Changes in Cognition and Hemodynamics 1 Year after Carotid Endarterectomy for Asymptomatic Stenosis

2021 ◽  
Author(s):  
Petr Košťál ◽  
Tomáš Mrhálek ◽  
Alena Kajanová ◽  
Martin Bombic ◽  
Jiří Kubále ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Cerebral Artery ◽  
Cognitive Skills ◽  
Posterior Cerebral Artery ◽  
Flow Volume ◽  
Immediate Memory ◽  
Cognitive Efficiency ◽  
Flow Change ◽  
Visuospatial Perception ◽  
The Impact

Abstract Objectives The impact of a change in hemodynamics on cognitive skills in patients with asymptomatic carotid stenosis (ACS) after carotid endarterectomy (CEA) remains unclear. The aim of this study was to evaluate the results of CEA for ACS at 1 year by assessing the changes in anterior, middle, and posterior cerebral artery blood flow in tandem with changes in cognitive efficiency. Methods Flow volume in cerebral arteries using quantitative magnetic resonance angiography was measured in a group of 14 males and 5 females before and at 1 year after CEA for ACS. Cognitive efficiency was assessed by Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The values of flow volume were processed using simple ratio (SR) and were used for covariance analyses with changes in cognitive skills after CEA. Results A significant improvement in cognitive efficiency indexes of immediate memory and visuospatial perception at 1 year after CEA for ACS was observed. Simultaneously, a significant deterioration of speech index was noted. During the analysis of association between flow and cognition, the highest correlation could be seen between the middle cerebral artery (MCA) flow and the visuospatial perception. A change in posterior cerebral artery (PCA) flow was associated with an increase in immediate memory index and anterior cerebral artery (ACA) flow change with the speech index. Conclusion Convergence of data supporting the association between revascularization and cognitive improvement were added in a small, single-center cohort of ACS patients undergoing CEA. No significant differences in cognition were seen between preoperative findings and at 1 year after CEA. Visuospatial perception improvement was linked to flow change in MCA, immediate memory improvement to flow change in PCA, and speech index change to flow change in ACA. Methodical limitations of this small study preclude formulating larger generalizations. Hemodynamic factors in CEA should be assessed in a larger-scale study.

scholarly journals The Mechanism of Macular Sparing

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Jonathan C. Horton ◽  
John R. Economides ◽  
Daniel L. Adams
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Occipital Lobe ◽  
Collateral Flow ◽  
Dual Representation ◽  
Field Representation ◽  
Occipital Pole ◽  
The Impact ◽  
Macular Sparing

Patients with homonymous hemianopia sometimes show preservation of the central visual fields, ranging up to 10°. This phenomenon, known as macular sparing, has sparked perpetual controversy. Two main theories have been offered to explain it. The first theory proposes a dual representation of the macula in each hemisphere. After loss of one occipital lobe, the back-up representation in the remaining occipital lobe is postulated to sustain ipsilateral central vision in the blind hemifield. This theory is supported by studies showing that some midline retinal ganglion cells project to the wrong hemisphere, presumably driving neurons in striate cortex that have ipsilateral receptive fields. However, more recent electrophysiological recordings and neuroimaging studies have cast doubt on this theory by showing only a minuscule ipsilateral field representation in early visual cortical areas. The second theory holds that macular sparing arises because the occipital pole, where the macula is represented, remains perfused after occlusion of the posterior cerebral artery because it receives collateral flow from the middle cerebral artery. An objection to this theory is that it cannot account for reports of macular sparing in patients after loss of an entire occipital lobe. On close scrutiny, such reports turn out to be erroneous, arising from inadequate control of fixation during visual field testing. Patients seem able to detect test stimuli on their blind side within the macula or along the vertical meridian because they make surveillance saccades. A purported treatment for hemianopia, called vision restoration therapy, is based on this error. The dual perfusion theory is supported by anatomical studies showing that the middle cerebral artery perfuses the occipital pole in many individuals. In patients with hemianopia from stroke, neuroimaging shows preservation of the occipital pole when macular sparing is present. The frontier dividing the infarcted territory of the posterior cerebral artery and the preserved territory of the middle cerebral artery is variable, but always falls within the representation of the macula, because the macula is so highly magnified. For physicians, macular sparing was an important neurological sign in acute hemianopia because it signified a posterior cerebral artery occlusion. Modern neuroimaging has supplanted the importance of that clinical sign but at the same time confirmed its validity. For patients, macular sparing remains important because it mitigates the impact of hemianopia and preserves the ability to read fluently. Expected final online publication date for the Annual Review of Vision Science, Volume 7 is September 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

scholarly journals Bilateral Vertebral Artery Hypoplasia and Fetal-Type Variants of the Posterior Cerebral Artery in Acute Ischemic Stroke

2021 ◽  
Vol 12 ◽  
Author(s):  
Chung-Fu Hsu ◽  
Kuan-Wen Chen ◽  
Chun-Hung Su ◽  
Chao-Yu Shen ◽  
Hsin-Yi Chi
Keyword(s):  
Ischemic Stroke ◽  
Vertebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Early Recognition ◽  
Laboratory Data ◽  
Brain Magnetic Resonance Imaging ◽  
Flow Volume ◽  
Vertebral Artery Hypoplasia

Aim: Unilateral vertebral artery hypoplasia is considered a risk factor for posterior circulation infarction. Despite the increasing attention on unilateral vertebral artery hypoplasia, few studies have discussed bilateral vertebral artery hypoplasia, its influence on stroke, or its collateral supply from the circle of Willis. We aimed to identify its characteristics, stroke pattern, and unique ultrasonographic and brain imaging findings.Materials and Methods: Of the 1,301 consecutive in-patients diagnosed with acute ischemic stroke from January 2013 to December 2015, medical and laboratory data and stroke or transient ischemic attack history were recorded. We enrolled patients who underwent both brain magnetic resonance imaging and sonography examinations. Vertebral artery and posterior cerebral artery analyses were conducted in accordance with clinical criteria.Results: Adequate imaging data were available for 467 patients. Of these, eight patients met the criteria for bilateral vertebral artery hypoplasia. The mean age was 62.9 ± 12.1 years. There were six male (75.0%) and two female patients (25.0%). A high prevalence of hypertension (7/8, 87.5%) was noted.Sonograms displayed a very low net flow volume in the vertebral arteries, with the average net flow volume being 28.9 ± 9.7 mL/min. A high frequency (6/8; 75.0%) of the fetal variant posterior cerebral artery from the carotids was found. The infarction patterns in these patients were all bilateral, scattered, and in multiple vascular territories.Conclusion: Patients with bilateral vertebral hypoplasia displayed a unique collateral supply, special stroke pattern, and younger stroke onset. Early recognition and stroke prevention should be considered critical in clinical practice.

Impact of fetal-type posterior cerebral artery on recanalization of posterior communicating artery aneurysms after coil embolization: matched-pair case–control study

2020 ◽  
Vol 12 (8) ◽  
pp. 783-787 ◽  
Author(s):  
Hyun Ho Choi ◽  
Young Dae Cho ◽  
Dong Hyun Yoo ◽  
Heui Seung Lee ◽  
Sung-Hyun Kim ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Coil Embolization ◽  
Posterior Cerebral Artery ◽  
Posterior Communicating Artery ◽  
Matched Pair ◽  
Radiologic Imaging ◽  
Relevant Variables ◽  
Endovascular Coil Embolization ◽  
The Impact

BackgroundIt is well known that hemodynamic stress may impact the recanalization of coiled aneurysms. One of the most common sites for aneurysms to develop is the posterior communicating artery (PcoA), the variants of which are defined by diameter ratios (PcoA/P1 segment).ObjectiveThis study was undertaken to investigate the impact of a fetal-type posterior cerebral artery (PCA) on recanalization of PcoA aneurysms after coil embolization based on matched-pair (fetal vs non-fetal PCA) analysis.MethodsA total of 480 consecutive PcoA aneurysms (PCA: fetal, n=156; non-fetal, n=324) subjected to coil embolization between January 2007 and June 2017 were selected for study. All lesions were followed for ≥6 months via radiologic imaging, grouped by adjacent PCAs as fetal (PcoA/P1 >1) or non-fetal (PcoA/P1 ≤1) type. Paired subjects were matched (1:1) for several relevant variables.ResultsOf the 480 coiled aneurysms, 159 (33.1%) showed recanalization (minor, 76; major, 83) in the course of follow-up (mean 33.8±21.9 months), developing significantly more often in fetal (37.8%) than in non-fetal (26.9%; p=0.020) PCA types. Once matched, however, 6-month and cumulative recanalization rates did not differ significantly by group (p=0.531 and p=0.568, respectively). Complications (hemorrhage, p=0.97; thromboembolism, p=0.94) during endovascular coil embolization also showed similar rates in these groups.ConclusionsThe chances of recanalization after coil embolization seem to be greater in PcoA aneurysms than in intracranial aneurysms overall, thus calling for careful follow-up monitoring. Surprisingly, PcoA type appeared unrelated in this regard.

Failure of Combined Treatment for the Thrombosed Posterior Cerebral Artery Aneurysm

2010 ◽  
Vol 38 (1) ◽  
pp. 52-56 ◽  
Author(s):  
Yasuo MURAI ◽  
Koji ADACHI ◽  
Yoichi YOSHIDA ◽  
Akira TERAMOTO ◽  
Takayuki MIZUNARI
Keyword(s):  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Combined Treatment ◽  
Artery Aneurysm ◽  
Cerebral Artery Aneurysm

Subarachnoid Hemorrhage due to Rupture of Infundibular Dilation of a Circumflex Branch of the Posterior Cerebral Artery

Neurosurgery ◽  
1994 ◽  
Vol 34 (6) ◽  
pp. 1075-1077 ◽  
Author(s):  
George Koike ◽  
Kyoji Seguchi ◽  
Kazuhiko Kyoshima ◽  
Shigeaki Kobayashi
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery

scholarly journals The mean velocity of posterior cerebral artery and basilar artery in Parkinson's disease with sleep disorders

2021 ◽  
Vol 4 ◽  
pp. 100207
Author(s):  
Muhammad Iqbal Basri ◽  
Ida Farida ◽  
Yudy Goysal ◽  
Jumraini Tammasse ◽  
Muhammad Akbar
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Sleep Disorders ◽  
Cerebral Artery ◽  
Basilar Artery ◽  
Posterior Cerebral Artery ◽  
Mean Velocity ◽  
The Mean

Doppler evaluation of the posterior cerebral artery in fetuses with transposition of great arteries

2020 ◽  
Vol 48 (5) ◽  
pp. 504-508
Author(s):  
Ya Tan ◽  
Shi Zeng ◽  
YuShan Liu ◽  
HuaYu Tang ◽  
BaiHua Zhao
Keyword(s):  
Cerebral Artery ◽  
Pulsatility Index ◽  
Posterior Cerebral Artery ◽  
Cerebral Arteries ◽  
Peak Systolic Velocity ◽  
Transposition Of Great Arteries ◽  
Velocity Time Integral ◽  
Time Integral ◽  
Diastolic Velocity ◽  
Doppler Evaluation

AbstractObjectiveTo observe Doppler ultrasound changes in the two segments of the posterior cerebral artery (PCA) in fetuses with transposition of the great arteries (TGA).MethodsThe peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI), and velocity-time integral (VTI) of the two segments of PCA (the first segment: PCAS1, the second segment: PCAS2) and of the middle cerebral artery (MCA) were compared in TGA fetuses and normal fetuses. The abnormality rate between the PCAS1-PI and MCA-PI was compared in TGA fetuses.ResultsThe PCAS1-PI and MCA-PI were smaller in the TGA fetuses than in the controls (all P < 0.05), but the PCAS2-PI was unchanged (P > 0.05). The MCA-VTI, PCAS1-VTI, and PCAS2-VTI were larger in the TGA fetuses (all P < 0.05). In the TGA fetuses, the abnormality rate of the PCAS1-PI was significantly higher than that of the MCA-PI (P < 0.05).ConclusionIn fetuses with TGA, there were hemodynamic differences between the two segments of the posterior cerebral arteries. Moreover, PCAS1 exhibited signs of vasodilatation more obviously than did the MCA in fetuses with TGA.

Mechanical thrombectomy of acute distal posterior cerebral artery occlusions

2021 ◽  
Vol 88 ◽  
pp. 57-62
Author(s):  
Milena Miszczuk ◽  
Hans Christian Bauknecht ◽  
Justus F. Kleine ◽  
Christoph Kabbasch ◽  
Thomas Liebig ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Posterior Cerebral Artery
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