlusion of the proximal CCA and middle cerebral artery. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Iatrogenic occlusion of the ophthalmic artery after cosmetic facial filler injections: a national survey by the Korean Retina Society.

    PubMed

    Park, Kyu Hyung; Kim, Yong-Kyu; Woo, Se Joon; Kang, Se Woong; Lee, Won Ki; Choi, Kyung Seek; Kwak, Hyung Woo; Yoon, Ill Han; Huh, Kuhl; Kim, Jong Woo

    2014-06-01

    Iatrogenic occlusion of the ophthalmic artery and its branches is a rare but devastating complication of cosmetic facial filler injections. To investigate clinical and angiographic features of iatrogenic occlusion of the ophthalmic artery and its branches caused by cosmetic facial filler injections. Data from 44 patients with occlusion of the ophthalmic artery and its branches after cosmetic facial filler injections were obtained retrospectively from a national survey completed by members of the Korean Retina Society from 27 retinal centers. Clinical features were compared between patients grouped by angiographic findings and injected filler material. Visual prognosis and its relationship to angiographic findings and injected filler material. Ophthalmic artery occlusion was classified into 6 types according to angiographic findings. Twenty-eight patients had diffuse retinal and choroidal artery occlusions (ophthalmic artery occlusion, generalized posterior ciliary artery occlusion, and central retinal artery occlusion). Sixteen patients had localized occlusions (localized posterior ciliary artery occlusion, branch retinal artery occlusion, and posterior ischemic optic neuropathy). Patients with diffuse occlusions showed worse initial and final visual acuity and less visual gain compared with those having localized occlusions. Patients receiving autologous fat injections (n = 22) had diffuse ophthalmic artery occlusions, worse visual prognosis, and a higher incidence of combined brain infarction compared with patients having hyaluronic acid injections (n = 13). Clinical features of iatrogenic occlusion of the ophthalmic artery and its branches following cosmetic facial filler injections were diverse according to the location and extent of obstruction and the injected filler material. Autologous fat injections were associated with a worse visual prognosis and a higher incidence of combined cerebral infarction. Extreme caution and care should be taken during

  1. Hemodynamic role of ophthalmic artery collateral in internal carotid artery occlusion.

    PubMed

    Tatemichi, T K; Chamorro, A; Petty, G W; Khandji, A; Oropeza, L A; Duterte, D I; Mohr, J P

    1990-03-01

    We performed duplex and transcranial Doppler studies in 36 patients with angiographically documented internal carotid artery occlusion (ICAO) to determine the effect of ophthalmic artery collateral (OAC) on measures of vascular resistivity both proximal and distal to the occlusion. Resistance in the common carotid artery, measured by the resistivity index, was significantly lower in the group with OAC than in those without OAC, indicating a shunt to the low resistance intracranial circuit. The pulsatility index (PI) of the Doppler signal in the ipsilateral middle cerebral artery, a measure of both inflow pressure and distal vascular resistance, did not differ between those with and without OAC. However, the presence of circle of Willis collateral pathways (anterior communicating and/or posterior communicating artery) did appear to have a significant effect on pulsatility. When both were present angiographically, PI was higher than in the group with only 1 Willisian collateral. These findings suggest that OAC has a marginal effect on vascular resistance in arterial bed distal to an ICAO, while Willisian collaterals appear to have a more important role in cerebral perfusion, as measured indirectly by Doppler methods.

  2. Endovascular Management of Central Retinal Arterial Occlusion.

    PubMed

    Agarwal, Nitin; Gala, Nihar B; Baumrind, Benjamin; Hansberry, David R; Thabet, Ahmad M; Gandhi, Chirag D; Prestigiacomo, Charles J

    2016-11-01

    Central retinal artery occlusion (CRAO) is an ophthalmologic emergency due to the sudden cessation of circulation to the inner retinal layer. Without immediate treatment, permanent blindness may ensue. Several treatment options exist, ranging from noninvasive medical management to thrombolysis. Nonetheless, ongoing debate exists regarding the best therapeutic strategy. The authors present the case of a 78-year-old woman with a medical history of hypercholesterolemia and rheumatoid arthritis who experienced complete loss of vision in her left eye. Following ophthalmologic evaluation demonstrating left CRAO, anterior chamber paracentesis was performed. Endovascular intervention was performed via local intra-arterial fibrinolysis with alteplase. Her vision returned to 20/20 following the procedure. In general, conventional therapies have not significantly improved patient outcomes. Several management options exist for CRAO. In general, conservative measures have not been reported to yield better patient outcomes as compared to the natural history of this medical emergency. Endovascular approaches are another option as observed with this case reported. In cases of CRAO, therapeutic strategies such as intra-arterial fibrinolysis utilize a local infusion of reactive tissue plasminogen activator directly at the site of occlusion via catheterization of the ophthalmic artery. Although several case series do show promising results after treating CRAO with intra-arterial fibrinolysis, further studies are required given the reports of complications.

  3. Perfusion of a cerebral protective solution enhances neuroprotection in a rabbit model of occlusion-reperfusion: prolonged cerebral dormancy time.

    PubMed

    Ye, Libin; Hua, Aiyuan; Dai, Bo; Lu, Tingting; Zhang, Zhaolin; Ye, Meilin; Weintraub, Michael; Li, Qingdi Quentin

    2014-01-01

    In the present study, we investigated the effect of a cerebral protective solution on prolongation of cerebral dormancy time in a rabbit model of occlusion-reperfusion. In a control group, rabbits were anesthetized and the four cerebral arteries (the left and right common carotid arteries and vertebral arteries) were occluded for 7.5 min followed by reperfusion. All six rabbits in the control group died. In contrast, a second group underwent perfusion of a cerebral protective solution for 15 min between artery occlusion and reperfusion. All six rabbits in this group survived. However, when the perfusion solution was changed to 5% glucose solution or rabbit plasma in two other groups, the rabbits in both the latter two groups also died. Neuroprotection was also observed when the protective solution was administered for 30-60 min after the onset of artery occlusion and before the return of blood flow (reperfusion). To understand the high rate of thrombotic stroke in the clinic, we assessed the influence of different organ tissue infusions on blood coagulation in vitro and found that blood clotting occurred faster in the presence of brain tissue infusion compared to liver, kidney, and heart tissue infusions. These results indicate a higher rate of thrombosis in brain tissue compared to any of the other tissues tested. The current study shows that perfusion of a cerebral protective solution produced a significant neuroprotective benefit in our rabbit model of occlusion-reperfusion, suggesting that administration of a cerebral protective solution may be an effective approach for the treatment of ischemic stroke.

  4. [The importance of Willis ring as valvular mechanism in cerebral circulation in patients with different degree of internal carotid artery occlusion].

    PubMed

    Volievica, Alma; Kulenovic, Amela; Lujinovic, Almira; Talovic, Elvira

    2006-01-01

    Cerebrovascular deseases , cerebral vessels deseases, represents one of the greatest problems of humankind. The reasons are not just the high incidence and relatively high prevalence of letal outcomes in the acute faze of the desease, but also high level of disfunctionality caused by this disease in numerous patients who survived cerebrovascular insult and haemorraghe The onset, course and outcome of cerebrovascular diseases depends among other things on the possibility o f colateral brain circulation establishment. Willis ring onthe base of the brain is the most important anastomosis between circulation in both carotid arteries and basilar artery. First precondition for Willis ring t o function as valvular mechanisam is its intact configuration. But, it is found in almost half of th e subjectsincluded in the study that certain anatomical abnormalities in the Willis ring structure exist. Presence of these abnormalities favors onset of vascular diseases since they unables colateral circulation establishment. Studies till now have shown that all components of Willis ring do not contribute equally in colateral function among obstructive diseases.

  5. Spontaneous occlusion of cerebral arteriovenous malformation following partial embolization with Onyx.

    PubMed

    Nas, Omer Fatih; Ozturk, Kerem; Gokalp, Gokhan; Hakyemez, Bahattin

    2017-02-01

    Management options for brain arteriovenous malformations (AVMs) are surgery, radiosurgery, and endovascular embolization. The aim of partial embolization in endovascular treatment is to make total resection possible. However, increased risk of bleeding in partial embolization creates some controversies about treatment options. Spontaneous total occlusion of cerebral AVMs following partial obliteration with embolization agents is a rarely seen condition. We present a case with an AVM vanishing from right posterior cerebral artery which spontaneously occluded following partial embolization with Onyx liquid agent.

  6. A New Approach of Short Wave Protection against Middle Cerebral Artery Occlusion/Reperfusion Injury via Attenuation of Golgi Apparatus Stress by Inhibition of Downregulation of Secretory Pathway Ca(2+)-ATPase Isoform 1 in Rats.

    PubMed

    Fan, Yongmei; Zhang, Changjie; Li, Ting; Peng, Wenna; Yin, Jing; Li, Xiaofao; Kong, Ying; Lan, Chunna; Wang, Rumi; Hu, Zhiping

    2016-07-01

    Short wave (SW), a pattern of electromagnetic therapy, achieves an oscillating electromagnetic field. It has been reported that it may have a potential effect on cerebral injury. The present study was designed to investigate the potential role and possible mechanism of SW in focal cerebral ischemia/reperfusion (I/R) injury in rats. Secretory pathway Ca(2+)/Mn(2+) ATPase isoform 1 is a major component of Golgi apparatus stress. It has been reported as representative of Golgi apparatus stress. Up to 120 minutes of middle cerebral artery occlusion (MCAO) and reperfusion injury was induced in male Sprague-Dawley rats. Different sessions of SW daily were administered over head after reperfusion from day 1 to day 7. Functional recovery scores, survival rates, infarct volume analysis, electron microscope test, and western blotting studies were used to analyze the therapy. SW protected against neuronal death and apoptosis in cornu ammon 1 region of hippocampus by reducing neuronal deficit, infarct volume, and ultrastructure. SW partly inhibited upregulation of caspase3. In addition, the expression of secretory pathway Ca(2+)-ATPase isoform 1 (SPCA1) was upregulated by SW. Our data indicate that SW can be protected against focal cerebral I/R injury, and the influence on Golgi apparatus stress might provide us a new perspective in further study. To the authors' knowledge, this is the first report using SW to increase expression of SPCA1 indicating modulate Golgi apparatus stress in MCAO and reperfusion model. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  7. CDP-choline reduces pro-caspase and cleaved caspase-3 expression, nuclear DNA fragmentation, and specific PARP-cleaved products of caspase activation following middle cerebral artery occlusion in the rat.

    PubMed

    Krupinski, J; Ferrer, I; Barrachina, M; Secades, J J; Mercadal, J; Lozano, R

    2002-05-01

    Citicoline has been demonstrated to be beneficial in several models of cerebral ischaemia. We tested the hypothesis that citicoline may provide apoptotic pathways following focal cerebral ischaemia. Focal cerebral ischaemia was produced by distal, permanent middle cerebral artery occlusion (MCAO) in Sprague-Dawley rats. The animals were randomised into four groups: (B+A) Citicoline 500 mg/kg IP 24 and 1 h before MCAO, and 23 h after MCAO; (A) citicoline 500 mg/kg IP, within 30 min after MCAO, and 23 h after MCAO; (C) vehicle IP; and (D) sham-operated. The animals were sacrificed at 12 h (n=8 per group) and 24 h (n=8 per group) after MCAO. Immunohistochemistry was performed on free-floating tissue sections with goat polyclonal antibodies to procaspase-1, -2, -3, -6 and -8, and in paraffin-embedded sections processed for cleaved caspase-3 (17 kDa) immunohistochemistry. Finally, some sections were stained with the method of in situ end-labelling of nuclear DNA fragmentation. For gel electrophoresis and Western blotting, antibodies to poly (ADP-ribose) polymerase (PARP) products of 89 kDa were used to reveal specific cleavage substrates of caspases. MCAO induced the expression of all procaspases and the expression of PARP products of 89 kDa, as well as cells with nuclear DNA fragmentation, at 12 and 24 h, in the infarcted core and penumbra. Citicoline reduced the expression of all procaspases at 12 and 24 h after MCAO, as well as the expression of cleaved caspase-3 in cells in the penumbra area. This was accompanied by a reduction in the number of cells bearing nuclear DNA fragments. The expression of caspase-cleaved products of PARP (PARP 89 kDa) was reduced in citicoline-treated ischaemic rats. These results show that citicoline inhibits the expression of proteins involved in apoptosis following MCAO.

  8. The role of carotid artery stenting for recent cerebral ischemia.

    PubMed

    Bosiers, M; Callaert, J; Deloose, K; Verbist, J; Keirse, K; Peeters, P

    2010-06-01

    Patients with cerebral ischemia as a result of acute cervical internal carotid artery occlusion are generally considered to have a poor prognosis. Despite maximal medical treatment, a better treatment for patients with acute ischemic stroke who present with serious neurologic symptoms on admission or continue to deteriorate neurologically due to a total occlusion, a dissection or a high-grade stenosis of the internal carotid artery is required. An effective intervention to improve their neurologic symptoms and clinical outcome has not yet been established and represents a challenging and complex problem. Treatment of acute symptomatic occlusion of the cervical internal carotid artery includes intravenous administration of thrombolytic agent, carotid endarterectomy and an interventional approach (intra-arterial administration of thrombolytic agent, transluminal angioplasty with or without stenting). The endovascular interventional approach is becoming a part of the stroke therapy armamentarium for intracranial occlusion. It may also now be considered in select patients with acute internal carotid artery occlusion. Stenting and angioplasty for acute internal carotid artery occlusion appears to be feasible, safe and may be associated with early neurological improvement. The encouraging preliminary results await confirmation from prospective, randomized studies.

  9. Giant vertebral artery aneurysm in a child treated with endovascular parent artery occlusion and coil embolization.

    PubMed

    Park, Hun-Soo; Nakagawa, Ichiro; Wada, Takeshi; Nakagawa, Hiroyuki; Hironaka, Yasuo; Kichikawa, Kimihiko; Nakase, Hiroyuki

    2014-01-01

    Intracranial giant vertebral artery aneurysms are extremely rare in the pediatric population and are associated with significant morbidity and mortality. The present report describes a case of a pediatric patient with giant vertebral artery aneurysm who presented with intracranial mass effect. This patient was successfully treated with endovascular parent artery occlusion and coil embolization. A 7-year-old girl presented with tetraparesis, ataxia, dysphagia, and dysphonia. Cerebral angiography revealed intracranial giant aneurysm arising from the right vertebral artery. The patient underwent endovascular parent artery occlusion alone to facilitate aneurysmal thrombosis as an initial treatment. This was done to avoid a coil mass effect to the brainstem. However, incomplete thrombosis occurred in the vicinity of the vertebral artery union. Therefore, additional coil embolization for residual aneurysm was performed. Two additional coil embolization procedures were performed in response to recurrence. Mass effect and clinical symptoms gradually improved, and the patient had no associated morbidity or recurrence at 2 years after the last fourth coil embolization. Intracranial giant vertebral artery aneurysms are rare and challenging in pediatric patients. Staged endovascular strategy can be a safe and effective treatment option.

  10. C-terminal ADAMTS-18 fragment induces oxidative platelet fragmentation, dissolves platelet aggregates, and protects against carotid artery occlusion and cerebral stroke

    PubMed Central

    Li, Zongdong; Nardi, Michael A.; Li, Yong-Sheng; Zhang, Wei; Pan, Ruimin; Dang, Suying; Yee, Herman; Quartermain, David; Jonas, Saran

    2009-01-01

    Anti-platelet integrin GPIIIa49-66 antibody (Ab) induces complement-independent platelet oxidative fragmentation and death by generation of platelet peroxide following NADPH oxidase activation. A C-terminal 385–amino acid fragment of ADAMTS-18 (a disintegrin metalloproteinase with thrombospondin motifs produced in endothelial cells) induces oxidative platelet fragmentation in an identical kinetic fashion as anti–GPIIIa49-66 Ab. Endothelial cell ADAMTS-18 secretion is enhanced by thrombin and activated by thrombin cleavage to fragment platelets. Platelet aggregates produced ex vivo with ADP or collagen and fibrinogen are destroyed by the C-terminal ADAMTS-18 fragment. Anti–ADAMTS-18 Ab shortens the tail vein bleeding time. The C-terminal fragment protects against FeCI3-induced carotid artery thrombosis as well as cerebral infarction in a postischemic stroke model. Thus, a new mechanism is proposed for platelet thrombus clearance, via platelet oxidative fragmentation induced by thrombin cleavage of ADAMTS-18. PMID:19218546

  11. Optimal management of infrainguinal arterial occlusive disease

    PubMed Central

    Pennywell, David J; Tan, Tze-Woei; Zhang, Wayne W

    2014-01-01

    Peripheral arterial occlusive disease is becoming a major health problem in Western societies as the population continues to age. In addition to risk of limb loss, the complexity of the disease is magnified by its intimate association with medical comorbidity, especially cardiovascular and cerebrovascular disease. Risk factor modification and antiplatelet therapy are essential to improve long-term survival. Surgical intervention is indicated for intermittent claudication when a patient’s quality of life remains unacceptable after a trial of conservative therapy. Open reconstruction and endovascular revascularization are cornerstone for limb salvage in patients with critical limb ischemia. Recent advances in catheter-based technology have made endovascular intervention the preferred treatment approach for infrainguinal disease in many cases. Nevertheless, lower extremity bypass remains an important treatment strategy, especially for reasonable risk patients with a suitable bypass conduit. In this review, we present a summary of current knowledge about peripheral arterial disease followed by a review of current, evidence-based medical and surgical therapy for infrainguinal arterial occlusive disease. PMID:25368519

  12. [Acute arterial occlusion associated disseminated hydatidosis].

    PubMed

    Somocurcio, Jose; Alvarez, Gamero; Lara Campos, Gloria; Cahuana Aparco, Judith; Calongos Porras, Estefanny; Bermejo Cataño, Pedro; Tejada Llacsa, Paul

    2014-04-01

    Hydatidosis or echinococcosis are terms used to denote the zoonotic infestation caused by adult and larval stages (metacestode) of the cestode from the genus Echinococcus (family tenidae). The term hydatidosis should be applied to the infestation caused by the metacestode while echinococcosis for the larval and adult stages. In Peru there is a high prevalence of this infection, liver and lung being the most affected organs. There are factors from the host and from the infectious agent that contribute to this infection, with the immune component of the host as an important infection and dissemination point. A case of acute arterial occlusion associated with disseminated hydatidosis in a 54 years old patient, born and from Huancavelica, with sudden onset of an acute arterial obstruction is reported. The patient did not improve after surgery and died within 48 hours of presentation.

  13. Common Carotid Artery Occlusion: A Case Series

    PubMed Central

    Bajkó, Zoltán; Bălaşa, Rodica; Moţăţăianu, Anca; Maier, Smaranda; Chebuţ, Octavia Claudia; Szatmári, Szabolcs

    2013-01-01

    Subjects and Methods. We analysed 5000 cerebrovascular ultrasound records. A total of 0.4% of the patients had common carotid artery occlusion (CCAO). Results. The mean age was 59.8 ± 14.2 years, and the male/female ratio was 2.33. The most frequent risk factors were hypertension, ischaemic heart disease, dyslipidemia, diabetes mellitus, and smoking. Right-sided and left-sided CCAO occurred in 65% and 30% of the cases, respectively, and bilateral occlusion was detected in one case (5%). Patent bifurcation was observed in 10 cases of CCAO in which the anterograde flow in the ICA was maintained from the external carotid artery with reversed flow. In two of the cases, the occluded CCA was hypoplastic. The aetiology of CCAO in the majority of cases was the atherosclerosis (15 cases). The male/female ratio was higher in the patients with occluded distal vessels, and the short-term outcome was poorer. Only two cases from this series underwent revascularisation surgery. Spontaneous recanalisation was observed in one case. Conclusions. The most frequent cause of CCAO was atherosclerosis. The outcome is improved in the cases with patent distal vessels, and spontaneous recanalisation is possible. Treatment methods have not been standardised. Surgical revascularisation is possible in cases of patent distal vessels, but the indications are debatable. PMID:24167740

  14. Clinical Scales Do Not Reliably Identify Acute Ischemic Stroke Patients With Large-Artery Occlusion.

    PubMed

    Turc, Guillaume; Maïer, Benjamin; Naggara, Olivier; Seners, Pierre; Isabel, Clothilde; Tisserand, Marie; Raynouard, Igor; Edjlali, Myriam; Calvet, David; Baron, Jean-Claude; Mas, Jean-Louis; Oppenheim, Catherine

    2016-06-01

    It remains debated whether clinical scores can help identify acute ischemic stroke patients with large-artery occlusion and hence improve triage in the era of thrombectomy. We aimed to determine the accuracy of published clinical scores to predict large-artery occlusion. We assessed the performance of 13 clinical scores to predict large-artery occlusion in consecutive patients with acute ischemic stroke undergoing clinical examination and magnetic resonance or computed tomographic angiography ≤6 hours of symptom onset. When no cutoff was published, we used the cutoff maximizing the sum of sensitivity and specificity in our cohort. We also determined, for each score, the cutoff associated with a false-negative rate ≤10%. Of 1004 patients (median National Institute of Health Stroke Scale score, 7; range, 0-40), 328 (32.7%) had an occlusion of the internal carotid artery, M1 segment of the middle cerebral artery, or basilar artery. The highest accuracy (79%; 95% confidence interval, 77-82) was observed for National Institute of Health Stroke Scale score ≥11 and Rapid Arterial Occlusion Evaluation Scale score ≥5. However, these cutoffs were associated with false-negative rates >25%. Cutoffs associated with an false-negative rate ≤10% were 5, 1, and 0 for National Institute of Health Stroke Scale, Rapid Arterial Occlusion Evaluation Scale, and Cincinnati Prehospital Stroke Severity Scale, respectively. Using published cutoffs for triage would result in a loss of opportunity for ≥20% of patients with large-artery occlusion who would be inappropriately sent to a center lacking neurointerventional facilities. Conversely, using cutoffs reducing the false-negative rate to 10% would result in sending almost every patient to a comprehensive stroke center. Our findings, therefore, suggest that intracranial arterial imaging should be performed in all patients with acute ischemic stroke presenting within 6 hours of symptom onset. © 2016 American Heart Association

  15. Influence of the site of arterial occlusion on multiple baseline hemodynamic MRI parameters and post-thrombolytic recanalization in acute stroke.

    PubMed

    Derex, L; Hermier, M; Adeleine, P; Pialat, J B; Wiart, M; Berthezène, Y; Froment, J C; Trouillas, P; Nighoghossian, N

    2004-11-01

    In this prospective MRI study, we evaluated the impact of the site of occlusion on multiple baseline perfusion parameters and subsequent recanalization in 49 stroke patients who were given intravenous tissue plasminogen activator (tPA). Pretreatment magnetic resonance angiography (MRA) revealed an arterial occlusion in 47 patients: (1) internal carotid artery (ICA) + M1 middle cerebral artery (MCA) occlusion (n=12); (2) M1 MCA occlusion (n=19); (3) M2 MCA, distal branches of the MCA and anterior cerebral artery (ACA) occlusion (n=16). Patients with ICA occlusion had significantly larger DWI, PWI and mismatch lesion volume on pretreatment MRI compared to patients with other sites of occlusion. The differences in cerebral blood flow (CBF) and peak height were significantly higher in patients with ICA occlusion compared to patients with other sites of occlusion (P=0.03 and P=0.04, respectively). Day 1 MRA showed recanalization in 28 patients (60%). The rate of recanalization was significantly different depending on the site of occlusion: 33% in ICA + M1 MCA occlusion, 63% in M1 MCA occlusion and 81% in either M2 MCA, distal branches of the MCA or ACA occlusion (P=0.002). Our data suggest that CBF and peak height are the most relevant MRI parameters to assess the severity of hemodynamic impairment in regard to the site of occlusion.

  16. Thrombectomy using a stent retriever with artificially induced vertebral artery vasospasm in a patient with acute basilar artery occlusion: a case report

    PubMed Central

    Kim, Sanghyeon; Choi, Jae-Hyung

    2015-01-01

    An acute basilar artery occlusion is not an uncommon cause of stroke. It represents 6–10% of large vessel strokes and has been associated with poor clinical outcomes. Multimodal treatments have been introduced to recanalise a basilar artery occlusion successfully. However, all mechanical thrombectomy devices are not always usable in an emergent situation. We present a case of basilar artery occlusion treated with a stent retriever assisted by a vertebral artery vasospasm. We attempted thrombectomy with a stent retriever several times. However, the captured thrombus was not pulled out and migrated to the distal basilar artery and posterior cerebral artery due to anterograde flow of the vertebral artery. We carefully advanced the catheter into the distal vertebral artery and generated a vasospasm. The vertebral artery vasospasm reduced the forward flow significantly like a balloon-guided catheter. The thrombus was pulled out with the stent. PMID:26678752

  17. SURGICAL EMBOLECTOMY FOR FOVEA-THREATENING ACUTE RETINAL ARTERY OCCLUSION

    PubMed Central

    Almeida, David R.P.; Mammo, Zaid; Chin, Eric K.

    2016-01-01

    Purpose: To describe a technique of surgical intraocular embolectomy in patients with acute fovea-threatening branch retinal artery occlusion. Methods: Pars plana vitrectomy with embolectomy involving embolus isolation, dissection, and removal in patients with an acute fovea-threatening arterial occlusion without a patent cilioretinal artery. Results: The surgical technique involves a core vitrectomy. The blocked artery is incised using a microvitreoretinal blade, and microsurgical forceps are used to retrieve the embolus. No significant complications were noted. The study technique offers an excellent safety profile and minimizes the risk of vitreous hemorrhage by carefully dissecting the vascular adventitial sheath and isolating the embolus. Conclusion: Surgical embolectomy is a viable technique for patients with acute fovea-threatening arterial occlusions without patent cilioretinal artery. Careful dissection and retrieval of the embolus minimizes the risk of vitreous hemorrhage, which is an important improvement in previous techniques for management of acute retinal arterial occlusions. PMID:26674278

  18. Cilio-retinal arterial circulation in central retinal vein occlusion.

    PubMed Central

    McLeod, D

    1975-01-01

    The hypothesis that an occlusion of the central retinal artery is an essential prerequisite for haemorrhage formation after central retinal vein obstruction has been investigated by examining the fundus changes in patients with a cilio-retinal arterial circulation; the findings are at variance with the 'combined occlusion hypothesis'. Comparisons were made between the pathological features in two retinal capillary beds with independent sources of arterial supply--namely, the central retinal and cilio-retinal arteries--but with an obstructed venous drainage channel common to both--namely, the central retinal vein. The importance of intraluminal pressure changes (as distinct from perfusion changes) in the causation of haemorrhages and oedema after venous occlusion is stressed, and the role of arterial disease in the pathogenesis of venous occlusions is distinguished from its role in determining the sequelae of such occlusions. Images PMID:1203235

  19. Central retinal artery occlusion following cosmetic blepharoplasty.

    PubMed Central

    Kelly, P W; May, D R

    1980-01-01

    A case is presented of a 70-year-old white male who underwent a bilateral cosmetic lower lid blepharoplasty with fat removal. He subsequently developed a right orbital haemorrhage which resulted in the occlusion of the central retinal artery. The patient had no light perception with his right eye for approximately 1 hour, but vision was eventually restored to 20/20 after emergency therapeutic measures. There are many possible causes of visual loss following blepharoplasty, with orbital haemorrhage being the most common. Visual loss secondary to blepharoplasty can be prevented in the preoperative, intraoperative, and postoperative phases of surgery. Blindness as a complication of cosmetic blepharoplasty can be reversible if recognised early and treated appropriately. These facts must be kept in mind by all surgeons who perform blepharoplasties. Images PMID:7448145

  20. Intracranial haemodynamics during vasomotor stress test in unilateral internal carotid artery occlusion estimated by 3-D transcranial Doppler scanner.

    PubMed

    Zbornikova, V; Lassvik, C; Hillman, J

    1995-04-01

    Seventeen patients, 14 males and 3 females, mean age 64 years (range 45-77 years) with longstanding unilateral occlusion of the internal carotid artery and minimal neurological deficit, were evaluated in order to find criteria for potential benefit of extracranial-intracranial by-pass surgery. 3-D transcranial Doppler was used for estimation of mean velocities and pulsatility index in the middle cerebral artery, anterior cerebral artery and posterior cerebral artery before and after iv injection of 1 g acetazolamide. The anterior cerebral artery was the supplying vessel to the occluded side in 16 patients and mean velocities were significantly (p < 0.001) faster on the occluded (59.3 +/- 14.5 cm sec-1) and nonoccluded (91.6 +/- 29.6 cm sec-1, p < 0.05)) side than those found in the middle cerebral artery (39.2 +/- 13.7 and 50.9 +/- 8.5 cm sec-1). In two patients a decrease of mean velocity after acetazolamide was noted in middle cerebral artery indicating 'steal' effect. In another 4 patients, poor vasomotor response was seen with less than 11% of mean velocity increase in the middle cerebral artery. Differences between posterior cerebral artery on the occluded and nonoccluded side were insignificant as well as those between middle and posterior on the occluded side. Resting values of pulsatility index differed significantly (p < 0.01) only between anterior and posterior cerebral artery on the nonoccluded side.(ABSTRACT TRUNCATED AT 250 WORDS)

  1. Acute Popliteal Artery Occlusion after Revision Total Knee Arthroplasty.

    PubMed

    Tsujimoto, Ryu; Matsumoto, Tomoyuki; Takayama, Koji; Kawakami, Yohei; Kamimura, Masato; Matsushita, Takehiko; Kuroda, Ryosuke; Kurosaka, Masahiro

    2015-01-01

    Acute arterial occlusions are a rare complication of total knee arthroplasty (TKA). However, in revision TKA, the risk of such complications is higher and these complications can lead to amputation if not adequately treated. We describe a case of acute popliteal artery occlusion 4 hours after second revision TKA in a patient with a history of several surgical procedures because of periprosthetic infection at a previous hospital. Revascularization was achieved via bypass grafting and amputation was narrowly avoided despite time lag after symptom onset to revascularization. In this case, it was possible that the arterial disease that accompanied the vascular endothelium injury such as pseudoaneurysm had existed since the previous surgery at another hospital and was destroyed by the surgical procedure, which led to the formation of thrombosis and arterial occlusion. Preoperative evaluation of the arterial condition should be considered to avoid acute arterial occlusive disease, especially in patients who had several previous surgical procedures.

  2. [Cerebral artery thrombosis in pregnancy].

    PubMed

    Charco Roca, L M; Ortiz Sanchez, V E; Hernandez Gutierrez-Manchon, O; Quesada Villar, J; Bonmatí García, L; Rubio Postigo, G

    2015-11-01

    A 28 year old woman, ASA I, who, in the final stages of her pregnancy presented with signs of neural deficit that consisted of distortion of the oral commissure, dysphagia, dysarthria, and weakness on the left side of the body. She was diagnosed with thrombosis in a segment of the right middle cerebral artery which led to an ischemic area in the right frontal lobe. Termination of pregnancy and conservative treatment was decided, with good resolution of the symptoms.

  3. Ten-minute umbilical cord occlusion markedly reduces cerebral blood flow and heat production in fetal sheep.

    PubMed

    Lotgering, Fred K; Bishai, John M; Struijk, Piet C; Blood, Arlin B; Hunter, Christian J; Power, Gordon G; Longo, Lawrence D

    2003-07-01

    The study was undertaken to determine to what extent a 10-minute total umbilical cord occlusion affects autoregulation of cerebral blood flow and cerebral heat production in the fetus. In seven chronically catheterized late-gestation fetal sheep (127-131 days' gestation), we studied fetal blood gas, hemodynamic, and thermal responses to 10-minute total umbilical cord occlusion. Ten-minute umbilical cord occlusion resulted in marked hypoxia/ischemia, with oxygen content decreasing from 6.5 +/- 0.4 to 0.6 +/- 0.1 vol% and lactate concentration increasing from 1.8 +/- 0.2 to 10.7 +/- 0.7 mmol/L. During this period, the fetuses showed reductions in heart rate from 163.5 +/- 3.4 to 97.1 +/- 5.4 beats/min, mean arterial pressure from 39.4 +/- 2.1 to 21.2 +/- 2.5 mm Hg, cerebral blood flow from 101.3% +/- 8.9% to 49.7% +/- 10.3%, and cerebral heat production from 95.0% +/- 6.3% to 29.6% +/- 4.8%. During cord occlusion, cerebral blood flow was pressure passive from the fourth minute onward. The reduction in cerebral heat production preceded the reduction in perfusion pressure and cerebral blood flow. Recovery of cerebral blood flow and heat production to control values was incomplete for more than 60 minutes after restoration of umbilical flow. Ten-minute total umbilical cord occlusion results in major reductions in cerebral blood flow and heat production. Autoregulation of cerebral blood flow was lost within 4 minutes of occlusion, probably as a result of hypoxia, combined with hypotension. The fact that the reduction in cerebral heat production preceded and exceeded the reduction in blood flow may suggest active down-regulation of cerebral metabolism, the mechanism of which is unclear at present.

  4. [Posterior cerebral artery infarctions with possible interaction between hypoperfusion and embolism].

    PubMed

    Durand-Birchenall, J; Bugnicourt, J-M

    2013-12-01

    Although embolism and hypoperfusion may well occur concurrently in a non-negligible proportion of cerebral infarction patients, there is currently lack of proof, especially in the posterior circulation. Here, we are reporting on a case of multiple cerebral infarctions in a patient with neurofibromatosis type 1, multiple vascular abnormalities of the posterior cerebral circulation and intracranial artery occlusion. We hypothesize that cerebral blood flow impairment may have affected the clearance and destination of embolic particles.

  5. Contemporary therapeutic strategies for occlusion of the artery of Percheron: a review of the literature.

    PubMed

    Li, Xintong; Agarwal, Nitin; Hansberry, David R; Prestigiacomo, Charles J; Gandhi, Chirag D

    2015-02-01

    The artery of Percheron (AOP) is a rare anatomic variant of the paramedian thalamic-mesencephalic arterial supply, arising as a solitary arterial trunk from the P1 segment of the posterior cerebral artery. Its occlusion, commonly caused by cardioembolism, leads to distal bilateral paramedian thalamic ischemia, oftentimes affecting the midbrain and/or the anterior thalamus. AOP occlusion presents with a clinical triad of altered mental status, vertical gaze palsy, and memory impairment, along with other associated symptoms. Digital subtraction angiography is effective for detecting AOP, while diffusion weighted MRI is best for diagnosis of its occlusion. Our extensive literature search sought to determine the best forms of treatment for uncomplicated AOP occlusion, with the inclusion criterion of implementation of medical treatment or other forms of therapy in patient recovery from this condition. We conclude that intravenous heparin and thrombolysis with tissue plasminogen activator are effective firstline treatment options for emergent AOP occlusion followed by a prescription of long term anticoagulants, while non-emergent cases without midbrain involvement could be treated through rehabilitation and continual monitoring by medical staff. Clinical trials of higher power are needed for a more comprehensive analysis of the treatment options for AOP occlusion.

  6. Circle of Willis Collateral During Temporary Internal Carotid Artery Occlusion II: Observations From Computed Tomography Angiography.

    PubMed

    Wang, Bill Hao; Leung, Andrew; Lownie, Stephen P

    2016-07-01

    The Circle of Willis (CoW) is the most effective collateral circulation to the brain during internal carotid artery (ICA) occlusion. Carotid stump pressure (CSP) is an established surrogate measure of the cerebral collateral circulation. This study aims to use hemodynamic and computed tomography angiography measurements to determine the strongest influences upon the dependent variable, CSP. These findings could help clinicians noninvasively assess the adequacy of the collateral circulation and facilitate surgical risk assessment in an outpatient setting. CSP and mean arterial pressure were measured during carotid endarterectomy or during carotid balloon test occlusion in 92 patients. Intracranial arterial diameters were measured on computed tomography angiography at 16 different locations. Univariate and multivariate analyses were used to determine the key factors associated with CSP. In a subgroup of individuals (n=27) with severe (>70% North American Symptomatic Carotid Endarterectomy Trial) contralateral stenosis or occlusion, the same analysis was performed. The contralateral anterior cerebral artery proximal to anterior communicating artery (A1) of the CoW had the strongest influence upon CSP, followed by the mean arterial pressure, the contralateral ICA diameter, and the anterior communicating artery diameter (R 2=0.364). In the subgroup with high-grade contralateral ICA stenosis, the ipsilateral posterior communicating artery exerted the strongest influence (R 2=0.620). During ICA occlusion, the anterior CoW dominates in preserving collateral flow, especially the contralateral A1 segment. In individuals with high-grade contralateral carotid stenosis, the posterior communicating artery calibre becomes a dominant influence. The most favourable anatomy consists of large contralateral A1 and anterior communicating arteries, and no contralateral carotid stenosis.

  7. Cerebral ischemia induces transcription of inflammatory and extracellular-matrix-related genes in rat cerebral arteries.

    PubMed

    Vikman, Petter; Ansar, Saema; Henriksson, Marie; Stenman, Emelie; Edvinsson, Lars

    2007-12-01

    Cerebral ischemia results in a local inflammatory response that contributes to the size of the lesion, however, the involvement of the cerebral vasculature is unknown. We hypothesise that the expression of inflammatory genes (Il6, iNOS, cxcl2, TNF-alpha and Il-1beta) and extracellular-matrix-related genes (MMP9, MMP13) is induced in cerebral arteries following cerebral ischemia via activation of mitogen activated kinases (MAPKs). This hypothesis was tested in vivo by experimental subarachnoid haemorrhage (SAH) and temporal middle cerebral artery occlusion (MCAO), and by organ culture of isolated cerebral arteries with quantitative real time PCR (mRNA expression) and immunohistochemistry (localization of protein expression). The gene promoters were investigated in silica with computer analysis. The mRNA analysis revealed that the ischemic models, SAH and MCAO, as well as organ culture of isolated cerebral arteries resulted in transcriptional upregulation of the abovementioned genes. The protein expression involved phosphorylation of three different MAPKs signalling pathways (p38, ERK 1/2 and SAPK/JNK) and the downstream transcription factors (ATF-2, Elk-1, c-Jun) shown by immunohistochemistry and quantified by image analysis. All three models revealed the same pattern of activation in the cerebrovascular smooth muscle cells. The in silica analysis demonstrated binding sites for said transcription factors. The results suggest that cerebral ischemia and organ culture induce activation of p38, ERK 1/2 and SAPK/JNK in cerebral arteries which in turn activate the transcription factors ATF-2, Elk-1 and c-Jun and the expression of inflammatory and extracellular-matrix-related genes in the wall of cerebral arteries.

  8. Hemi-central retinal artery occlusion in young adults.

    PubMed

    Rishi, Pukhraj; Rishi, Ekta; Sharma, Tarun; Mahajan, Sheshadri

    2010-01-01

    Amongst the clinical presentations of retinal artery occlusion, hemi-central retinal artery occlusion (Hemi-CRAO) is rarely described. This case series of four adults aged between 22 and 36 years attempts to describe the clinical profile, etiology and management of Hemi-CRAO. Case 1 had an artificial mitral valve implant. Polycythemia and malignant hypertension were noted in Case 2. The third patient had Leiden mutation while the fourth patient had Eisenmenger's syndrome. Clinical examination and fundus fluorescein angiography revealed a bifurcated central retinal artery at emergence from the optic nerve head, in all cases. Color Doppler examination of the central retinal artery confirmed branching of the artery behind the lamina cribrosa. It is hypothesized that bifurcation of central retinal artery behind the lamina cribrosa may predispose these hemi-trunks to develop an acute occlusion if associated with underlying risk factors. The prognosis depends upon arterial recanalisation and etiology of the thromboembolic event.

  9. Distal anterior cerebral artery aneurysms.

    PubMed

    Lehecka, Martin; Dashti, Reza; Lehto, Hanna; Kivisaari, Riku; Niemelä, Mika; Hernesniemi, Juha

    2010-01-01

    Distal anterior cerebral artery (DACA) aneurysms, also known as pericallosal artery aneurysms, represent about 6% of all intracranial aneurysms. They are located on the A2-A5 segments of the anterior cerebral artery and on its distal branches. This paper summarizes present knowledge on radiological features, treatment options, treatment results, and long-term follow-up of DACA aneurysms. Typical features of DACA aneurysms are small size, broad base, and branches originating from the base. When ruptured, they cause intracerebral hematoma in nearly half of the cases. DACA aneurysms are nowadays more often treated with microsurgical clipping than endovascular coiling due to their distal location and morphologic features. With clipping the results are same or slightly better than for aneurysms at other locations, coiling is often associated with more complications than in other aneurysms. Clipping is a long-lasting treatment with very small recurrence rate, there is no long-term data available on efficacy of coiling yet. For ruptured DACA aneurysms the most important factors affecting outcome is the severity of initial bleeding and patient's age.

  10. Management of patients with symptomatic carotid artery occlusion.

    PubMed

    Kappelle, L Jaap; Klijn, Catharina J M; Tulleken, Cornelis A F

    2002-01-01

    The annual risk of stroke in patients with symptomatic carotid artery occlusion (CAO) and impaired cerebral blood flow (CBF) is approximately 10%. Increased oxygen extraction fraction measured by positron emission tomography (PET) and low cerebrovascular reactivity assessed by transcranial Doppler is associated with an increased risk of recurrent ischemic stroke in these patients. Recently, other risk factors have been identified: (1) symptoms of purported hemodynamic origin; (2) ongoing symptoms in the presence of documented symptomatic CAO; (3) leptomeningeal collaterals visible on angiography; and (4) low NAA/choline ratio on magnetic resonance (MR) spectroscopy. Evidence is growing that a second extracranial-intracranial (EC-IC) bypass trial might be worthwhile in patients with symptomatic CAO. Probably, only patients with ongoing symptoms and compromised CBF should be included in such a trial. Current evidence based therapeutic options for patients with symptomatic CAO include antithrombotic medication and control of vascular risk factors. For stenosis of the contralateral internal or ipsilateral external carotid artery endarterectomy may be considered. Ongoing symptoms may cease after tapering of antihypertensive medication.

  11. Digital Artery Occlusion Secondary to Plastic Shopping Bag Trauma

    PubMed Central

    Joy, R; Isaacs, JL; McCarthy, RJ

    2007-01-01

    Upper limb digital arterial occlusion is uncommon. We present the case of a 47-year-old man with an ischaemic right middle finger (dominant hand) due to trauma from carrying a heavy plastic shopping bag. Duplex scanning revealed no proximal source of emboli. An angiogram demonstrated occlusions in the medial and lateral digital arteries of the middle digit at the level of the proximal phalanx. Treatment with heparin and warfarin resulted in complete resolution of symptoms. PMID:18201465

  12. ["Malignant" middle cerebral artery territory infarction].

    PubMed

    Mendel, Tadeusz

    2005-01-01

    The pathology, clinical course, outcome, diagnosis, treatment and prognosis of dramatic malignant middle cerebral artery territory infarction were presented. About 10% of stroke patients suffer from malignant middle cerebral artery territory infarction, mainly due to brain edema and herniation. This syndrome causes high mortality. The newest conservative and surgical treatment was presented.

  13. Neuroprotective efficacy of poly-arginine R18 and NA-1 (TAT-NR2B9c) peptides following transient middle cerebral artery occlusion in the rat.

    PubMed

    Milani, Diego; Cross, Jane L; Anderton, Ryan S; Blacker, David J; Knuckey, Neville W; Meloni, Bruno P

    2017-01-01

    We examined the efficacy of R18 in a transient MCAO model and compared its effectiveness to the well-characterized neuroprotective NA-1 peptide. R18 and NA-1 peptides were administered intravenously (30, 100, 300, 1000nmol/kg), 60min after the onset of 90min of MCAO. Infarct volume, cerebral swelling and functional outcomes (neurological score, adhesive tape and rota-rod) were measured 24h after MCAO. R18 reduced total infarct volume by 35.1% (p=0.008), 24.8% (p=0.059), 12.2% and 9.6% for the respective 1000 to 30nmol/kg doses, while the corresponding doses of NA-1 reduced lesion volume by 26.1% (p=0.047), 16.6%, 16.5% and 7%, respectively. R18 also reduced hemisphere swelling by between 46.1% (1000 and 300nmol/kg; p=0.009) and 24.4% (100nmol/kg; p=0.066), while NA-1 reduced swelling by 25.7% (1000nmol/kg; p=0.054). In addition, several R18 and NA-1 treatment groups displayed a significant improvement in at least one parameter of the adhesive tape test. These results confirm the neuroprotective properties of R18, and suggest that the peptide is a more effective neuroprotective agent than NA-1. This provides strong justification for the continuing development of R18 as a neuroprotective treatment for stroke.

  14. Central retinal artery occlusion (reversible in sickle trait with glaucoma.

    PubMed Central

    Radius, R L; Finkelstein, D

    1976-01-01

    We report a case of central retinal artery occlusion in an 18-year-old black woman with sickle-trait haemoglobinopathy and acute glaucoma after hyphaema. The central retinal artery occlusion occurred immediately after treatment of the glaucoma with osmotic agents, raising the possibility that they played a precipitating role. We suggest that osmotic agents be used with extreme caution in sickle patients with glaucoma. The occlusion was treated by anterior chamber paracentesis with eventual return of good vision. The reversibility of retinal and optic nerve function after total ischaemia is discussed. PMID:952815

  15. Carotid artery occlusion by rhinoorbitocerebral mucormycosis.

    PubMed

    Al-Otaibi, Faisal; Albloushi, Monirah; Alhindi, Hindi; Timms, Michael S

    2012-01-01

    Mucormycosis is the third most common invasive fungal infection that particularly occurs in immunocompromised patients. Intracranial and extracranial arteriovenous vasculopathy is a complication that makes this disease more complex and difficult to treat. We describe a 23-year-old female, who presented to her local hospital with acute blindness and diabetic ketoacidosis-induced coma requiring intensive care treatment. She was found to have lesions in the nasal sinuses, orbit, and frontal base. The left carotid artery was occluded from its origin in the neck to the supraclinoid segment and left cavernous sinus involvement. No cerebral infarction was noted. Biopsies obtained by endonasal debridement confirmed mucormycosis. In addition to antimicrobial therapy, she underwent several multidisciplinary approaches to treat her disease. Multiple endonasal, and cranial procedures were done including bilateral orbital exenteration. After prolonged treatment on the intensive care unit she made a remarkable recovery to the point where she was communicating verbally and had normal limb movements and later discharged home. She remained alive and well for two months, but later succumbed to a recurrence of her disease. In conclusion, mucormycosis-induced vasculopathy is a complex problem, which merits aggressive treatment of this invasive disease. It is normally regarded as an indicator of grave prognosis.

  16. Leptospirosis and Peripheral Artery Occlusive Disease

    PubMed Central

    Chiu, Chun-Hsiang; Lin, Cheng-Li; Lee, Feng-You; Wang, Ying-Chuan; Kao, Chia-Hung

    2016-01-01

    Abstract Data on the association between peripheral artery occlusive disease (PAOD) and leptospirosis are limited. We conducted a retrospective cohort study for determining whether leptospirosis is one of the possible risk factors for PAOD. Patients diagnosed with leptospirosis by using 2000 to 2010 data from the Taiwan National Health Insurance Research Database. Patients with leptospirosis without a history of PAOD were selected. For each leptospirosis patient, 4 controls without a history of leptospirosis and PAOD were randomly selected and frequency-matched for sex, age, the year of the index date, and comorbidity diseases. The follow-up period was from the time of the initial diagnosis of leptospirosis to the diagnosis date of PAOD, or December 31, 2011. The Cox proportional hazard regression models were used for analyzing the risk of PAOD. During the follow-up period, the cumulative incidence of PAOD was higher among the patients from the leptospirosis cohort than among the nonleptospirosis cohort (log-rank test, P < 0.001). In total, 29 patients with PAOD from the leptospirosis cohort and 81 from the nonleptospirosis cohort were observed with the incidence rates of 2.1 and 1.3 per 1000 person-years, respectively, yielding a crude hazards ratio (HR) of 1.62 (95% confidence interval [CI] = 1.44–1.81) and adjusted HR (aHR) of 1.75 (95% CI = 1.58–1.95). The risk of PAOD was 1.75-fold higher in the patients with leptospirosis than in the general population. PMID:26986166

  17. Spontaneous Recanalization of Superior Mesenteric Artery Occlusion Following Angioplasty and Stenting of Inferior Mesenteric Artery

    SciTech Connect

    Akpinar, Erhan Cil, Barbaros E.; Arat, Anil; Baykal, Atac; Karaman, Kerem; Balkanci, Ferhun

    2006-02-15

    An 84-year-old woman with a history of hypertension and coronary artery disease was admitted with a progressively worsening diffuse abdominal pain. Computed tomography scan of the abdomen and angiography revealed occlusion of the origin and proximal portion of superior mesenteric artery. Aortography also showed severe origin stenosis of inferior mesenteric artery and that the distal part of the superior mesenteric artery was supplied by a prominent marginal artery of Drummond. Patient was effectively treated with percutaneous transluminal angioplasty and stenting of the inferior mesenteric artery. Follow-up imaging studies demonstrated patency of the stent and spontaneous recanalization of superior mesenteric artery occlusion.

  18. Subclavian artery occlusion after radiotherapy for carcinoma of the breast

    SciTech Connect

    Hashmonai, M.; Elami, A.; Kuten, A.; Lichtig, C.; Torem, S.

    1988-05-15

    Disturbance of the arterial circulation in the ipsilateral upper limb following mastectomy is a rare sequel attributed to adjuvant radiotherapy. A review of the literature revealed 20 such cases, and two more are presented. Different mechanisms of injury leading to arterial occlusion have been proposed. This is a late complication with a considerable time lag between irradiation and onset of symptoms. The symptoms vary in type and severity, but are consistent with peripheral occlusive arterial disease. To alleviate symptoms and prevent limb loss, reconstructive vascular surgery is advocated, and was successfully performed in one of our patients. 18 references.

  19. Effect of endovascular reperfusion in relation to site of arterial occlusion

    PubMed Central

    Hamilton, Scott A.; Liebeskind, David S.; Tomsick, Tom A.; Demchuk, Andrew M.; Nogueira, Raul G.; Marks, Michael P.; Jahan, Reza; Gralla, Jan; Yoo, Albert J.; Yeatts, Sharon D.; Palesch, Yuko Y.; Saver, Jeffrey L.; Pereira, Vitor M.; Broderick, Joseph P.; Albers, Gregory W.; Lansberg, Maarten G.

    2016-01-01

    Objective: To assess whether the association between reperfusion and improved clinical outcomes after stroke differs depending on the site of the arterial occlusive lesion (AOL). Methods: We pooled data from Solitaire With the Intention for Thrombectomy (SWIFT), Solitaire FR Thrombectomy for Acute Revascularisation (STAR), Diffusion and Perfusion Imaging Evaluation for Understanding Stroke Evolution Study 2 (DEFUSE 2), and Interventional Management of Stroke Trial (IMS III) to compare the strength of the associations between reperfusion and clinical outcomes in patients with internal carotid artery (ICA), proximal middle cerebral artery (MCA) (M1), and distal MCA (M2/3/4) occlusions. Results: Among 710 included patients, the site of the AOL was the ICA in 161, the proximal MCA in 389, and the distal MCA in 160 patients (M2 = 131, M3 = 23, and M4 = 6). Reperfusion was associated with an increase in the rate of good functional outcome (modified Rankin Scale [mRS] score 0–2) in patients with ICA (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.7–7.2) and proximal MCA occlusions (OR 6.2, 95% CI 3.8–10.2), but not in patients with distal MCA occlusions (OR 1.4, 95% CI 0.8–2.6). Among patients with M2 occlusions, a subset of the distal MCA cohort, reperfusion was associated with excellent functional outcome (mRS 0–1; OR 2.2, 95% CI 1.0–4.7). Conclusions: The association between endovascular reperfusion and better clinical outcomes is more profound in patients with ICA and proximal MCA occlusions compared to patients with distal MCA occlusions. Because there are limited data from randomized controlled trials on the effect of endovascular therapy in patients with distal MCA occlusions, these results underscore the need for inclusion of this subgroup in future endovascular therapy trials. PMID:26802090

  20. Rare Post-Tonsillectomy Internal Carotid Artery Pseudoaneurysm: Management by Parent Artery Occlusion Using Detachable Balloons.

    PubMed

    Sharma, Arun; Kumar, Sanjeev; Devarajan, S Leve Joseph; Agarwal, Himanshu

    2017-10-01

    Iatrogenic cervical internal carotid artery pseudoaneurysm is a rare and potentially lethal complication following tonsillectomy. It can be complicated by thromboembolism, mass effect and eventually may rupture leading to death. Various endovascular treatment options are available for the management of these pseudoaneurysms, including coil embolization, detachable balloon occlusion, or stent graft placement. Parent artery occlusion using detachable balloons can be a therapeutic option in a subset of patients. However, evaluation of cross circulation with preprocedure balloon test occlusion is imperative in such cases.

  1. Current status of thrombolysis for peripheral arterial occlusive disease.

    PubMed

    Ouriel, Kenneth

    2002-11-01

    Acute peripheral arterial occlusion occurs as a result of thrombosis or embolism. A reduction in the prevalence of rheumatic heart disease accounts for a shift in the frequency of embolic to thrombotic occlusions. Also, a dramatic increase in the number of lower extremity arterial bypass graft procedures explains the predominance of graft occlusions in most recent series of patients with acute limb ischemia. While open surgical procedures remain the gold standard in the treatment of peripheral arterial occlusion, thrombolytic agents have been employed as an alternative to primary surgical revascularization in patients with acute limb ischemia. Systemic administration of thrombolytic agents, while effective for small coronary artery clots, fails to achieve dissolution of the large peripheral arterial thrombi. Catheter-directed administration of the agents directly into the occlusive thrombus is the only means of effecting early recanalization. Prior to 1999, urokinase was the sole agent used in North America for peripheral arterial indications, but the loss of the agent from the marketplace forced clinicians to turn to alternate agents, specifically alteplase and reteplase. Interest in the use of platelet glycoprotein inhibitors and mechanical thrombectomy devices also rose, coincident with the loss of urokinase from the marketplace. Most clinicians welcome the predicted return of urokinase to the marketplace. New investigative trials should be organized and executed to answer some of the remaining questions related to thrombolytic treatment of peripheral arterial disease. Foremost in this regard remains the question of which patients are best treated with percutaneous thrombolytic techniques and which are best treated with primary operative intervention. Ultimately, however, the thrombolytic agents are but one tool in the armamentarium of the vascular practitioner. This review is directed at providing the practicing clinician with the basic fund of knowledge

  2. Carotid endarterectomy in patients with contralateral carotid artery occlusion.

    PubMed

    Dalainas, Ilias; Nano, Giovanni; Bianchi, Paolo; Casana, Renato; Malacrida, Giovanni; Tealdi, Domenico G

    2007-01-01

    The aim of this study was to evaluate the 30-day outcome of carotid endarterectomy in patients with contralateral carotid artery occlusion and compare it to that in patients with patent contralateral carotid artery. We compared 2,959 carotid endarterectomies performed in patients with patent contralateral internal carotid artery to 373 carotid endarterectomies performed in patients with occlusion of the contralateral carotid artery in the same institute between 1988 and 2004. Patient demographics, surgical and anesthesiological strategy, perioperative neurological and cardiac events, and deaths were compared. The patients were grouped and analyzed according to the presence or absence of symptoms and to their gender. No significant difference was shown in perioperative cardiological and neurological events and deaths in patients with contralateral carotid occlusion versus patients without contralateral carotid occlusion. Females had significant more neurological events than males, in both the asymptomatic (P < 0.001) and symptomatic (P = 0.02) groups. Concomitant occlusion of the contralateral carotid artery was not associated with increased risk of perioperative cardiological or neurological adverse events. However, female gender was associated with higher risk for adverse neurological events.

  3. The isolated occlusion of the angular gyri artery. A correlative neurological and anatomical study--case report.

    PubMed

    Marinkovic, S V; Kovacevic, M S; Kostic, V S

    1984-01-01

    We examined a patient who had signs of a cerebral hemisphere lesion: right hemiparesis, facial weakness, right hemianopsy, acustico-mnestic dysphasia, "empty speech," acalculia, visuo-spatial agnosia and constructional apraxia, but without changes in consciousness. Taking into account clinical signs, computed tomography and carotid angiography findings, we concluded that our patient had an infarction zone in the left temporo-parieto-occipital region, as a consequence of the isolated angular gyri artery (ANG) occlusion. Some clinical signs were a direct effect of the ANG's occlusion. Namely, this artery supplies the cortical regions of great functional significance: the planum polare and temporale, the transverse temporal gyri, the superior and middle temporal gyri, the angular and supramarginal gyri, as well as the superior, middle and inferior occipital gyri. But the other symptoms and signs could be explained by the pathophysiological effect of the cerebral edema on regions supplied by the non-occluded branches of the middle cerebral artery.

  4. Superficial Temporal Artery-Middle Cerebral Artery Bypass Surgery for Refractory Symptomatic Intracranial Atherosclerotic Stenosis.

    PubMed

    Ma, Yan; Yang, Fan; Jiao, Liqun; Li, Meng; Wang, Yabing; Chen, Yanfei; Ling, Feng

    2017-08-01

    To evaluate blood flow changes after bypass surgery for refractory symptomatic intracranial atherosclerotic stenosis (ICAS). We examined a cohort of consecutive patients with symptomatic ICAS. Superficial temporal artery-middle cerebral artery (MCA) bypass was performed in refractory patients with poor perfusion. Angiograms were graded systematically for antegrade, collateral, and bypass flow, and clinical variables were collected preoperatively, at 7 days postoperatively, and 3, 6, and 12 months postoperatively. Among 185 consecutive cases with ICAS, 15 patients who were unsuitable for or did not respond to the best medical therapy or stenting underwent bypass surgery. No patients had new ischemic deficits within 7 days postoperatively. The mean follow-up period was 30.2 ± 12.3 months. Within this period, all anastomoses were patent by methods of ultrasound or computed tomography angiography. In 2 patients, stenotic lesions exhibited early postoperative occlusion conversion at 7 days on digital subtraction angiography. In 2 patients, stenotic lesions showed progression of occlusion at 6 and 8 months. The 2 lesions with early occlusion were both located in the MCA. The extent of retrograde blood flow via bypass anastomosis was correlated with early occlusion conversion. For refractory ICAS in patients with compromised hemodynamics, direct bypass might induce early occlusion of a stenotic area. MCA lesions may have a greater tendency toward early occlusion conversion. Copyright © 2017. Published by Elsevier Inc.

  5. Accuracy of National Institutes of Health Stroke Scale Score in Predicting the Site of Arterial Occlusion in Acute Stroke: A Transcranial Doppler Study.

    PubMed

    Gupta, Deepak; Sharma, Arvind; Uchino, Ken; Alexandrov, Andrei V; Khan, Khurshid; Shuaib, Ashfaq; Saqqur, Maher

    2016-09-01

    In acute stroke, it is crucial to assess for intracranial large-vessel occlusion and site of occlusion. The National Institutes of Health Stroke Scale score (NIHSSS) is the frequently used clinical tool to predict the site of arterial occlusion. In this study we aimed to determine the following: (1) if there is a correlation between the site of occlusion and the NIHSSS at presentation (bNIHSSS); and (2) if there is a bNIHSSS cutoff which can distinguish proximal occlusions (PO) from distal occlusions (DO). Up to 313 patients from CLOTBUST data bank with demonstrable intracranial arterial occlusion and having received intravenous recombinant tissue plasminogen activator (rt-PA) were included. Occlusions were classified as PO (terminal internal carotid artery, M1 segment of middle cerebral artery [M1 MCA], and basilar artery) or DO (M2 MCA, anterior cerebral artery, posterior cerebral artery, and vertebral artery). By univariate analysis, bNIHSSS, thrombolysis in brain ischemia (TIBI) flow grade before rt-PA, degree of recanalization after rt-PA, and modified Rankin Scale score at 3 months were significantly different between various sites of occlusion. By univariate analysis, a higher bNIHSSS, lower TIBI flow grade, and lower ASPECTS (Alberta Stroke Program Early CT Score) differentiated PO from DO. Lower TIBI flow grade and higher bNIHSSS differentiated PO from DO by logistic regression analysis. No single NIHSSS cutoff with acceptable sensitivity and specificity could be derived to differentiate PO from DO. Although NIHSSS are higher in PO, there is no satisfactory NIHSSS cutoff which differentiates PO from DO. A vascular imaging or transcranial doppler should be obtained to determine the site of arterial occlusion in acute stroke. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  6. Association Between Prolonged Seizures and Malignant Middle Cerebral Artery Infarction in Children With Acute Ischemic Stroke.

    PubMed

    Andrade, Andrea; Bigi, Sandra; Laughlin, Suzanne; Parthasarathy, Sujatha; Sinclair, Adriane; Dirks, Peter; Pontigon, Ann Marie; Moharir, Mahendranath; Askalan, Rand; MacGregor, Daune; deVeber, Gabrielle

    2016-11-01

    Malignant middle cerebral artery infarct syndrome is a potentially fatal complication of stroke that is poorly understood in children. We studied the frequency, associated characteristics, and outcomes of this condition in children. Children, aged two months to 18 years with acute middle cerebral artery infarct diagnosed at our center between January 2005 and December 2012 were studied. Associations with malignant middle cerebral artery infarct syndrome were sought, including age, seizures, neurological deficit severity (Pediatric National Institute of Health Stroke Severity Score), stroke etiology, fever, blood pressure, blood glucose, infarct location, infarct volume (modified pediatric Alberta Stroke Program Early Computed Tomography Score), and arterial occlusion. Death and neurological outcomes were determined. Among 66 children with middle cerebral artery stroke, 12 (18%) developed malignant middle cerebral artery infarct syndrome, fatal in three. Prolonged seizures during the first 24 hours (odds ratio, 25.51; 95% confidence interval, 3.10 to 334.81; P = 0.005) and a higher Pediatric National Institute of Health Stroke Severity Score (odds ratio, 1.22; 95% confidence interval, 1.08 to 1.45; P = 0.006) were independently associated with malignant middle cerebral artery infarct syndrome. All children aged greater than two years with a Pediatric National Institute of Health Stroke Severity Score ≥8 and initial seizures ≥5 minutes duration developed malignant middle cerebral artery infarct syndrome (100%). Malignant middle cerebral artery infarct syndrome affects nearly one in five children with acute middle cerebral artery stroke. Children with higher Pediatric National Institute of Health Stroke Severity Scores and prolonged initial seizures are at greatly increased risk for malignant middle cerebral artery infarct syndrome. Children with middle cerebral artery infarcts warrant intensive neuroprotective management and close monitoring to enable

  7. Central Retinal Artery Occlusion With Subsequent Central Retinal Vein Occlusion in Biopsy-Proven Giant Cell Arteritis.

    PubMed

    Williams, Zoë R; Wang, Xiaofei; DiLoreto, David A

    2016-09-01

    Central retinal artery occlusion with subsequent central retinal vein occlusion in the same eye is a rare entity. We present a 72-year-old man with biopsy-proven giant cell arteritis who developed bilateral arteritic anterior ischemic optic neuropathy and a left central retinal artery occlusion. Subsequently, he developed a left central retinal vein occlusion within 2 weeks of his initial vision loss. His vision did not improve with corticosteroids.

  8. Symptomatic steno-occlusion in patients with acute cerebral infarction: prevalence, distribution, and functional outcome.

    PubMed

    Kang, Jihoon; Park, Tai Hwan; Lee, Kyung Bok; Park, Jong-Moo; Ko, Youngchai; Lee, Soo Joo; Hong, Keun-Sik; Cho, Yong-Jin; Lee, Ji Sung; Lee, Juneyoung; Lee, Byung-Chul; Yu, Kyung-Ho; Kim, Dae-Hyun; Cha, Jae-Kwan; Lee, Jun; Jang, Myung Suk; Han, Moon-Ku; Bae, Hee-Joon

    2014-01-01

    Symptomatic steno-occlusion (SYSO) in acute ischemic stroke has a significant impact on treatment options and prognosis. However, the prevalence, distribution, clinical characteristics, and outcome of SYSO are not well known. We retrospectively identified 3,451 patients hospitalized because of ischemic stroke within 24 hours of symptom onset at 9 stroke centers in South Korea. Patients who did not undergo magnetic resonance imaging were excluded. SYSO was defined as stenosis or occlusion of cerebral arteries with relevant ischemic lesions in the corresponding arterial territory. The number, location, and severity of SYSOs and their effects on functional outcome were analyzed. In total, 1,929 of 3,057 subjects (63.1%) had SYSO. The most frequently affected vessels were the middle cerebral artery (34.6%), extracranial internal carotid artery (14%), vertebral artery (12.4%), and basilar artery (8.7%). SYSO predicted poor outcome on the modified Rankin Scale 3-6 (odds ratio, 1.77; 95% confidence interval, 1.46-2.15) with adjustments. Involvement of 2 or more vessels was observed in 30.6% of patients with SYSO and independently increased the risk of poor outcome (odds ratio, 2.76; 95% confidence interval, 2.12-3.59). The severity of SYSO was associated with outcome and showed a significant dose-response trend (P<0.001). The effect of SYSO on outcome did not significantly differ by individual arterial location (P for contrast=0.21). Approximately 60% of patients with acute ischemic stroke had SYSO, and the severity and number were inversely correlated with outcome. The results suggest that SYSO could predict stroke outcome.

  9. A Case of Branch Retinal Artery Occlusion following Uneventful Phacoemulsification

    PubMed Central

    Dragnev, Daniel; Barr, Dai; Kulshrestha, Manoj; Shanmugalingam, Sinnathamboo

    2013-01-01

    We would like to present a case of branch retinal artery occlusion following uneventful phacoemulsification, possibly caused by sub-Tenon's anaesthesia. There were no predisposing general health problems. There are two possible mechanisms: (1) mechanical effect of the bolus anaesthetic; (2) pharmacologically mediated changes in the vascular calibre. The latter mechanism is much more probable, because of the vasoconstrictive properties of both medications used. This is the first reported case of branch retinal artery occlusion after sub-Tenon's anaesthesia with preservative-free medications. PMID:23626570

  10. History of uterine artery occlusion and subsequent pregnancy.

    PubMed

    Burbank, Fred

    2009-06-01

    During mature placenta formation, select fetal trophoblasts invade maternal decidual arterioles and junctional zone arteries and change them into low-resistance uteroplacental arteries. Consequently, physicians performing vascular procedures that occlude the uterine arteries should understand their effects on miscarriage rates, the various toxemias of pregnancy, gross and microscopic placental anatomy, and invasive placentation. Thus, the objective of this article is to review the effects of vascular occlusion on pregnancy. In the long run, placental abnormalities may be the canary in the mine shaft to globally judge the effect of uterine artery embolization on pregnancy.

  11. The Basilar Artery on Computed Tomography Angiography Prognostic Score for Basilar Artery Occlusion.

    PubMed

    Alemseged, Fana; Shah, Darshan G; Diomedi, Marina; Sallustio, Fabrizio; Bivard, Andrew; Sharma, Gagan; Mitchell, Peter J; Dowling, Richard J; Bush, Steven; Yan, Bernard; Caltagirone, Carlo; Floris, Roberto; Parsons, Mark W; Levi, Christopher R; Davis, Stephen M; Campbell, Bruce C V

    2017-03-01

    Basilar artery occlusion is associated with high risk of disability and mortality. This study aimed to assess the prognostic value of a new radiological score: the Basilar Artery on Computed Tomography Angiography (BATMAN) score. A retrospective analysis of consecutive stroke patients with basilar artery occlusion diagnosed on computed tomographic angiography was performed. BATMAN score is a 10-point computed tomographic angiography-based grading system which incorporates thrombus burden and the presence of collaterals. Reliability was assessed with intraclass coefficient correlation. Good outcome was defined as modified Rankin Scale score of ≤3 at 3 months and successful reperfusion as thrombolysis in cerebral infarction 2b-3. BATMAN score was externally validated and compared with the Posterior Circulation Collateral score. The derivation cohort included 83 patients with 41 in the validation cohort. In receiver operating characteristic (ROC) analysis, BATMAN score had an area under receiver operating characteristic curve of 0.81 (95% confidence interval [CI], 0.7-0.9) in derivation cohort and an area under receiver operating characteristic curve of 0.74 (95% CI, 0.6-0.9) in validation cohort. In logistic regression adjusted for age and clinical severity, BATMAN score of <7 was associated with poor outcome in derivation cohort (odds ratio, 5.5; 95% CI, 1.4-21; P=0.01), in validation cohort (odds ratio, 6.9; 95% CI, 1.4-33; P=0.01), and in endovascular patients, after adjustment for recanalization and time to treatment (odds ratio, 4.8; 95% CI, 1.2-18; P=0.01). BATMAN score of <7 was not associated with recanalization. Interrater agreement was substantial (intraclass coefficient correlation, 0.85; 95% CI, 0.8-0.9). BATMAN score had greater accuracy compared with Posterior Circulation Collateral score (P=0.04). The addition of collateral quality to clot burden in BATMAN score seems to improve prognostic accuracy in basilar artery occlusion patients. © 2017

  12. Complex neurological symptoms in bilateral thalamic stroke due to Percheron artery occlusion

    PubMed Central

    Caruso, Paola; Manganotti, Paolo; Moretti, Rita

    2017-01-01

    The artery of Percheron is a rare anatomical variant where a single thalamic perforating artery arises from the proximal posterior cerebral artery (P1 segment) between the basilar artery and the posterior communicating artery and supplies the rostral mesencephalon and both paramedian territories of the thalami. Almost one-third of human brains present this variant. Occlusion of the artery of Percheron mostly results in a bilateral medial thalamic infarction, which usually manifests with altered consciousness (including coma), vertical gaze paresis, and cognitive disturbance. The presentation is similar to the “top of the basilar syndrome”, and early recognition should be prompted. We describe the case of a young female with this vessel variant who experienced a bilateral thalamic stroke. Magnetic resonance angiography demonstrated bilateral thalamic infarcts and a truncated artery of Percheron. Occlusion of the vessel was presumably due to embolism from a patent foramen ovale. Thrombolysis was performed, with incomplete symptom remission, cognitive impairment, and persistence of speech disorders. Early recognition and treatment of posterior circulation strokes is mandatory, and further investigation for underlying stroke etiologies is needed. PMID:28053539

  13. Missed Total Occlusion Due to the Occipital Artery Arising from the Internal Carotid Artery

    SciTech Connect

    Ustunsoz, Bahri Gumus, Burcak; Koksal, Ali; Koroglu, Mert; Akhan, Okan

    2007-02-15

    A 56-year-old man was referred for digital subtraction angiography (DSA) with an ultrasound diagnosis of right proximal internal carotid artery (ICA) stenosis for possible carotid artery stenting. DSA revealed total occlusion of the ICA and an occipital artery arising from the stump and simulating continuation of the ICA. An ascending pharyngeal artery also arose from the same occipital artery. This case is of interest because this is a rare variation besides being a cause of misdiagnosis at carotid ultrasound.

  14. Early middle cerebral artery stenosis following stent-assisted thrombectomy

    PubMed Central

    Akpınar, Süha

    2015-01-01

    Stent-assisted thrombectomy (SAT) is an extensively used endovascular treatment method for stroke in which the thrombectomy stents come into direct contact with the vascular intimal surface and entrap the thrombus causing the arterial occlusion. Although there are a few studies that demonstrate that the vessel wall changes in the arteries where stroke intervention is performed, we observed progressive stenosis in early follow-up imaging studies in a case. We present a middle cerebral artery (MCA) stroke patient who had four repetitive stent passes during SAT and developed distal MCA stenosis 2 months after SAT at the control magnetic resonance angiography (MRA). Inclusion of early follow-up MRA studies would be helpful in defining the silent vascular changes in patients who have undergone repetitive SAT. PMID:26015531

  15. Distinctive patterns on CT angiography characterize acute internal carotid artery occlusion subtypes

    PubMed Central

    Hong, Ji Man; Lee, Sung Eun; Lee, Seong-Joon; Lee, Jin Soo; Demchuk, Andrew M.

    2017-01-01

    Abstract Noninvasive computed tomography angiography (CTA) is widely used in acute ischemic stroke, even for diagnosing various internal carotid artery (ICA) occlusion sites, which often need cerebral digital subtraction angiography (DSA) confirmation. We evaluated whether clinical outcomes vary depending on the DSA-based occlusion sites and explored correlating features on baseline CTA that predict DSA-based occlusion site. We analyzed consecutive patients with acute ICA occlusion who underwent DSA and CTA. Occlusion site was classified into cervical, cavernous, petrous, and carotid terminus segments by DSA confirmation. Clinical and radiological features associated with poor outcome at 3 months (3–6 of modified Rankin scale) were analyzed. Baseline CTA findings were categorized according to carotid occlusive shape (stump, spearhead, and streak), presence of cervical calcification, Willisian occlusive patterns (T-type, L-type, and I-type), and status of leptomeningeal collaterals (LMC). We identified 49 patients with occlusions in the cervical (n = 17), cavernous (n = 22), and carotid terminus (n = 10) portions: initial NIH Stroke Scale (11.4 ± 4.2 vs 16.1 ± 3.7 vs 18.2 ± 5.1; P < 0.001), stroke volume (27.9 ± 29.6 vs 127.4 ± 112.6 vs 260.3 ± 151.8 mL; P < 0.001), and poor outcome (23.5 vs 77.3 vs 90.0%; P < 0.001). Cervical portion occlusion was characterized as rounded stump (82.4%) with calcification (52.9%) and fair LMC (94.1%); cavernous as spearhead occlusion (68.2%) with fair LMC (86.3%) and no calcification (95.5%); and terminus as streak-like occlusive pattern (60.0%) with poor LMC (60.0%), and no calcification (100%) on CTA. Our study indicates that acute ICA occlusion can be subtyped into cervical, cavernous, and terminus. Distinctive findings on initial CTA can help differentiate ICA-occlusion subtypes with specific characteristics. PMID:28151850

  16. Patterns of recurrent disease after recanalization of femoropopliteal artery occlusions

    SciTech Connect

    Vroegindeweij, Dammis; Tielbeek, Alexander V.; Buth, Jaap; Vos, Louwerens D.; Bosch, Harrie C. M. van den

    1997-07-15

    Purpose. In this prospective study we investigated the site, occurrence, and development of stenoses and occlusions following recanalization of superficial femoral artery occlusions. Methods. Recanalization of an occluded femoropopliteal artery was attempted in 62 patients. Follow-up examinations included clinical examination and color-flow duplex scanning at regular intervals. Arteriography was used to determine the localization of the recurrent disease relative to the initially occluded segment. Results. During a mean follow-up of 23 months (range 0-69 months) 14 high-grade restenoses, indicated by a peak systolic velocity ratio {>=}3.0, were detected by color-flow duplex scanning. Occlusion of the treated segment occurred in 11 patients. The cumulative 3-year primary patency rate for high-grade restenoses and occlusions combined was 44% (SE 9%). By arteriographic examination the site of restenosis was localized in the distal half of the treated vessel segment in 16 of 21 cases. Conclusion. Most restenoses and occlusions occurred during the first year and most disease developed at the previous intervention site. The site of restenosis is more frequently in the distal part of the initially treated segment, a finding that may have therapeutic implications.

  17. Rationale of cerebral protection devices in left atrial appendage occlusion.

    PubMed

    Meincke, Felix; Spangenberg, Tobias; Kreidel, Felix; Frerker, Christian; Virmani, Renu; Ladich, Elena; Kuck, Karl-Heinz; Ghanem, Alexander

    2017-01-01

    Aims of this case-series were to assess the feasibility of cerebral protection devices in interventional left atrial appendage occlusion (iLAAO) procedures and to yield insight into the pathomorphological correlate of early, procedural cerebral embolization during iLAAO. Five consecutive patients underwent iLLO flanked by the Sentinel CPS® (Claret Medical, Inc., Santa Rosa, CA) cerebral protection system. Placement and recapture of the Sentinel(®) device as well as the iLAAO were successful and safe in all cases. Histomorphometric analysis of the collected filters showed embolized debris in all patients. Acute thrombus was found in three patients, organizing thrombus in four. Interestingly, two patients had endocardial or myocardial tissue in their filters. Cerebral protection during iLAAO with the Sentinel CPS(®) device is feasible. Furthermore, this dataset identifies the formation and embolization of thrombus and cardiac tissue as emboligeneic sources and potential future targets to reduce procedural complications. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  18. Cerebral infarction due to carotid occlusion and carbon monoxide exposure III. Influence of neck vein occlusion.

    PubMed Central

    Laas, R; Igloffstein, J

    1983-01-01

    Unilateral cerebral infarcts were produced in the rat by ligation of one common carotid artery and a subsequent exposure to carbon monoxide. In animals which had undergone an additional ligation of the external jugular veins leading to a moderate increase of the cephalic venous pressure the outcome of the procedure was ameliorated significantly. Venous pressure elevation was thought to reduce the venous vascular resistance effectively by preventing the leptomeningeal veins from collapsing. Collapse of the leptomeningeal veins probably occurred during the severe carbon monoxide-induced hypotension causing a steep increase of cerebral vascular resistance. Images PMID:6886722

  19. Percutaneous Recanalization of Acute Internal Carotid Artery Occlusions in Patients with Severe Stroke

    SciTech Connect

    Dabitz, Rainer; Triebe, Stefan; Leppmeier, Ullrich; Ochs, Guenther; Vorwerk, Dierk

    2007-02-15

    Background. Sudden symptomatic occlusions of the proximal internal carotid artery (ICA) resulting in severe middle cerebral artery (MCA) ischemia and stroke are usually not accessible by rt-PA thrombolysis and the prognosis is usually very poor. Mechanical recanalization of the proximal ICA combined with intravenous and intra-arterial thrombolysis was therefore used as a rescue procedure. Methods. Ten patients (9 men, 1 woman; mean age 56.1 years) were treated with emergency recanalization of the proximal carotid artery by using stents and/or balloon angioplasty as a rescue procedure. Three patients showed dissection, and 7 had atherothrombotic occlusions. Nine of 10 presented with an initial modified Rankin Scale (mRS) of 5, the remaining patient with mRS 4 (average NIHSS 21.4). After sonographic confirmation of ICA with associated MCA/distal ICA occlusion and bridging with rt-PA (without abciximab) an emergency angiography was performed with subsequent mechanical recanalization by percutaneous transluminal angioplasty (PTA) (n = 1) or primary stenting (n = 9) using self-expanding stents. Distal protection was used in 1 of 10 patients. Results. Recanalization of the proximal ICA was achieved in all. At least partial recanalization of the intracerebral arteries was achieved in all, and complete recanalization in 5. In 4 of 10 patients limited hemorrhage was detected during CT controls. Major complications included 2 patients who had to undergo hemicraniectomy. One patient died from malignant infarction. At the time of discharge from the stroke unit 9 of 10 patients had improved markedly, 5 patients having an mRS of {<=}2, and 3 patients a mRS of 3. At control after a mean of 20 weeks, 7 of 8 (88%) patients had a mRS {<=}2, and 1 a mRS of 3. Conclusions. Primary mechanical recanalization of ICA occlusions by stent and PTA combined with fibrinolysis and/or GPIIb/IIIa-receptor antagonists seems to be feasible to improve patient outcome significantly.

  20. Suppression of ischemia in arterial occlusive disease by JNK-promoted native collateral artery development

    PubMed Central

    Ramo, Kasmir; Sugamura, Koichi; Craige, Siobhan; Keaney, John F; Davis, Roger J

    2016-01-01

    Arterial occlusive diseases are major causes of morbidity and mortality. Blood flow to the affected tissue must be restored quickly if viability and function are to be preserved. We report that disruption of the mixed-lineage protein kinase (MLK) - cJun NH2-terminal kinase (JNK) signaling pathway in endothelial cells causes severe blockade of blood flow and failure to recover in the murine femoral artery ligation model of hindlimb ischemia. We show that the MLK-JNK pathway is required for the formation of native collateral arteries that can restore circulation following arterial occlusion. Disruption of the MLK-JNK pathway causes decreased Dll4/Notch signaling, excessive sprouting angiogenesis, and defects in developmental vascular morphogenesis. Our analysis demonstrates that the MLK-JNK signaling pathway is a key regulatory mechanism that protects against ischemia in arterial occlusive disease. DOI: http://dx.doi.org/10.7554/eLife.18414.001 PMID:27504807

  1. Technical Failure of Giant Supraclinoid Aneurysm after Internal Carotid Artery Occlusion

    PubMed Central

    Liu, Dong; Lv, Ming; Li, Youxiang; Yang, Xinjian; Wu, Zhongxue

    2014-01-01

    Summary We describe three cases of technical failure in patients with giant supraclinoid aneurysm treated with internal carotid artery (ICA) occlusion. Case 1 was a 65-year-old woman who presented with a two-month history of headache accompanied by blurred vision of the left eye. Case 2 was a 43-year-old woman who presented with a six-month history of headache accompanied by blurred vision of the right eye. Case 3 was a 21-year-old man admitted due to headache and blurred vision of the left eye, accompanied by left oculomotor nerve palsy for three months. Cerebral angiography revealed giant supraclinoid aneurysms in these patients. All of them were treated with ICA occlusion. One case had recurrent headache symptoms after the first procedure and was retreated. Two cases suffered from post-procedural intracranial hemorrhagic complications. Before ICA occlusion for giant supraclinoid aneurysm, balloon occlusion test was used to evaluate the collateral anastomosis between the external carotid artery (ECA) and the ICA, and still plays an important role in preventing treatment failure. PMID:25496684

  2. Stent-based mechanical thrombectomy in acute basilar artery occlusion.

    PubMed

    Cohen, José E; Leker, Ronen R; Moscovici, Samuel; Attia, Moshe; Itshayek, Eyal

    2011-12-01

    Stent-based mechanical thrombectomy was recently proposed as an effective alternative to other mechanical techniques to achieve recanalization of large-vessel embolic occlusions in the anterior circulation. To our knowledge, there are no reports of the use of this technique in acute basilar artery occlusion (ABAO). We present a patient with complete endovascular recanalization of ABAO using a stent-based thrombectomy technique. Advantages and limitations of this technique in the management of ABAO are discussed. The stent-thrombectomy technique is promising, and will need further evaluation in posterior circulation stroke. Copyright © 2011 Elsevier Ltd. All rights reserved.

  3. Cerebral vascular findings in PAPA syndrome: cerebral arterial vasculopathy or vasculitis and a posterior cerebral artery dissecting aneurysm.

    PubMed

    Khatibi, Kasra; Heit, Jeremy J; Telischak, Nicholas A; Elbers, Jorina M; Do, Huy M

    2015-06-24

    A young patient with PAPA (pyogenic arthritis, pyoderma gangrenosum, and acne) syndrome developed an unusual cerebral arterial vasculopathy/vasculitis (CAV) that resulted in subarachnoid hemorrhage from a ruptured dissecting posterior cerebral artery (PCA) aneurysm. This aneurysm was successfully treated by endovascular coil sacrifice of the affected segment of the PCA. The patient made an excellent recovery with no significant residual neurologic deficit.

  4. Cerebral vascular findings in PAPA syndrome: cerebral arterial vasculopathy or vasculitis and a posterior cerebral artery dissecting aneurysm.

    PubMed

    Khatibi, Kasra; Heit, Jeremy J; Telischak, Nicholas A; Elbers, Jorina M; Do, Huy M

    2016-08-01

    A young patient with PAPA (pyogenic arthritis, pyoderma gangrenosum, and acne) syndrome developed an unusual cerebral arterial vasculopathy/vasculitis (CAV) that resulted in subarachnoid hemorrhage from a ruptured dissecting posterior cerebral artery (PCA) aneurysm. This aneurysm was successfully treated by endovascular coil sacrifice of the affected segment of the PCA. The patient made an excellent recovery with no significant residual neurologic deficit.

  5. Pancreaticoduodenal artery aneurysm associated with coeliac artery occlusion from an aortic intramural hematoma

    PubMed Central

    Sakatani, Akihiko; Doi, Yoshinori; Kitayama, Toshiaki; Matsuda, Takaaki; Sasai, Yasutaka; Nishida, Naohiro; Sakamoto, Megumi; Uenoyama, Naoto; Kinoshita, Kazuo

    2016-01-01

    Pancreaticoduodenal artery aneurysms are a rare type of visceral artery aneurysm, whose rupture is associated with high mortality. These aneurysms are of particular interest because local haemodynamic change caused by coeliac artery obstruction plays an important role in their development. However, the pathophysiological mechanism of coeliac artery obstruction is not completely understood. Pressure from the median arcuate ligament is most frequently reported cause. Although it is well-known that stenosis or occlusion of the visceral vessels may be caused by aortic syndrome, reports of pancreaticoduodenal artery aneurysm associated with coeliac artery occlusion due to aortic syndrome are extremely rare. Our case indicates a new aetiology for a pancreaticoduodenal artery aneurysm and demonstrates the rapid deterioration of the patient affected. PMID:27122676

  6. Antidromic effect of calcitonin gene-related peptide containing nerves on cerebral arteries in rats--a possible role of sensory nerves on cerebral circulatio.

    PubMed

    Asari, J; Suzuki, K; Matsumoto, M; Sasaki, T; Kodama, N

    2001-12-01

    It has generally been thought that the neurogenic control of cerebral circulation is decided mainly by the autonomic nervous system. Recent studies, however, indicate that sensory nerves rich in calcitonin gene-related peptide (CGRP) are also distributed on cerebral arteries. CGRP is one of neuropeptides that has strong vasodilative effect. This indicates that sensory nerves may antidromically dilate cerebral arteries mediated by CGRP. The aim of this study is to investigate the relationship between the CGRP containing nerves and cerebral circulation. Firstly, we developed a selective denervation model of CGRP containing nerves. The denervation was performed with intrathecal administration of capsaicin in rats. Secondly, we measured the change of regional cerebral blood flow (rCBF) during the occlusion of bilateral common carotid artery or systemic hypotension. CGRP immunoreactivity around cerebral arteries disappeared after capsaicin treatment. The rCBF during the occlusion of bilateral common carotid artery decreased more in the capsaicin group than in the control group. There was no significant difference in the changes of rCBF during systemic hypotension. These results showed that CGRP containing nerves would participate in the vascular response of cerebral arteries. It is likely that sensory nerves with CGRP should have antidromic effect on cerebral circulation.

  7. Percutaneous transluminal angioplasty for innominate artery stenosis and total occlusion of subclavian artery in Takayasu's-type arteritis.

    PubMed

    Staller, B J; Maleki, M

    1989-02-01

    Previous reports describe high success rates achieved by dilating subclavian artery stenoses. Attempts at angioplasty for total occlusions have been uniformly unsuccessful. No previous case successfully recanalizing total subclavian artery occlusion was found after an extensive literature search. Modified guidewire technique facilitated safe crossing of the occlusion.

  8. Noninvasive assessment of arterial compliance of human cerebral arteries with short inversion time arterial spin labeling

    PubMed Central

    Warnert, Esther AH; Murphy, Kevin; Hall, Judith E; Wise, Richard G

    2015-01-01

    A noninvasive method of assessing cerebral arterial compliance (AC) is introduced in which arterial spin labeling (ASL) is used to measure changes in arterial blood volume (aBV) occurring within the cardiac cycle. Short inversion time pulsed ASL (PASL) was performed in healthy volunteers with inversion times ranging from 250 to 850 ms. A model of the arterial input function was used to obtain the cerebral aBV. Results indicate that aBV depends on the cardiac phase of the arteries in the imaging volume. Cerebral AC, estimated from aBV and brachial blood pressure measured noninvasively in systole and diastole, was assessed in the flow territories of the basal cerebral arteries originating from the circle of Willis: right and left middle cerebral arteries (RMCA and LMCA), right and left posterior cerebral arteries (RPCA and LPCA), and the anterior cerebral artery (ACA). Group average AC values calculated for the RMCA, LMCA, ACA, RPCA, and LPCA were 0.56%±0.2%, 0.50%±0.3%, 0.4%±0.2%, 1.1%±0.5%, and 1.1%±0.3% per mm Hg, respectively. The current experiment has shown the feasibility of measuring AC of cerebral arteries with short inversion time PASL. PMID:25515216

  9. Popliteal artery occlusion in a young baseball athlete.

    PubMed

    Guo, Mindy Ming-Huey; Chuech, Leonard Shun-Jen; Yang, Cheng-Hsu; Wu, Chiung-Jen; Guo, Gary Bih-Fang

    2007-02-01

    Popliteal artery occlusion is a rare vascular complication in athletes and has not been previously documented in baseball players. A 21-year-old male baseball player presented with a 10-month history of progressive claudication because of repeated trauma-induced popliteal artery occlusion from frequently practicing stealing bases by sliding down onto his right leg. He was found to have a transient deficiency in both protein C and protein S. The patient underwent percutaneous transluminal recanalization angioplasty followed by anticoagulation therapy, with good results. This case illustrates the importance of awareness of this potential complication in baseball athletes, work-up for a hypercoagulable state and the feasibility of angioplasty therapy in the management of ischemic limbs after trauma.

  10. Middle cerebral artery alterations in a rat chronic hypoperfusion model

    PubMed Central

    Márquez-Martín, Ana; Jiménez-Altayó, Francesc; Dantas, Ana P.; Caracuel, Laura; Planas, Anna M.

    2012-01-01

    Chronic cerebral hypoperfusion (CHP) induces microvascular changes that could contribute to the progression of vascular cognitive impairment and dementia in the aging brain. This study aimed to analyze the effects of CHP on structural, mechanical, and myogenic properties of the middle cerebral artery (MCA) after bilateral common carotid artery occlusion (BCCAO) in adult male Wistar rats. Sham animals underwent a similar surgical procedure without carotid artery (CA) ligation. After 15 days of occlusion, MCA and CA were dissected and MCA structural, mechanical, and myogenic properties were assessed by pressure myography. Collagen I/III expression was determined by immunofluorescence in MCA and CA and by Western blot in CA. mRNA levels for 1A1, 1A2, and 3A1 collagen subunits were quantified by quantitative real-time PCR in CA. Matrix metalloproteinase (MMP-1, MMP-2, MMP-9, and MMP-13) and hypoxia-inducible factor-1α (HIF-1α) protein expression were determined in CA by Western blot. BCCAO diminished cross-sectional area, wall thickness, and wall-to-lumen ratio. Nevertheless, whereas wall stress was increased, stiffness was not modified and myogenic response was diminished. Hypoperfusion triggered HIF-1α expression. Collagen I/III protein expression diminished in MCA and CA after BCCAO, despite increased mRNA levels for 1A1 and 3A1 collagen subunits. Therefore, the reduced collagen expression might be due to proteolytic degradation, since the expression of MMP-1 and MMP-9 increased in the CA. These data suggest that BCCAO induces hypotrophic remodeling by a mechanism that involves a reduction of collagen I/III in association with increased MMP-1 and MMP-9 and that decreases myogenic tone in major arteries supplying the brain. PMID:22096118

  11. Idiopathic Isolated Cilioretinal Artery Occlusion Treated with Hyperbaric Oxygen Therapy

    PubMed Central

    Aktaş, Serdar; Uyar, Osman Murat; Özer, Erol; Aktaş, Hatice; Eltutar, Kadir

    2016-01-01

    Cilioretinal artery occlusion (CLRAO) is a rare event which has been reported in association with various systemic diseases. We report a case of idiopathic isolated CLRAO treated successfully with hyperbaric oxygen (HBO) therapy. A 26-year-old man presented with sudden, painless vision loss and an inferior hemivisual field defect in the left eye. Fundus fluorescein angiography revealed an occluded cilioretinal artery. After 2 weeks of HBO therapy, visual acuity improved from 20/200 to 20/20. The visual field defect improved. PMID:28058169

  12. Total occlusion of left main coronary artery without angina pectoris.

    PubMed

    DePace, N L; Kimbiris, D; Iskandrian, A S; Bemis, C E; Segal, B L

    1983-05-01

    A patient had total occlusion of the left main coronary artery that was proved by coronary arteriography. The patient was initially seen with clinical signs of congestive heart failure but without symptoms of angina pectoris or ECG evidence of myocardial infarction. The patient's extensive right-to-left coronary artery collaterals may have contributed to the absence of chest pain. Because of the severe left ventricular dysfunction and the absence of chest pain, the patient was treated with medical therapy. Six months after the cardiac catheterization, he was alive and well under New York Heart Association functional classification II.

  13. Natural history of patients with chronic occlusion of the internal carotid artery.

    PubMed

    Nader, J; Bogousslavsky, J

    1993-01-01

    Although 3% of the elderly population may have asymptomatic unilateral internal carotid artery occlusion (ICAO), between 10% and 20% of patients with initial stroke in the carotid territory have appropriate ipsilateral extracranial ICAO. In the latter instance, it is often difficult to establish whether ICAO is (a) an acute thrombotic process on an underlying atheromatous stenosis; (b) an acute embolic ICAO (from heart or aorta); or (c) an old ICAO that was previously asymptomatic. Intracranial studies show that the first stroke ipsilateral to ICAO is usually associated with occlusions distal to ICAO, which suggest artery-to-artery embolism. On the other hand, the follow-up of stroke patients with ICAO shows that delayed cerebral infarction distal to the established ICAO often involves watershed areas and may correspond to hemodynamic disturbances. Because the international extracranial/intracranial arterial bypass study did not show any surgical benefit, current management is mainly directed to stabilization of associated causes of hemodynamic failure (hypotension, bradycardia, etc.). Attempts to find subgroups that may benefit from bypass surgery are still ongoing. However, the prognosis of these patients is negatively influenced by a particularly high risk of cardiac death.

  14. Cerebral Arterial Thrombosis in Ulcerative Colitis

    PubMed Central

    Casella, Giovanni; Cortelezzi, Claudio Camillo; Marialuisa, DeLodovici; Cariddi Lucia, Princiotta; Elena Pinuccia, Verrengia; Baldini, Vittorio; Segato, Sergio

    2013-01-01

    Thrombosis, mainly venous, is a rare and well-recognized extraintestinal manifestation of inflammatory bowel disease (IBD). We describe a 25-year-old Caucasian man affected by ulcerative colitis and sclerosing cholangitis with an episode of right middle cerebral arterial thrombosis resolved by intraarterial thrombolysis. We perform a brief review of the International Literature. PMID:23864966

  15. Cerebral arterial thrombosis in ulcerative colitis.

    PubMed

    Casella, Giovanni; Cortelezzi, Claudio Camillo; Marialuisa, Delodovici; Cariddi Lucia, Princiotta; Elena Pinuccia, Verrengia; Baldini, Vittorio; Segato, Sergio

    2013-01-01

    Thrombosis, mainly venous, is a rare and well-recognized extraintestinal manifestation of inflammatory bowel disease (IBD). We describe a 25-year-old Caucasian man affected by ulcerative colitis and sclerosing cholangitis with an episode of right middle cerebral arterial thrombosis resolved by intraarterial thrombolysis. We perform a brief review of the International Literature.

  16. Balloon Occlusion of the Contralateral Iliac Artery to Assist Recanalization of the Ipsilateral Iliac Artery in Total Aortoiliac Occlusion: A Technical Note

    PubMed Central

    Jaffan, Abdel Aziz A.

    2013-01-01

    Endovascular recanalization of chronic total aortoiliac occlusion is technically challenging. Inability to reenter the true aortic lumen, following retrograde iliac recanalization, is one of the most common causes of failure. We describe a case of a total aortoiliac occlusion where balloon occlusion of the right common iliac artery, following its recanalization from a brachial approach, was used to facilitate antegrade recanalization of the occluded contralateral left common iliac artery. PMID:23762730

  17. Successful Cross-circulation Stent-Retriever Embolectomy Through Posterior Communicating Artery for Acute MCA Occlusion by Using Trevo XP ProVue

    PubMed Central

    Kim, Seul Kee; Baek, Byung Hyun; Heo, Tae Wook

    2016-01-01

    Acute ischemic stroke due to embolic occlusion of the middle cerebral artery (MCA) in patients with chronic ipsilateral internal carotid artery (ICA) occlusion is quite rare. Several previous reports demonstrated that intra-arterial (IA) thrombolytic therapy or aspiration thrombectomy using the cross-circulation technique via an alternative collateral pathway is feasible in acute stroke patients with an unfavorable direct route to the occluded sites. However, stent-retriever embolectomy via the cross-circulation approach has not been reported in the literature. The present paper reports the first case of successful stent-retriever embolectomy for acute MCA occlusion via the patent posterior communicating artery (PComA) by using Trevo XP ProVue stent-retriever in a patient with acute MCA stroke and chronic occlusion at the origin site of the ipsilateral ICA. PMID:26958415

  18. Subintimal Angioplasty for Peripheral Arterial Occlusive Disease: A Systematic Review

    SciTech Connect

    Met, Rosemarie Lienden, Krijn P. Van; Koelemay, Mark J. W.; Bipat, Shandra; Legemate, Dink A.; Reekers, Jim A.

    2008-07-15

    The objective of this study was to summarize outcomes of subintimal angioplasty (SA) for peripheral arterial occlusive disease. The Cochrane Library, Medline and Embase databases were searched to perform a systematic review of the literature from 1966 through May 2007 on outcomes of SA for peripheral arterial occlusive disease of the infrainguinal vessels. The keywords 'percutaneous intentional extraluminal revascularization,' 'subintimal angioplasty,' 'peripheral arterial disease,' 'femoral artery,' 'popliteal artery,' and 'tibial artery' were used. Assessment of study quality was done using a form based on a checklist of the Dutch Cochrane Centre. The recorded outcomes were technical and clinical success, primary (assisted) patency, limb salvage, complications, and survival, in relation to the clinical grade of disease (intermittent claudication or critical limb ischemia [CLI] or mixed) and location of lesion (femoropopliteal, crural, or mixed). Twenty-three cohort studies including a total of 1549 patients (range, 27 to 148) were included in this review. Methodological and reporting quality were moderate, e.g., there was selection bias and reporting was not done according to the reporting standards. These and significant clinical heterogeneity obstructed a meta-analysis. Reports about length of the lesion and TASC classification were too various to summarize or were not mentioned at all. The technical success rates varied between 80% and 90%, with lower rates for crural lesions compared with femoral lesions. Complication rates ranged between 8% and 17% and most complications were minor. After 1 year, clinical success was between 50% and 70%, primary patency was around 50% and limb salvage varied from 80% to 90%. In conclusion, taking into account the methodological shortcomings of the included studies, SA can play an important role in the treatment of peripheral arterial disease, especially in the case of critical limb ischemia. Despite the moderate patency

  19. Rapidly progressive dementia due to bilateral internal carotid artery occlusion with infarction of the total length of the corpus callosum.

    PubMed

    Rabinstein, Alejandro A; Romano, Jose G; Forteza, Alejandro M; Koch, Sebastian

    2004-04-01

    The authors report a patient with rapidly progressive cognitive decline due to bilateral internal carotid artery occlusion (ICAO) resulting in multiple pathologically proven cerebral infarctions including the entire length of the corpus callosum. The gradual evolution of the deficits was suggestive of hemodynamic ischemia. Bilateral ICAO should be considered in the differential diagnosis of patients with rapidly cognitive decline. Although ICAO commonly spares the splenium, complete callosal infarction is possible in the presence of bilateral ICAO.

  20. Are inflammatory parameters predictors of amputation in acute arterial occlusions?

    PubMed

    Saskin, Huseyin; Ozcan, Kazim S; Duzyol, Cagri; Baris, Ozgur; Koçoğulları, Uğur C

    2017-04-01

    Background The aim of the present study was to investigate the role of inflammatory markers to predict amputation following embolectomy in acute arterial occlusion. Methods A total of 123 patients operated for arterial thromboembolectomy due to acute embolism were included in the study. The patients without an extremity amputation following thromboembolectomy were classified as Group 1 ( n = 91) and the rest were classified as Group 2 ( n = 32). These groups were compared in terms of clinical and demographic characteristics, C-reactive protein, complete blood count parameters, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and red cell distribution width. Results The average age was 68.0 ± 11.7 years. The most common thromboembolism localization was femoral artery. When preoperative mean C-reactive protein ( p = 0.0001), mean platelet volume ( p = 0.0001), platelet-lymphocyte ratio ( p = 0.0001), neutrophil-lymphocyte ratio ( p = 0.0001) and red cell distribution width ( p = 0.0001) were compared, a statistically significant difference was observed between groups. In univariate and multivariate regression analysis, higher levels of preoperative C-reactive protein ( p = 0.009) and mean platelet volume ( p = 0.04) were detected as independent risk factors of early extremity amputation. Conclusion We observed that preoperative mean platelet volume and C-reactive protein were predictors of amputation after thromboembolectomy in acute arterial occlusion.

  1. [Reconstruction of foot arteries after injury in arterial occlusive disease].

    PubMed

    Flis, V; Tomazic, T

    1993-06-01

    At the Maribor Teaching Hospital two elderly with progressive atherosclerotic disease below the knee were treated between 1986-1992 for open fracture of ankle joint and pedal arterial trauma. The only patent atherosclerotic vessel (dorsal artery of the foot) that was disrupted was reconstructed in both cases by interposition of a part of the great and small saphenous vein in one case each. A termino-terminal anastomosis with a long, triangular patch was used, fixed with interrupted sutures. The fractures were stabilized with external fixators. Both extremities were saved.

  2. Progressive Cortical Neuronal Damage and Chronic Hemodynamic Impairment in Atherosclerotic Major Cerebral Artery Disease.

    PubMed

    Yamauchi, Hiroshi; Kagawa, Shinya; Kishibe, Yoshihiko; Takahashi, Masaaki; Higashi, Tatsuya

    2016-06-01

    Cross-sectional studies suggest that chronic hemodynamic impairment may cause selective cortical neuronal damage in patients with atherosclerotic internal carotid artery or middle cerebral artery occlusive disease. The purpose of this longitudinal study was to determine whether the progression of cortical neuronal damage, evaluated as a decrease in central benzodiazepine receptors (BZRs), is associated with hemodynamic impairment at baseline or hemodynamic deterioration during follow-up. We evaluated the distribution of BZRs twice using positron emission tomography and (11)C-flumazenil over time in 80 medically treated patients with atherosclerotic internal carotid artery or middle cerebral artery occlusive disease that had no ischemic episodes during follow-up. Using 3D stereotactic surface projections, we quantified abnormal decreases in the BZRs in the cerebral cortex within the middle cerebral artery distribution and correlated changes in the BZR index with the mean hemispheric values of hemodynamic parameters obtained from (15)O gas positron emission tomography. In the hemisphere affected by arterial disease, the BZR index in 40 patients (50%) was increased during follow-up (mean 26±20 months). In multivariable logistic regression analyses, increases in the BZR index were associated with the decreased cerebral blood flow at baseline and an increased oxygen extraction fraction during follow-up. Increases in the oxygen extraction fraction during follow-up were associated with a lack of statin use. In patients with atherosclerotic internal carotid artery or middle cerebral artery disease, the progression of cortical neuronal damage was associated with hemodynamic impairment at baseline and hemodynamic deterioration during follow-up. Statin use may be beneficial against hemodynamic deterioration and therefore neuroprotective. © 2016 American Heart Association, Inc.

  3. Bilateral simultaneous central retinal artery occlusion following head injury.

    PubMed

    Narang, Subina; Kochhar, Suman; Gupta, Sonika; Gupta, Hemlata; Bansal, Rakesh; Sood, Sunandan

    2007-12-01

    To report a case of bilateral simultaneous central retinal artery occlusion (CRAO) following head injury in a young 29-year-old man. A 29-year-old man presented with head injury following road traffic accident. Posterior segment evaluation revealed CRAO in both eyes. The patient was treated for CRAO in the form of immediate ocular massage, paracentesis, intravenous mannitol and transdermal isosorbide dinitrate patch. Despite treatment the vision continued to be no perception of light. Systemic investigations were unremarkable. Color Doppler of carotid arteries showed plaque in left carotid bulb and thrombus in right internal carotid artery. Bilateral simultaneous CRAO following head trauma has not been reported earlier. Thorough ocular examination is recommended in all cases of head injury.

  4. Branch retinal artery occlusion caused by toxoplasmosis in an adolescent.

    PubMed

    Chiang, Elizabeth; Goldstein, Debra A; Shapiro, Michael J; Mets, Marilyn B

    2012-09-01

    Branch retinal artery occlusion (BRAO), while not uncommon in elderly patient populations, is rare in children and adolescents. We report a case of a BRAO secondary to toxoplasmosis in this demographic. A previously healthy 17-year-old male developed a unilateral BRAO in conjunction with inflammation and increased intraocular pressure. Family history was positive for cerebrovascular accidents in multiple family members at relatively young ages. The patient had a hypercoagulable workup as well as a cardiovascular workup which were both normal. A rheumatologic workup was unremarkable. By 3 weeks, a patch of retinitis was more easily distinguished from the BRAO and the diagnosis of ocular toxoplasmosis was made. Treatment was started with prednisone and azithromycin with subsequent improvement in vision. Toxoplasma antibody levels were elevated for IgG and negative for IgM, IgA, and IgE. The etiology of the BRAO was attributed to ocular toxoplasmosis. Vascular occlusions are rare in toxoplasmosis. This is the third case report of a BRAO in a patient in the pediatric population. The diagnosis of ocular toxoplasmosis should be considered in young patients with retinal artery occlusions associated with inflammation.

  5. Acute arterial occlusion in the midpiece of femoral artery following total knee arthroplasty: Report of one case.

    PubMed

    He, Rui; Yang, Liu

    2016-04-01

    Acute arterial occlusion is a rare complication following total knee arthroplasty (TKA). The incidence as reported previously is from 0.03% to 0.17%; however, the sequelae can be disastrous because of its potential threat to limb loss.We report a case of acute arterial occlusion in the midpiece of femoral artery following TKA occurred 40 min postoperatively. The occlusion site existed at the midpiece of femoral artery is uncommon. Arterial circulation of the lower limb could not be restored by the thrombolysis and thrombectomy treatments performed within 11 h after TKA. In the end, amputation had to be carried out. In the treatment of acute arterial occlusion following TKA with a tourniquet, it is important to fully consider that arteriosclerosis may induce atheromatous plaque disruption, which might be the reason for acute arterial occlusion.

  6. Cerebral palsy after perinatal arterial ischemic stroke.

    PubMed

    Golomb, Meredith R; Garg, Bhuwan P; Saha, Chandan; Azzouz, Faouzi; Williams, Linda S

    2008-03-01

    The frequency of cerebral palsy, degree of disability, and predictors of disability were assessed in children in a perinatal arterial stroke database. Risk factors were assessed at the univariate level using the Pearson chi(2) and Fisher exact test and at the multivariate level using logistic regression analysis. Seventy-six of 111 children with perinatal stroke (68%) had cerebral palsy, most commonly hemiplegic (66/76; 87%). Multivariate analysis of the entire cohort showed both delayed presentation (OR,9.96; 95% CI, 3.10-32.02) and male sex (OR, 2.55; 95% CI, 1.03-6.32) were associated with cerebral palsy. In subgroup multivariate analyses: in children with neonatal presentation, bilateral infarcts were associated with triplegia or quadriplegia (OR, 5.33; 95% CI, 1.28-22.27); in children with unilateral middle cerebral artery infarcts, delayed presentation (OR, 10.60; 95% CI, 2.28-72.92) and large-branch infarction (OR, 8.78; 95% CI, 2.18-43.67) were associated with cerebral palsy. These data will aid physicians in planning long-term rehabilitative care for children with perinatal stroke.

  7. Percutaneous Endovascular Treatment of Chronic Iliac Artery Occlusion

    SciTech Connect

    Carnevale, F. C. De Blas, Mariano; Merino, Santiago; Egana, Jose M.; Caldas, Jose G.M.P.

    2004-09-15

    Purpose: To evaluate the clinical and radiological long-term results of recanalization of chronic occluded iliac arteries with balloon angioplasty and stent placement.Methods: Sixty-nine occluded iliac arteries (mean length 8.1 cm; range 4-16 cm) in 67 patients were treated by percutaneous transluminal angioplasty and stent placement. Evaluations included clinical assesment according to Fontaine stages, Doppler examinations with ankle-brachial index (ABI) and bilateral lower extremity arteriograms. Wallstent and Cragg vascular stents were inserted for iliac artery recanalization under local anesthesia. Follow-up lasted 1-83 months (mean 29.5 months).Results: Technical success rate was 97.1% (67 of 69). The mean ABI increased from 0.46 to 0.85 within 30 days after treatment and was 0.83 at the most recent follow-up. Mean hospitalization time was 2 days and major complications included arterial thrombosis (3%), arterial rupture (3%) and distal embolization (1%). During follow-up 6% stenosis and 9% thrombosis of the stents were observed. Clinical improvement occurred in 92% of patients. Primary and secondary patency rates were 75% and 95%, respectively.Conclusion: The long-term patency rates and clinical benefits suggest that percutaneous endovascular revascularization with metallic stents is a safe and effective treatment for patients with chronic iliac artery occlusion.

  8. Coronary artery occlusion after arterial switch operation in an asymptomatic 15-year-old boy

    PubMed Central

    Saini, Ashish P; Cyran, Stephen E; Ettinger, Steven M; Pauliks, Linda B

    2016-01-01

    A 15-year-old boy with transposition of the great arteries (TGA) and neonatal arterial switch operation (ASO) presented with complete occlusion of the left main coronary artery (LMCA). Intra-operatively, an intramural left coronary artery was identified. Therefore, since age 7 years he had a series of screening exercise stress tests. At 13 years old, he had 3 to 4 mm ST segment depression in the infero-lateral leads without symptoms. This progressed to 4.2 mm inferior ST segment depression at 15 years old with normal stress echocardiogram. Sestamibi myocardial perfusion scan and cardiac magnetic resonance imaging was inconclusive. Therefore, a coronary angiogram was obtained which showed complete occlusion of the LMCA with ample collateralization from the right coronary artery system. This was later confirmed on a computed tomogram (CT) angiogram, obtained in preparation of coronary artery bypass grafting. The case illustrates the difficulty of detecting coronary artery stenosis and occlusion in young patients with rich collateralization. Coronary CT angiogram and conventional angiography were the best imaging modalities to detect coronary anomalies in this adolescent with surgically corrected TGA. Screening CT angiography may be warranted for TGA patients, particularly for those with known coronary anomalies. PMID:27574609

  9. Door-to-Needle Time Under 60 Minutes and Picture-to-Puncture Under 90 Minutes: Initiatives and Outcomes in Reducing Time to Recanalization for Cerebral Major Artery Occlusion

    PubMed Central

    OTA, Takahiro; SATO, Masayuki; AMANO, Tatsuo; MATSUMARU, Yuji

    2016-01-01

    The adoption of stent retrievers has significantly improved outcomes of intravenous treatment for acute stroke due to major artery occlusion, and reducing the time to recanalization may achieve further improvements. We reviewed reductions in “door-to-needle time” (DNT) and “picture-to-puncture time” (P2P), as the results of measures to consolidate stroke response capabilities in our hospital, and compared treatment outcomes in acute recanalization patients. We investigated DNT by the route of admission for 96 consecutive patients who received intravenous tissue plasminogen activator between July 2012 and June 2015. We then retrospectively studied 52 patients with acute stroke who underwent endovascular recanalization within 8 h after stroke onset, grouped according to recanalization before (Group I; n = 23) or after (Group II; n = 29) introduction of stent retrievers. Between 2012 and 2015, mean DNT decreased. Significant differences between Groups I and II were only seen in times required, with significantly shorter DNT, picture-to-puncture time, admission to puncture time, and puncture to guiding catheter placement time in Group II. A considerable difference in DNT was seen according to the route of patient admission, and consolidation of hospital stroke response capability successfully reduced the time from admission to recanalization. PMID:27385058

  10. [Occlusion of maxillary artery in treatment of trigeminal neuralgia].

    PubMed

    Novak, Vesna; Bosnjaković, Petar; Ristić, Sasa; Kostić, Aleksandar; Jelenković, Boban; Novak, Martin

    2012-01-01

    This paper deals with a treating method of trigeminal neuralgia classified so far as idiopathic neuralgias and treated conservatively. The study was aimed at proving the compression of peripheral branches of N. trigeminus in those patients by vascular elements of A. maxillaris within the bone-ligament space of the scull and the face base. The study sample consisted of 76 patients having trigeminal neuralgia. The compression was proved by clinical examination, by angiography and electrophysiological investigations. Endovascular occlusion of A. maxillaris is the original method and it was carried out in selected patients. This method was applied in 76 patients. Embolisation was done in 71 patients by using occlusion spiral and gelfoan was used in 3 patients. Externa carotid artery ligation was done in 2 cases. The effect of absolute improvement has been achieved and verified by electrophysiological method and subjective assessment of the patients.

  11. Endovascular treatment strategies for supra-aortic arterial occlusive disease.

    PubMed

    Peeters, P; Verbist, J; Deloose, K; Bosiers, M

    2005-06-01

    Because of the focal nature of stenoses or occlusions in the supra-aortic vasculature, the high blood-pressures in this area and the very low morbidity rates related to percutaneous therapy have largely replaced surgical revascularization as the initial treatment of choice for patients with supra-aortic arterial occlusive disease. The initial technical success and durability of percutaneous angioplasty (PTA) and stenting in these lesions is excellent. Nevertheless several factors can make PTA and stenting a complex procedure that requires advanced endovascular skills for a successful outcome. Profound knowledge of surgical reconstruction techniques or extra-anatomic bypasses remains mandatory, as it is occasionally required for failure of endovascular techniques or if contraindications exist.

  12. Protective effect of the novel cerebrovascular-selective calcium antagonist (+/-)-(E)-1-(3-fluoro-6, 11-dihydrodibenz[b,e]-oxepine-11-yl)-4-(3-phenyl-2-propenyl)-piperazine dimaleate on ischemic brain damage after permanent middle cerebral artery occlusion in rats.

    PubMed

    Minato, H; Honda, Y; Masuda, Y; Fujitani, B; Hosoki, K

    1996-06-01

    In this study the effect of post-ischemic treatment of AJ-3941 ((+/-)-(E)-1-(3-fluoro-6,11-dihydrodibenz [b,e]-oxepine-11-yl)-4-(3-phenyl-2-propenyl)-piperazine dimaleate, CAS 143110-70-7) a cerebrovascular-selective calcium antagonist, on brain infarction and edema in a rat model of focal cerebral ischemia with permanent middle cerebral artery occlusion (MCAo) was evaluated. Brain infarct size was determined at 24 h after MCAo by measuring 2,3,5-triphenyltetrazolium chloride-negative stained area of the serial brain sections. Post-ischemic treatment of AJ-3941 (3 mg/kg p.o.), 10 min and 3 h after the insult, significantly reduced brain infarct size by 44-80%, compared to vehicle control. The reducing effect was observed both in the cortical and subcortical regions. Three days after MCAo, contents of water and Na+ in the ipsilateral hemisphere significantly increased comparing with those in control rats. Post-ischemic treatment with AJ-3941 (3 and 10 mg/kg twice daily p.o. for 2 days) markedly inhibited the increase in water content and suppressed the increase in Na+ content. In the contralateral hemisphere, these contents showed no significant differences between vehicle-treated group and either control (non-operated) or AJ-3941-treated group. AJ-3941 had only minimum effect on body temperature and physiological parameters, such as blood pressure, blood gases and glucose, even when the maximum dose used (10 mg/kg) was repeatedly administered. These results indicate that post-ischemic treatment with AJ-3941 may ameliorate the brain infarction and edema after permanent focal cerebral ischemia, and they also suggest that AJ-3941 has a beneficial effect in the treatment of ischemic cerebral damage.

  13. Predictive Value of Balloon Test Occlusion of the Internal Carotid Artery

    PubMed Central

    Segal, David H.; Sen, Chandranath; Bederson, Joshua B.; Catalano, Peter; Sacher, Michael; Stollman, Aryeh L.; Lorberboym, Mordechai

    1995-01-01

    Balloon test occlusion (BTO) of the internal carotid artery (ICA) is used in conjunction with single-photon emission computed tomography (SPECT) imaging to assess the cerebrovascular collateral reserve prior to surgical manipulation of the artery. The present report reviews 56 consecutive patients with tumors or vascular lesions at the base of the skull who underwent BTO and subsequent treatment on that basis within a 3-year period. Four patients underwent carotid sacrifice, since they tolerated the BTO and had normal SPECT imaging. Postoperatively, one patient had patchy infarcts in the frontal lobe, another a middle cerebral artery territory infarction, a third had a lacunar infarct, and the fourth had an impending stroke and was treated with an emergent revascularization procedure. There were 15 patients who underwent saphenous vein bypass grafting, of these there were three graft occlusions, one of which resulted in an infarction. There were two other infarctions due to technical difficulties, one being related to the revascularization procedure. Based on these results, we suggest that passing BTO with a normal SPECT study does not necessarily indicate that the patient is immune to stroke following carotid sacrifice. Revascularization should be considered, when ICA sacrifice is deemed necessary to treat the pathologic condition adequately, to minimize the likelihood of a stroke. ImagesFigure 2Figure 3Figure 4Figure 5Figure 6Figure 7 PMID:17171183

  14. Improvement of exhausted cerebral vasoreactivity in carotid occlusion: benefit of statins?

    PubMed

    Reinhard, Matthias; Guschlbauer, Brigitte; Olschewski, Manfred; Weiller, Cornelius; Hetzel, Andreas

    2011-05-01

    In internal carotid artery occlusion (ICAO), a spontaneous increase of cerebral vasoreactivity (CVR) may occur over time. Statins are known to increase CVR. We analyzed the influence of statin treatment and other cofactors on CVR improvement in patients with ICAO. Sixty-six patients with ICAO were reexamined after 15 ± 6 months. CVR in both middle cerebral arteries was assessed by transcranial Doppler and inhalation of 7% CO(2). Pre-defined cut-off values were used to define exhausted CVR. Cofactors analyzed were: age, sex, hypertension, diabetes, statin treatment, degree of contralateral stenosis, quality of intracranial collateral flow, duration of ICAO. Mean CVR did not differ between the two studies. Twenty patients had exhausted CVR at baseline, 11 of them improved above the cut-off at follow-up (55%). Factors significantly associated with this improvement were good collateral pattern at baseline (p = 0.0065) and statin treatment (p = 0.0179). Odds ratios for improving CVR were 36.0 [95% CI 2.7-476.3] for good collateral flow and 20.0 [95% CI 1.7-238.6] for statin treatment. In conclusion, exhausted CVR frequently improves during the course of ICAO. Good collateral function and statin treatment are significantly associated with improving CVR.

  15. Emergency Stenting of Unprotected Left Main Coronary Artery after Acute Catheter-Induced Occlusive Dissection

    PubMed Central

    Akgul, Ferit; Batyraliev, Talantbek; Besnili, Fikret; Karben, Zarema

    2006-01-01

    Left main coronary artery dissection occurs very rarely during selective coronary angiography, but it generally progresses to complete coronary occlusion. The traditional treatment of occlusive dissection of the unprotected left main coronary artery has been surgical. Percutaneous treatment has been sporadic and controversial. We report a case of iatrogenic occlusive dissection of the unprotected left main coronary artery during diagnostic coronary angiography, followed by successful stenting of the lesion. PMID:17215985

  16. A Microarray Study of Middle Cerebral Occlusion Rat Brain with Acupuncture Intervention

    PubMed Central

    Zhang, Chao; Wen, Yan; Fan, Xiaonong; Yang, Sha; Tian, Guang; Zhou, Xueyi; Chen, Yaqiong; Meng, Zhihong

    2015-01-01

    Microarray analysis was used to investigate the changes of gene expression of ischemic stroke and acupuncture intervention in middle cerebral artery occlusion (MCAo) rat brain. Results showed that acupuncture intervention had a remarkable improvement in neural deficit score, cerebral blood flow, and cerebral infarction volume of MCAo rats. Microarray analysis showed that a total of 627 different expression genes were regulated in ischemic stroke. 417 genes were upregulated and 210 genes were downregulated. A total of 361 different expression genes were regulated after acupuncture intervention. Three genes were upregulated and 358 genes were downregulated. The expression of novel genes after acupuncture intervention, including Tph1 and Olr883, was further analyzed by Real-Time Quantitative Polymerase Chain Reaction (RT-PCR). Upregulation of Tph1 and downregulation of Olr883 indicated that the therapeutic effect of acupuncture for ischemic stroke may be closely related to the suppression of poststroke depression and regulation of olfactory transduction. In conclusion, the present study may enrich our understanding of the multiple pathological process of ischemic brain injury and indicate possible mechanisms of acupuncture on ischemic stroke. PMID:25861363

  17. Neuroprotective effect of ginkgolide K against acute ischemic stroke on middle cerebral ischemia occlusion in rats.

    PubMed

    Ma, Shuwei; Yin, Huafeng; Chen, Lvyi; Liu, Hongxia; Zhao, Ming; Zhang, Xiantao

    2012-01-01

    Ginkgolide K, a natural platelet-activating factor receptor antagonist, was isolated from the leaves of Ginkgo biloba. However, little is known about its neuroprotective effect in ischemia-reperfusion (I/R)-induced cerebral injury. Hence, the present study was carried out to investigate the effect of ginkgolide K on neuroprotection and the potential mechanisms in the rat I/R model induced by middle cerebral artery occlusion (MCAO). The rats were pretreated with ginkgolide K 2, 4 and 8 mg/kg (i.v.) once a day for 5 days before MCAO. Neurological deficit score (NDS), brain water content, 2,3,5-triphenyltetrazolium chloride (TTC) staining and pathology of brain tissue, as well as indexes of oxidative stress [superoxide dismutase (SOD), malondialdehyde (MDA), nitric oxide (NO) and nitric oxide synthase (NOS)] were measured at 24 h after ischemia. The results indicated that pretreatment with ginkgolide K significantly diminished the volume of infarction and brain water content, and improved NDS. Moreover, ginkgolide K markedly reversed the level of MDA, NO, NOS and SOD to their normal state in serum or cerebral ischemic section. In addition, hematoxylin and eosin staining showed the neuronal injury was significantly improved after being pretreated with ginkgolide K. These findings demonstrate that ginkgolide K exhibits neuroprotective properties through its antioxidative action in MCAO rats.

  18. [Cilioretinal artery occlusion and central retinal vein occlusion complicating hyperhomocysteinemia: a case report].

    PubMed

    Berkani, Z; Kitouni, Y; Belhadj, A; Sifi, K; Abbadi, N; Bellatrache, C; Hartani, D; Kherroubi, R

    2013-09-01

    Hyperhomocysteinemia is known to be a risk factor in both retinal artery and retinal vein occlusions. We report the case of a young patient with combined occlusion of the cilioretinal artery and the central retinal vein due to hyperhomocysteinemia. A 23-year-old patient without significant medical history, presented for sudden, painless visual loss in the right eye. Ophthalmologic examination revealed best-corrected visual acuity of the right eye 8/10 P2, and 10/10 P2 on the left. Anterior segment exam was normal in both eyes, while the right fundus revealed white, ischemic edema, centered around a cilioretinal artery, sparing the fovea, with some hemorrhagic spots and disc edema. Fluorescein angiography confirmed delayed filling of the right cilioretinal artery and revealed a normal disc on the left. Two weeks later, the clinical picture had evolved into a right ischemic CRVO, confirmed by a second angiogram, with a decrease in visual acuity to 3/10. A work-up was performed, including: a full lipid profile, serum electrolytes, ESR, CRP, a complete blood count (leukocytes, platelets, hemoglobin were normal), a coagulation work-up (PT, PTT, protein C, protein S, antithrombin III, factor V Leiden were normal), ANCA, antiphospholipid antibodies and antinuclear antibodies were negative, and finally cardiology studies (cardiac echo, carotid Doppler) and neurology (brain MRI) were ordered and came back normal. Otherwise, plasma homocysteine was moderately high on two samples, at 18.3 μmol/L and 17.78 μmol/L. Thyroid and renal work-ups were ordered. Urgent PRP was performed, and vitamin therapy (vitB12, vitB6, folic acid) was instituted. The subsequent course was remarkable for recovery of visual acuity to 10/10, P2 with persistence of an inferior altitudinal central scotoma. MTHFR C677T polymorphism was negative. Retinal vascular occlusions (RVO) are serious events, which require investigation for underlying systemic disease, which can be life-threatening. The clinical

  19. Preliminary Experience with Vascular Plugs for Parent Artery Occlusion of the Carotid or Vertebral Arteries

    PubMed Central

    Lee, Woosung; Shin, Yong Sam; Kim, Kyung Hyun; Kim, Yong Bae; Hong, Chang-Ki

    2016-01-01

    Objective The purpose of this study was to report the authors' preliminary experience using the Amplatzer Vascular Plug (AVP) (St. Jude Medical, Plymouth, MN, USA) for parent artery occlusion of the internal carotid artery (ICA) or vertebral artery (VA). Materials and Methods Between September 2008 and December 2015, we performed 52 therapeutic parent artery occlusions (PAOs) by an endovascular technique. Among them, 10 patients underwent PAO of the carotid or vertebral arteries using AVPs. Clinical and radiographic data of these patients were retrospectively reviewed. Results The devices were used for VA dissection that presented with subarachnoid hemorrhage (SAH) in five patients, traumatic arteriovenous fistula (AVF) in two patients, spontaneous AVF in one patient, recurrence of carotid-cavernous fistula (CCF) in one patient, and symptomatic unruptured giant ICA aneurysm in one patient. The devices were used in conjunction with detachable and/or pushable coils and in the extracranial segments of the ICA or VA. Complete occlusion of the parent artery was achieved in all patients. There was one intra-procedural rupture of the VA dissection during coiling prior to using the device. Conclusion Results from the current series suggest that the AVP might be used for therapeutic PAO in the extracranial segments of the ICA or VA. PMID:27847763

  20. Acute thromboembolic occlusion of the superior mesenteric artery following covered stent occlusion in the superior mesenteric artery: endovascular therapy using mechanical rotational thrombectomy.

    PubMed

    Goltz, Jan P; Petritsch, Bernhard; Spor, Leo; Hahn, Dietbert; Kickuth, Ralph

    2012-09-01

    Acute thromboembolic occlusion of the superior mesenteric artery is a rare and often fatal condition in which surgery represents the golden standard in therapy. We present a case in which a patient was treated with covered stent implantation for acute bleeding from the superior mesenteric artery following pancreatic resection, radiation, and embolization of a hepatic artery pseudoaneurysm. Some weeks later clinical signs were suggestive of acute thromboembolic occlusion of the superior mesenteric artery and digital subtraction angiography showed occlusion of the previously implanted covered stents. The patient was successfully treated transfemorally with percutaneous mechanical instent thrombectomy using a 6F Rotarex® catheter. We conclude that in selected cases percutaneous mechanical thrombectomy may represent a minimally-invasive alternative to open surgical thrombectomy for treatment of acute thromboembolic occlusion of the superior mesenteric artery.

  1. Surgical experience of the ruptured distal anterior cerebral artery aneurysms.

    PubMed

    Lee, Jong-Young; Kim, Moon-Kyu; Cho, Byung-Moon; Park, Se-Hyuck; Oh, Sae-Moon

    2007-10-01

    Distal anterior cerebral artery (DACA) aneurysms are fragile and known to have high risks for intraoperative premature rupture and a relatively high associated morbidity. To improve surgical outcomes of DACA aneurysms, we reviewed our surgical strategy and its results postoperatively. A total of 845 patients with ruptured cerebral aneurysms were operated in our hospital from January 1991 to December 2005. Twenty-three of 845 patients had ruptured DACA aneurysms which were operated on according to our surgical strategy. Our surgical strategy was as follows; early surgery, appropriate releasing of CSF, appropriate surgical approach, using neuronavigating system, securing the bridging veins, using temporary clipping and/or tentative clipping, meticulous manipulation of aneurysm, and using micro-Doppler flow probe. Twenty of 23 patients who had complete medical records were studied retrospectively. We observed the postoperative radiographic findings and checked Glasgow Outcome Scale score sixth months after the operation. Nineteen DACA aneurysms were clipped through a unilateral interhemispheric approach and one DACA aneurysm was clipped through a pterional approach. Postoperative radiographic findings revealed complete clipping of aneurysmal neck without stenosis or occlusion of parent arteries. In two patients, a residual neck of aneurysm was visualized. Seventeen patients showed good recovery, one patient resulted in moderate disability, while 2 patients died. With our surgical strategy it was possible to achieve acceptable surgical morbidity and mortality rates in patients with DACA aneurysms. Appropriate use of tentative clipping, temporary clipping and neuro-navigating systems can give great help for safe approach and clipping of DACA aneurysm.

  2. PET evaluation of cerebral blood flow reactivity in symptomatic and asymptomatic carotid artery stenosis

    SciTech Connect

    Dey, H.M.; Brass, L.; Rich, D.

    1994-05-01

    The purpose of this study was to use acetazolamide (AZ) enhanced O-15 water PET to evaluate cerebral perfusion reserve in symptomatic and asymptomatic carotid artery stenosis. We hypothesized that impaired vasoreactivity would be associated with symptomatic disease and a higher likelihood of future ischemic events. Twenty-two patients with significant (>75%) carotid artery occlusion underwent cerebral blood flow imaging at baseline and following AZ infusion. Paired O-15 data sets were coregistered and globally normalized. Regions of interest were drawn on baseline blood flow images and superimposed upon (AZ - baseline) difference images to derive a % change in regional blood flow after AZ administration. The results showed a significant difference in cerebral perfusion reserve between symptomatic (n=19) and asymptomatic (n=3) carotid artery disease.

  3. Plasmacytic Aortitis with Occlusion of the Right Coronary Artery

    PubMed Central

    Zambetti, Benjamin R.; Garrett, Edward

    2016-01-01

    Patient: Male, 55 Final Diagnosis: Plasmacytic aortitis Symptoms: Dizziness • nausea Medication: — Clinical Procedure: — Specialty: Surgery Objective: Unusual clinical course Background: Inflammation of the aortic wall, known as aortitis, is a rare clinical entity which is frequently asymptomatic, or identified when the patient presents with an aortic aneurysm or dissection. It is most often caused by infection or autoimmune vasculitides such as giant cell or Takayasu’s arteritis. Case Report: The case presented is that of a 55-year-old man with symptomatic occlusion of the right coronary artery caused by a plasmacytic aortitis suggestive of IgG4 disease, which was successfully treated with coronary artery bypass grafting and an ascending aortic graft. Conclusions: A review of the current literature emphasizes how poorly the etiology and natural history of plasmacytic aortitis is understood. PMID:27471062

  4. Posterior circulation cerebral hyperperfusion syndrome after high flow external carotid artery to middle cerebral artery bypass.

    PubMed

    Quach, Eric T; Gonzalez, Andres A; Shilian, Parastou; Russin, Jonathan J

    2015-09-01

    We present the first report, to our knowledge, in which revascularization of the middle cerebral artery (MCA) with a high flow extracranial-intracranial procedure resulted in symptomatic hyperemia of the posterior circulation. Cerebral hyperperfusion syndrome (CHS) is a poorly understood phenomenon that is classically seen in the distribution of a revascularized artery. A 37-year-old woman presented with a 3 month history of cognitive and speech difficulties, persistent headaches, weakness, numbness, and paresthesia which was worse in the right extremities and face. She was found to have bilateral watershed infarcts worse in the left cerebral hemisphere, severe bilateral stenosis of the supraclinoid internal carotid artery, and a small left superior hypophyseal aneurysm. The patient underwent left cerebral hemisphere revascularization with a high flow external carotid artery to MCA bypass with aneurysm trapping. During skin closure, significant changes were seen in her bilateral upper extremity motor-evoked potentials. The patient's postoperative exam was noted for an intermittent inability to follow commands, bilateral upper extremity weakness, vertical nystagmus, and alogia that all dramatically improved with strict blood pressure control. Postoperative perfusion imaging revealed posterior circulation hyperemia. This patient highlights the potential for hyperemic complications outside the revascularized arterial territory. Strict blood pressure control is recommended in order to prevent and manage hyperemia-associated symptoms. Improving our understanding of CHS may assist in identifying at risk patients and at risk arterial territories in order to optimize CHS prevention and management strategies.

  5. Intra-arterial and Intravenous Tirofiban Infusion for Thromboembolism during Endovascular Coil Embolization of Cerebral Aneurysm.

    PubMed

    Kim, Sang Heum; Kim, Tae Gon; Kong, Min Ho

    2017-09-01

    Thromboembolism is the one of the most serious complications that can occur during endovascular coil embolization of cerebral aneurysm. We report on the effectiveness and safety of intra-arterial/intravenous (IA/IV) glycoprotein IIb/IIIa inhibitor (tirofiban) infusion for treating thromboembolism during endovascular coil embolization of cerebral aneurysm. We performed a retrospective analysis of 242 patients with ruptured or unruptured cerebral aneurysms (n=264) who underwent endovascular coil embolization from January 2011 to June 2014. Thromboembolism occurred in 20 patients (7.4%), including 14 cases of ruptured aneurysms and 6 cases of unruptured aneurysms. The most common site of aneurysms was the anterior communicating artery (n=8), followed by middle cerebral artery (n=6). When we found an enlarged thromboembolism during coil embolization, we tried to dissolve it using tirofiban administered via IA and IV loading (5 μg/kg, respectively) for 3-5 minutes followed by IV maintenance (0.08 μg/kg/min) for approximately 4-24 hours. In 4 of 5 patients with total vessel occlusion, the vessel was recanalized to Thrombolysis in Cerebral Infarction Perfusion Scale (TICI) grade 3, and in 1 patient to TICI grade 2a. In 2 patients with partial vessel occlusion and 13 patients with minimal occlusion, the vessel recanalized to TICI grade 3. Irrelevant intracerebral hemorrhage was noted in 1 patient (5%), and thromboemboli-related cerebral infarction developed in 5 patients (25%), of which only 1 (5%) was symptomatic. IA/IV infusion and IV maintenance with tirofiban appear to be an effective rescue treatment for thromboembolism during endovascular coil embolization in patients with ruptured or unruptured cerebral aneurysms.

  6. Endovascular Therapeutic Approaches for Acute Superior Mesenteric Artery Occlusion

    SciTech Connect

    Acosta, S. Sonesson, B.; Resch, T.

    2009-09-15

    The purpose of this study was to characterize the outcome of attempted endovascular intervention in patients with acute embolic or thrombotic superior mesenteric artery (SMA) occlusion. The records of 21 patients during a 3-year period between 2005 and 2008 were retrieved from the in-hospital registry. The first group included 10 patients (6 women and 4 men; median age 78 years) with acute embolic occlusion of the SMA. The median duration of symptoms from symptom onset to angiography was 30 hours (range 6 to 120). Synchronous emboli (n = 12) occurred in 6 patients. Embolus aspiration was performed in 9 patients, and 7 of these had satisfactory results. Complementary local thrombolysis was successful in 2 of 3 patients. Residual emboli were present at completion angiography in all 7 patients who underwent successful aspiration embolectomy, and bowel resection was necessary in only 1 of these patients. One serious complication occurred because of a long SMA dissection. The in-hospital survival rate was 90% (9 of 10 patients). The second group included 11 patients (10 women and 1 man; median age 68 years) with atherosclerotic acute SMA occlusions. The median time of symptom duration before intervention was 97 hours (range 17 to 384). The brachial, femoral, and SMA routes were used in 6, 7, and 5 patients, respectively. SMA stenting was performed through an antegrade (n = 7) or retrograde (n = 3) approach. Bowel resection was necessary in 4 patients. No major complications occurred. The in-hospital survival rate was 82% (9 of 11 patients). Endovascular therapy of acute SMA occlusion provides a good alternative to open surgery.

  7. Retinal artery occlusion due to Bartonella henselae infection: a case series.

    PubMed

    Eiger-Moscovich, Maya; Amer, Radgonde; Oray, Merih; Tabbara, Khalid F; Tugal-Tutkun, Ilknur; Kramer, Michal

    2016-08-01

    To report a case series of six patients suffering from branch retinal artery occlusion due to Bartonella henselae infection, in order to raise awareness to this etiology in the differential diagnosis of retinal artery occlusion. A retrospective case series of patients with branch retinal artery occlusion due to ocular cat scratch disease who presented at four tertiary medical centers in Israel, Turkey and Saudi Arabia between the years 2008-2014. Data retrieved from the medical records included demographic data, exposure, complaints, visual acuity, clinical findings and imaging, laboratory assessment, treatment, disease course and visual outcome. The study group consisted of six patients who presented with branch retinal artery occlusion with or without neuroretinitis. One patient had multiple artery occlusions. Diagnosis of cat scratch disease was established based on positive serology and accompanying systemic symptoms, after ruling out other causes of retinal artery occlusion. Treatment included various regimens of antibiotics and systemic steroids. Visual outcome depended upon the obstructed artery. Cat scratch disease may cause retinal artery occlusion in infected patients, leaving them with a permanent visual field defect. When retinal artery occlusion occurs as an early sign of the disease, prompt recognition may prevent further events. Thorough history and relevant tests may be of great value. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  8. Doppler sonography to monitor flow in different cerebral arteries in the rabbit.

    PubMed

    Roatta, S; Roncari, S; Micieli, G; Bosone, D; Passatore, M

    2000-07-01

    Most of the transcranial Doppler (TCD) experimental studies on cerebral haemodynamics have been performed in the rabbit because of the similarity between its Willis circle and that of the human, but these studies have mainly been limited to the basilar artery. The present study was aimed at extending the use of TCD sonography to all other large cerebral arteries. In anaesthetised rabbits, these arteries were insonated from three different recording sites, i.e. top-cranial, suboccipital and orbital, using a two-channel pulsed Doppler device equipped with 4 and 8 MHz probes. First, discrimination between intra- and extracranial arteries was achieved through a standard 'rebreathing' test (hypercapnic-hypoxic stimulation). The distinctive blood velocity response patterns, reflecting the different extents of metabolic reactivity in intra- and extracranial territories, are described and discussed. Intracranial arteries were then identified on the basis of their response to ipsi- and contralateral common carotid artery occlusion. This procedure allowed recording from the following arteries: anterior common trunk, anterior cerebral, internal carotid, middle cerebral and basilar; the latter could be simultaneously monitored with any of the others. This study provides an experimental model allowing investigation of regional differences in the haemodynamic response to neurogenic and pharmacological stimuli.

  9. Stroke risk after abrupt internal carotid artery sacrifice: Accuracy of preoperative assessment with balloon test occlusion and stable xenon-enhanced CT

    SciTech Connect

    Linskey, M.E.; Jungreis, C.A.; Yonas, H.; Hirsch, W.L. Jr.; Sekhar, L.N.; Horton, J.A.; Janosky, J.E.

    1994-05-01

    To evaluate stable xenon-enhanced CT cerebral blood flow with balloon test occlusion as a predictor of stroke risk in internal carotid artery sacrifice. Abrupt internal carotid artery occlusion was performed by surgical or endovascular means below the origin of the ophthalmic artery in 31 normotensive patients who were assessed preoperatively by a 15-minute clinical balloon test occlusion followed by an internal carotid artery-occluded xenon CT cerebral blood flow study. One patient, who passed the clinical test occlusion but exhibited regions of cerebral blood flow less than 30 mL/100 g per minute on the occlusion xenon CT cerebral blood flow study went on to have a fatal stroke corresponding exactly to the region of assessment. Neuroimaging demonstrated possible flow-related infarctions, which subsequently developed in three patients. Two patients were asymptomatic, and one patient was left with a mild residual hemiparesis. Our protocol provided a statistically significant reduction in subsequent infarction rate and infarction-related death rate when compared with a control group of normotensive abrupt internal carotid artery occlusion patients who did not undergo any preoperative stroke-risk assessment (reported in the literature). The estimated false-negative rate for our preoperative assessment protocol ranged from 3.3% to 10% depending on the assessment of the cause of the three potentially flow-related infarctions. Although life-threatening major vascular territory infarctions have been avoided, our protocol is less sensitive to changes predicting smaller, often minimally symptomatic, vascular border zone infarctions and does not predict postoperative thromboembolic strokes. 94 refs., 5 figs., 4 tabs.

  10. Pipeline embolization of posterior communicating artery aneurysms associated with a fetal origin posterior cerebral artery.

    PubMed

    Wallace, Adam N; Kayan, Yasha; Austin, Matthew J; Delgado Almandoz, Josser E; Kamran, Mudassar; Cross, DeWitte T; Moran, Christopher J; Osbun, Joshua W; Kansagra, Akash P

    2017-09-01

    Flow diversion may have advantages in the treatment of posterior communicating artery (PComA) aneurysms associated with a fetal origin posterior cerebral artery (PCA), which can be challenging to treat with conventional techniques. However, a PComA incorporated into the aneurysm may prevent or delay aneurysm occlusion. Also, coverage of a fetal origin PCA risks infarction of a large vascular territory. The purpose of this study was to examine the safety and effectiveness of using the Pipeline Embolization Device (PED) to treat PComA aneurysms associated with a fetal origin PCA. Retrospective review of PComA aneurysms associated with a fetal origin PCA treated with the PED at two neurovascular centers was performed. Periprocedural complications and clinical and angiographic outcomes were reviewed. Seven female patients underwent a total of seven PED procedures to treat seven PcomA aneurysms associated with a fetal origin PCA. The symptomatic complication rate was 14% (1/7) per patient and 13% (1/8) per procedure. Angiographic follow up was obtained for 6 of 7 aneurysms. Follow-up DSA at 5-7 months after treatment demonstrated complete occlusion of 17% (1/6) of aneurysms. One aneurysm was retreated with a second PED and occlusion was demonstrated 36 months after the second treatment, yielding an overall complete occlusion rate of 33% (2/6). PED treatment was largely ineffective at treating PComA aneurysms associated with a fetal origin PCA, and should only be considered when conventional treatment options, including microsurgical clipping, are not feasible. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Bilateral internal carotid artery and vertebral artery dissections with retinal artery occlusion after a roller coaster ride - case report and a review.

    PubMed

    Ozkan Arat, Yonca; Volpi, John; Arat, Anıl; Klucznik, Richard; Diaz, Orlando

    2011-01-01

    We present the first case of a woman with no significant medical history who developed dissections of bilateral carotid and bilateral vertebral arteries, as well as a retinal artery occlusion, after a roller coaster ride. A 35-year-old woman developed right-sided neck pain followed by a frontal headache immediately after a roller coaster ride. Five days after the incident, she developed complete loss of vision in her right eye for two hours. Subsequently, the vision improved but remained significantly decreased. On presentation, her visual acuity was 20/200 in the right and 20/20 in the left eye. Her fundus exam revealed retinal edema in the superotemporal retinal artery distribution without any visible emboli. Her neurological exam was otherwise normal. The cerebral angiogram showed bilateral internal carotid and vertebral artery dissections. The patient remained stable with conservative therapy without further worsening of vision or any new neurological deficits. Outcomes for cervicocephalic arterial dissection are usually favorable, but early diagnosis is critical for initiation of appropriate treatment of possible complications. Physicians must have a high index of suspicion for arterial dissection when patients note any headache, neck pain or vertigo triggered by violent motion after leisure activities such as roller coaster rides.

  12. A vertebral artery dissection with basilar artery occlusion in a child.

    PubMed

    Devue, Katleen; Van Ingelgem, Annemie; De Keukeleire, Katrien; De Leeuw, Marc

    2014-01-01

    This paper presents the case report of an 11-year-old boy with an acute dissection with thrombosis of the left vertebral artery and thrombosis of the basilar artery. The patient was treated with acute systemic thrombolysis, followed by intra-arterial thrombolysis, without any clinical improvement, showing left hemiplegia, bilateral clonus, hyperreflexia, and impaired consciousness. MRI indicated persistent thrombosis of the arteria basilaris with edema and ischemia of the right brainstem. Heparinization for 72 hours, followed by a two-week LMWH treatment and subsequent oral warfarin therapy, resulted in a lasting improvement of the symptoms. Vertebral artery dissection after minor trauma is rare in children. While acute basilar artery occlusion as a complication is even more infrequent, it is potentially fatal, which means that prompt diagnosis and treatment are imperative. The lack of class I recommendation guidelines for children regarding treatment of vertebral artery dissection and basilar artery occlusion means that initial and follow-up management both require a multidisciplinary approach to coordinate emergency, critical care, interventional radiology, and child neurology services.

  13. A Vertebral Artery Dissection with Basilar Artery Occlusion in a Child

    PubMed Central

    Devue, Katleen; Van Ingelgem, Annemie; De Keukeleire, Katrien; De Leeuw, Marc

    2014-01-01

    This paper presents the case report of an 11-year-old boy with an acute dissection with thrombosis of the left vertebral artery and thrombosis of the basilar artery. The patient was treated with acute systemic thrombolysis, followed by intra-arterial thrombolysis, without any clinical improvement, showing left hemiplegia, bilateral clonus, hyperreflexia, and impaired consciousness. MRI indicated persistent thrombosis of the arteria basilaris with edema and ischemia of the right brainstem. Heparinization for 72 hours, followed by a two-week LMWH treatment and subsequent oral warfarin therapy, resulted in a lasting improvement of the symptoms. Vertebral artery dissection after minor trauma is rare in children. While acute basilar artery occlusion as a complication is even more infrequent, it is potentially fatal, which means that prompt diagnosis and treatment are imperative. The lack of class I recommendation guidelines for children regarding treatment of vertebral artery dissection and basilar artery occlusion means that initial and follow-up management both require a multidisciplinary approach to coordinate emergency, critical care, interventional radiology, and child neurology services. PMID:25587466

  14. Proximal Bright Vessel Sign on Arterial Spin Labeling Magnetic Resonance Imaging in Acute Cardioembolic Cerebral Infarction.

    PubMed

    Kato, Ayumi; Shinohara, Yuki; Kuya, Keita; Sakamoto, Makoto; Kowa, Hisanori; Ogawa, Toshihide

    2017-07-01

    The congestion of spin-labeled blood at large-vessel occlusion can present as hyperintense signals on perfusion magnetic resonance imaging with 3-dimensional pseudo-continuous arterial spin labeling (proximal bright vessel sign). The purpose of this study was to clarify the difference between proximal bright vessel sign and susceptibility vessel sign in acute cardioembolic cerebral infarction. Forty-two patients with cardioembolic cerebral infarction in the anterior circulation territory underwent magnetic resonance imaging including diffusion-weighted imaging, 3-dimensional pseudo-continuous arterial spin labeling perfusion magnetic resonance imaging, T2*-weighted imaging, and 3-dimensional time-of-flight magnetic resonance angiography using a 3-T magnetic resonance scanner. Visual assessments of proximal bright vessel sign and the susceptibility vessel sign were performed by consensus of 2 experienced neuroradiologists. The relationship between these signs and the occlusion site of magnetic resonance angiography was also investigated. Among 42 patients with cardioembolic cerebral infarction, 24 patients showed proximal bright vessel sign (57.1%) and 25 showed susceptibility vessel sign (59.5%). There were 19 cases of proximal bright vessel sign and susceptibility vessel sign-clear, 12 cases of proximal bright vessel sign and susceptibility vessel sign-unclear, and 11 mismatched cases. Four out of 6 patients with proximal bright vessel sign-unclear and susceptibility vessel sign-clear showed distal middle cerebral artery occlusion, and 2 out of 5 patients with proximal bright vessel sign-clear and susceptibility vessel sign-unclear showed no occlusion on magnetic resonance angiography. Proximal bright vessel sign is almost compatible with susceptibility vessel sign in patients with cardioembolic cerebral infarction. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  15. Cerebral perfusion imaging with albumin microspheres tagged with /sup 99m/Tc and /sup 111/In in cases with internal carotid occlusion

    SciTech Connect

    Etani, H.; Kimura, K.; Yoneda, S.; Tsuda, Y.; Isaka, Y.; Nakamura, M.; Asai, T.

    1982-09-01

    Cerebral perfusion imaging with dual-tracer (/sup 99m/Tc and /sup 111/In) human albumin microspheres (HAM scintigraphy) was performed in 15 cases with unilateral occlusion of the internal carotid artery, for the diagnosis and evaluation of collateral circulation patterns. After injection of /sup 99m/Tc microspheres into one common carotid artery and /sup 111/In HAMs into the other, two perfusion images, one for each carotid artery, were clearly differentiated by appropriate pulse-height discrimination. With this method, diagnosis of internal carotid artery occlusion was definitely made in eight patients, suspected in six, and missed in one. The collateral perfusion areas from the contralateral ICA and ipsilateal external carotid artery were well demonstrated by this method, and the scintigraphic results agreed well with the angiographic findings in all cases. Dual-tracer HAM scintigraphy is capable of adding information about collaterals at the capillary level to the anatomic information obtained by angiography.

  16. Treatment Strategies for Acute Ischemic Stroke Caused by Carotid Artery Occlusion

    PubMed Central

    Li, Wei; Yin, Qin; Xu, Gelin; Liu, Xinfeng

    2016-01-01

    Background: Acute ischemic stroke caused by internal carotid artery (ICA) occlusion usually has a poor prognosis, especially the T occlusion cases without functional collaterals. The efficacy of intravenous (IV) or intra-arterial (IA) thrombolysis with recombinant tissue plasminogen activator (rt-PA) remains ambiguous in these patients. Eendovascular recanalization of the occluded carotid has been attempted in recent years as a potential strategy. However, the different etiologies of ICA occlusion pose a significant challenge to neurointerventionists. Recently, several endovascular evolvements have been reported in treating carotid occlusion-related stroke. This review summarizes the current status of treatment for acute ICA occlusion. PMID:27781043

  17. Microvasculature of the human cerebral white matter: arteries of the deep white matter.

    PubMed

    Nonaka, Hiroko; Akima, Michio; Hatori, Tsutomu; Nagayama, Tadashi; Zhang, Zean; Ihara, Fumie

    2003-06-01

    The vascular architecture of the human cerebral deep white matter was studied using soft X-ray and diaphanized specimens, achieved by intra-arterial injection of barium and vascular stain respectively, and also by electron microscopic examination of the corrosion cast of arteries in normal adult brains. The deep white matter arteries passed through the cerebral cortex with a few branches to the cortex and ran straight through the white matter. The arteries concentrated ventriculopetally to the white matter around the lateral ventricle. Anastomoses were noted around the ventricular wall at the terminals of the deep white matter arteries. No centrifugal branches irrigating the periventricular white matter from the lenticulo-striate arteries were observed in the present study. The presence of anastomoses among the terminal branches of deep white matter arteries protects against ischemic change or infarction in this area from an occlusion of a single deep white matter artery. This may lead to development of terminal zone infarction from ischemia or vascular diseases, affecting multiple deep white matter arteries. The subcortical and deep white matter arteries had thick adventitial sheaths and large adventitial spaces in the white matter but not in the cortex. The presence or absence of the adventitial space is regarded as another characteristic difference between the arteries in the white matter and cortex. This difference may influence pathological changes in vascular lesions in these respective areas.

  18. Life-threatening Cerebral Edema Caused by Acute Occlusion of a Superior Vena Cava Stent

    SciTech Connect

    Sofue, Keitaro Takeuchi, Yoshito Arai, Yasuaki; Sugimura, Kazuro

    2013-02-15

    A71-year-old man with advanced lung cancer developed a life-threatening cerebral edema caused by the acute occlusion of a superior vena cava (SVC) stent and was successfully treated by an additional stent placement. Although stent occlusion is a common early complication, no life-threatening situations have been reported until now. Our experience highlights the fact that acute stent occlusion can potentially lead to the complete venous shutdown of the SVC, resulting in life-threatening cerebral edema, after SVC stent placement. Immediate diagnosis and countermeasures are required.

  19. Middle cerebral artery thrombosis: acute blood-brain barrier consequences

    SciTech Connect

    Dietrich, W.D.; Prado, R.; Watson, B.D.; Nakayama, H.

    1988-07-01

    The effect of middle cerebral artery (MCA) thrombosis on the integrity of the blood-brain barrier (BBB) was studied in rats using horseradish peroxidase (HRP). Endothelial injury with subsequent platelet thrombosis was produced by means of a rose bengal-sensitized photochemical reaction, facilitated by irradiating the right proximal MCA segment with the focused beam of an argon laser. At 15 minutes following thrombosis formation, diffuse leakage of HRP was observed bilaterally within cortical and subcortical brain areas. Peroxidase extravasation was most dense within the territory of the occluded artery including neocortical areas and dorso-lateral striatum. Contralaterally, a similar distribution was observed but with less intense HRP leakage. Ultrastructural studies demonstrated an increase in permeability to HRP within arterioles, venules and capillaries. At these sites, the vascular endothelium contained HRP-filled pinocytotic vesicles and tubular profiles. Although less intense, bilateral HRP leakage was also observed following MCA stenosis or femoral artery occlusion. Endothelial-platelet interactions at the site of vascular injury may be responsible for releasing substances or neurohumoral factors which contribute to the acute opening of the BBB.

  20. Bilateral internal carotid artery occlusion associated with the antiphospholipid antibody syndrome.

    PubMed

    Anand, Pria; Mann, Sharan K; Fischbein, Nancy J; Lansberg, Maarten G

    2014-01-01

    A 39-year-old woman presented with a right-hemispheric stroke 1 year after she had suffered a left-hemispheric stroke. Her diagnostic workup was notable for bilateral occlusions of the internal carotid arteries at their origins and a positive lupus anticoagulant antibody test. There was no evidence of carotid dissection or another identifiable cause for her carotid occlusions. These findings suggest that the antiphospholipid antibody syndrome may be implicated in the pathological changes that resulted in occlusions of the extracranial internal carotid arteries. Young stroke patients who present with unexplained internal carotid artery occlusions may benefit from testing for the presence of antiphospholipid antibodies.

  1. Bilateral Internal Carotid Artery Occlusion Associated with the Antiphospholipid Antibody Syndrome

    PubMed Central

    Anand, Pria; Mann, Sharan K.; Fischbein, Nancy J.; Lansberg, Maarten G.

    2014-01-01

    A 39-year-old woman presented with a right-hemispheric stroke 1 year after she had suffered a left-hemispheric stroke. Her diagnostic workup was notable for bilateral occlusions of the internal carotid arteries at their origins and a positive lupus anticoagulant antibody test. There was no evidence of carotid dissection or another identifiable cause for her carotid occlusions. These findings suggest that the antiphospholipid antibody syndrome may be implicated in the pathological changes that resulted in occlusions of the extracranial internal carotid arteries. Young stroke patients who present with unexplained internal carotid artery occlusions may benefit from testing for the presence of antiphospholipid antibodies. PMID:24707268

  2. Design and validation of a prehospital stroke scale to predict large arterial occlusion: the rapid arterial occlusion evaluation scale.

    PubMed

    Pérez de la Ossa, Natalia; Carrera, David; Gorchs, Montse; Querol, Marisol; Millán, Mònica; Gomis, Meritxell; Dorado, Laura; López-Cancio, Elena; Hernández-Pérez, María; Chicharro, Vicente; Escalada, Xavier; Jiménez, Xavier; Dávalos, Antoni

    2014-01-01

    We aimed to develop and validate a simple prehospital stroke scale to predict the presence of large vessel occlusion (LVO) in patients with acute stroke. The Rapid Arterial oCclusion Evaluation (RACE) scale was designed based on the National Institutes of Health Stroke Scale (NIHSS) items with a higher predictive value of LVO on a retrospective cohort of 654 patients with acute ischemic stroke: facial palsy (scored 0-2), arm motor function (0-2), leg motor function (0-2), gaze (0-1), and aphasia or agnosia (0-2). Thereafter, the RACE scale was validated prospectively in the field by trained medical emergency technicians in 357 consecutive patients transferred by Emergency Medical Services to our Comprehensive Stroke Center. Neurologists evaluated stroke severity at admission and LVO was diagnosed by transcranial duplex, computed tomography, or MR angiography. Receiver operating curve, sensitivity, specificity, and global accuracy of the RACE scale were analyzed to evaluate its predictive value for LVO. In the prospective cohort, the RACE scale showed a strong correlation with NIHSS (r=0.76; P<0.001). LVO was detected in 76 of 357 patients (21%). Receiver operating curves showed a similar capacity to predict LVO of the RACE scale compared with the NIHSS (area under the curve 0.82 and 0.85, respectively). A RACE scale≥5 had sensitivity 0.85, specificity 0.68, positive predictive value 0.42, and negative predictive value 0.94 for detecting LVO. The RACE scale is a simple tool that can accurately assess stroke severity and identify patients with acute stroke with large artery occlusion at prehospital setting by medical emergency technicians.

  3. [Disseminated arterial occlusions revealing bilateral venous thrombosis with paradoxical embolisms].

    PubMed

    Elsendoorn, A; Desport, E; Vialle, R; Frat, J-P; Bridoux, F; Touchard, G

    2009-06-01

    Paradoxical embolism is a diagnosis of exclusion. Clinical triad associates deep venous thrombosis with or without pulmonary embolism, arterial embolism, and intracardiac communication with right-to-left shunt. The intracardiac communication is generally related to a patent foramen ovale (PFO). We report a 75-year-old patient, who presented with bilateral deep venous thrombosis of the legs, complicated by massive pulmonary embolism and paradoxical embolisms through a PFO. This resulted in cerebral, mesenteric, splenic and bilateral kidney infarctions. A promptly initiated anticoagulant treatment allowed a favourable outcome.

  4. Bilateral extensive cerebral infarction and mesenteric ischemia associated with segmental arterial mediolysis in two young women.

    PubMed

    Basso, Monique Camila; Flores, Patrícia Carrasco; de Azevedo Marques, Ary; de Souza, Guilherme Leme; D'Elboux Guimarães Brescia, Marília; Campos, Cynthia Resende; de Cleva, Roberto; Saldiva, Paulo Hilario Nascimento; Mauad, Thais

    2005-10-01

    Segmental arterial mediolysis (SAM) is a rare non-atherosclerotic non-inflammatory vascular disease that affects mainly muscular arteries of the splanchnic and cerebral territories. Reported herein are two cases of SAM in young women with fatal outcome. One of the patients had an atypical form of the disease, which primarily affected small intestinal submucosal and subserosal arteries, and resulted in acute mesenteric ischemia. The other had bilateral brain infarction with SAM of internal carotid arteries (ICA). Pathological examination of both cases did not reveal the cause of blood flow disturbance: large mesenteric branches of the former and ICA of the latter were free of either dissection or thrombosis; in addition, small intestinal arteries of the first patient did not show signs of vasculitis. These findings suggest that unusual pathways of arterial occlusion and dissection may occur in the context of SAM.

  5. Association factor analysis between osteoporosis with cerebral artery disease

    PubMed Central

    Jin, Eun-Sun; Jeong, Je Hoon; Lee, Bora; Im, Soo Bin

    2017-01-01

    Abstract The purpose of this study was to determine the clinical association factors between osteoporosis and cerebral artery disease in Korean population. Two hundred nineteen postmenopausal women and men undergoing cerebral computed tomography angiography were enrolled in this study to evaluate the cerebral artery disease by cross-sectional study. Cerebral artery disease was diagnosed if there was narrowing of 50% higher diameter in one or more cerebral vessel artery or presence of vascular calcification. History of osteoporotic fracture was assessed using medical record, and radiographic data such as simple radiography, MRI, and bone scan. Bone mineral density was checked by dual-energy x-ray absorptiometry. We reviewed clinical characteristics in all patients and also performed subgroup analysis for total or extracranial/ intracranial cerebral artery disease group retrospectively. We performed statistical analysis by means of chi-square test or Fisher's exact test for categorical variables and Student's t-test or Wilcoxon's rank sum test for continuous variables. We also used univariate and multivariate logistic regression analyses were conducted to assess the factors associated with the prevalence of cerebral artery disease. A two-tailed p-value of less than 0.05 was considered as statistically significant. All statistical analyses were performed using R (version 3.1.3; The R Foundation for Statistical Computing, Vienna, Austria) and SPSS (version 14.0; SPSS, Inc, Chicago, Ill, USA). Of the 219 patients, 142 had cerebral artery disease. All vertebral fracture was observed in 29 (13.24%) patients. There was significant difference in hip fracture according to the presence or absence of cerebral artery disease. In logistic regression analysis, osteoporotic hip fracture was significantly associated with extracranial cerebral artery disease after adjusting for multiple risk factors. Females with osteoporotic hip fracture were associated with total calcified

  6. A SPECT study in internal carotid artery occlusion: Discrepancies between flow image and neurologic deficits

    SciTech Connect

    Moriwaki, H.; Hougaku, H.; Matsuda, I.; Kusunoki, M.; Shirai, J. )

    1989-08-01

    A SPECT (single photon emission computed tomography) study in internal carotid artery (ICA) occlusion was performed in 6 patients. The validity of iodoamphetamine (IMP) SPECT study in the evaluation of cerebral blood flow (CBF) or neurologic function is still controversial. In this study, the authors showed several cases in whom SPECT images of brain were not compatible with their neurologic deficits. In 2 typical cases, a large low-density area was observed in the non-dominant hemisphere in computed tomography (CT) scan, but no apparent motor-sensory deficits in left limbs were present. In these patients, SPECT study also revealed flow reduction in the affected side of the brain. So there was a possibility that an IMP brain image could not always reflect CBF, which maintains neurologic function of the brain.

  7. Concurrent Graves' disease and intracranial arterial stenosis/occlusion: special considerations regarding the state of thyroid function, etiology, and treatment.

    PubMed

    Ohba, Shigeo; Nakagawa, Toru; Murakami, Hideki

    2011-07-01

    Several studies have shown the relation between Graves' disease and stenosis/occlusion of intracranial arteries. To our knowledge, only 31 cases, including our case, of concurrent Graves' disease and moyamoya syndrome or intracranial arterial stenosis/occlusion have been described. The patients were predominantly women, and their ages ranged from 10 to 54 years (mean, 29.3 years). Transient ischemic attacks and cerebral infarction were the common symptoms in these patients. Except one previous case and the present case, all cases showed thyrotoxicity when the cerebral ischemic event occurred. Among the 29 cases, in which the treatment regimen was known, antithyroid therapy was administered in 25 cases, and surgical treatment for cerebral vessel diseases was performed in 11 cases. Most of the patients eventually recovered from the neurological symptoms after medical and/or surgical treatment; one of the patients died, and one patient's condition worsened. Although the mechanism underlying intracranial arterial occlusion or stenosis in patients with Graves' disease has not been elucidated, several hypotheses have been described. Thyroid hormones may augment vascular sensitivity to the sympathetic nervous system and induce pathological changes in the arterial walls. An immune-mediated mechanism may play a role in the pathogenesis of these diseases. Atherosclerosis may be associated with these disorders. Vasculitis induced by antithyroid drugs may cause changes in the intracranial arteries. Finally, the possibility of a mere coincidence of Graves' disease and these vascular changes should also be considered. Cerebrovascular hemodynamic changes induced by thyrotoxicosis were considered to be responsible for the cerebral ischemic events. Excessive thyroid hormone production is considered to increase the cerebral metabolism and oxygen consumption. In addition, thyrotoxicosis-induced hypercoagulability may influence ischemic events. Therefore, the possibility of

  8. Selective thrombolysis performed through meningo-ophthalmic artery in central retinal artery occlusion.

    PubMed

    Cohen, José E; Moscovici, Samuel; Halpert, Michael; Itshayek, Eyal

    2012-03-01

    The poor natural history of central retinal artery occlusion (CRAO) is usually not modified with conventional, conservative management techniques. Guidelines for selective intraarterial ophthalmic thrombolysis are still lacking. While many centers continue to perform this procedure with promising results, others are reluctant due to conflicting findings in recent studies. We present our experience in a 36-year-old male with CRAO. Based on the patient's clinical presentation, we planned to perform selective intraarterial ophthalmic thrombolysis via the ophthalmic artery. When angiography demonstrated that the retina was not supplied by the ophthalmic artery, but by a meningo-ophthalmic artery branching from the internal maxillary artery, we instead administered thrombolytic agents via the meningo-ophthalmic artery. The patient's vision recovered completely, with visual acuity and visual field examination at 30 day follow up comparable to his pre-treatment status. This case emphasizes the need for external carotid artery examination in cases of nonvisualization of the ophthalmic artery. In addition, it illustrates the successful use of the meningo-ophthalmic artery to perform selective intraarterial thrombolysis for CRAO. Copyright © 2011 Elsevier Ltd. All rights reserved.

  9. A Review: Proteomics in Retinal Artery Occlusion, Retinal Vein Occlusion, Diabetic Retinopathy and Acquired Macular Disorders

    PubMed Central

    Cehofski, Lasse Jørgensen; Honoré, Bent; Vorum, Henrik

    2017-01-01

    Retinal artery occlusion (RAO), retinal vein occlusion (RVO), diabetic retinopathy (DR) and age-related macular degeneration (AMD) are frequent ocular diseases with potentially sight-threatening outcomes. In the present review we discuss major findings of proteomic studies of RAO, RVO, DR and AMD, including an overview of ocular proteome changes associated with anti-vascular endothelial growth factor (VEGF) treatments. Despite the severe outcomes of RAO, the proteome of the disease remains largely unstudied. There is also limited knowledge about the proteome of RVO, but proteomic studies suggest that RVO is associated with remodeling of the extracellular matrix and adhesion processes. Proteomic studies of DR have resulted in the identification of potential therapeutic targets such as carbonic anhydrase-I. Proliferative diabetic retinopathy is the most intensively studied stage of DR. Proteomic studies have established VEGF, pigment epithelium-derived factor (PEDF) and complement components as key factors associated with AMD. The aim of this review is to highlight the major milestones in proteomics in RAO, RVO, DR and AMD. Through large-scale protein analyses, proteomics is bringing new important insights into these complex pathological conditions. PMID:28452939

  10. Diagnosis of Intracranial Artery Dissection

    PubMed Central

    KANOTO, Masafumi; HOSOYA, Takaaki

    2016-01-01

    Cerebral arterial dissection is defined as a hematoma in the wall of a cervical or an intracranial artery. Cerebral arterial dissection causes arterial stenosis, occlusion, and aneurysm, resulting in acute infarction and hemorrhage. Image analysis by such methods as conventional angiography, computed tomography, magnetic resonance imaging, and so on plays an important role in diagnosing cerebral arterial dissection. In this study, we explore the methods and findings involved in the diagnosis of cerebral arterial dissection. PMID:27180630

  11. Central retinal artery occlusion and infective endocarditis: rigor does matter.

    PubMed

    Piqueras Flores, J; Esquinas Blanco, G; Pinilla Rivas, M; Montero, M A; Marina Breysse, M; López Lluva, M T

    2015-11-01

    A patient with acute amaurosis due central retinal artery occlusion (CRAO), who had mitral regurgitation and Streptococcus viridans positive blood cultures. Using transesophageal ultrasound, the patient was diagnosed with native valve infective endocarditis without fever, and with loss of vision as the only symptom. CRAO due to infective endocarditis is rare and there are few cases reported in the literature. Semiology and a systematic and comprehensive study of patients with this ophthalmological pathology helps uncover serious underlying medical conditions. Infective endocarditis has many different forms of presentation and a high clinical suspicion is often required to reach a diagnosis. Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  12. Internal carotid artery occlusion: association with atherosclerotic disease in other arterial beds and vascular risk factors.

    PubMed

    Paraskevas, Kosmas I; Mikhailidis, Dimitri P; Liapis, Christos D

    2007-01-01

    The aim of this article is to investigate the association between internal carotid artery occlusion (ICAO) and the presence of atherosclerotic disease and vascular risk factors. The clinical characteristics and risk factors of 120 patients presenting with ICAO were retrospectively reviewed. All patients (n = 120) had at least 1 of the 4 vascular risk factor (diabetes, smoking, hypercholesterolemia, and hypertension); 2, 3, or all 4 risk factors were present in 14 to 82 of the patients (11.7% to 68.3%), 10 to 39 of the patients (8.3% to 32.5%), and 9 of the patients (7.5%), respectively. A total of 84 patients (70%) with ICAO had disease in at least 1 additional vascular bed (aorta, coronary or lower limb arteries). In addition to ICAO, vascular disease was present in 2 and all 3 of these arterial beds in 42 (35%) and 9 (7.5%) patients, respectively. Furthermore, stenosis or occlusion of the ipsilateral or contralateral vertebral arteries was recorded in 19 of 120 patients (15.8%). Regarding the contralateral carotid artery, 1 patient had bilateral ICAO. One patient had contralateral common carotid artery occlusion, and 1 patient was excluded from the analysis because of surgery to the contralateral carotid artery. Of the remaining 117 patients, 34 (29.0%) had less than 50% contralateral carotid artery stenosis. Thirty-two patients (27.4%) had 50% to 69%, and 51 (43.6%) had 70% to 99% stenosis. Ultrasonographic imaging of the carotid plaque of the contralateral carotid artery revealed that 52 of the 120 arteries (43.3%) were uniformly or predominantly echolucent (types I and II, respectively). Fifty-nine (49.2%) were predominantly or uniformly echogenic (types III and IV), and 9 (7.5%) could not be classified. A similar distribution of echomorphology was observed on the occluded side. ICAO is associated with widespread atherosclerotic disease and a high prevalence of vascular risk factors. Detection of ICAO should prompt the investigation of other arterial beds and

  13. Waveform patterns and peak reversed velocity in vertebral arteries predict severe subclavian artery stenosis and occlusion.

    PubMed

    Chen, Shun-Ping; Hu, Yuan-Ping

    2015-05-01

    This study investigated the value of analyzing spectral Doppler waveform patterns and measuring the peak reversed velocity (PRV) of the vertebral artery (VA) in predicting proximal severe subclavian artery (SA) stenosis and occlusion. Fifty-one patients with proximal SA stenosis were studied retrospectively. Based on the depth of the mid-systolic notch, the Doppler waveforms of the ipsilateral VA were divided into five subtypes (type I, n = 8; type II, n = 8; type III, n = 6; type IV, n = 13; and type V, n = 16). PRV was also measured. PRV receiver operating characteristic curves were constructed to obtain the best cutoff value for predicting severe SA stenosis or complete SA occlusion. The results indicated that both VA Doppler waveform and PRV were associated with the degree of SA stenosis (p < 0.05). PRV and the Doppler waveform in the VA had similar accuracy in predicting SA occlusion (84.3%, 43/51). PRV was more accurate than VA waveforms in predicting severe SA stenosis (98%, 50/51 vs. 94.1%, 48/51). However, no significant differences between the two methods in predicting severe SA stenosis were observed (p = 0.84). Thus, with severe obstruction of the SA, typical Doppler waveform patterns of the VA could be observed. PRV is a helpful criterion in predicting severe stenosis and occlusion of the SA.

  14. Dual-Energy CT Angiography in Peripheral Arterial Occlusive Disease

    SciTech Connect

    Brockmann, Carolin Jochum, Susanne; Sadick, Maliha; Huck, Kurt; Ziegler, Peter; Fink, Christian; Schoenberg, Stefan O.; Diehl, Steffen J.

    2009-07-15

    We sought to study the accuracy of dual-energy computed tomographic angiography (DE-CTA) for the assessment of symptomatic peripheral arterial occlusive disease of the lower extremity by using the dual-energy bone removal technique compared with a commercially available conventional bone removal tool. Twenty patients underwent selective digital subtraction angiography and DE-CTA of the pelvis and lower extremities. CTA data were postprocessed with two different applications: conventional bone removal and dual-energy bone removal. All data were reconstructed and evaluated as 3D maximum-intensity projections. Time requirements for reconstruction were documented. Sensitivity, specificity, accuracy, and concordance of DE-CTA regarding degree of stenosis and vessel wall calcification were calculated. A total of 359 vascular segments were analyzed. Compared with digital subtraction angiography, sensitivity, specificity, and accuracy, respectively, of CTA was 97.2%, 94.1%, and 94.7% by the dual-energy bone removal technique. The conventional bone removal tool delivered a sensitivity of 77.1%, a specificity of 70.7%, and an accuracy of 72.0%. Best results for both postprocessing methods were achieved in the vascular segments of the upper leg. In severely calcified segments, sensitivity, specificity, and accuracy stayed above 90% by the dual-energy bone removal technique, whereas the conventional bone removal technique showed a substantial decrease of sensitivity, specificity, and accuracy. DE-CTA is a feasible and accurate diagnostic method in the assessment of symptomatic peripheral arterial occlusive disease. Results obtained by DE-CTA are superior to the conventional bone removal technique and less dependent on vessel wall calcifications.

  15. Parent artery occlusion for ruptured “true” posterior communicating artery aneurysm

    PubMed Central

    Takeda, Nobuaki; Oishi, Hidenori; Arai, Hajime

    2015-01-01

    A case of a patient with a ruptured true posterior communicating artery (PCoA) aneurysm is reported, who had been managed by early endovascular parent artery occlusion with coils. The small blister aneurysm was located at the proximal PCoA itself and directed superiorly. Postoperative course was uneventful. During 1-month follow-up, the patient recovered well and could care for herself. Aneurysms of the PCoA itself are very rare. As reported to date, surgical procedures would favor microsurgical clipping over endovascular coil embolization. Endovascular treatment may be a good alternative to surgical trapping for true PCoA blister aneurysm. PMID:25953771

  16. Cutis marmorata and cerebral arterial gas embolism.

    PubMed

    Wilmshurst, Peter T

    2015-12-01

    Dr Kemper and colleagues reported that, when air was injected into the cerebral circulation of pigs, they developed a rash that looked very similar to cutis marmorata of cutaneous decompression illness (DCI) and to livido reticularis. They postulated that cutaneous DCI in divers may be centrally mediated as a result of cerebral gas embolism. It would be helpful if Kemper et al. described the distribution of the rash in their pigs. In divers, cutaneous DCI is generally confined to parts of the body with significant amounts of subcutaneous fat, such as the trunk and thighs, and the rash often crosses the midline. Colleagues and I have reported that cutaneous DCI is commonly associated with significant right-to-left shunts and particularly persistent foramen ovale (PFO). We postulated that the manifestations of shunt-related DCI, whether neurological or cutaneous, are in large part determined by peripheral amplification of embolic bubbles in those tissues that are most supersaturated with dissolved nitrogen (or other inert gas) at the time that emboli arrive. Hence we postulated that cutaneous DCI is the result of amplification of gas emboli that invade cutaneous capillaries. Dr Kemper has kindly sent me a number of the publications from his department on which their report of this skin rash in pigs is based. The aim of their experiments was to produce significant brain injury by means of cerebral air embolism. Their pigs had no tissues supersaturated with inert gas. They were ventilated with a FiO₂ of 0.4 and anaesthetised with ketamine and midazolam. They were also given pancuronium and atropine, before air was injected into their cerebral circulation. If their findings in pigs and the resulting hypothesis were applicable to man, it would mean that one could get cutaneous DCI without decompression: one would only need cerebral gas embolism. During contrast echocardiography, I have produced arterial gas embolism in many hundreds of patients with right

  17. Primary Stenting of Subclavian and Innominate Artery Occlusive Disease: A Single Center's Experience

    SciTech Connect

    Brountzos, E. N. Petersen, B.; Binkert, C.; Panagiotou, I.; Kaufman, J. A.

    2004-11-15

    Purpose: To review immediate and midterm results of primary stenting for innominate and subclavian artery occlusive lesions. Methods: Retrospective data were collected from 48 consecutive symptomatic patients (27 men and 21 women, median age 64 years) having 49 subclavian and innominate artery lesions treated with stenting. Of the patients 52% had concomitant ischemic heart disease, and 30% had carotid and/or vertebral artery disease. Indication for treatment was vertebrobasilar insufficiency (VBI) in 16.6% of the patients; upper limb ischemia (ULI) in 31.3%; VBI and ULI in 12.5%; transient ischemic attack in 16.7%; angina in 12.5% before or after left internal mammary artery-to-coronary artery bypass grafting; and leg claudication in 10.4% before or after axillofemoral bypass grafting. Balloon-expandable stents were used in 44 lesions and self-expandable stents in 5 lesions. In total, 53 stents were placed in 48 patients. Results: Technical success was 96%, and clinical success 94%. We encountered four complications (two puncture site hematomas, one distal hand embolization and one transient cerebral ischemia). Two patients died within 30 days from other causes, and seven patients were lost to follow-up. Mean follow-up time was 16.7 months (range 0.3 to 68.2). Five patients had recurrent lesions treated by surgical (n = 2) or endovascular (n = 3) means. Cumulative primary patency rate was 91.7% and 77% at 12 and 24 months, respectively. Cumulative secondary patency rate was 96.5% and 91.7% at 12 and 24 months, respectively. Conclusion: Stenting of subclavian and innominate artery lesions resulted in immediate resolution of patients' symptoms with durable midterm effect and few complications in a larger patient group with serious comorbid conditions.

  18. rt-PA Thrombolysis in Acute Thromboembolic Upper-Extremity Arterial Occlusion

    SciTech Connect

    Cejna, Manfred; Salomonowitz, Erich; Wohlschlager, Helmut; Zwrtek, Karin; Boeck, Rudolf; Zwrtek, Ronald

    2001-07-15

    Purpose: Retrospective analysis of the results of rt-PA thrombolysis in the treatment of acute thromboembolic occlusion of the upper limb.Methods: Of 55 patients with demonstrated acute embolic arterial occlusion, rt-PA thrombolysis was performed on 40 occlusions in 38 patients (23 women with a mean age of 62 years, range 32-85 years; 15 men with a mean age of 65 years, range 32-92 years) according to the following design: 6 mg rt-PA/hr for 30 min, 3 mg rt-PA/hr for the next 30 min, 1 mg rt-PA/hr for 7 hr, and 0.4 mg rt-PA/hr until the end of lysis. Onset of symptoms varied from 1 to 14 days. Included were three isolated upper-arm occlusions, nine combined brachial and forearm occlusions, and 28 forearm and hand artery occlusions.Results: The overall success rate was 55%. The lysis results for isolated upper arm, combined brachial and forearm occlusions, and forearm and hand artery occlusions were 100%, 66%, and 46%, respectively. In eight patients surgical embolectomy had to be performed after failed thrombolysis. No amputation was required in the follow-up period. No lethal complications occurred.Conclusions: Interventional rt-PA treatment of proximal upper-extremity arterial occlusions may be performed with comparable success rates to surgical embolectomy and without severe complications. For distal occlusions the results are inferior to the success rates obtained with surgery.

  19. Development of functional in vivo imaging of cerebral lenticulostriate artery using novel synchrotron radiation angiography

    NASA Astrophysics Data System (ADS)

    Lin, Xiaojie; Miao, Peng; Mu, Zhihao; Jiang, Zhen; Lu, Yifan; Guan, Yongjing; Chen, Xiaoyan; Xiao, Tiqiao; Wang, Yongting; Yang, Guo-Yuan

    2015-02-01

    The lenticulostriate artery plays a vital role in the onset and development of cerebral ischemia. However, current imaging techniques cannot assess the in vivo functioning of small arteries such as the lenticulostriate artery in the brain of rats. Here, we report a novel method to achieve a high resolution multi-functional imaging of the cerebrovascular system using synchrotron radiation angiography, which is based on spatio-temporal analysis of contrast density in the arterial cross section. This method provides a unique tool for studying the sub-cortical vascular elasticity after cerebral ischemia in rats. Using this technique, we demonstrated that the vascular elasticity of the lenticulostriate artery decreased from day 1 to day 7 after transient middle cerebral artery occlusion in rats and recovered from day 7 to day 28 compared to the controls (p < 0.001), which paralleled with brain edema formation and inversely correlated with blood flow velocity (p < 0.05). Our results demonstrated that the change of vascular elasticity was related to the levels of brain edema and the velocity of focal blood flow, suggesting that reducing brain edema is important for the improvement of the function of the lenticulostriate artery in the ischemic brain.

  20. Transcatheter Splenic Artery Occlusion for Treatment of Splenic Artery Steal Syndrome After Orthotopic Liver Transplantation

    SciTech Connect

    Uflacker, Renan; Selby, J. Bayne; Chavin, Kenneth; Rogers, Jeffrey; Baliga, Prabhakar

    2002-08-15

    Purpose: To review some aspects of the problem of splenic artery steal syndrome as cause of ischemia in transplanted livers and treatment by selective splenic artery occlusion. Materials and Methods: Eleven liver transplant patients from a group of 350 patients, nine men and two women,ranging in age from 40 years to 61 years (mean 52 years), presented with biochemical evidences of liver ischemia and failure, ranging from one to 60 days following orthotopic liver transplantation. Diagnosis of splenic artery steal syndrome was suspected by elevated enzymes, Doppler ultrasound and confirmed by celiac angiogram. Patients with confirmed hepatic artery thrombosis before angiography were excluded from the study. Embolization with Gianturco coils was performed. Results: All patients were treated by splenic artery embolization with Gianturco coils. The 11 patients improved clinically within 24 hours of the procedure with significant change in the biochemical and clinical parameters. Followup ranged from one month to two years. One of the 11 patient initially improved, but developed hepatic artery thrombosis within 24 hours of the embolic treatment,requiring surgical repair. Conclusion: Splenicartery steal syndrome following liver transplantation surgery can be diagnosed by celiac angiography, and effectively treated by splenic artery embolization with coils. Embolization is one of the treatments available, it is minimally invasive, and leads to immediate clinical improvement. Hepatic artery thrombosis is a possible complication of the procedure.

  1. Superselective Intra-Arterial Ethanol Sclerotherapy of Feeding Artery and Nidal Aneurysms in Ruptured Cerebral Arteriovenous Malformations.

    PubMed

    Settecase, F; Hetts, S W; Nicholson, A D; Amans, M R; Cooke, D L; Dowd, C F; Higashida, R T; Halbach, V V

    2016-04-01

    In the endovascular treatment of cerebral arteriovenous malformations, ethanol sclerotherapy is seldom used due to safety concerns. However, when limited reflux of an embolic agent is permissible or when there is a long distance to the target, ethanol may be preferable. We reviewed 10 patients with 14 cerebral AVM feeding artery aneurysms or intranidal aneurysms treated with intra-arterial ethanol sclerotherapy at our institution between 2005 and 2014. All patients presented with acute intracranial hemorrhage. Thirteen of 14 aneurysms were treated primarily with 60%-80% ethanol into the feeding artery. Complete target feeding artery and aneurysm occlusion was seen in all cases; 8/13 (62%) were occluded by using ethanol alone. No retreatments or recurrences were seen. One permanent neurologic deficit (1/13, 7.7%) and no deaths occurred. In a subset of ruptured cerebral AVMs, ethanol sclerotherapy of feeding artery aneurysms and intranidal aneurysms can be performed with a high degree of technical success and a low rate of complication. © 2016 by American Journal of Neuroradiology.

  2. Treatment of ruptured middle cerebral artery aneurysms by endovascular approach: a single-center experience.

    PubMed

    Zhao, Xintong; Li, Zhenbao; Fang, Xinggen; Liu, Jiaqiang; Wu, Degang; Lai, Niansheng

    2017-05-01

    The optimal treatment modalities of ruptured middle cerebral artery aneurysm are still controversial. The objective of this study is to analyze the outcomes of patients with ruptured middle cerebral artery aneurysms treated by endovascular coiling. From October 2011 to October 2015, 67 patients with 71 ruptured middle cerebral artery aneurysms received endovascular coiling in our hospital. We retrospectively reviewed the clinical, radiologic records and outcomes. Of all the 71 aneurysms (67 patients), 42 were treated by coil embolization merely, 27 by stent-assisted coiling and 2 unruptured aneurysms in patients with bilateral middle cerebral artery aneurysms without receiving treatment. Complete occlusion was achieved in 82.6% (57/69) of all the procedures. Each of incomplete and partial occlusion rates was 8.7% (6/69). Intraoperative rupture of aneurysms occurred in two procedures (2.9%). Thrombogenesis occurred in eight procedures (11.6%). Brain infarction occurred in eight patients (11.9%). Post-operative rebleeding occurred in seven patients (10.4%). Sixty-three patients were followed at a mean follow-up of 8.24 ± 7.16 months. The mortality and good outcome rate were 3.2% and 90.5%, respectively. Aneurysm recurrence occurred in 6 (13.3%) of the 45 aneurysms at a mean follow-up of 8.44 ± 7.83 months. Endovascular coiling is effective for patients with ruptured middle cerebral artery aneurysms. Individualized treatment should be assessed by experienced specialist. It is essential to perform randomized large trials to confirm the efficiency of endovascular coiling.

  3. Clinical Analysis Comparing Efficacy between a Distal Filter Protection Device and Proximal Balloon Occlusion Device during Carotid Artery Stenting.

    PubMed

    Lee, Jong Hyeok; Sohn, Hee Eon; Chung, Seung Young; Park, Moon Sun; Kim, Seong Min; Lee, Do Sung

    2015-10-01

    The main concern during transfemoral carotid artery stenting (CAS) is preventing cerebral embolus dislodgement. We compared clinical outcomes and intraprocedural embolization rates of CAS using a distal filter protection device or proximal balloon occlusion device. From January 2011 to March 2015, a series of 58 patients with symptomatic or asymptomatic internal carotid artery stenosis ≥70% were treated with CAS with embolic protection device in single center. All patients underwent post-CAS diffusion-weighted magnetic resonance imaging (DW-MRI) to detect new ischemic lesions. We compared clinical outcomes and postprocedural embolization rates. CAS was performed in all 61 patients. Distal filter protection success rate was 96.6% (28/29), whose mean age was 70.9 years, and mean stenosis was 81%. Their preprocedural infarction rate was 39% (11/28). Subsequent DW-MRI revealed 96 new ischemic lesions in 71% (20/28) patients. In contrast, the proximal balloon occlusion device success rate was 93.8% (30/32), whose mean age was 68.8 years and mean stenosis was 86%. Preprocedure infarction rate was 47% (14/30). DW-MRI revealed 45 new ischemic lesions in 57% (17/30) patients. Compared with distal filter protection device, proximal balloon occlusion device resulted in fewer ischemic lesions per patient (p=0.028). In each group, type of stent during CAS had no significant effect on number of periprocedural embolisms. Only 2 neurologic events occurred in the successfully treated patients (one from each group). Transfemoral CAS with proximal balloon occlusion device achieves good results. Compared with distal filter protection, proximal balloon occlusion might be more effective in reducing cerebral embolism during CAS.

  4. Percutaneous Treatment in Iliac Artery Occlusion: Long-Term Results

    SciTech Connect

    Gandini, Roberto; Fabiano, Sebastiano; Chiocchi, Marcello; Chiappa, Roberto Simonetti, Giovanni

    2008-11-15

    We evaluated the long-term results of recanalization with primary stenting for patients with long and complex iliac artery occlusions. This was a retrospective nonrandomised study. Between 1995 and 1999, 138 patients underwent recanalization of an occluded iliac artery with subsequent stenting. Patency results were calculated using Kaplan-Meier analysis. The mean length of follow-up was 108 months. Variables affecting primary stent patency such as patient age; stent type and diameter; lesion site, shape, and length; Society of Cardiovascular and Interventional Radiology classification; total runoff score; Fontaine classification; and cardiovascular risk factors were analysed using Breslow test. These variables were then evaluated for their relation to stent patency using Cox proportional hazards test. Technical success was 99%. Primary patency rates were 90% (SE .024), 85% (SE .029), 80% (SE .034), and 68% (SE .052) at 3, 5, 7, and 10 years, respectively. Lesion site (p = 0.022) and stent diameter (p = 0.028) were shown to have a statistically significant influence on primary stent patency. Long-term results of iliac recanalization and stent placement were excellent, without major complications, even in highly complex vascular obstructions. A primary endovascular approach appears to be justified in the majority of patients as a less invasive alternative treatment to surgery. In any case, a first-line interventional approach should be considered in elderly patients or in patients with severe comorbidities.

  5. Stenting for a symptomatic posterior cerebral artery stenosis.

    PubMed

    Xu, Gelin; Zheng, Ling; Zhou, Zhiming; Liu, Xinfeng

    2009-05-01

    Evolvement of endovascular devices and increase of operator expertise have made angioplasty and stenting in intracranial vessels technically possible. Stenting has been reported in treating stenosis in middle and anterior cerebral arteries with favorable outcomes. However, the feasibility of stenting for stenosis in posterior cerebral artery (PCA) has not been established. We report a patient with progressive focal cerebral ischemic symptoms, which were arrested after reconstruction of the associated PCA stenosis with stenting.

  6. A novel method to determine perineal artery occlusion among male bicyclists

    PubMed Central

    Hotaling, James M.; Kathrins, Martin; Baftiri, Amit P.; Freels, Sally; Niederberger, Craig S.

    2015-01-01

    Background. Perineal pressure due to bicycle riding has been associated with erectile dysfunction. We developed a novel method to measure the occlusive force exerted over the perineal arteries and determined perineal artery occlusion by a variety of seat designs. Methods. Doppler ultrasonography facilitated perineal artery localization and determination of the force required for perineal artery occlusion in 20 healthy men. Flexiforce® sensors were affixed over the proximal and distal aspects of the perineal arteries bilaterally. Individuals completed bicycle rides in the road- and stationary-settings with six distinct seat designs, including those with and without an anterior “nose.” Results. The occlusion time proportion of the total ride time was calculated for each trial. The overall occlusion time proportion was 0.59 (95% CI [0.45–0.73]) across all seats and settings. The “no-nose” bicycle seat and the stationary-setting demonstrated significantly lower occlusion proportion times than the traditional nose bicycle seat and road-setting, respectively. However, all bicycle seats yielded an occlusion time proportion of 0.41 or greater. Discussion. Our method of real-time, non-invasive force measurement localized to the perineal arteries may be used to validate future bicycle seat design. It also underscores the significant risk of perineal artery insufficiency in men who are avid bicyclists. This risk may be minimized by using newer “no-nose” bicycle seats. PMID:26713236

  7. A novel method to determine perineal artery occlusion among male bicyclists.

    PubMed

    Parthiban, Sujeeth; Hotaling, James M; Kathrins, Martin; Baftiri, Amit P; Freels, Sally; Niederberger, Craig S

    2015-01-01

    Background. Perineal pressure due to bicycle riding has been associated with erectile dysfunction. We developed a novel method to measure the occlusive force exerted over the perineal arteries and determined perineal artery occlusion by a variety of seat designs. Methods. Doppler ultrasonography facilitated perineal artery localization and determination of the force required for perineal artery occlusion in 20 healthy men. Flexiforce(®) sensors were affixed over the proximal and distal aspects of the perineal arteries bilaterally. Individuals completed bicycle rides in the road- and stationary-settings with six distinct seat designs, including those with and without an anterior "nose." Results. The occlusion time proportion of the total ride time was calculated for each trial. The overall occlusion time proportion was 0.59 (95% CI [0.45-0.73]) across all seats and settings. The "no-nose" bicycle seat and the stationary-setting demonstrated significantly lower occlusion proportion times than the traditional nose bicycle seat and road-setting, respectively. However, all bicycle seats yielded an occlusion time proportion of 0.41 or greater. Discussion. Our method of real-time, non-invasive force measurement localized to the perineal arteries may be used to validate future bicycle seat design. It also underscores the significant risk of perineal artery insufficiency in men who are avid bicyclists. This risk may be minimized by using newer "no-nose" bicycle seats.

  8. Evaluation of Ophthalmic Artery Branch Retrograde Intervention in the Treatment of Central Retinal Artery Occlusion (CRAO)

    PubMed Central

    Wang, Runsheng; Qian, Lu; Wang, Yi; Zheng, Yi; Du, Shanshuang; Lei, Tao; Lv, Peilin; Long, Tan; Wang, Wenjun

    2017-01-01

    Background Central retinal artery occlusion (CRAO) is the occlusion of the central retinal artery resulting in retinal infarction and acute vision loss. Digital subtraction angiography (DSA)–guided superselective ophthalmic artery or selective carotid thrombolysis remains the preferred treatment method for CRAO. This study aimed to evaluate the safety and clinical efficacy of the novel ophthalmic artery branch retrograde thrombolytic intervention for CRAO. Material/Methods Fifty patients with monocular CRAO were enrolled, including 28 males and 22 females (mean age: 55.7±2.3 years). The patients were randomly divided into two groups for thrombolysis with urokinase (400,000 U) and papaverine (30 mg) by either ophthalmic artery branch retrograde intervention (group A, n=26) or superselective ophthalmic artery/selective carotid intervention (group B, n=24). There was no significant difference in age (P=0.58), gender ratio (P=0.49), and time to onset (P=1.00) between the two groups. The adverse reactions and clinical efficacy were evaluated by postoperative DSA, fundus fluorescein angiography (FFA), and visual acuity tests. Results No serious complications, abnormal eye movement, or vitreous hemorrhage occurred in either group. DSA showed that group A had an effective rate (92.30%) comparable to that of group B (100%, χ2=2.08, P=0.25). FFA suggested that both groups had similar treatment efficacy (χ2=3.09, P=0.21). Visual acuity tests also confirmed a similar efficacy of the two intervention approaches (χ2=0.25, P=0.88). Conclusions The developed novel ophthalmic artery branch retrograde intervention is highly effective and safe for CRAO, and may be a superior method compared with the conventional approach. PMID:28064304

  9. Surgical Experience of the Ruptured Distal Anterior Cerebral Artery Aneurysms

    PubMed Central

    Lee, Jong-Young; Kim, Moon-Kyu; Cho, Byung-Moon; Park, Se-Hyuck

    2007-01-01

    Objective Distal anterior cerebral artery (DACA) aneurysms are fragile and known to have high risks for intraoperative premature rupture and a relatively high associated morbidity. To improve surgical outcomes of DACA aneurysms, we reviewed our surgical strategy and its results postoperatively. Methods A total of 845 patients with ruptured cerebral aneurysms were operated in our hospital from January 1991 to December 2005. Twenty-three of 845 patients had ruptured DACA aneurysms which were operated on according to our surgical strategy. Our surgical strategy was as follows; early surgery, appropriate releasing of CSF, appropriate surgical approach, using neuronavigating system, securing the bridging veins, using temporary clipping and/or tentative clipping, meticulous manipulation of aneurysm, and using micro-Doppler flow probe. Twenty of 23 patients who had complete medical records were studied retrospectively. We observed the postoperative radiographic findings and checked Glasgow Outcome Scale score sixth months after the operation. Results Nineteen DACA aneurysms were clipped through a unilateral interhemispheric approach and one DACA aneurysm was clipped through a pterional approach. Postoperative radiographic findings revealed complete clipping of aneurysmal neck without stenosis or occlusion of parent arteries. In two patients, a residual neck of aneurysm was visualized. Seventeen patients showed good recovery, one patient resulted in moderate disability, while 2 patients died. Conclusion With our surgical strategy it was possible to achieve acceptable surgical morbidity and mortality rates in patients with DACA aneurysms. Appropriate use of tentative clipping, temporary clipping and neuro-navigating systems can give great help for safe approach and clipping of DACA aneurysm. PMID:19096557

  10. Comprehensive analysis of myocardial infarction due to left circumflex artery occlusion: comparison with infarction due to right coronary artery and left anterior descending artery occlusion

    SciTech Connect

    Huey, B.L.; Beller, G.A.; Kaiser, D.L.; Gibson, R.S.

    1988-11-01

    Forty consecutive patients with creatine kinase-MB confirmed myocardial infarction due to circumflex artery occlusion (Group 1) were prospectively evaluated and compared with 107 patients with infarction due to right coronary artery occlusion (Group 2) and 94 with left anterior descending artery occlusion (Group 3). All 241 patients underwent exercise thallium-201 scintigraphy, radionuclide ventriculography, 24 h Holter electrocardiographic (ECG) monitoring and coronary arteriography before hospital discharge and were followed up for 39 +/- 18 months. There were no significant differences among the three infarct groups in age, gender, number of risk factors, prevalence and type of prior infarction, Norris index, Killip class and frequency of in-hospital complications. Acute ST segment elevation was present in only 48% of patients in Group 1 versus 71 and 72% in Groups 2 and 3, respectively (p = 0.012), and 38% of patients with a circumflex artery-related infarct had no significant ST changes (that is, elevation or depression) on admission (versus 21 and 20% for patients in Groups 2 and 3, respectively) (p = 0.001). Abnormal R waves in lead V1 were more common in Group 1 than in Group 2 (p less than 0.003) as was ST elevation in leads I, aVL and V4 to V6 (p less than or equal to 0.048). These differences in ECG findings between Group 1 and 2 patients correlated with a significantly higher prevalence of posterior and lateral wall asynergy in the group with a circumflex artery-related infarct. Infarct size based on peak creatine kinase levels and multiple radionuclide variables was intermediate in Group 1 compared with that in Group 2 (smallest) and Group 3 (largest). During long-term follow-up, the probability of recurrent cardiac events was similar in the three infarct groups.

  11. Flash fluorescence with indocyanine green videoangiography to identify the recipient artery for bypass with distal middle cerebral artery aneurysms: operative technique.

    PubMed

    Rodríguez-Hernández, Ana; Lawton, Michael T

    2012-06-01

    Distal middle cerebral artery (MCA) aneurysms frequently have nonsaccular morphology that necessitates trapping and bypass. Bypasses can be difficult because efferent arteries lie deep in the opercular cleft and may not be easily identifiable. We introduce the "flash fluorescence" technique, which uses videoangiography with indocyanine green (ICG) dye to identify an appropriate recipient artery on the cortical surface for the bypass, enabling a more superficial and easier anastomosis. Flash fluorescence requires 3 steps: (1) temporary clip occlusion of the involved afferent artery; (2) videoangiography demonstrating fluorescence in uninvolved arteries on the cortical surface; and (3) removal of the temporary clip with flash fluorescence in the involved efferent arteries on the cortical surface, thereby identifying a recipient. Alternatively, temporary clips can occlude uninvolved arteries, and videoangiography will demonstrate initial fluorescence in efferent arteries during temporary occlusion and flash fluorescence in uninvolved arteries during reperfusion. From a consecutive series of 604 MCA aneurysms treated microsurgically, 22 (3.6%) were distal aneurysms and 11 required a bypass. The flash fluorescence technique was used in 3 patients to select the recipient artery for 2 superficial temporal artery-to-MCA bypasses and 1 MCA-MCA bypass. The correct recipient was selected in all cases. The flash fluorescence technique provides quick, reliable localization of an appropriate recipient artery for bypass when revascularization is needed for a distal MCA aneurysm. This technique eliminates the need for extensive dissection of the efferent artery and enables a superficial recipient site that makes the anastomosis safer, faster, and less demanding.

  12. Right Coronary Artery Fistula and Occlusion Causing Myocardial Infarction after Blunt Chest Trauma

    PubMed Central

    Kim, Kun Il; Lee, Won Yong; Ko, Ho Hyun; Kim, Hyoung Soo; Lee, Hee Sung

    2014-01-01

    Myocardial infarction (MI) secondary to coronary artery fistula and the subsequent occlusion of the distal right coronary artery (RCA) after blunt chest trauma is a rare entity. Here, we describe a case of coronary artery fistula and occlusion with an inferior MI that occurred following blunt chest trauma. At the initial visit to the emergency room after a car accident, this patient had been undiagnosed with acute myocardial infarction, readmitted five months after ischemic insult, and revealed to have experienced MI due to RCA-right atrial fistula and occlusion of the distal RCA. He underwent coronary surgery and recovered without complications. PMID:25207252

  13. An automated coronary artery occlusion device for stimulating collateral development in vivo.

    PubMed

    Rys, Richard; LaDisa, John F; Tessmer, John P; Gu, Weidong; Kersten, Judy R; Warltier, David C; Pagel, Paul S

    2002-01-01

    Repetitive, brief coronary artery occlusions produce collateral development in experimental animals. This model causes coronary collateralization in a highly reproducible fashion, but the process is very labor intensive. We report the design and use of a fully automated hydraulic coronary occlusion device capable of producing repetitive coronary occlusions and enhancement of coronary collateral development in dogs. The device consists of analog electronics that allow adjustment of occlusion number, frequency, pressure and duration, and mechanical components responsible for the coronary occlusion. The motor and piston of the device are coupled to a chronically implanted hydraulic vascular occluder placed around the left anterior descending coronary artery (LAD) of dogs instrumented for measurement of systemic and coronary hemodynamics. One group of dogs (n = 6) underwent brief (2 min) LAD occlusions once per hour, eight times per day, 5 days/week for 3 weeks to stimulate collateral development (measured using radioactive microspheres). Another group of dogs (n = 6) that did not receive repetitive occlusions served as controls. The device reproducibly produced repetitive LAD occlusions for the duration, frequency, and time interval initially programmed. A time-dependent increase in transmural collateral blood flow was observed in dogs undergoing repetitive occlusions using the device. Collateral blood flow was unchanged in dogs that did not undergo occlusions. The automated occluder device reliably produces repetitive coronary occlusions and may facilitate further study of coronary collateral development in response to chronic myocardial ischemia.

  14. Emergent stent-assisted angioplasty of extracranial internal carotid artery and intracranial stent-based thrombectomy in acute tandem occlusive disease: technical considerations.

    PubMed

    Cohen, José E; Gomori, Moshe; Rajz, Gustavo; Moscovici, Samuel; Leker, Ronen R; Rosenberg, Shai; Itshayek, Eyal

    2013-09-01

    Tandem occlusions of the internal carotid artery (ICA) and a major intracranial artery respond poorly to intravenous thrombolytic therapy, and are usually managed by endovascular means. This study describes experience with stent-assisted endovascular ICA revascularization and stent-based thrombectomy. In patients with tandem ICA-middle cerebral artery (MCA)/distal ICA occlusion, the carotid occlusion was recanalized by primary angioplasty and stent implantation, and the distal occlusion by stent-based thrombectomy. Two variant techniques are described. Seven consecutive patients, mean age 64.1 years (range 49-75) and mean admission National Institutes of Health Stroke Scale score of 23, were included. Occlusion sites were tandem proximal ICA and MCA trunk (six patients) and tandem proximal left ICA and ICA terminus (one patient). Complete recanalization with complete perfusion (Thrombolysis in Myocardial Infarction [TIMI] 3, Thrombolysis in Cerebral Infarction [TICI] 3) was achieved in six patients and partial recanalization with partial perfusion (TIMI 2, TICI 2A) in one. Mean time to therapy was 4.9 h (range 3-6.5); mean time to recanalization was 55 min (range 38-65 min). CT performed 1 day after recanalization showed cortical sparing (>90% of the cortex at risk) in seven patients. Five patients (72%) presented with good clinical outcome (modified Rankin Scale (mRS) score 0-2) at 1 month; one patient (patient No 7) reached an mRS score of 3 and one patient died. In selected cases of acute ICA occlusion and concomitant major vessel embolic stroke, angioplasty and stenting of the proximal occlusion and stent-based thrombectomy of the intracranial occlusion may be feasible, effective and safe, and provide early neurological improvement. Further experience and prospective studies are warranted.

  15. A Large Posttraumatic Subclavian Artery Aneurysm Complicated by Artery Occlusion and Arteriobronchial Fistula Successfully Treated Using a Covered Stent

    SciTech Connect

    Stefanczyk, Ludomir; Czeczotka, Jaroslaw; Elgalal, Marcin; Sapieha, Michal; Rowinski, Olgierd

    2011-02-15

    The treatment of posttraumatic aneurysms of peripheral arteries using covered stents is increasingly commonplace. We present the case of a 10-year-old girl with a pseudoaneurysm of the subclavian artery complicated by an arteriobronchial fistula with hemorrhaging into the bronchial tree and distal subclavian artery occlusion. Despite the lack of artery patency, endovascular stent graft implantation was successful. Pseudoaneurysm exclusion and involution was achieved, together with a patent implant and maintained collateral circulation patency.

  16. Tumor necrosis factor-α inhibition attenuates middle cerebral artery remodeling but increases cerebral ischemic damage in hypertensive rats.

    PubMed

    Pires, Paulo W; Girgla, Saavia S; Moreno, Guillermo; McClain, Jonathon L; Dorrance, Anne M

    2014-09-01

    Hypertension causes vascular inflammation evidenced by an increase in perivascular macrophages and proinflammatory cytokines in the arterial wall. Perivascular macrophage depletion reduced tumor necrosis factor (TNF)-α expression in cerebral arteries of hypertensive rats and attenuated inward remodeling, suggesting that TNF-α might play a role in the remodeling process. We hypothesized that TNF-α inhibition would improve middle cerebral artery (MCA) structure and reduce damage after cerebral ischemia in hypertensive rats. Six-week-old male stroke-prone spontaneously hypertensive rats (SHRSP) were treated with the TNF-α inhibitor etanercept (ETN; 1.25 mg·kg(-1)·day(-1) ip daily) or PBS (equivolume) for 6 wk. The myogenic tone generation, postischemic dilation, and passive structure of MCAs were assessed by pressure myography. Cerebral ischemia was induced by MCA occlusion (MCAO). Myogenic tone was unchanged, but MCAs from SHRSP + ETN had larger passive lumen diameter and reduced wall thickness and wall-to-lumen ratio. Cerebral infarct size was increased in SHRSP + ETN after transient MCAO, despite an improvement in dilation of nonischemic MCA. The increase in infarct size was linked to a reduction in the number of microglia in the infarct core and upregulation of markers of classical macrophage/microglia polarization. There was no difference in infarct size after permanent MCAO or when untreated SHRSP subjected to transient MCAO were given ETN at reperfusion. Our data suggests that TNF-α inhibition attenuates hypertensive MCA remodeling but exacerbates cerebral damage following ischemia/reperfusion injury likely due to inhibition of the innate immune response of the brain.

  17. Automatic labeling of cerebral arteries in magnetic resonance angiography.

    PubMed

    Dunås, Tora; Wåhlin, Anders; Ambarki, Khalid; Zarrinkoob, Laleh; Birgander, Richard; Malm, Jan; Eklund, Anders

    2016-02-01

    In order to introduce 4D flow magnetic resonance imaging (MRI) as a standard clinical instrument for studying the cerebrovascular system, new and faster postprocessing tools are necessary. The objective of this study was to construct and evaluate a method for automatic identification of individual cerebral arteries in a 4D flow MRI angiogram. Forty-six elderly individuals were investigated with 4D flow MRI. Fourteen main cerebral arteries were manually labeled and used to create a probabilistic atlas. An automatic atlas-based artery identification method (AAIM) was developed based on vascular-branch extraction and the atlas was used for identification. The method was evaluated by comparing automatic with manual identification in 4D flow MRI angiograms from 67 additional elderly individuals. Overall accuracy was 93%, and internal carotid artery and middle cerebral artery labeling was 100% accurate. Smaller and more distal arteries had lower accuracy; for posterior communicating arteries and vertebral arteries, accuracy was 70 and 89%, respectively. The AAIM enabled fast and fully automatic labeling of the main cerebral arteries. AAIM functionality provides the basis for creating an automatic and powerful method to analyze arterial cerebral blood flow in clinical routine.

  18. Cryptic Recanalization of Chronic Vertebral Artery Occlusion by Head Rotation.

    PubMed

    Yagi, Kenji; Nakagawa, Hiroshi; Mure, Hideo; Okita, Shinya; Nagahiro, Shinji

    2017-04-01

    Chronic vertebral artery occlusion (VAO) can be associated with ischemic stroke, as thrombi formed under blood flow stagnation around the stump of the VAO may migrate into the brain. We report a new mechanism of chronic VAO-associated ischemic stroke and a patient with cryptic recanalization of chronic VAO by head rotation. A 74-year-old man presented with chronic right VAO and repeated ischemic embolic stroke in the posterior circulation despite antiplatelet therapy. He also manifested vertigo with 30° leftward head rotation, indicative of rotational vertebrobasilar insufficiency due to mechanical compression of the patent left vertebral artery (VA) at the C4-C5 level. Surgical decompression of the vessel via the anterior approach resulted in the disappearance of his rotational vertebrobasilar insufficiency. Adequate decompression of the VA on the left side was confirmed on postoperative computed tomography angiography scans obtained with his head rotated more to the left than on preoperative scans. Unexpected partial recanalization of his right chronic VAO was observed at the C5-C6 level. VAO was due to VA compression by osteophytes at neutral head position; it was released by head rotation. We suspected that his repeated brain infarcts were attributable to head rotation-related opening and closing of the VA lumen and these decompressed the left VA by removing the implicated osteophyte via the anterior approach. Cryptic recanalization of chronic VAO by head rotation contributed to repeated infarcts in the posterior circulation and was resolved by surgical decompression. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  19. Monitoring cerebral tissue oxygen saturation at frontal and parietal regions during carotid artery stenting.

    PubMed

    Meng, Lingzhong; Hall, Melanie; Settecase, Fabio; Higashida, Randall T; Gelb, Adrian W

    2016-04-01

    Cerebral oximetry is normally placed on the upper forehead to monitor the frontal lobe cerebral tissue oxygen saturation (SctO2). We present a case in which the SctO2 was simultaneously monitored at both frontal and parietal regions during internal carotid artery (ICA) stenting. Our case involves a 79-year-old man who presented after a sudden fall and was later diagnosed with a watershed ischemic stroke in the distal fields perfused by the left middle cerebral artery. He had diffuse atherosclerotic occlusive lesions in the carotid and cerebral arterial systems including an 85 % stenotic lesion in the left distal cervical ICA. The brain territory perfused by the left ICA was devoid of collateral flow from anterior and posterior communicating arteries due to an abnormal circle of Willis. During stenting, the SctO2 monitored at both frontal and parietal regions tracked the procedure-induced acute flow change. However, the baseline SctO2 values of frontal and parietal regions differed. The SctO2-MAP correlation was more consistent on the stroked hemisphere than the non-stroked hemisphere. This case showed that SctO2 can be reliably monitored at the parietal region, which is primarily perfused by the ICA. SctO2 of the stroked brain is more pressure dependent than the non-stroked brain.

  20. Necrotizing Fasciitis of the Periorbital Region Complicated by Combined Central Retinal Artery Occlusion, Central Retinal Vein Occlusion, and Posterior Ciliary Occlusion.

    PubMed

    Sultan, Harris; Malik, Amina; Li, Helen K; Chévez-Barrios, Patricia; Lee, Andrew G

    A 50 year-old man on immunosuppressive agents presented with left eye vision loss, periorbital swelling, pain, and ophthalmoplegia. The patient was clinically found to have a central retinal artery and vein occlusion. A CT scan was performed which demonstrated intraorbital fat stranding, however the patient lacked sinus disease. The etiology of the orbital infection was held in question. The area was debrided in the operating room, and the specimen demonstrated group A streptococcal species consistent with necrotizing fasciitis. Periorbital necrotizing fasciitis should be suspected in patients with rapidly progressive orbital symptoms without sinus disease as lack of surgical intervention can result in poor outcomes. The unusual aspect to this case is the mechanism of vision loss, as the authors hypothesize that there was vascular infiltration of the infection resulting in the central retinal artery occlusion and central retinal vein occlusion which have not been previously reported secondary to necrotizing fasciitis of the orbit.

  1. Cerebral vasospasm affects arterial critical closing pressure

    PubMed Central

    Varsos, Georgios V; Budohoski, Karol P; Czosnyka, Marek; Kolias, Angelos G; Nasr, Nathalie; Donnelly, Joseph; Liu, Xiuyun; Kim, Dong-Joo; Hutchinson, Peter J; Kirkpatrick, Peter J; Varsos, Vassilis G; Smielewski, Peter

    2015-01-01

    The effect of cerebral vasospasm (CVS) after aneurysmal subarachnoid hemorrhage (SAH) on critical closing pressure (CrCP) has not been fully delineated. Using cerebral impedance methodology, we sought to assess the behavior of CrCP during CVS. As CrCP expresses the sum of intracranial pressure (ICP) and vascular wall tension, we also explored its role in reflecting changes in vascular tone occurring in small vessels distal to spasm. This retrospective analysis was performed using recordings from 52 patients, diagnosed with CVS through transcranial Doppler measurements. Critical closing pressure was calculated noninvasively using arterial blood pressure and blood flow velocity. Outcome was assessed at both discharge and 3 months after ictus with the Glasgow Outcome Scale. The onset of CVS caused significant decreases in CrCP (P=0.025), without any observed significant changes in ICP (P=0.134). Vasospasm induced asymmetry, with CrCP ipsilateral to CVS becoming significantly lower than contralateral (P=0.025). Unfavorable outcomes were associated with a significantly lower CrCP after the onset of CVS (discharge: P=0.014; 3 months after SAH: P=0.020). Critical closing pressure is reduced in the presence of CVS in both temporal and spatial assessments. As ICP remained unchanged during CVS, reduced CrCP most probably reflects a lower wall tension in dilated small vessels distal to spasm. PMID:25465041

  2. Bilateral renal artery occlusion in a patient with primary antiphospholipid antibody syndrome: thrombosis, vasculitis or both?

    PubMed

    Ames, P R; Cianciaruso, B; Bellizzi, V; Balletta, M; Lubrano, E; Scarpa, R; Brancaccio, V

    1992-11-01

    A 43-year-old man presented with oliguria and hypertension. Renal arteriography showed bilateral renal artery occlusion. Circulating antiphospholipid antibodies were found together with a change in natural anticoagulant plasma levels. Immunofluorescence of examined vessels showed immune complex vasculitis. We discuss the pathogenetic mechanism leading to the development of this rare occlusive event.

  3. Preservation of retinal structure and function after cilioretinal artery occlusion: a case report

    PubMed Central

    Brown, Craig J

    2016-01-01

    Cilioretinal artery occlusion is a cause of sudden, often catastrophic loss of central vision. There are no established effective treatments. Recently, a patient presented 24 hours after a cilioretinal artery occlusion, following a cardiac catheterization prior to which her blood thinners had been discontinued. Lacking an effective way to address the severe retinal ischemic oxidative stress, she was offered, under compassionate use, a multivitamin complex designed to address retinal ischemia and oxidative stress. Significant components of this product are L-methylfolate and n-acetyl cysteine. The patient experienced a rapid unexpected improvement in vision and preservation of retinal structure, suggesting that marked improvement in retinal artery occlusions outcomes may be possible as late as 24 hours postocclusion. This is the third reported case of cilioretinal artery occlusion associated with cardiac catheterization. PMID:26929671

  4. Basilar artery occlusion: Prognostic signs of severity on computed tomography.

    PubMed

    Poletti, Pierre-Alexandre; Pereira, Vitor Mendes; Lovblad, Karl-Olof; Canel, Lucie; Sztajzel, Roman; Becker, Minerva; Perneger, Thomas; Platon, Alexandra

    2015-07-01

    To determine the computed tomography (CT) signs that are predictive of the clinical outcome of basilar artery occlusion (BAO). The study population consisted in 37 patients (14 women, 23 men, mean age: 63 years), admitted with onset of neurological deficit, starting 1-72 h prior to admission, who were diagnosed with BAO on the basis of a CT examination with intravenous contrast agent. The following signs were collected on CT scans performed on admission: clot density on noncontrast images, clot length, and clot location, as well as the presence of acute ischemic lesions. The results were compared against the modified Rankin Scale (mRS) score of patients at 3 months, favorable clinical outcome being defined as a mRS score ≤3. The clinical outcome was favorable in 13 (35%) of the 37 patients and unfavorable in 24 (65%). Signs of acute ischemia were visible in 13 of the 24 patients with unfavorable outcome but in none of the 13 patients with favorable outcome (p<0.001). None of the other CT signs analyzed were significantly correlated with clinical prognosis. Of all the CT signs analyzed, only the presence of signs of acute ischemia on the admission CT of patients with BAO was associated with poor prognosis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. Principles of conservative treatment of occlusive arterial disease.

    PubMed

    Coffman, J D

    1983-01-01

    Conservative medical treatment is indicated for patients who have stable symptoms of intermittent claudication without rest symptoms or signs, rapidly progressive disease, or disability interfering with gainful employment (see Fig. 1). Valuable general measures include meticulous care of the limbs, avoidance of trauma and infections, and maintenance of normal body weight. Cessation of tobacco smoking is extremely important, and a regimented exercise program is therapeutically beneficial (see Table 1). The high risk factors of diabetes mellitus and hypertension should be controlled. Hyperlipoproteinemia should be treated if present, but it is currently not known if treatment of elevated cholesterol or triglyceride levels prevents progression of or reverses the disease process. If a recent arterial occlusion is suspected, fibrinolytic therapy can be expected to benefit approximately one third of the patients. Anticoagulants and vasodilator drugs have not been shown to be of value. In patients with rest symptoms or signs, who are not candidates for surgical revascularization of the limb, bed rest with dependency of the limb in a warm environment, good foot care, and analgesics are most important. Ulcers should be treated with wet dressings to preserve granulation tissue, and parenteral antibiotics are used if infection is present. When rest symptoms or trophic lesions have disappeared or improved, the patient may be gradually ambulated but should continue to sleep with the head of the bed elevated and should maintain meticulous foot care.

  6. Occlusion of the left main coronary artery and collateral circulation via the conus branch.

    PubMed

    de Agustin, Jose Alberto; Nunez-Gil, Ivan Javier; del Carmen Manzano, Maria; Vivas, David; Mateos, Borja Ruiz; Carda, Rocio; Vilacosta, Isidre; Zamorano, Jose Luis; Macaya, Carlos

    2009-05-01

    We report the case of a 71-year-old-man, a smoker, admitted for unstable angina. Subsequent investigation revealed complete proximal occlusion of the left main coronary with an unusual collateral circulation. The left coronary artery was filled by a large conus branch originating from the right sinus of Valsalva. This case shows the importance of looking for atypical collateral circulation in patients with chronic occlusion of the left main coronary artery and normal left ventricular function.

  7. Color-Coded Digital Subtraction Angiography in the Management of a Rare Case of Middle Cerebral Artery Pure Arterial Malformation

    PubMed Central

    Feliciano, Caleb E; Pamias-Portalatin, Eva; Mendoza-Torres, Jorge; Effio, Euclides; Moran, Yadira; Rodriguez-Mercado, Rafael

    2014-01-01

    Summary The advent of flow dynamics and the recent availability of perfusion analysis software have provided new diagnostic tools and management possibilities for cerebrovascular patients. To this end, we provide an example of the use of color-coded angiography and its application in a rare case of a patient with a pure middle cerebral artery (MCA) malformation. A 42-year-old male chronic smoker was evaluated in the emergency room due to sudden onset of severe headache, nausea, vomiting and left-sided weakness. Head computed tomography revealed a right basal ganglia hemorrhage. Cerebral digital subtraction angiography (DSA) showed a right middle cerebral artery malformation consisting of convoluted and ectatic collateral vessels supplying the distal middle cerebral artery territory-M1 proximally occluded. An associated medial lenticulostriate artery aneurysm was found. Brain single-photon emission computed tomography with and without acetazolamide failed to show problems in vascular reserve that would indicate the need for flow augmentation. Twelve months after discharge, the patient recovered from the left-sided weakness and did not present any similar events. A follow-up DSA and perfusion study using color-coded perfusion analysis showed perforator aneurysm resolution and adequate, albeit delayed perfusion in the involved vascular territory. We propose a combined congenital and acquired mechanism involving M1 occlusion with secondary dysplastic changes in collateral supply to the distal MCA territory. Angiographic and cerebral perfusion work-up was used to exclude the need for flow augmentation. Nevertheless, the natural course of this lesion remains unclear and long-term follow-up is warranted. PMID:25496681

  8. Nettleship collaterals: circumpapillary cilioretinal anastomoses after occlusion of the central retinal artery.

    PubMed

    Ragge, N K; Hoyt, W F

    1992-03-01

    In extremely rare cases, after occlusion of the central retinal artery, a complete ring of peripapillary anastomotic channels develops. One such case is described and a proposed term given to these channels--'Nettleship collaterals'--after the man who first described them. These collaterals are dilated pathways within the terminal capillary networks of the posterior ciliary arteries and the branches of the central retinal artery. Formation of the channels is believed to be promoted by prelaminar obstruction of the central retinal artery.

  9. Venous stasis retinopathy in symptomatic carotid artery occlusion: prevalence, cause, and outcome.

    PubMed

    Klijn, Catharina J M; Kappelle, L Jaap; van Schooneveld, Mary J; Hoppenreijs, Vincent P T; Algra, Ale; Tulleken, Cornelis A F; van Gijn, Jan

    2002-03-01

    Chronic ocular ischemia is a rare form of ischemia of the eye in patients with carotid artery occlusion (CAO). The early and often asymptomatic stage of chronic ocular ischemia is referred to as venous stasis retinopathy (VSR). The aim of this study was to gain insight into the prevalence, cause, and outcome of VSR in patients with symptomatic CAO. In 110 patients with symptomatic CAO, we prospectively investigated the frequency of VSR, the association between the presence of VSR and impaired cerebral blood flow, and the proportion of patients who developed clinically manifest chronic ocular ischemia with ischemia of the anterior eye segment or blindness. At study entry, VSR was found in 32 patients (29%; 95% CI, 21 to 38), particularly in those with symptoms classically associated with a hemodynamic cause, such as limb shaking (relative risk, 2.4; 95% CI, 1.0 to 5.9). Patients with VSR had lower pulsatility indexes in the ophthalmic artery in case of reversed flow, lower cerebral CO2 reactivity, and lower cerebropetal blood flow than patients without VSR. On follow-up (mean, 29 months), clinically manifest chronic ocular ischemia developed in 4 patients (annual rate, 1.5%; 95% CI, 0.4 to 3.8); it tended to occur more often in patients in whom VSR was present at study entry (relative risk, 7.3; 95% CI, 0.8 to 68). One third of patients with symptomatic CAO has VSR on ophthalmoscopy. VSR is associated with an impaired flow state of the brain. Development of clinically manifest chronic ocular ischemia is rare.

  10. Endovascular Treatment of Giant Serpentine Aneurysm of the Middle Cerebral Artery

    PubMed Central

    Jeong, Young Ha; Koo, Youn Moo; Choi, Jong Wook; Whang, Kum; Hu, Chul; Cho, Sung Min

    2016-01-01

    Giant serpentine aneurysms are uncommon types of aneurysmal disease and have angiographically authentic features. We report a case of a 44-year-old male with headache and seizure. He presented a giant serpentine aneurysm arising from the middle cerebral artery (MCA). It was a large intracranial aneurysm thrombosed as a mass-like lesion while it maintained its outflow drainage into the distal MCA branches. The balloon occlusion test (BOT) was performed to test the tolerance of temporary collateral circulation. Following routine cerebral angiography, we performed an endovascular embolization on the proximal artery of MCA. He was discharged from the hospital with alert mental status and mild Gerstmann syndrome. The short-term follow-up imaging studies showed the decreased mass effect, and the patient presented an improved Gerstmann syndrome. After a careful evaluation of BOT, an endovascular embolization can be one of the powerful therapeutic instruments for giant serpentine aneurysm. PMID:27847772

  11. Genetic modification of cerebral arterial wall: implications for prevention and treatment of cerebral vasospasm.

    PubMed

    Vijay, Anantha; Santhanam, R; Katusic, Zvonimir S

    2006-10-01

    Genetic modification of cerebral vessels represents a promising and novel approach for prevention and/or treatment of various cerebral vascular disorders, including cerebral vasospasm. In this review, we focus on the current understanding of the use of gene transfer to the cerebral arteries for prevention and/or treatment of cerebral vasospasm following subarachnoid hemorrhage (SAH). We also discuss the recent developments in vascular therapeutics, involving the autologous use of progenitor cells for repair of damaged vessels, as well as a cell-based gene delivery approach for the prevention and treatment of cerebral vasospasm.

  12. Neuroprotective effect of nobiletin on cerebral ischemia-reperfusion injury in transient middle cerebral artery-occluded rats.

    PubMed

    Yasuda, Nodoka; Ishii, Takayuki; Oyama, Dai; Fukuta, Tatsuya; Agato, Yurika; Sato, Akihiko; Shimizu, Kosuke; Asai, Tomohiro; Asakawa, Tomohiro; Kan, Toshiyuki; Yamada, Shizuo; Ohizumi, Yasushi; Oku, Naoto

    2014-04-22

    Nobiletin, a citrus polymethoxylated flavone, is reported to possess various pharmacological activities such as anticancer, anti-inflammation, and antioxidant effects. Recently, nobiletin was shown to provide therapeutic benefit for the treatment of Alzheimer׳s disease by activating cAMP-response element-binding protein (CREB). In the present study, we investigated whether nobiletin could protect the brain against ischemia-reperfusion (I/R) injury and improve functional outcome in cerebral I/R model rats, since CREB activation is known to protect neuronal cells in cerebral ischemia. Nobiletin was injected twice at 0 and 1h after the start of reperfusion in transient middle cerebral artery occlusion (t-MCAO) rats. Cerebral I/R induced prominent brain damage in the ischemic hemisphere of t-MCAO rat brains; however, nobiletin treatment significantly reduced the infarct volume and suppressed the brain edema. Immunohistochemical and TUNEL staining indicated that nobiletin treatment significantly suppressed neutrophil invasion into the ischemic region and significantly decreased apoptotic brain cell death in ischemic hemisphere, suggesting that the anti-inflammatory effect and anti-apoptotic effect should be regarded as the neuroprotective mechanism of nobiletin. Moreover, nobiletin treatment ameliorated motor functional deficits in the ischemic rats compared with those deficits of the vehicle-treated group. These results indicate that nobiletin is a potential neuroprotectant for the treatment of cerebral I/R injury.

  13. Acute basilar artery occlusion in the Basilar Artery International Cooperation Study: does gender matter?

    PubMed

    Arnold, Marcel; Fischer, Urs; Compter, Annette; Gralla, Jan; Findling, Oliver; Mattle, Heinrich P; Kappelle, L Jaap; Tanne, David; Algra, Ale; Schonewille, Wouter J

    2010-11-01

    Randomized trials suggested a different benefit of intravenous thrombolysis (IVT) and intra-arterial thrombolysis (IAT) between men and women with anterior circulation stroke because of a worse outcome of women in the control group. We compared outcome and recanalization in men and women with basilar artery occlusion treated with antithrombotic treatment alone, IVT or combined IVT-IAT, or IAT in the Basilar Artery International Cooperation Study. Overall, 389 male and 226 female patients were analyzed. In the antithrombotic treatment group, 68 of 111 (61%) men and 47 of 70 (67%) women had a poor outcome defined as a modified Rankin Scale score of 4 to 6 (adjusted risk ratio [aRR], 0.96; 95% CI, 0.75 to 1.24), in the IVT/combined IVT-IAT group, 47 of 77 (61%) men and 24 of 43 (56%) women (aRR, 1.19; 95% CI, 0.89 to 1.60), and in the IAT group, 142 of 185 (77%) men and 71 of 102 (70%) women (aRR, 1.01; 95% CI, 0.88 to 1.17). Mortality was not different between men and women in the antithrombotic treatment group (aRR, 0.80; 95% CI, 0.55 to 1.16), the IVT/combined IVT-IAT group (aRR, 1.11; 95% CI, 0.72 to 1.73), or in the IAT group (aRR, 1.01; 95% CI, 0.75 to 1.36). Insufficient recanalization after combined IVT-IAT or IAT was similar in men and women (23% versus 22%; aRR, 0.92; 95% CI, 0.58 to 1.46). In patients with acute basilar artery occlusion, no significant gender differences for outcome and recanalization were observed, regardless of treatment modality.

  14. Carotid Artery Stenting in a Patient with Spontaneous Recanalization of a Proximal Internal Carotid Artery Occlusion: a Case Report

    PubMed Central

    Koh, Jun Seok; Choi, Woo Suk

    2006-01-01

    We report here on a rare case of carotid artery angioplasty and stenting in a patient with spontaneous recanalization after complete occlusion of the proximal internal carotid artery (ICA). The patient initially showed severe stenosis at the left proximal ICA on MR angiography (MRA). Digital subtraction angiography (DSA) performed three days after MRA showed complete occlusion of the proximal ICA. The follow-up DSA after four weeks showed recanalization of the ICA, and then carotid artery stenting was successfully performed. There has been no neurologic complication during more than one year follow-up. PMID:17143034

  15. Application of transcranial cerebral oxygen monitoring during the balloon occlusion test

    NASA Astrophysics Data System (ADS)

    Alp, M. Serdar; Dujovny, Manuel; Aletich, Victor; Misra, Mukesh; Debrun, Gerard; Ausman, James I.

    1997-08-01

    The purpose of this paper is to evaluate the value of transcranial cerebral oximeter in combination with other monitoring techniques during the balloon occlusion test. In this study 22 patients underwent balloon occlusion testing and were monitored by neurological examination, electroencephalography, transcranial Doppler, and transcranial cerebral oximetry. Eighteen patients had an intracranial aneurysm and four patients had skull base meningiomas. Seventeen patients passed the test without any symptoms. One patient underwent extracranial-intracranial by-pass surgery after failing the first test and passed the second test after the treatment. Transcranial cerebral oximeter showed 10% or less decrease in rSO2 in patients who passed the test and 10% or higher decrease in rSO2 for more than one minute in patients who failed. Electroencephalography and cerebral oximetry are found to be the most dependable monitoring methods for predicting neurological deficits after balloon inflation. Transcranial cerebral oximeter has provided non- invasive monitoring with real-time quantitative information and it was very useful during the balloon occlusion test.

  16. Traumatically induced vertebral artery occlusion associated with cervical spine injuries: prospective study using magnetic resonance angiography.

    PubMed

    Taneichi, Hiroshi; Suda, Kota; Kajino, Tomomichi; Kaneda, Kiyoshi

    2005-09-01

    A prospective study using magnetic resonance angiography (MRA) on a consecutive cohort of patients with cervical spine injuries. To investigate clinical and radiographic features of vertebral artery injury/occlusion associated with nonpenetrating cervical spine trauma. With the popularization of MRA, vertebral artery injury has been a common complication of cervical spine trauma. However, detailed clinical features such as restoration of blood flow in occluded vessels and collateral circulation have not been fully evaluated. During a 2-year period, 64 consecutive patients with cervical spine fractures and/or dislocations were prospectively evaluated for patency of the vertebral artery and collateral circulation. Extracranial and intracranial MRAs were conducted at initial injury and follow-up. Vertebral artery occlusion occurred in 11 patients, including 10 with unilateral and 1 with bilateral. Only the patient with bilateral occlusion was symptomatic but had no permanent neurologic deficit as a result of brain ischemia. He had complete circle of Willis, which provides sufficient collateral blood supply from anterior circulation. Follow-up MRAs revealed restoration of blood flow in occluded vessel(s) in 3 patients. All of them had compressive injuries. The incidence of traumatically induced vertebral artery occlusion was 17.2%. The potential for blood flow restoration was higher in compressive injuries than in distractive injuries. The mechanism of occlusion in compressive injuries is likely to be vasospasm or minor artery dissection, which may cause reversible occlusion because vessels are subjected to relatively minor stretching in compressive injuries. Vertebral artery occlusion was rarely symptomatic because of sufficient collateral blood supply through not only contralateral vertebral artery but also the circle of Willis.

  17. Management of acute central retinal artery occlusion: Intravenous thrombolysis is feasible and safe.

    PubMed

    Préterre, Cécile; Godeneche, Gaelle; Vandamme, Xavier; Ronzière, Thomas; Lamy, Matthias; Breuilly, Christophe; Urbanczyk, Cédric; Wolff, Valérie; Lebranchu, Pierre; Sevin-Allouet, Mathieu; Guillon, Benoit

    2017-01-01

    Background Although acute central retinal artery occlusion is as a stroke in the carotid territory (retinal artery), its management remains controversial. The aim of this study was to assess the feasibility and safety of intravenous thrombolysis delivered within 6 h of central retinal artery occlusion in French stroke units. Methods We performed a retrospective analysis of patients treated with intravenous alteplase (recombinant tissue-plasminogen activator), based on stroke units thrombolysis registers from June 2005 to June 2015, and we selected those who had acute central retinal artery occlusion. The feasibility was assessed by the ratio of patients that had received intravenous alteplase within 6 h after central retinal artery occlusion onset among those who had been admitted to the same hospital for acute central retinal artery occlusion. All adverse events were documented. Results Thirty patients were included. Visual acuity before treatment was limited to "hand motion", or worse, in 90% of the cases. The mean onset-to-needle time was 273 min. The individuals treated with intravenous alteplase for central retinal artery occlusion represented 10.2% of all of the patients hospitalized for central retinal artery occlusion in 2013 and 2014. We observed one occurrence of major bleeding, a symptomatic intracerebral hemorrhage. Conclusion When applied early on, intravenous thrombolysis appears to be feasible and safe, provided that contraindications are given due consideration. Whether intravenous thrombolysis is more effective than conservative therapy remains to be determined. In order to conduct a well-designed prospective randomized control trial, an organized network should be in place.

  18. Assessment of gene expression profiles in peripheral occlusive arterial disease.

    PubMed

    Bubenek, Serban; Nastase, Anca; Niculescu, Ana Maria; Baila, Sorin; Herlea, Vlad; Lazar, Vadimir; Paslaru, Liliana; Botezatu, Anca; Tomescu, Dana; Popescu, Irinel; Dima, Simona

    2012-01-01

    Molecular events responsible for the onset and progression of peripheral occlusive arterial disease (POAD) are incompletely understood. Gene expression profiling may point out relevant features of the disease. Tissue samples were collected as operatory waste from a total of 36 patients with (n = 18) and without (n = 18) POAD. The tissues were histologically evaluated, and the patients with POAD were classified according to Leriche-Fontaine (LF) classification: 11% with stage IIB, 22% with stage III, and 67% with stage IV. Total RNA was isolated from all samples and hybridized onto Agilent 4×44K Oligo microarray slides. The bioinformatic analysis identified genes differentially expressed between control and pathologic tissues. Ten genes with a fold change ≥ 2 (1 with a fold change ≥ 1.8) were selected for quantitative polymerase chain reaction validation (GPC3, CFD, GDF10, ITLN1, TSPAN8, MMP28, NNMT, SERPINA5, LUM, and FDXR). C-reactive protein (CRP) was assessed with a specific assay, while nicotinamide N-methyltransferase (NNMT) was evaluated in the patient serum by enzyme-linked immunosorbent assay. A multiple regression analysis showed that the level of CRP in the serum is correlated with the POAD LF stages (r(2) = 0.22, P = 0.046) and that serum NNMT is higher in IV LF POAD patients (P = 0.005). The mRNA gene expression of LUM is correlated with the LF stage (r(2) = 0.45, P = 0.009), and the mRNA level of ITLN1 is correlated with the ankle-brachial index (r(2) = 0.42, P = 0.008). Our analysis shows that NNMT, ITLN1, LUM, CFD, and TSPAN8 in combination with other known markers, such as CRP, could be evaluated as a panel of biomarkers of POAD. Copyright © 2012 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  19. Leptospirosis and Peripheral Artery Occlusive Disease: A Nationwide Cohort Analysis.

    PubMed

    Chiu, Chun-Hsiang; Lin, Cheng-Li; Lee, Feng-You; Wang, Ying-Chuan; Kao, Chia-Hung

    2016-03-01

    Data on the association between peripheral artery occlusive disease (PAOD) and leptospirosis are limited. We conducted a retrospective cohort study for determining whether leptospirosis is one of the possible risk factors for PAOD. Patients diagnosed with leptospirosis by using 2000 to 2010 data from the Taiwan National Health Insurance Research Database. Patients with leptospirosis without a history of PAOD were selected. For each leptospirosis patient, 4 controls without a history of leptospirosis and PAOD were randomly selected and frequency-matched for sex, age, the year of the index date, and comorbidity diseases. The follow-up period was from the time of the initial diagnosis of leptospirosis to the diagnosis date of PAOD, or December 31, 2011. The Cox proportional hazard regression models were used for analyzing the risk of PAOD. During the follow-up period, the cumulative incidence of PAOD was higher among the patients from the leptospirosis cohort than among the nonleptospirosis cohort (log-rank test, P < 0.001). In total, 29 patients with PAOD from the leptospirosis cohort and 81 from the nonleptospirosis cohort were observed with the incidence rates of 2.1 and 1.3 per 1000 person-years, respectively, yielding a crude hazards ratio (HR) of 1.62 (95% confidence interval [CI] = 1.44-1.81) and adjusted HR (aHR) of 1.75 (95% CI = 1.58-1.95).The risk of PAOD was 1.75-fold higher in the patients with leptospirosis than in the general population.

  20. Clinical and radiological predictors of recanalisation and outcome of 40 patients with acute basilar artery occlusion treated with intra-arterial thrombolysis

    PubMed Central

    Arnold, M; Nedeltchev, K; Schroth, G; Baumgartner, R; Remonda, L; Loher, T; Stepper, F; Sturzenegger, M; Schuknecht, B; Mattle, H

    2004-01-01

    Objective: To define predictors of recanalisation and clinical outcome of patients with acute basilar artery occlusions treated with local intra-arterial thrombolysis (IAT). Methods: Vascular risk factors, severity of the neurological deficit graded by the National Institutes of Health stroke scale (NIHSS), and radiological findings were recorded at presentation. Outcome was measured using the modified Rankin scale (mRS) three months later and categorised as favourable (mRS 0–2), poor (mRS 3–5), or death (mRS 6). Results: 40 patients were studied. Median NIHSS on admission was 18. Mean time from symptom onset to treatment was 5.5 hours (range 2.3 to 11). Outcome was favourable in 14 patients (35%) and poor in nine (23%); 17 (42%) died. There were two symptomatic cerebral haemorrhages (5%). Recanalisation of the basilar artery was achieved in 32 patients (80%); it was complete (TIMI grade 3) in 20% and partial (TIMI grade 2) in 60%. In multivariate logistic regression analysis, low NIHSS score on admission (p = 0.002) and vessel recanalisation (p = 0.005) were independent predictors of favourable outcome. Recanalisation occurred more often with treatment within six hours of symptom onset (p = 0.003) and when admission computed tomography showed a hyperdense basilar artery sign (p = 0.007). In a univariate model, quadriplegia (p = 0.002) and coma (p = 0.004) were associated with a poor outcome or death. Conclusions: Low baseline NIHSS on admission and recanalisation of basilar artery occlusions predict a favourable outcome after intra-arterial thrombolysis. Early initiation of IAT and the presence of a hyperdense basilar artery sign on CT were associated with a higher likelihood of recanalisation. PMID:15146000

  1. Retinal Arterial Occlusive Disease in a Young Patient with Cat Scratch Disease

    PubMed Central

    Batsos, Georgios; Kabanarou, Stamatina A.; Fotiou, Pantelis; Rouvas, Alexandros; Xirou, Tina

    2013-01-01

    Purpose To report an unusual case of a branch retinal arterial occlusion and bilateral multifocal retinitis in a young woman with cat scratch disease. Methods A 23-year-old woman was referred to our clinic complaining of a sudden scotoma in the upper part of the visual field of her left eye. Fundoscopy revealed occlusion of an inferior temporal branch of the retinal artery in the left eye and bilateral multifocal retinitis, which was confirmed by fluorescein angiography. Subsequent indocyanine angiography did not reveal choroidal involvement. Laboratory analysis showed rising IgG titers for Bartonella henselae. Results Cat scratch disease was diagnosed, and a 4-week course of doxycycline was initiated. The patient responded well to the antibiotics. Both retinitis and arterial occlusion were resolved, the visual field was regained and the patient reported elimination of her symptoms. Conclusions Cat scratch disease should be considered in the differential diagnosis in young patients with retinal occlusive disease. PMID:24019792

  2. Retinal arterial occlusive disease in a young patient with cat scratch disease.

    PubMed

    Batsos, Georgios; Kabanarou, Stamatina A; Fotiou, Pantelis; Rouvas, Alexandros; Xirou, Tina

    2013-01-01

    To report an unusual case of a branch retinal arterial occlusion and bilateral multifocal retinitis in a young woman with cat scratch disease. A 23-year-old woman was referred to our clinic complaining of a sudden scotoma in the upper part of the visual field of her left eye. Fundoscopy revealed occlusion of an inferior temporal branch of the retinal artery in the left eye and bilateral multifocal retinitis, which was confirmed by fluorescein angiography. Subsequent indocyanine angiography did not reveal choroidal involvement. Laboratory analysis showed rising IgG titers for Bartonella henselae. Cat scratch disease was diagnosed, and a 4-week course of doxycycline was initiated. The patient responded well to the antibiotics. Both retinitis and arterial occlusion were resolved, the visual field was regained and the patient reported elimination of her symptoms. Cat scratch disease should be considered in the differential diagnosis in young patients with retinal occlusive disease.

  3. Fermented soybeans, Chungkookjang, prevent hippocampal cell death and β-cell apoptosis by decreasing pro-inflammatory cytokines in gerbils with transient artery occlusion.

    PubMed

    Park, Sunmin; Kim, Da Sol; Kang, Sunna; Moon, Bo Reum

    2016-02-01

    Since Chungkookjang, a short-term fermented soybean, is known to improve glucose metabolism and antioxidant activity, it may prevent the neurological symptoms and glucose disturbance induced by artery occlusion. We investigated the protective effects and mechanisms of traditional (TFC) and standardized Chungkookjang fermented with Bacillus licheniformis (BLFC) against ischemia/reperfusion damage in the hippocampal CA1 region and against hyperglycemia after transient cerebral ischemia in gerbils. Gerbils were subjected to either an occlusion of the bilateral common carotid arteries for 8 min to render them ischemic or a sham operation. Ischemic gerbils were fed either a 40% fat diet containing 10% of either cooked soybean (CSB), TFC, or BLFC for 28 days. Neuronal cell death and cytokine expression in the hippocampus, neurological deficit, serum cytokine levels, and glucose metabolism were measured. TFC and BLFC contained more isoflavonoid aglycones than CSB. Artery occlusion increased the expressions of IL-1β and TNF-α as well as cell death in the hippocampal CA1 region and induced severe neurological symptoms. CSB, TFC, and BLFC prevented the neuronal cell death and the symptoms such as dropped eyelid, bristling hair, reduced muscle tone and flexor reflex, and abnormal posture and walking patterns, and suppressed cytokine expressions. CSB was less effective than TFC and BLFC. Artery occlusion induced glucose intolerance due to decreased insulin secretion and β-cell mass. TFC and BLFC prevented the impairment of glucose metabolism by artery occlusion. Especially TFC and BLFC increased β-cell proliferation and suppressed the β-cell apoptosis by suppressing TNF-α and IL-1β which in turn decreased cleaved caspase-3 that caused apoptosis. In conclusion, TFC and BLFC may prevent and alleviate neuronal cell death in the hippocampal CA1 region and neurological symptoms and poststroke hyperglycemia in gerbils with artery occlusion. This might be associated with

  4. Fermented soybeans, Chungkookjang, prevent hippocampal cell death and β-cell apoptosis by decreasing pro-inflammatory cytokines in gerbils with transient artery occlusion

    PubMed Central

    Park, Sunmin; Kim, Da Sol; Moon, Bo Reum

    2015-01-01

    Since Chungkookjang, a short-term fermented soybean, is known to improve glucose metabolism and antioxidant activity, it may prevent the neurological symptoms and glucose disturbance induced by artery occlusion. We investigated the protective effects and mechanisms of traditional (TFC) and standardized Chungkookjang fermented with Bacillus licheniformis (BLFC) against ischemia/reperfusion damage in the hippocampal CA1 region and against hyperglycemia after transient cerebral ischemia in gerbils. Gerbils were subjected to either an occlusion of the bilateral common carotid arteries for 8 min to render them ischemic or a sham operation. Ischemic gerbils were fed either a 40% fat diet containing 10% of either cooked soybean (CSB), TFC, or BLFC for 28 days. Neuronal cell death and cytokine expression in the hippocampus, neurological deficit, serum cytokine levels, and glucose metabolism were measured. TFC and BLFC contained more isoflavonoid aglycones than CSB. Artery occlusion increased the expressions of IL-1β and TNF-α as well as cell death in the hippocampal CA1 region and induced severe neurological symptoms. CSB, TFC, and BLFC prevented the neuronal cell death and the symptoms such as dropped eyelid, bristling hair, reduced muscle tone and flexor reflex, and abnormal posture and walking patterns, and suppressed cytokine expressions. CSB was less effective than TFC and BLFC. Artery occlusion induced glucose intolerance due to decreased insulin secretion and β-cell mass. TFC and BLFC prevented the impairment of glucose metabolism by artery occlusion. Especially TFC and BLFC increased β-cell proliferation and suppressed the β-cell apoptosis by suppressing TNF-α and IL-1β which in turn decreased cleaved caspase-3 that caused apoptosis. In conclusion, TFC and BLFC may prevent and alleviate neuronal cell death in the hippocampal CA1 region and neurological symptoms and poststroke hyperglycemia in gerbils with artery occlusion. This might be associated with

  5. [Nontraumatic arterial dissection of the anterior cerebral artery with simultaneous cerebral infarction and subarachnoid hemorrhage: a case report].

    PubMed

    Kimura, Shigeyoshi; Igarashi, Takahiro; Kotani, Akio; Katayama, Yoichi

    2010-03-01

    We encountered a case of nontraumatic arterial dissection of the anterior cerebral artery (ACA) which exhibited cerebral infarction and subarachnoid hemorrhage (SAH) simultaneously, and whose symptoms were improved by conservative treatment. A 55-year-old female presenting with headache and weakness in her left leg was admitted to our hospital. CT scans on admission revealed SAH in the interhemispheric fissure and surface of the right frontal lobe, but CT scans at 3 days after onset demonstrated cerebral infarction in the medial part of the right frontal lobe. Cerebral angiography on day 6 disclosed an aneurysmal dilatation and narrowing at the right A2-A3 segment. We continued conservative therapy including blood pressure control, since there was no symptomatic deterioration. The aneurysmal dilatation disappeared and the weakness of the left leg also improved. This case indicates that conservative treatment could be an option for the management of nontraumatic arterial dissection of the ACA with simultaneous cerebral infarction and SAH.

  6. Ophthalmic artery blood flow in patients with internal carotid artery occlusion

    PubMed Central

    Yamamoto, T; Mori, K; Yasuhara, T; Tei, M; Yokoi, N; Kinoshita, S; Kamei, M

    2004-01-01

    Aim: To evaluate the risk factors for rubeosis iridis by colour Doppler imaging (CDI) in patients with complete internal carotid artery occlusion (ICAO). Methods: 34 eyes of 32 consecutive patients with complete ICAO were enrolled. Using CDI, blood flow direction (forward, reverse, undetectable) in the ophthalmic artery (OA), central retinal artery (CRA), and short posterior ciliary artery (SPCA) were determined. Arterial mean blood velocity (Vmean) and resistive index (RI) were calculated and correlations between the rubeosis iridis incidence and CDI parameters analysed. Results: The eyes were classified into four types according to blood flow direction: forward flow in OA, CRA, and SPCA (type 1; n = 11); reverse OA and forward CRA and SPCA flow (type 2a; n = 12); reverse OA and undetectable CRA and SPCA flow (type 2b; n = 8); undetectable flow in all three arteries (type 3; n = 3). Rubeosis iridis was seen only in type 2b and 3 eyes. Type 2b showed significantly (p<0.01) higher Vmean and lower RI values in the OA, indicating more rapid reverse flow than in type 2a eyes. Although in type 1 and 2a eyes OA flow was in opposite directions, they manifested no rubeosis iridis and no difference in the Vmean and RI values of the CRA and SPCA. Conclusions: The classification of eyes from patients with ICAO into four types by CDI may facilitate the identification of the eyes at high risk for rubeosis iridis. Markedly diminished flow in both the CRA and SPCA may result in rubeosis iridis, regardless of OA flow direction. PMID:15031166

  7. Mapping of cerebral perfusion territories using territorial arterial spin labeling: techniques and clinical application.

    PubMed

    Hartkamp, Nolan S; Petersen, Esben T; De Vis, Jill B; Bokkers, Reinoud P H; Hendrikse, Jeroen

    2013-08-01

    A knowledge of the exact cerebral perfusion territory which is supplied by any artery is of great importance in the understanding and diagnosis of cerebrovascular disease. The development and optimization of territorial arterial spin labeling (T-ASL) MRI techniques in the past two decades have made it possible to visualize and determine the cerebral perfusion territories in individual patients and, more importantly, to do so without contrast agents or otherwise invasive procedures. This review provides an overview of the development of ASL techniques that aim to visualize the general cerebral perfusion territories or the territory of a specific artery of interest. The first efforts of T-ASL with pulsed, continuous and pseudo-continuous techniques are summarized and subsequent clinical studies using T-ASL are highlighted. In the healthy population, the perfusion territories of the brain-feeding arteries are highly variable. This high variability requires special consideration in specific patient groups, such as patients with cerebrovascular disease, stroke, steno-occlusive disease of the large arteries and arteriovenous malformations. In the past, catheter angiography with selective contrast injection was the only available method to visualize the cerebral perfusion territories in vivo. Several T-ASL methods, sometimes referred to as regional perfusion imaging, are now available that can easily be combined with conventional brain MRI examinations to show the relationship between the cerebral perfusion territories, vascular anatomy and brain infarcts or other pathology. Increased availability of T-ASL techniques on clinical MRI scanners will allow radiologists and other clinicians to gain further knowledge of the relationship between vasculature and patient diagnosis and prognosis. Treatment decisions, such as surgical revascularization, may, in the near future, be guided by information provided by T-ASL MRI in close correlation with structural MRI and quantitative

  8. Obstruction of the Aorta and Left Pulmonary Artery After Gianturco Coil Occlusion of Patent Ductus Arteriosus

    SciTech Connect

    Kuo, H.-Cg; Ko, Sheung-Fat; Wu, Yu-Tsun; Huang, Chien-Fu; Chien, Shao-Ju; Tiao, Mao-Meng; Liang, Chi-Di

    2005-01-15

    We report an unusual case of simultaneous obstruction of the left pulmonary artery and descending thoracic aorta after Gianturco coil occlusion in a 15-month-old boy. The diagnosis was made by echocardiography and cardiac angiography. At surgery, thrombi coating on the protruded parts of the Gianturco coil in the pulmonary artery and aorta were found.

  9. Temporary Arterial Balloon Occlusion as an Adjunct to Yttrium-90 Radioembolization

    SciTech Connect

    Hagspiel, Klaus D.; Nambiar, Ashwin; Hagspiel, Lauren M.; Ahmad, Ehab Ali; Bozlar, Ugur

    2013-06-15

    Purpose. This study was designed to describe the technique of arterial occlusion using a temporary occlusion balloon system as an alternative to coil occlusion during Yttrium-90 radioembolization of hepatic tumors. Methods. Review of charts, angiography, and follow-up imaging studies of consecutive patients undergoing oncological embolization procedures in which a HyperForm system (ev3 Neurovascular, Irvine, CA) was used. Intraprocedural target vessel occlusion and patency of the target vessel on follow-up were recorded. Clinical data and Bremsstrahlung scans were reviewed for evidence of nontarget embolization. Results. Four radioembolization procedures were performed in three patients (all female, age 48-54 (mean 52) years). Five arteries were temporarily occluded (three gastroduodenal arteries, one right gastric artery, and one cystic artery). All radioembolization procedures were successfully completed. Follow-up imaging (either digital subtraction angiography (DSA) or computed tomography angiography (CTA)) was available for all patients between 28-454 (mean 183) days following the procedure, demonstrating all five vessels to be patent. No clinical or imaging evidence for nontarget embolization was found. Conclusions. Temporary balloon occlusion of small and medium-sized arteries during radioembolization allows safe therapy with preserved postprocedural vessel patency on early and midterm follow-up.

  10. Mechanical Recanalization of Subacute Vessel Occlusion in Peripheral Arterial Disease with a Directional Atherectomy Catheter

    SciTech Connect

    Massmann, Alexander Katoh, Marcus; Shayesteh-Kheslat, Roushanak; Buecker, Arno

    2012-10-15

    Purpose: To retrospectively examine the technical feasibility and safety of directional atherectomy for treatment of subacute infrainguinal arterial vessel occlusions. Methods: Five patients (one woman, four men, age range 51-81 years) with peripheral arterial disease who experienced sudden worsening of their peripheral arterial disease-related symptoms during the last 2-6 weeks underwent digital subtraction angiography, which revealed vessel occlusion in native popliteal artery (n = 4) and in-stent occlusion of the superficial femoral artery (n = 1). Subsequently, all patients were treated by atherectomy with the SilverHawk (ev3 Endovascular, USA) device. Results: The mean diameter of treated vessels was 5.1 {+-} 1.0 mm. The length of the occlusion ranged 2-14 cm. The primary technical success rate was 100%. One patient experienced a reocclusion during hospitalization due to heparin-induced thrombocytopenia. There were no further periprocedural complications, in particular no peripheral embolizations, until hospital discharge or during the follow-up period of 1 year. Conclusion: The recanalization of infrainguinal arterial vessel occlusions by atherectomy with the SilverHawk device is technically feasible and safe. In our limited retrospective study, it was associated with a high technical success rate and a low procedure-related complication rate.

  11. [A case of vertebral artery occlusion following heading play in soccer].

    PubMed

    Motohashi, Osamu; Kameyama, Motonobu; Kon, Hiroyuki; Fujimura, Miki; Onuma, Takehide

    2003-04-01

    A 13-year-old boy suffered from cerebeller infarction due to right vertebral artery occlusion after heading a ball during a rainy soccer game. Dissection of the vertebral artery after trivial head trauma is well known, but heading as the cause has not been reported. We speculated in this present case that excessive impact force to the young boy's neck due to the heavy rain-soaked ball might have caused right vertebral artery dissection and occlusion. High quality balls are recommended for young amateur players on rainy days.

  12. Iatrogenic central retinal artery occlusion after carotid body tumor embolization and excision.

    PubMed

    Rangel, Carlos M; Jaramillo, Sergio; Varón, Clara L; Prada, Angélica M

    2017-01-01

    Objective: To report a case of iatrogenic central retinal artery occlusion after embolization and surgical resection of carotid body paraganglioma. Methods: Case report Results: One adult female patient presented with persistent unilateral visual loss after embolization with Embosphere(®) and Contour(®) microparticles of carotid body tumor. Fluorescein angiography revealed intraluminal microspheres in the central retinal artery ramifications. OCT revealed intraretinal spherical, hyporeflective particles with posterior shadowing. Conclusions: Central retinal artery occlusion should be assessed as a possible complication after surgical repair of head and neck paragangliomas.

  13. Iatrogenic central retinal artery occlusion after carotid body tumor embolization and excision

    PubMed Central

    Rangel, Carlos M.; Jaramillo, Sergio; Varón, Clara L.; Prada, Angélica M.

    2017-01-01

    Objective: To report a case of iatrogenic central retinal artery occlusion after embolization and surgical resection of carotid body paraganglioma. Methods: Case report Results: One adult female patient presented with persistent unilateral visual loss after embolization with Embosphere® and Contour® microparticles of carotid body tumor. Fluorescein angiography revealed intraluminal microspheres in the central retinal artery ramifications. OCT revealed intraretinal spherical, hyporeflective particles with posterior shadowing. Conclusions: Central retinal artery occlusion should be assessed as a possible complication after surgical repair of head and neck paragangliomas. PMID:28401029

  14. Acute Stroke and Obstruction of the Extracranial Carotid Artery Combined with Intracranial Tandem Occlusion: Results of Interventional Revascularization

    SciTech Connect

    Lescher, Stephanie Czeppan, Katja; Porto, Luciana; Singer, Oliver C.; Berkefeld, Joachim

    2015-04-15

    PurposeDue to high thrombus load, acute stroke patients with tandem obstructions of the extra- and intracranial carotid arteries or the middle cerebral artery show a very limited response to systemic thrombolysis. Interventional treatment with mechanical thrombectomy—often in combination with acute stenting of underlying atherosclerotic stenosis or dissection—is increasingly used. It has been shown that such complex interventions are technically feasible. The lack of optimal management strategies and clinical data encouraged us to review our acute stroke interventions in patient with anterior circulation tandem lesions to determine lesion patterns, interventional approaches, and angiographic or clinical outcomes.Patients and MethodsWe retrospectively analyzed a series of 39 consecutive patients with intracranial vessel occlusion of the anterior circulation simultaneously presenting with high-grade cervical internal carotid artery (ICA) stenosis or occlusion.ResultsEmergency ICA stent implantation was technically feasible in all patients, and intracranial recanalization with TICI ≥ 2b was reached in a large number of patients (64 %). Good clinical outcomes (mRS ≤ 2 at 3 months) were achieved in one third of the patients (36 %). Symptomatic hemorrhages occurred in four patients (10 %). Mortality was 10 %.ConclusionEndovascular recanalization of acute cervical carotid artery occlusion was technically feasible in all patients, and resulted in high extra- and intracranial revascularization rates. A trend for favorable clinical outcome was seen in a higher TICI score, younger age, good collateral status, and combined IV rTPA and endovascular therapy.

  15. Progressive Deconstruction of a Distal Posterior Cerebral Artery Aneurysm Using Competitive Flow Diversion

    PubMed Central

    Johnson, Andrew K.; Lopes, Demetrius K.; Moftakhar, Roham

    2016-01-01

    Progressive deconstruction is an endovascular technique for aneurysm treatment that utilizes flow diverting stents to promote progressive thrombosis by diverting blood flow away from the aneurysm's parent vessel. While the aneurysm thromboses, collateral blood vessels develop over time to avoid infarction that can often accompany acute parent vessel occlusion. We report a 37-year-old woman with a left distal posterior cerebral artery aneurysm that was successfully treated with this strategy. The concept and rationale of progressive deconstruction are discussed in detail. PMID:26958413

  16. Acute occlusion of the left iliac artery after long-distance-running.

    PubMed

    Schmidt, O; Thaler, K H; Lang, W

    2001-02-01

    We report a case of spontaneous iliac occlusion in a 44-year-old male patient after long-distance running. Atherogenic risk factors like hypertension, diabetes, hypercholesterolemia and smoking were missing. Spontaneous iliac occlusion is extremely rare and only a few cases have been documented. Angiography showed occlusion of the left iliac artery with collateral flow via the obturator artery to the common femoral artery. Thrombectomy was performed but reocclusion occurred. An iliacofemoral bypass, arterial lysis and bypass thrombectomy was necessary within a few months. At the last follow-up visit two years afterwards the patient was symptom-free. This case indicates that exercise-dependent blood flow disturbances in long-distance-runners could produce changes of the intima.

  17. Absent anterior communicating artery and varied distribution of anterior cerebral artery.

    PubMed

    Ozturk, Hakan A; Sanli, Emine C; Kurtoglu, Zeliha

    2008-10-01

    During the cerebral dissection of a 67-year-old male cadaver, a unique combination of variations at the circle of Willis and anterior cerebral artery (ACA) distribution were encountered. The A1 segment of both ACA were fused without an anterior communicating artery (ACoA), forming an X shape and giving rise to a common pericallosal artery (CPA), an incomplete distal ACA, and an incomplete distal anterior cerebral artery (IACA). The IACA had an unusual course, which may be important from the surgical point of view. The CPA continued as the A2 and A3 segments, and bifurcated into 2 pericallosal arteries. Branching patterns of the varied arteries to the interhemispheric region were evaluated, and results were discussed. Additionally, both posterior communicating arteries were hypoplastic. There was no aneurysm formation at the circle of Willis and its branches.

  18. Variant course of bilateral anterior cerebral artery in semilobar holoprosencephaly.

    PubMed

    Pendharkar, Hima; Venkateshappa, Bhaskar Madivala; Prasad, Chandrajit

    2015-12-01

    We report an unusual case of semilobar holoprosencephaly with variant course of bilateral anterior cerebral arteries (ACA) in a 1-year-old child. This is a very rare arterial variant, given that holoprosencephalic brains are usually associated with azygous ACAs.

  19. A Stereotactic Probabilistic Atlas for the Major Cerebral Arteries.

    PubMed

    Dunås, Tora; Wåhlin, Anders; Ambarki, Khalid; Zarrinkoob, Laleh; Malm, Jan; Eklund, Anders

    2017-01-01

    Improved whole brain angiographic and velocity-sensitive MRI is pushing the boundaries of noninvasively obtained cerebral vascular flow information. The complexity of the information contained in such datasets calls for automated algorithms and pipelines, thus reducing the need of manual analyses by trained radiologists. The objective of this work was to lay the foundation for such automated pipelining by constructing and evaluating a probabilistic atlas describing the shape and location of the major cerebral arteries. Specifically, we investigated how the implementation of a non-linear normalization into Montreal Neurological Institute (MNI) space improved the alignment of individual arterial branches. In a population-based cohort of 167 subjects, age 64-68 years, we performed 4D flow MRI with whole brain volumetric coverage, yielding both angiographic and anatomical data. For each subject, sixteen cerebral arteries were manually labeled to construct the atlas. Angiographic data were normalized to MNI space using both rigid-body and non-linear transformations obtained from anatomical images. The alignment of arterial branches was significantly improved by the non-linear normalization (p < 0.001). Validation of the atlas was based on its applicability in automatic arterial labeling. A leave-one-out validation scheme revealed a labeling accuracy of 96 %. Arterial labeling was also performed in a separate clinical sample (n = 10) with an accuracy of 92.5 %. In conclusion, using non-linear spatial normalization we constructed an artery-specific probabilistic atlas, useful for cerebral arterial labeling.

  20. Endovascular parent-artery occlusion of large or giant unruptured internal carotid artery aneurysms. A long-term single-center experience.

    PubMed

    Shimizu, Kampei; Imamura, Hirotoshi; Mineharu, Yohei; Adachi, Hidemitsu; Sakai, Chiaki; Tani, Shoichi; Arimura, Koichi; Beppu, Mikiya; Sakai, Nobuyuki

    2017-03-01

    The development of stent-like devices has increased treatment options for complex internal carotid artery (ICA) aneurysms, but the optimal treatment remains unclear. The purpose of this study was to evaluate the safety and efficacy of endovascular parent-artery occlusion (PAO) for ICA aneurysms. We retrospectively reviewed 28 patients with unruptured ICA aneurysms ⩾10mm treated with PAO between April 2002 and March 2015 at our institution. Patients who developed neurologic symptoms or with venous-phase delay >2s during balloon test occlusion were not treated by PAO. Patients with venous-phase delays of 1-2s underwent superficial temporal artery to middle cerebral artery (STA-MCA) bypass prior to PAO. The median patient age was 65 (range, 26-84)years. Nineteen aneurysms (68%) were located in the cavernous segment. The median aneurysm size was 25 (range 11-40)mm. Venous-phase delay of 1-2s was observed in five patients. Perioperative ischemic complications (N=9, 32%), which occurred within 30days after treatment, were significantly associated with venous-phase delays of 1-2s (p<0.01) and history of hypertension (p<0.01). Six-month morbidity was observed in one (3.6%) patient. Complete occlusion at final follow-up and delayed (i.e. ⩾31days after treatment) ischemic events were observed in 100% and 0% of patients, respectively, over a median period of 63 (range, 6-147) months. Despite the high frequency of perioperative ischemic episodes, endovascular PAO with selective use of STA-MCA bypass showed excellent long-term outcomes in patients with unruptured ICA aneurysms ⩾10mm.

  1. Improvement in cerebral hemodynamic parameters and outcomes after superficial temporal artery-middle cerebral artery bypass in patients with severe stenoocclusive disease of the intracranial internal carotid or middle cerebral arteries.

    PubMed

    Low, Shiong Wen; Teo, Kejia; Lwin, Sein; Yeo, Leonard L L; Paliwal, Prakash R; Ahmad, Aftab; Sinha, Arvind K; Teoh, Hock Luen; Wong, Lily Y H; Chong, Vincent F; Seet, Raymond C S; Chan, Bernard P L; Yeo, Tseng Tsai; Chou, Ning; Sharma, Vijay K

    2015-09-01

    Both the older and the recent extracranial-intracranial (EC-IC) bypass trials for symptomatic carotid occlusion failed to demonstrate a reduction in stroke recurrence. However, the role of superficial temporal artery (STA)-middle cerebral artery (MCA) bypass in patients with symptomatic intracranial stenoocclusive disease has been rarely evaluated. The authors evaluated serial changes in various cerebral hemodynamic parameters in patients with severe stenoocclusive disease of the intracranial internal carotid artery (ICA) or middle cerebral artery (MCA) and impaired cerebral vasodilatory reserve (CVR), treated by STA-MCA bypass surgery or medical treatment. Patients with severe stenoocclusive disease of the intracranial ICA or MCA underwent transcranial Doppler (TCD) ultrasonography and CVR assessment using the breath-holding index (BHI). Patients with impaired BHI (< 0.69) were further evaluated with acetazolamide-challenge technitium-99m hexamethylpropyleneamine oxime ((99m)Tc HMPAO) SPECT. STA-MCA bypass surgery was offered to patients with impaired CVR on SPECT. All patients underwent TCD and SPECT at 4 ± 1 months and were followed up for cerebral ischemic events. A total of 112 patients were included. This total included 73 men, and the mean age of the entire study population was 56 years (range 23-78 years). (99m)Tc HMPAO SPECT demonstrated impaired CVR in 77 patients (69%). Of these 77 patients, 46 underwent STA-MCA bypass while 31 received best medical treatment. TCD and acetazolamide-challenge (99m)Tc HMPAO SPECT repeated at 4 ± 1 months showed significant improvement in the STA-MCA bypass group. During a mean follow-up of 34 months (range 18-39 months), only 6 (13%) of 46 patients in the bypass group developed cerebral ischemic events, as compared with 14 (45%) of 31 patients receiving medical therapy (absolute risk reduction 32%, p = 0.008). STA-MCA bypass surgery in carefully selected patients with symptomatic severe intracranial stenoocclusive

  2. Bilateral vs single internal thoracic artery grafting for left main coronary artery occlusion.

    PubMed

    Otaki, M; Lust, R M; Sun, Y S; Norton, T O; Spence, P A; Zeri, R S; Hopson, S B; Chitwood, R

    1994-10-01

    This study was conducted to compare the coronary flow distributed by single and bilateral internal thoracic artery (ITA) grafts in the setting of the left main coronary occlusion. Ten dogs underwent coronary artery bypass grafting through a left thoracotomy, off pump, using a brief local occlusion to perform the anastomosis. Dogs were randomly assigned to receive either a single left ITA (LITA) graft to the circumflex coronary artery (CFX), or bilateral ITA grafts, with additional placement of the right ITA (RITA) to the left anterior descending artery (LAD). After the grafts were placed, the left main coronary artery was ligated. Electromagnetic flows were obtained in the LAD and the CFX proximally and distally to ITA grafts in both groups before grafting and after grafting. ITA flow in situ was also measured before rotation from the chest wall. Total left ventricular flow requirements were satisfied equally well by either a single LITA graft (116.7 +/- 11.6 mL/min) or bilateral ITA grafts (total, 116.8 +/- 9.6 mL/min divided as LITA, 55.9 +/- 7.4 mL/min; RITA, 60.9 +/- 12.0 mL/min). When two grafts were replaced, competitive flow in the proximal regions of both native vessels was noted, although basal flow requirements were maintained. When an individual graft was occluded in the bilaterally grafted system, the remaining graft immediately recruited the additional flow, demonstrating that either right or left ITA can support flow demands five to six times higher than in situ chest wall flow (RITA, 21.9 +/- 3.1 mL/min; LITA, 22.3 +/- 4.9 mL/min). These data suggest that in this canine model, a single ITA graft can support the entire flow requirements of the left ventricle. Assuming no intervening stenosis is present in native coronary systems, bilateral ITA grafting may provide a margin of safety, but under resting conditions, provides no perfusion advantages over a single ITA graft.

  3. Reversible cerebral vasoconstriction syndrome with concurrent bilateral carotid artery dissection.

    PubMed

    Bayer-Karpinska, Anna; Patzig, Maximilian; Adamczyk, Christopher; Dimitriadis, Konstantinos; Wollenweber, Frank A; Dichgans, Martin; Jahn, Klaus; Opherk, Christian

    2013-05-01

    The pathophysiological basis of reversible cerebral vasoconstriction syndrome is poorly understood but carotid artery dissection has been discussed as a rare possible cause. So far, only single cases of unilateral carotid artery dissection and reversible cerebral vasoconstriction syndrome have been reported. Here, we describe the case of a 54-year old patient presenting to the emergency department with right hemiparesis, hypaesthesia and dysarthria. Furthermore, he reported two episodes of thunderclap headache after autosexual activity. Cerebral imaging showed ischaemic infarcts, slight cortical subarachnoid haemorrhage, bilateral carotid artery dissection and fluctuating intracranial vessel irregularities, compatible with reversible cerebral vasoconstriction syndrome. An extensive diagnostic work-up was normal. No typical trigger factors of reversible cerebral vasoconstriction syndrome could be found. The patient received intravenous heparin and the calcium channel blocker nimodipine. Follow-up imaging revealed no vessel irregularities, the left internal carotid artery was still occluded. This case supports the assumption that carotid artery dissection should be considered as a potential trigger of reversible cerebral vasoconstriction syndrome, possibly by altering sympathetic vascular tone.

  4. Association between hemodynamic conditions and occlusion times after flow diversion in cerebral aneurysms.

    PubMed

    Mut, Fernando; Raschi, Marcelo; Scrivano, Esteban; Bleise, Carlos; Chudyk, Jorge; Ceratto, Rosana; Lylyk, Pedro; Cebral, Juan R

    2015-04-01

    Evaluation of flow diversion treatment of intracranial aneurysms is difficult owing to lack of knowledge of the target hemodynamic environment. To identify hemodynamic conditions created after flow diversion that induce fast aneurysm occlusion. Two groups of aneurysms treated with flow diverters alone were selected: (a) aneurysms completely occluded at 3 months (fast occlusion), and (b) aneurysms patent or incompletely occluded at 6 months (slow occlusion). A total of 23 aneurysms were included in the study. Patient-specific computational fluid dynamics models were constructed and used to characterize the hemodynamic environment immediately before and after treatment. Average post-treatment hemodynamic conditions between the fast and slow occlusion groups were statistically compared. Aneurysms in the fast occlusion group had significantly lower post-treatment mean velocity (fast=1.13 cm/s, slow=3.11 cm/s, p=0.02), inflow rate (fast=0.47 mL/s, slow=1.89 mL/s, p=0.004) and shear rate (fast=20.52 1/s, slow=32.37 1/s, p=0.02) than aneurysms in the slow occlusion group. Receiver operating characteristics analysis showed that mean post-treatment velocity, inflow rate, and shear rate below a certain threshold could discriminate between aneurysms of the fast and slow occlusion groups with good accuracy (84%, 77%, and 76%, respectively). The occlusion time of cerebral aneurysms treated with flow diverters can be predicted by the hemodynamic conditions created immediately after device implantation. Specifically, low post-implantation flow velocity, inflow rate, and shear rate are associated with fast occlusion times. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  5. Incidence and outcome of radial artery occlusion following transradial artery coronary angioplasty.

    PubMed

    Stella, P R; Kiemeneij, F; Laarman, G J; Odekerken, D; Slagboom, T; van der Wieken, R

    1997-02-01

    Coronary angioplasty with 6F guiding catheters via the radial artery is associated with a minimal risk for major entry site-related complications. Although the incidence of radial artery occlusion (RAO) in the literature is approximately 30% after prolonged cannulations, little is known about the incidence and its clinical consequences of RAO following transradial percutaneous coronary angioplasty. In a prospective study, 563 patients with a normal Allen test were evaluated on patency and function of the radial artery after transradial angioplasty, by physical and ultrasound examination at discharge, and at 1 month follow-up. At discharge, 30 patients (5.3%) had clinical evidence of RAO. At follow-up, persistent RAO was found in 16 patients (2.8%). In this study we found a low incidence of RAO after transradial percutaneous coronary angioplasty. None of the patients with temporary or persistent RAO had any major clinical symptoms. Therefore, the occurrence of RAO can be considered a minor complication in patients with a previously good double blood supply to the hand.

  6. [A case of accessory middle cerebral artery associated with internal carotid artery aneurysm (author's transl)].

    PubMed

    Munekata, K; Omori, H; Kanazawa, Y; Miyazaki, S; Fukushima, H; Kamata, K

    1979-12-01

    A case of accessory middle cerebral artery associated with internal carotid artery aneurysm was reported. A 50-year-old female was admitted to our hospital with complaints of headache, nausea, vomiting and conciousness disturbance. Lumbar puncture showed bloody CSF. Right carotid angiogram revealed saccular aneurysm of the internal carotid-posterior communicating artery and accessory middle cerebral artery originating from the horizontal portion of the right anterior cerebral artery. No other vascular lesion was observed on other angiograms. Operation was performed 2 days after admission. The neck of the aneurysm was clipped. Postoperative aseptic meningitis was cured by frequent lumbar punctures, and her course was uneventful. The etiological hypothesis of these cerebral vascular anomalies was briefly discussed.

  7. Influence of arterial occlusion on outcome after intravenous thrombolysis for acute ischemic stroke.

    PubMed

    Medlin, Friedrich; Amiguet, Michael; Vanacker, Peter; Michel, Patrik

    2015-01-01

    We aimed to assess the interaction between intravenous thrombolysis (IVT) and arterial occlusion on acute cervicocerebral computed tomographic angiography on the outcome of patients with acute ischemic stroke. Patients from the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) registry with onset-to-door-time ≤4 hours, acute cervicocerebral computed tomographic angiography, a premorbid modified Rankin Scale ≤2, and a National Institute of Health Stroke Scale (NIHSS) >4 were selected. Patients with significant intracranial arterial obstruction (≥50%-99%) and undergoing acute endovascular treatment were excluded. An interaction analysis of IVT and initial arterial occlusion for favorable 3 months outcome (modified Rankin Scale <3) were performed with adjustment for potential confounders. Among 654 included patients, 382 (58%) showed arterial occlusion, of whom 263 (69%) received IVT. Two hundred seventy-two showed no/minimal obstruction of whom 139 (51%) received IVT. In the adjusted interaction analysis, there was a trend in favor of the arterial occlusion group (odds ratio [OR]=3.97; 95% confidence interval [CI], 0.83-18.97; P=0.08). IVT (versus no IVT) was associated with better outcome in patients with occlusion (adjusted OR for favorable outcome, 3.01; 95% CI, 1.10-8.28) but not in patients with no/minimal obstruction (OR, 0.76; 95% CI, 0.21-2.74). Conversely, patients with occlusion had a similar rate of favorable outcome as no/minimal obstruction when thrombolysed (OR, 0.5; 95% CI, 0.17-1.47) but had a less favorable outcome without thrombolysis (OR, 0.13; 95% CI, 0.04-0.44). In this retrospective analysis of consecutive patients with acute ischemic stroke, there was a trend for more favorable outcomes with IVT in the setting of initial arterial occlusion than in the setting of no/minimal obstruction. Before confirmation in randomized controlled studies, this information should not influence thrombolysis decisions, however. © 2014 American Heart

  8. Surgical flow modification of the anterior cerebral artery-anterior communicating artery complex in the management of giant aneurysms of internal carotid artery bifurcation: An alternative for a difficult clip reconstruction

    PubMed Central

    Pahl, Felix Hendrik; de Oliveira, Matheus Fernandes; Beer-Furlan, André Luiz; Rotta, José Marcus

    2016-01-01

    Background: Internal carotid artery bifurcation (ICAb) aneurysms account for about 2–15% of all intracranial aneurysms. In giant and complex cases, treatment may be difficult and dangerous, once some aneurysms have wide neck and anterior cerebral artery (ACA) and middle cerebral artery (MCA) may arise from the aneurysm itself. Clip reconstruction may be difficult in such cases. Whenever possible, the occlusion of ACA transform the bifurcation in a single artery reconstruction (ICA to MCA), much easier than a bifurcation reconstruction. Methods: In patients with giant and complex ICAb aneurysms, we propose routine preoperative angiography with anatomical evaluation of anterior communicating artery (ACoA) patency during cervical common carotid compression with concomitant contralateral carotid artery injection. This allowed visualization of the expected reversal of flow in the A1 segment–ACoA complex. When test is positive, we can perform ipsilateral ACA (A1 segment) clip occlusion and flow modification of the ACA-ACoA complex transforming a three vessel (ICA, ACA, and MCA) reconstruction into a two vessel (ICA and MCA) reconstruction. Results: Two patients were treated, with 100% of occlusion and good outcome. Conclusions: Surgical treatment of giant and complex ICAb may be achieved with acceptable morbidity. PMID:27313968

  9. Third nerve palsy following carotid artery dissection and posterior cerebral artery thrombectomy: Case report and review of the literature

    PubMed Central

    Kogan, Michael; Natarajan, Sabareesh K.; Kim, Nina; Sawyer, Robert N.; Snyder, Kenneth V.; Siddiqui, Adnan H.

    2014-01-01

    Background: Common causes of oculomotor nerve palsy are diabetes, aneurysmal compression, and uncal herniation. A lesser-known cause of third nerve dysfunction is ischemia, often due to carotid artery dissection. Case Description: An 80-year-old man presented with an acute ischemic stroke with a National Institutes of Health Stroke Scale score of >20 from a high cervical internal carotid artery (ICA) dissection and a tandem ICA terminus embolic occlusion with extension of clot into the adjacent fetal posterior cerebral artery (PCA). We used a stentriever to perform selective PCA thrombectomy, with immediate postthrombectomy development of ipsilateral anisocoria. The anisocoria progressed into complete oculomotor nerve palsy over 8 h after the procedure. Conclusions: The clinical course described in this case is consistent with injury to the third nerve due to mechanical injury or occlusion of perforator supply to the nerve during thrombectomy. Oculomotor nerve palsy is a rare but known complication after ischemia; however, to our knowledge, this is the first case after thrombectomy for a PCA embolus. PMID:25525555

  10. Retrievable Stent-Assisted Coiling Technique Using a Solitaire Stent: Treatment of Pancreaticoduodenal Artery Aneurysm Associated With Celiac Artery Occlusion.

    PubMed

    Sanal, Bekir; Nas, Omer Fatih; Hacikurt, Kadir; Hakyemez, Bahattin; Erdogan, Cuneyt

    2016-02-01

    True aneurysm of pancreaticoduodenal arcade (PDA) is usually accompanied by stenosis or occlusion of celiac trunk (CeT). The up-to-date and first choice treatment modality of PDA aneurysm is the endovascular approach in nearly all cases except few selected ones necessitating surgery. The main approach in endovascular treatment is embolization of the aneurysm by preserving the parent artery. A case with concomitant CeT occlusion and PDA aneurysm was treated with coil embolization by preserving inferior pancreaticoduodenal artery with retrievable Solitaire(®) stent. In our knowledge, this is the first case with PDA aneurysm treated with this technique.

  11. Atypical Unilateral Posterior Reversible Encephalopathy Syndrome Mimicking a Middle Cerebral Artery Infarction.

    PubMed

    Çamlıdağ, İlkay; Cho, Yang-Je; Park, Mina; Lee, Seung Koo

    2015-01-01

    Posterior reversible encephalopathy syndrome (PRES) is usually a reversible clinical and radiological entity associated with typical features on brain MR or CT imaging. However, the not-so-uncommon atypical radiological presentations of the condition are also present and they may go unrecognised as they are confused with other conditions. Here, we report a very rare case of atypical, unilateral PRES in a 49-year-old uremic, post-transplant female patient who presented with seizures. Initial MRI showed high-grade occlusion of the left middle cerebral artery (MCA) and lesions suggestive of subacute infarction in the ipsilateral frontotemporoparietal lobe. Patient symptoms had resolved a day after the onset without any specific treatment but early follow-up CT findings suggested hemorrhagic transformation. Follow-up MRI performed 2 years later showed complete disappearence of the lesions and persisting MCA occlusion.

  12. Ophthalmic artery aneurysm treated by surgical clipping and balloon-assisted temporary carotid occlusion.

    PubMed

    Dehdashti, Amir R

    2015-07-01

    A 29-year-old woman is diagnosed with a large broad-base right ophthalmic artery aneurysm. Despite an intact visual field, she complained of mild right visual blurriness. Between endovascular and surgical treatments, surgery was favored due to her young age. It was decided to perform the surgery with simultaneous endovascular temporary carotid balloon occlusion. A right pterional craniotomy and intradural anterior clinoidectomy were performed, the balloon was positioned in the petrous carotid, and the distal durai ring was opened exposing the proximal neck. Under temporary proximal carotid balloon occlusion and distal carotid clip occlusion, the aneurysm was fully dissected and clipped. Intraoperative angiogram confirmed complete aneurysm occlusion and patency of the ophthalmic artery. The patient's neurological exam remained unchanged. The video can be found here: http://youtu.be/BIQKTl9bDqA .

  13. Uterine Artery Embolization Versus Laparoscopic Uterine Artery Occlusion: The Outcomes of a Prospective, Nonrandomized Clinical Trial

    SciTech Connect

    Mara, Michal; Kubinova, Kristyna; Maskova, Jana; Horak, Petr; Belsan, Tomas; Kuzel, David

    2012-10-15

    Purpose: To compare outcomes of two different types of occlusive therapy of uterine fibroids. Methods: Women with fibroid(s) unsuitable for laparoscopic myomectomy (LM) were treated with uterine artery embolization (UAE) or laparoscopic uterine artery occlusion (LUAO). Results: Before the procedure, patients treated with UAE (n = 100) had a dominant fibroid greater in size (68 vs. 48 mm) and a mean age lower (33.1 vs. 34.9 years) than surgically treated patients (n = 100). After 6 months, mean shrinkage of fibroid volume was 53 % after UAE and 39 % after LUAO (p = 0.063); 82 % of women after UAE, but only 23 % after LUAO, had complete myoma infarction (p = 0.001). Women treated with UAE had more complications (31 vs. 11 cases, p = 0.006) and greater incidence of hysteroscopically verified intrauterine necrosis (31 vs. 3 %, p = 0.001). Both groups were comparable in markers of ovarian functions and number of nonelective reinterventions. The groups did not differ in pregnancy (69 % after UAE vs. 67 % after LUAO), delivery (50 vs. 46 %), or abortion (34 vs. 33 %) rates. The mean birth weight of neonates was greater (3270 vs. 2768 g, p = 0.013) and the incidence of intrauterine growth restriction lower (13 vs. 38 %, p = 0.046) in post-UAE patients. Conclusion: Both methods are effective in the treatment of women with future reproductive plans and fibroids not suitable for LM. UAE is more effective in causing complete ischemia of fibroids, but it is associated with greater risk of intrauterine necrosis. Both methods have low rate of serious complications (except for a high abortion rate).

  14. Correlation of CT cerebral vascular territories with function. 3. Middle cerebral artery

    SciTech Connect

    Berman, S.A.; Hayman, L.A.; Hinck, V.C.

    1984-05-01

    Schematic displays are presented of the cerebral territories supplied by branches of the middle cerebral artery as they would appear on axial and coronal computed tomographic (CT) scan sections. Companion diagrams of regional cortical function and a discussion of the fiber tracts are provided to simplify correlation of clinical deficits with coronal and axial CT abnormalities.

  15. Detection of underdiagnosed concurrent branch retinal artery occlusion in a patient with central retinal vein occlusion using spectral domain optical coherence tomography.

    PubMed

    Karapetyan, Anushavan; Ouyang, Pingbo; Tang, Luo Sheng; Zeng, Jiexi; Ying, Michele Dominique Li

    2014-07-12

    Combined branch retinal artery and central retinal vein occlusion is a rare condition that has been infrequently reported. This case report, aside from reporting the above-mentioned condition, highlights the importance of performing spectral domain optical coherence tomography in establishing a complete diagnosis, especially in uncertain and complicated cases. We also present spectral domain optical coherence tomography findings of a case of combined unilateral simultaneous central retinal vein and branch retinal artery occlusion. We present a single case of an initially missed, unilateral branch retinal artery occlusion combined with central retinal vein occlusion in a 51-year-old female Chinese patient without a significant past medical history, who experienced sudden, painless vision diminution in her right eye