Attempt to delineate occluded arteries with initial plain computed tomography in acute cerebral arterial occlusion

2020 ◽  
Vol 29 (12) ◽  
pp. 105390
Author(s):  
Jouji Kokuzawa ◽  
Yasuhiko Kaku ◽  
Nozomi Sasaki ◽  
Kiyomitsu Kano ◽  
Naoki Oka ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Arterial Occlusion ◽  
Cerebral Arterial Occlusion

Influence of diabetes on diagnostic performance of computed tomography angiography of the calf arteries in acute limb ischemia

2021 ◽  
pp. 028418512110069
Author(s):  
Talha Butt ◽  
Leena Lehti ◽  
Jan Apelqvist ◽  
Anders Gottsäter ◽  
Stefan Acosta
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Diagnostic Performance ◽  
Intraclass Correlation ◽  
Arterial Occlusion ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Diabetic Patients ◽  
Acute Limb Ischemia ◽  
Below The Knee

Background Patients with diabetes mellitus (DM) have a more extensive distal arterial occlusive disease compared to non-diabetic patients. Diagnostic imaging is a necessity to identify the location and extent of the arterial occlusion in acute limb ischemia (ALI). Computed tomography angiography (CTA) is the most commonly used modality and the diagnostic performance with CTA of calf arteries may be questioned. Purpose To evaluate diagnostic performance of CTA of calf arteries in ALI and to compare patients with and without DM. Material and Methods All thrombolytic treatments performed during 2001–2008 in patients with ALI were included. Initial digital subtraction angiography (DSA) and CTA of all patients were classified according to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) below-the-knee arteries and compared to CTA. Two raters assessed the CTA images independently. Inter-rater reliability was expressed as intraclass correlation (ICC) with 95% confidence intervals (CI). Results Patients with (n = 23) and without (n = 85) DM had lower ( P = 0.006) glomerular filtration rate. ICC between CTA and DSA was 0.33 (95% CI –0.22 to 0.56) and 0.71 (95% CI 0.38–0.68) in patients with and without DM, respectively. Sensitivity with CTA for TASC D lesions in patients with and without DM was 0.14 (95% CI –0.12 to 0.40) and 0.64 (95% CI 0.48–0.80), respectively. Conclusion The sensitivity of CTA for assessment of infra-popliteal TASC D lesions in patients with ALI was not acceptable in patients with DM in contrast to those without DM. Another imaging option at present times should be considered for patients with DM.

Middle cerebral arterial occlusion in a child with osteopetrosis major

2001 ◽  
Vol 11 (1) ◽  
pp. 145-147 ◽  
Author(s):  
H. A. Tasdemir ◽  
A. Dagdemir ◽  
C. Celenk ◽  
D. Albayrak
Keyword(s):  
Arterial Occlusion ◽  
Cerebral Arterial Occlusion

L-arginine decreases infarct size caused by middle cerebral arterial occlusion in SHR

1992 ◽  
Vol 263 (5) ◽  
pp. H1632-H1635 ◽  
Author(s):  
E. Morikawa ◽  
Z. Huang ◽  
M. A. Moskowitz
Keyword(s):  
Cerebral Ischemia ◽  
Infarct Size ◽  
Focal Cerebral Ischemia ◽  
Arterial Occlusion ◽  
Cerebral Blood Vessels ◽  
Hypertensive Rats ◽  
Vessel Occlusion ◽  
Spontaneously Hypertensive ◽  
Cerebral Arterial Occlusion ◽  
Carotid Arterial

L-Arginine, but not D-arginine, serves as a precursor for the synthesis of nitric oxide (NO), a potent dilator of cerebral blood vessels. We examined the effects of administering L-arginine (300 mg/kg ip) on the volume of infarction in two models of focal cerebral ischemia in spontaneously hypertensive rats (SHR). L-Arginine was administered before (16 and 3 h) and after (5 min and 2 h) vessel occlusion, and animals were killed 24 h later. L-Arginine treatment decreased infarct size in rats subjected to distal middle cerebral arterial (MCA) plus ipsilateral common carotid arterial (CCA) occlusion by 31% [147 +/- 12 (saline) vs. 101 +/- 9 mm3 (L-arginine), P < 0.05]. D-Arginine, administered according to the same dosage and protocol, was without effect. In the group subjected to proximal MCA occlusion, L-arginine decreased infarction size in the striatum by 28% [47 +/- 5 (saline) vs. 34 +/- 3 mm3 (L-arginine), P < 0.05] and neocortex by 11% [193 +/- 7 (saline) vs. 171 +/- 8 mm3 (L-arginine), P < 0.05]. Changes in blood pressure or other measured physiological parameters did not account for the observed differences. The possible use of L-arginine for the treatment of focal cerebral ischemia merits further investigation.

Hypervolemic hemodilution in experimental focal cerebral ischemia

1983 ◽  
Vol 59 (3) ◽  
pp. 500-509 ◽  
Author(s):  
James H. Wood ◽  
Frederick A. Simeone ◽  
Eugene A. Fink ◽  
Michael A. Golden
Keyword(s):  
Molecular Weight ◽  
Focal Cerebral Ischemia ◽  
Arterial Occlusion ◽  
Total Blood ◽  
Content Type ◽  
Arterial Blood ◽  
Hypervolemic Hemodilution ◽  
The Mean ◽  
Cerebral Arterial Occlusion ◽  
Hemispheric Infarction

✓ Cerebrovascular and cardiac alterations evoked by intravascular volume expansion with low molecular weight dextran (LMD, molecular weight 40,000), an advocated adjunct in the clinical prevention or therapy of acute stroke and cerebral vasospasm, were studied in splenectomized dogs. Clipping of the right distal internal carotid artery and the proximal middle cerebral artery (MCA) in eight dogs decreased regional cortical blood flow (rCoBF) by 58% without changing cardiac output (CO), and caused 10% ± 5% (SE) hemispheric infarction. Ten other dogs underwent similar cerebral arterial occlusion and were infused twice with LMD within 2 hours; each infusion equaled 20% of the respective dog's total blood volume. Both CO and rCoBF in the territory of the occluded MCA increased significantly by 119% ± 13% and 42% ± 6%, respectively, following the two LMD infusions. Although the mean arterial blood pressure was unaltered, the hematocrit decreased significantly and the intracranial pressure (ICP) increased significantly. The mean hemispheric infarction in these 10 treated dogs was 4% ± 2%. Another nine dogs underwent arterial manipulation without clipping. Two hemodiluting LMD infusions, similar to those in the 10 dogs, significantly elevated CO and ICP but not rCoBF. These data suggest that hypervolemic hemodilution with LMD effectively elevates collateral perfusion to ischemic regions of brain distal to occluded MCA segments and concomitantly raises the CO and ICP.

scholarly journals "Low perfusion hyperemia" following middle cerebral arterial occlusion in cats of different age groups.

Stroke ◽  
1980 ◽  
Vol 11 (6) ◽  
pp. 629-636 ◽  
Author(s):  
M Tomita ◽  
F Gotoh ◽  
T Amano ◽  
N Tanahashi ◽  
K Tanaka
Keyword(s):  
Age Groups ◽  
Arterial Occlusion ◽  
Cerebral Arterial Occlusion

scholarly journals Measurement of cerebrovascular reserve by multimodal imaging for cerebral arterial occlusion or stenosis patients: protocol of a prospective, randomized, controlled clinical trial

2019 ◽  
Author(s):  
xiao zhipeng ◽  
ji ke ◽  
lin yong ◽  
wan jieqing ◽  
pan yaohua ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Ischemic Stroke ◽  
Arterial Occlusion ◽  
Transluminal Angioplasty ◽  
Cerebrovascular Reactivity ◽  
Stroke Recurrence ◽  
Controlled Clinical Trial ◽  
Cerebrovascular Reserve ◽  
Randomized Controlled ◽  
Cerebral Arterial Occlusion

Abstract Background Cerebrovascular reactivity (CVR), index of cerebral hemodynamics, might guide the treatment of ischemic stroke. However, the previous studies that the therapeutic strategy of stroke mainly depends on the degree of vascular stenosis with steady-state vascular parameters, such as cerebral blood flow, and CVR factors are not under consideration. Measurement of CVR by multimodal image might improve the prognosis for ischemic stroke. Methods/design The study is a prospective, randomized, paralleled controlled clinical trial to examine the multimodal image evaluation for CVR. A total of 66 eligible patients will be recruited from Renji hospital, Shanghai Jiaotong University School of Medicine. The patients will be categorized based on CVR into two subgroups as follows: CVR>10% group and CVR<10% group. And the patients will be randomly assigned to medical management, percutaneous transluminal angioplasty and stenting, and intracranial and extra-cranial bypass groups in a 1:1:1 ratio. The primary end point is all adverse events and ipsilateral stroke recurrence at 6, 12, 24 months after the management. The secondary outcomes include the CVR, the National Institute of Health stroke scale and the Modified Rankin Scale at 6, 12, 24 months. Discussion Measurement of cerebrovascular reserve by multimodal image is recommended by most recent studies to guide the treatment of ischemic stroke, and thus its efficacy and evaluation accuracy need to be established in randomized controlled settings. This prospective, randomized, paralleled controlled registry study, together with other ongoing studies, will present more evidence for optimal individualized accurate treatment of ischemic stroke.

scholarly journals Value of computed tomography angiographic collateral status in prediction of malignant middle cerebral artery infarction

2020 ◽  
pp. 4-20
Author(s):  
Sasitorn Petcharunpaisan ◽  
Wannaporn Ngernbumrung ◽  
Sukalaya Lerdlum
Keyword(s):  
Computed Tomography ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Arterial Occlusion ◽  
Intravenous Thrombolysis ◽  
P Value ◽  
Anterior Circulation ◽  
Independent Predictive Factor ◽  
Middle Cerebral Artery Infarction ◽  
Clinical Criteria

Background: Cerebral collateral circulation is necessary to maintain cerebral blood flow and penumbra when arterial insufficiency occurred. Only a few studies about collateral status on development of malignant middle cerebral artery infarction (mMCAi) have been documented. Objective: To determine whether collateral status evaluated by single phase computed tomographic angiography (CTA) help prediction of mMCAi in patients with large arterial occlusion whom not received endovascular treatment. Material and Methods: We retrospectively reviewed patients with acute ischemic stroke in anterior circulation in our institute during January 2015 to December 2015. We analyzed clinical data, baseline National Institutes of Health Stroke Scale (NIHSS), Alberta Stroke Program Early CT Score (ASPECTS) on baseline nonenhanced computed tomography of the brain (NECT brain), and CTA collateral status. Malignant MCA infarction was defined according to clinical criteria. Results: Thirty-five patients were included. Mean age was 68.8±15.56 years. Mean baseline NIHSS and baseline ASPECTS were 17(±5) and 6(±3), respectively. All patients received intravenous thrombolysis. CTA collateral status and baseline NECT ASPECTS significantly correlated with development of mMCAi (P-value = 0.007 and 0.001). Only baseline NECT ASPECTS was an independent predictive factor for mMCAi (OR 0.63, 95%CI 0.46-0.86, P-value =0.004). Patients with baseline NECT ASPECTS ≤ 7 were more likely develop mMCAi (OR 14.29 95%CI 1.57-129.94, P-value 0.018). Conclusion: In acute stroke patients with proximal MCA or ICA occlusion received intravenous thrombolysis alone, baseline NECT ASPECTS and CTA collateral status were significantly correlate with development of mMCAi. However, only baseline ASPECTS ≤ 7 was an independent predictor for mMCAi.

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