Journal of vascular and interventional neurology最新文献

Background: Hypertension can be found in up to 80% of patients with acute stroke. Many factors have been related to this phenomenon such as age, history of hypertension, and stroke severity. The aim of our study was to determine the relationship between infarct volume and blood pressure, at admission, in young patients with acute ischemic stroke.

Materials and methods: Patients younger than 55 years old admitted within 24 hours of ischemic stroke were included. Socio-demographic variables, systolic blood pressure, diastolic blood pressure, and infarct volume at admission were assessed. Statistical analysis: mean and SEM for quantitative variables, percentages for qualitative, and Spearman correlations (p value < 0.05 was considered statistically significant).

Results: Twenty-two patients (12 men), mean age: 44.64 ± 1.62 years. The most frequent vascular risk factors were: hypertension, smoking, and overweight (40.9%). Mean systolic and diastolic blood pressure on admission were: 143.27 ± 6.57 mmHg and 85.14 ± 3.62 mmHg, respectively. Infarct volume: 11.55 ± 4.74 ml. Spearman correlations: systolic blood pressure and infarct volume: p = 0.15 r: -0.317; diastolic blood pressure and infarct volume: p = 0.738 r: -0.76.

Conclusion: In our series of young patients with acute ischemic stroke, large infarct volume was not associated with high blood pressure at admission.

Background: Stroke ranks as the second leading cause of death and the leading cause of morbidity worldwide. Large intracranial arterial stenosis (ICAS) is a major cause of stroke.

Methods: This study investigated the prevalence and associated vascular risk factors of ICAS in a high-risk population in Qalyeubia Governorate, Egypt. A cross-sectional pilot survey using transcranial Doppler (TCD) was conducted at Toukh Central Hospital and Aghore El-qubra primary healthcare units in the Qalyeubia Governorate from 1 January 2016 until the end of June 2016.

Results: A total of 153 participants were included in this study. The prevalence of asymptomatic ICAS was 13.1%. Among the modifiable risk factors, cardiac diseases, hypertension, diabetes, obesity, dyslipidemia, physical inactivity, and smoking were the strongest independent predictors of ICAS.

Conclusion: This pilot study concluded that the prevalence of asymptomatic ICAS is relatively high in Egypt, and modifiable risk factors were the strongest predisposing factors of ICAS. TCD is an efficient non-invasive modality for the diagnostic evaluation of ICAS.

Objective: Vasoactive substances, including marijuana, are known precipitating factors of reversible cerebral vasoconstriction syndrome (RCVS). Our objective was to describe the demographics, suspected etiology, and outcomes of RCVS patients, with specific interest in examining the subset of patients who used marijuana prior to the onset of RCVS.

Methods: We identified and described consecutive RCVS cases treated at a regional, high-volume Comprehensive Stroke Center in Colorado (2012-2015). Univariate analyses were performed to examine the associations between the characteristics and outcomes (stroke and discharge disposition) of the RCVS patients by precipitating factors. We compared patients who used marijuana to those who did not and patients who used marijuana to patients who used vasoactive substances aside from marijuana.

Results: Forty patients had RCVS. Sixteen (40%) cases were deemed idiopathic and 24 (60%) were secondary to a suspected trigger. Vasoactive substances were the most common suspected trigger (n = 18/24, 75%), 6 (33%) of which were marijuana. Approximately 80% of patients experienced an intracranial hemorrhage, 20% had an ischemic stroke, and yet 78% were discharged home. Patients with RCVS secondary to marijuana were more often male (p = 0.05) and younger (p = 0.02) compared to those who did not use marijuana; no differences were observed in the outcomes. These findings were consistent when examining marijuana versus other vasoactive substances.

Conclusion: This study suggests there are demographic differences between patients with RCVS triggered by marijuana compared to the typical RCVS patient. As more states legalize marijuana, medical conditions such as RCVS and their association with marijuana warrants further study and awareness.

Background: Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are both viable treatment options for carotid artery stenosis. We sought to compare perioperative outcomes after CEA and CAS for the management of carotid stenosis using a "real-world" sample.

Methods: We conducted a retrospective observational study using the National Surgical Quality Improvement Program database to compare 30-day (periprocedural) outcomes in patients with carotid stenosis undergoing CEA versus CAS from 2005 to 2012. Baseline characteristics and periprocedural outcomes including stroke, myocardial infarction, mortality and combined outcome (composite of any stroke, myocardial infarction, or death) were compared.

Results: A total of 54,640 patients were identified who underwent CEA and 488 who underwent CAS. Patients undergoing CEA were more likely to be older and have symptomatic stenosis, and less likely to be white, have congestive heart failure, and have chronic obstructive pulmonary disease. There were no significant differences between CEA and CAS in periprocedural mortality (0.9% vs. 1.2%, p = 0.33), stroke (1.6% vs. 1.6 p = 0.93), myocardial infarction (0.9% vs. 1.6%, p = 0.08), or combined outcome (3.0% vs. 4.9%, p = 0.09). The interaction between symptomatic status and procedure type was not significant, indicating the association of symptomatic status with 30-day mortality (p = 0.29) or the combined periprocedural outcome (p = 0.57) were similar in cases receiving CEA and CAS.

Conclusion: Early outcomes after CEA and CAS for carotid artery stenosis appear to be similar in a "real-world" sample and comparable to clinical trials. Patients undergoing CAS were more likely to be younger and surgically have higher risk based on baseline characteristics likely reflecting clinical practice case selection.

Objectives: Virtual reality (VR) allows users to experience realistic, immersive 3D virtual environments with the depth perception and binocular field of view of real 3D settings. Newer VR technology has now allowed for interaction with 3D objects within these virtual environments through the use of VR controllers. This technical note describes our preliminary experience with VR as an adjunct tool to traditional angiographic imaging in the preprocedural workup of a patient with a complex pseudoaneurysm.

Methods: Angiographic MRI data was imported and segmented to create 3D meshes of bilateral carotid vasculature. The 3D meshes were then projected into VR space, allowing the operator to inspect the carotid vasculature using a 3D VR headset as well as interact with the pseudoaneurysm (handling, rotation, magnification, and sectioning) using two VR controllers.

Results: 3D segmentation of a complex pseudoaneurysm in the distal cervical segment of the right internal carotid artery was successfully performed and projected into VR. Conventional and VR visualization modes were equally effective in identifying and classifying the pathology. VR visualization allowed the operators to manipulate the dataset to achieve a greater understanding of the anatomy of the parent vessel, the angioarchitecture of the pseudoaneurysm, and the surface contours of all visualized structures.

Conclusion: This preliminary study demonstrates the feasibility of utilizing VR for preprocedural evaluation in patients with anatomically complex neurovascular disorders. This novel visualization approach may serve as a valuable adjunct tool in deciding patient-specific treatment plans and selection of devices prior to intervention.

Background and purpose: Traditional methods of computed tomographic angiography (CTA) can be unreliable in detecting carotid artery pseudo-occlusions or in accurately locating the site of carotid artery occlusion. With these methods, lack of adequate distal runoff due to pseudo-occlusion or intracranial occlusion can result in the inaccurate diagnoses of complete occlusion or cervical carotid occlusion, respectively. The site of carotid occlusion has important therapeutic and interventional considerations. We present several cases in which 4D CTA was utilized to accurately and noninvasively diagnose carotid pseudo-occlusion and intracranial internal carotid artery (ICA) occlusion.

Methods: We identified five patients who presented to our institute with ischemic stroke symptoms and evaluated images from traditional CTA protocols and 4D CTA protocols in each of these patients, comparing diagnoses rendered by each imaging technique.

Results: In two patients, traditional CTA suggested the presence of complete ICA occlusion. However, 4D CTA demonstrated pseudo-occlusion. Similarly, in three patients, traditional CTA demonstrated cervical ICA occlusion, whereas the 4D CTA demonstrated intracranial ICA occlusion.

Conclusion: 4D CTA may be a more effective noninvasive imaging technique than traditional CTA to detect intracranial carotid artery occlusions and carotid artery pseudo-occlusions. Accurate, rapid, and noninvasive diagnosis of carotid artery lesions may help tailor and expedite endovascular intervention.

Background: Patients with vertebral, subclavian, or innominate arterial stenosis can present with recurrent symptoms that can adversely affect the quality of life (QOL). We aimed at determining the short-term effects of endovascular treatment (ET) on QOL in these patients.

Methods: European Quality of Life Five Dimension Scale (EQ-5D) utility index and visual analog scale (VAS) were ascertained before and within one month of ET in patients with vertebral, subclavian, or innominate arterial stenosis with recurrent episodes of vertigo, near syncope, and/or ataxia. The EQ-5D utility scores were derived from responses to five questions on EQ-5D questionnaire (-0.109 for the least to 1 for most favorable). The EQ-5D VAS score was obtained by subject's indication of his/her health state on a scale of 0 (worst) to 100 (best).

Results: Angioplasty and/or stent placement was performed in 10 patients for stenosis in extracranial vertebral (n = 6), intracranial vertebral (n = 1), subclavian (n = 2), or innominate artery (n = 1). There was a significant reduction in preprocedure severity [mean ± standard deviation (SD)] of stenosis compared with postprocedure severity (79.9 ± 14.05% vs. 26.4 ± 37.7%, p < 0.001). There was a significant improvement in mean values of EQ-5D VAS postprocedure compared with preprocedure values (72 vs. 57.5, p = 0.018). Minimal important difference (improvement of at least 0.074) on EQ-5D utility index and on VAS (improvement ≥ 10 points) was reported by five and six of 10 patients, respectively.

Conclusions: Improvement in QOL appears to be an important measure of effectiveness of ET in patients with vertebral, subclavian, or innominate arterial stenosis with recurrent episodes of vertigo, near syncope, and/or ataxia.