scholarly journals Predicting Adverse Outcomes in Monochorionic-Diamniotic Twins: The Role of Intertwin Discrepancy in Middle Cerebral Artery Doppler Measurements and the Cerebroplacental Ratio

2021 ◽  
Author(s):  
Thalia Mok ◽  
Yalda Afshar ◽  
Lawrence D. Platt ◽  
Rong Guo ◽  
Rashmi R. Rao ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Adverse Outcomes ◽  
Neonatal Outcomes ◽  
Absolute Difference ◽  
Cerebroplacental Ratio ◽  
The Absolute ◽  
Nicu Admission ◽  
Twin Pregnancies

Objective This study was aimed to evaluate the role of intertwin discrepancy in middle cerebral artery peak systolic velocity (MCA-PSV) and cerebroplacental ratio (CPR) for the prediction of adverse outcomes in monochorionic-diamniotic (MCDA) twin pregnancies. Study Design A retrospective cohort study of MCDA pregnancies that underwent ultrasound surveillance at a perinatal referral center from 2007 to 2017. Intertwin MCA-PSV discrepancy (MCA-ΔPSV-MoM) was defined as the absolute difference of MCA-PSV multiple of the median (MoM) for gestational age between twins. Intertwin CPR discrepancy (CPR-Δ) was defined as the absolute difference of CPR between twins. The maximum MCA-ΔPSV-MoM and CPR-Δ before and after 26 weeks of gestation were assessed as predictors of pregnancy and neonatal outcomes through simple logistic regression models and Pearson's correlation coefficients. Receiver operating characteristic (ROC) curves were generated to determine the predictive value of maximum MCA-ΔPSV-MoM and CPR-Δ. Results A total of 143 MCDA pregnancies met inclusion criteria. There was a significant association between MCA-ΔPSV-MoM at <26 weeks and the development of twin anemia-polycythemia sequence (TAPS; p = 0.007), intrauterine fetal demise (IUFD; p = 0.009), and neonatal intensive care unit (NICU) admission (p < 0.05). MCA-ΔPSV-MoM at ≥26 weeks was associated with the development of TAPS (p < 0.001). CPR-Δ at <26 weeks was associated with the development of twin-twin transfusion syndrome (TTTS; p = 0.03) and NICU admission (p = 0.02). MCA-ΔPSV-MoM at ≥26 weeks was highly predictive of TAPS (area under curve [AUC] = 0.92). A cut-off of 0.44 would identify TAPS with 100% sensitivity and 73% specificity. Conclusion In MCDA pregnancies, intertwin MCA and CPR discrepancies are associated with adverse pregnancy and neonatal outcomes, including TAPS, TTTS, IUFD, and NICU admission. Evaluation of intertwin MCA and CPR differences demonstrated the potential for clinical predictive utility in the surveillance of MCDA twin pregnancies. Key Points

scholarly journals Role of doppler in the middle cerebral artery in prediction of fetal distress during labor in uncomplicated pregnancies at 40 weeks and beyond

2020 ◽  
Vol 69 (1) ◽  
pp. 63-72
Author(s):  
Nikolay N. Rukhlyada ◽  
Vyacheslav M. Bolotskikh ◽  
Elvira R. Semyonova ◽  
Olga A. Klitsenko
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Perinatal Outcome ◽  
Fetal Distress ◽  
Adverse Perinatal Outcome ◽  
Hypoxic Brain Damage ◽  
Uncomplicated Pregnancy ◽  
Cerebroplacental Ratio ◽  
Hypoxic Brain

The aim of this study was to reveal correlation between Doppler in the fetal middle cerebral artery and fetal decompensation during labor in uncomplicated pregnancies at 40 weeks and beyond. We by means of ultrasound Doppler examined 260 women at 40 to 42 weeks of uncomplicated pregnancy 48 hours before delivery, with fetal condition assessed subsequently during labor and immediately after delivery. We found out that in the group of women with caesarean section caused by fetal distress during labor, pulsatility indices in the middle cerebral artery evaluated just before labor were significantly lower than in the group of women whose fetus had better condition during labor. The same trend was observed when comparing Doppler velocimetry using the fetal cerebroplacental ratio. Moreover, we identified that in the group of women with newborns having Apgar 7 and less, middle cerebral artery measured less than 48 hours before delivery were lower than in the group of women having babies in better conditions. Furthermore, as result of this study, the trigger threshold for PI was found to be 0.835, below which fetuses have adverse perinatal outcome during labor. Thus, it was shown that Doppler in the fetal middle cerebral artery in uncomplicated pregnancies at 40 weeks and beyond could predict fetal distress and avoid hypoxic brain damage to the fetus during labor.

scholarly journals Spontaneous Middle Cerebral Artery (MCA) dissection and stenosis: Role of vessel wall imaging and 3D-RA endoluminal view as adjunct diagnostic tools in endovascular therapy

2021 ◽  
Vol 25 ◽  
pp. 101170
Author(s):  
Mohd Fandi Al Khafiz Kamis ◽  
Mohd Naim Mohd Yaakob ◽  
Ezamin Abdul Rahim ◽  
Ahmad Sobri Muda ◽  
Mohamad Syafeeq Faeez Md Noh
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Endovascular Therapy ◽  
Vessel Wall ◽  
Vessel Wall Imaging ◽  
Diagnostic Tools ◽  
Wall Imaging

scholarly journals Role of cyclic flow reductions in the guinea pig middle cerebral artery thrombosis model

1998 ◽  
Vol 76 ◽  
pp. 98
Author(s):  
Ken-ichi Kawano ◽  
Kazuo Umemura ◽  
Kazunao Kondo ◽  
Yasuhiko Ikeda ◽  
Yasuhiro Suzuki ◽  
...  
Keyword(s):  
Guinea Pig ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Cyclic Flow ◽  
Thrombosis Model ◽  
Artery Thrombosis

scholarly journals Role of thrombogenic factors on the middle cerebral artery thrombosis in guinea pigs

1997 ◽  
Vol 73 ◽  
pp. 125
Author(s):  
Kazuva Hokamura ◽  
Kazuo Umemura ◽  
Seiji Kaku ◽  
Kenichi Kawano ◽  
Mitsuyoshi Nakashima
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Guinea Pigs ◽  
Artery Thrombosis

Endovascular stenting for rescue of a failed donor graft during superficial temporal artery to middle cerebral artery bypass surgery: case report

2019 ◽  
Vol 24 (5) ◽  
pp. 572-576
Author(s):  
Melissa A. LoPresti ◽  
Visish M. Srinivasan ◽  
Robert Y. North ◽  
Vijay M. Ravindra ◽  
Jeremiah Johnson ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Endovascular Management ◽  
Donor Graft ◽  
Mca Aneurysm ◽  
Direct Bypass

Direct bypass has been used to salvage failed endovascular treatment; however, little is known of the reversed role of endovascular management for failed bypass.The authors report the case of a 7-year-old patient who underwent a superficial temporal artery to middle cerebral artery (STA-MCA) bypass for treatment of a giant MCA aneurysm and describe the role of endovascular rescue in this case. Post-bypass catheter angiogram showed occlusion of the proximal extracranial STA donor with patent anastomosis, possibly due to STA dissection. A self-expanding Neuroform Atlas stent was deployed across the dissection flap, and follow-up images showed revascularization of the STA with good MCA runoff.This case demonstrates that direct extracranial-intracranial bypass failure can infrequently originate from the STA donor vessel and that superselective angiogram can be useful for identification and treatment in such cases. With more advanced endovascular techniques the tide has turned in the treatment of complex cerebrovascular cases, with this case being an early example of successful rescue stenting for endovascular management of a failed donor after STA-MCA bypass.

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