Case 24 Dissection of the Right Extracranial Internal Carotid Artery and Left M1 Middle Cerebral Artery

2017 ◽  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Extracranial Internal Carotid Artery ◽  
The Right

scholarly journals Treatment of Middle Cerebral Artery Occlusion and Internal Carotid Artery Dissection with Combined Mechanical Thrombectomy and Stenting of the Internal Carotid Artery

2013 ◽  
Vol 26 (1) ◽  
pp. 84-88 ◽  
Author(s):  
A. Wetter ◽  
Mi-Rim Shin ◽  
D. Meila ◽  
F. Brassel ◽  
M. Schlunz-Hendann
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Artery Dissection ◽  
Severe Stroke ◽  
The Right

We describe a case of combined mechanical thrombectomy of the right middle cerebral artery and stent angioplasty of the right internal carotid artery in a severe stroke caused by arterio-arterial embolism due to a traumatic dissection of the internal carotid artery. The patient was admitted with an NIHSS score of 19 and was discharged from hospital with a score of 2. Three months later neurological examination disclosed no pathological findings. The case demonstrates the crucial role of interventional procedures in the treatment of severe stroke where intravenous thrombolysis has little prospect of success.

scholarly journals Systematization, Description, and Territory of the Middle Cerebral Artery in Brain Surface of the Turtle (Trachemys scripta elegans)

2018 ◽  
Vol 44 (1) ◽  
pp. 7
Author(s):  
Juliana Voll ◽  
Rui Campos
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Cerebral Hemisphere ◽  
Internal Carotid ◽  
Convex Surface ◽  
Trachemys Scripta ◽  
Trachemys Scripta Elegans ◽  
The Right

Background: Trachemys scripta elegans, in Brazil, has been considered an exotic and invasive turtle; it competes with autochthon species for habitat and food, threatening biodiversity. These animals have been exported to Brazil as pets; however, despite of the commercial interest in the last years, there are only few reports about the turtle central nervous system vascularization. Therefore, this study had the objective to describe and systematize the middle cerebral artery at the brain surface of the turtle (Trachemys scripta elegans), determining a standard model of irrigation and the main ramifications and territory, in this species.Materials, Methods & Results: Thirty turtles received pre-anesthetic medication composed of ketamine (80 mg/kg) and midazolam (2 mg/kg) followed by euthanasia with a sodium thiopental (100 mg/kg) overdose. The aortic arches were cannulated through the single ventricle, the cranial cava veins were incised and the vascular system washed with saline solution and heparin, and then filled with latex. Pieces remained immersed in running water and a bone window was opened in the cranial vault. Samples were fixed with formaldehyde and each brain with a spinal cord segment was removed from the cranial vault, the duramater was removed and the arteries dissected. Results were recorded and it was observed that the middle cerebral artery, collateral branch of the rostral branch of the internal carotid artery, varied between one to three components. These vessels anastomosed, originating a net that was projected from the base of the brain dorsorostralwards, reaching the convex surface of the olfactory bulb. Their lateral ramifications formed the convex hemispheric arteries, which ascended to the convex surface of the cerebral hemisphere and reached, caudally, the proximities of the caudal pole, anastomosing with the occipital hemispheric branches of the caudal cerebral artery and, dorsally, anastomosed with the caudal medial hemispheric branches of the caudal inter-hemispheric artery. Rostrally, its terminal branches, dorsal and ventral, formed a vascular ring around the coronal sulcus, which separated the cerebral hemisphere from the sessile olfactory bulb together with the rostral medial hemispheric branches of the rostral inter-hemispheric artery, branch of the rostral cerebral artery. The arteries of the olfactory bulb were originated from this ring. The middle cerebral artery in 63.4% of the samples to the right and in 56.7% to the left was double. But in 33.3% to the right and 20% to the left was triple, whereas in 3.3% to the right and in 23.3% to the left was a single vessel.Discussion: Authors reported that the middle cerebral artery, in reptiles, was originated as a single trunk, which subdivided into several arteries or was formed from several short trunks that ramified towards the convex surface of the cerebral hemisphere. In a study about turtles, the middle cerebral artery presented single origin and was emitted from the rostral branch of the internal carotid artery, emitting secondary branches that irrigated a portion of the dorsolateral surface of the cerebral hemispheres. In alligators, the rostral branch of the internal carotid artery originated a large middle cerebral artery, which emitted secondary branches towards the lateral surface of the cerebral hemisphere, continuing as rostral cerebral artery. In Cayman, the middle cerebral artery consisted of a formation of a net originated from one to five vessels, which was projected in sequence as collateral branches of the rostral branch of the internal carotid artery. This pattern of the middle cerebral artery was also observed in Trachemys, however, the net formation of the middle cerebral artery was after the emission of one to three vessels.

scholarly journals Free-floating thrombus and a fragment of atherosclerotic plaque in the lumen of the internal carotid artery – review of 2 cases

2021 ◽  
Vol 35 (1) ◽  
pp. 56-65
Author(s):  
S.V. Konotopchyk ◽  
F.H. Rzayeva ◽  
O.A. Pastushyn ◽  
N.M. Nosenko ◽  
O.Ye. Svyrydiuk ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Atherosclerotic Plaque ◽  
Cerebral Angiography ◽  
Internal Carotid ◽  
Floating Thrombus ◽  
Critical Stenosis ◽  
The Right

Free-floating thrombus or a fragment of atherosclerotic plaque (mobile plaque) in the lumen of the carotid artery is extremely rare. Atherosclerosis is the most common cause underlying their occurrence. The optimal treatment strategy has not been developed, at least in part due to the rarity of observations, as well as the lack of comparative studies between conservative and surgical treatment (carotid artery stenting, endovascular thrombectomy, endarterectomy). We present two cases that demonstrate the treatment tactics of these rather rare pathologies. Patient Yu., 62 years old, was hospitalized with focal neurological symptoms, National Institutes of Health Stroke Scale of 12. According to the CT of the brain, signs of an ischemic stroke in the right middle cerebral artery circulation were detected. Selective cerebral angiography diagnosed thrombosis of the arteries of the precentral and central sulcus of the right middle cerebral artery, critical stenosis of the mouth of the right internal carotid artery, and a free-floating thrombus in its lumen with a fixation point at the level of atherosclerotic plaque, which blocked the lumen of the artery by more than 60 %. Endovascular aspiration of a free-floating thrombus was performed, followed by angioplasty and stenting of critical stenosis with a favorable clinical outcome. Patient L., 73 years old, applied for carotid ultrasonography, during which a mobile atherosclerotic plaque was diagnosed at the level of the bifurcation of the right common carotid artery. Digital selective cerebral angiography confirmed a plaque fragment floating in the lumen of the artery. After applying a loading dose of ticagrelor without complications, an emergency implantation of a carotid stent was performed at the level of the bifurcation of the right common carotid artery.Taking into account the modern possibilities of interventional radiology and a wide range of tools, the endovascular approach to the treatment of complicated atherosclerotic plaque with a floating component or a formed blood clot is the best treatment option with a good safety profile.

scholarly journals Extracranial internal carotid artery vasospasm during thrombectomy

2017 ◽  
Vol 31 (3) ◽  
pp. 313-316
Author(s):  
Isamu Miura ◽  
Akitsugu Kawashima ◽  
Masataka Hayashi ◽  
Akane Tanda ◽  
Tomomi Ishikawa ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Stent Retriever ◽  
Extracranial Internal Carotid Artery ◽  
Acute Cerebral Ischemia ◽  
Guiding Catheter ◽  
Mechanical Irritation

The use of a stent retriever increases the risk of intracranial vasospasm. Here, we report the case of a man who developed severe vasospasm in a long segment of the extracranial internal carotid artery after mechanical irritation by a stent retriever inserted for the treatment of acute cerebral ischemia. A 47-year-old right-handed man presented with sudden-onset right-sided weakness and difficulty speaking. The patient’s National Institutes of Health Stroke Scale score was 6 and he had an Alberta Stroke Program Early Computed Tomography Score of 9. The patient was started on intravenous alteplase therapy, and an acute thrombectomy was performed. Left internal carotid digital subtraction angiography showed narrowing of the left common and internal carotid arteries and occlusion of the proximal left M1 segment of the middle cerebral artery. A stent retriever was retracted into a guiding catheter placed at the left carotid bulb under continuous suction. Recanalization of the middle cerebral artery was not achieved and there was significant narrowing in a long segment of the extracranial internal carotid artery associated with exacerbation of the patient’s aphasia. The cervical vasospasm improved after nicardipine infusion via the catheter. We encountered vasospasm in a long segment of the extracranial internal carotid artery after mechanical irritation by a stent retriever. If a stent retriever is used in a patient with a narrow extracranial internal carotid artery, consideration should be given to using a Penumbra or smaller guiding catheter located in the distal internal carotid artery to prevent irritation to the cervical vessel wall.

scholarly journals Trapping, dome puncture, and direct suction decompression in conjunction with assistant superficial temporal artery- middle cerebral artery bypass to clip giant internal carotid artery bifurcation aneurysm

2019 ◽  
Vol 10 ◽  
pp. 205
Author(s):  
Seiei Torazawa ◽  
Hideaki Ono ◽  
Tomohiro Inoue ◽  
Takeo Tanishima ◽  
Akira Tamura ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Optimal Treatment ◽  
Aneurysm Neck ◽  
Bifurcation Aneurysm

Background: Very large and giant aneurysms (≥20 mm) of the internal carotid artery (ICA) bifurcation (ICAbif) are definitely rare, and optimal treatment is not established. Endovascular treatments are reported as suboptimal due to difficulties of complete occlusion and tendencies to recanalization. Therefore, direct surgery remains an effective strategy if the clipping can be performed safely and reliably, although very difficult. Case Description: Two cases of ICAbif aneurysms (>20 mm) were treated. Prior assistant superficial temporal artery (STA)-middle cerebral artery (MCA) bypass was performed to avoid ischemic complications during prolonged temporary occlusion of the arteries in both cases. In Case 1 (22-mm aneurysm), the dome was inadvertently torn in applying the clip because trapping had resulted in insufficient decompression. Therefore, in Case 2 (28-mm aneurysm), almost complete trapping of the aneurysm and subsequent dome puncture was performed, and the aneurysm was totally deflated by suction from the incision. This complete aneurysm decompression allowed safe dissection and successful clipping. Conclusion: Trapping, deliberate aneurysm dome puncture, and suction decompression from the incision in conjunction with assistant STA-MCA bypass can achieve complete aneurysm deflation, and these techniques enable safe dissection of the aneurysm and direct clipping of the aneurysm neck. Direct clipping with this technique for very large and giant ICAbif aneurysms may be the optimal treatment choice with the acceptable outcome if endovascular treatment remains suboptimal.

Blister Aneurysms of the Internal Carotid Artery: Microsurgical Results and Management Strategy

Neurosurgery ◽  
2017 ◽  
Vol 80 (2) ◽  
pp. 235-247 ◽  
Author(s):  
Christopher M. Owen ◽  
Nicola Montemurro ◽  
Michael T. Lawton
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Treatment Strategy ◽  
Internal Carotid ◽  
Artery Bypass ◽  
External Carotid ◽  
Parent Artery ◽  
Intraoperative Rupture

Abstract BACKGROUND: Blister aneurysms of the supraclinoid internal carotid artery (ICA) are challenging lesions with high intraoperative rupture rates and significant morbidity. An optimal treatment strategy for these aneurysms has not been established. OBJECTIVE: To analyze treatment strategy, operative techniques, and outcomes in a consecutive 17-year series of ICA blister aneurysms treated microsurgically. METHODS: Seventeen patients underwent blister aneurysm treatment with direct clipping, bypass and trapping, or clip-reinforced wrapping. RESULTS: Twelve aneurysms (71%) were treated with direct surgical clipping. Three patients required bypass: 1 superficial temporal artery to middle cerebral artery bypass, 1 external carotid artery to middle cerebral artery bypass, and 1 ICA to middle cerebral artery bypass. One patient was treated with clip-reinforced wrapping. Initial treatment strategy was enacted 71% of the time. Intraoperative rupture occurred in 7 patients (41%), doubling the rate of a poor outcome (57% vs 30% for patients with and without intraoperative rupture, respectively). Severe vasospasm developed in 9 of 16 patients (56%). Twelve patients (65%) were improved or unchanged after treatment, and 10 patients (59%) had good outcomes (modified Rankin Scale scores of 1 or 2). CONCLUSION: ICA blister aneurysms can be cautiously explored and treated with direct clipping as the first-line technique in the majority of cases. Complete trapping of the parent artery with temporary clips and placing permanent clip blades along normal arterial walls enables clipping that avoids intraoperative aneurysm rupture. Trapping/bypass is used as the second-line treatment, maintaining a low threshold for bypass with extensive or friable pathology of the carotid wall and in patients with incomplete circles of Willis.

Sign in / Sign up

Export Citation Format

Share Document