Predicting the degree of difficulty of the trans-radial approach in cerebral angiography

2020 ◽  
pp. neurintsurg-2020-016448 ◽  
Author(s):  
Nickalus R Khan ◽  
Jeremy Peterson ◽  
David Dornbos III ◽  
Vincent Nguyen ◽  
Nitin Goyal ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Cerebral Angiography ◽  
Large Diameter ◽  
Tertiary Care ◽  
Clinical Factors ◽  
Femoral Access ◽  
Radial Loop ◽  
Grading Scale ◽  
Stroke Center ◽  
Bovine Aortic Arch

BackgroundTo evaluate anatomical and clinical factors that make trans-radial cerebral angiography more difficult.MethodsA total of 52 trans-radial diagnostic angiograms were evaluated in a tertiary care stroke center from December 2019 until March 2020. We analyzed a number of anatomical variables to evaluate for correlation to outcome measures of angiography difficulty.ResultsThe presence of a proximal radial loop had a higher conversion to femoral access (p<0.03). The presence of a large diameter aortic arch (p<0.01), double subclavian innominate curve (p<0.01), left proximal common carotid artery (CCA) loop (p<0.001), acute subclavian vertebral angle (p<0.01), and absence of bovine aortic arch anatomy (p=0.03) were associated with more difficult trans-radial cerebral angiography and increased fluoroscopy time-per-vessel.ConclusionThe presence of a proximal radial loop, large diameter aortic arch, double subclavian innominate curve, proximal left CCA loop, acute subclavian vertebral angle, and absence of bovine aortic arch anatomy were associated with more difficult trans-radial cerebral angiography. We also introduce a novel grading scale for diagnostic trans-radial angiography.

scholarly journals Synchronous Carotid Bifurcation Endarterectomy and Retrograde Kissing Stenting of the Innominate and Left Common Carotid Artery in a Patient with a Bovine Aortic Arch

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Alessandro Robaldo ◽  
Guido Carignano ◽  
Alberto Balderi ◽  
Claudio Novali
Keyword(s):  
Carotid Artery ◽  
Aortic Arch ◽  
Common Carotid Artery ◽  
Carotid Arteries ◽  
High Risk Patient ◽  
Carotid Bifurcation ◽  
Left Common Carotid Artery ◽  
The Right ◽  
Bovine Aortic Arch ◽  
Common Carotid Arteries

Management of the symptomatic multiple stenosis of supra-aortic vessels (MSSVs) in a “bovine” aortic arch (BAA) configuration is infrequently reported. The optimal treatment choice remains debatable. A successful hybrid treatment for a proximal critical stenosis of the innominate and left common carotid artery was performed in a high-risk patient with a tandem symptomatic lesion in the right carotid bifurcation and a concentric vulnerable plaque in the bovine trunk. This case supports the feasibility, safety, and efficacy of a combined carotid bifurcation endarterectomy and retrograde kissing stenting of common carotid arteries with cerebral protection after evaluation of radiological, anatomical, and clinical parameters.

‘Bovine’ Aortic Arch – A Marker for Thoracic Aortic Disease

Cardiology ◽  
2012 ◽  
Vol 123 (2) ◽  
pp. 116-124 ◽  
Author(s):  
Matthew Hornick ◽  
Remo Moomiaie ◽  
Hamid Mojibian ◽  
Bulat Ziganshin ◽  
Zakaria Almuwaqqat ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Aortic Disease ◽  
Thoracic Aortic Disease ◽  
Bovine Aortic Arch

Pulsatile Tinnitus From Bovine Aortic Arch Variant

2012 ◽  
Vol 63 (4) ◽  
pp. 324
Author(s):  
María José Lesmas Navarro ◽  
Carlos De Paula Vernetta ◽  
Verónica Rodríguez Rivera
Keyword(s):  
Aortic Arch ◽  
Pulsatile Tinnitus ◽  
Bovine Aortic Arch

Abstract P404: Causes of Recrudescent Stroke Symptoms in Emergent Stroke Evaluations

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jeffrey Quinn ◽  
Mohammad Hajighasemi ◽  
Laurie Paletz ◽  
Sonia Figueroa ◽  
Konrad Schlick
Keyword(s):  
Los Angeles ◽  
Medical Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Ischemic Lesion ◽  
Tertiary Care Medical Center ◽  
Stroke Mimic ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Rule Out

Introduction: Recrudescent symptoms of remote central nervous system lesions (primarily due to prior ischemic or hemorrhagic stroke) is a specific stroke mimic that is commonly in the differential diagnosis in patients presenting for emergent stroke evaluation. To date, best practices have yet to be established in terms of ensuring accurate diagnosis and the relative rates of causative systemic illnesses are not well described. We seek to better delineate the etiologies of recrudescent stroke symptoms seen at a tertiary care medical center via emergency stroke evaluation “Code Brain” (CB) as a first step towards clarifying diagnostic criteria for this entity. Methods: Data was obtained via retrospective chart review from consecutive patients via departmental database listing all CB consults seen at a tertiary care comprehensive stroke center in Los Angeles, California between the timeframe of January 2018- June 2020. Diagnoses for each case were adjudicated by faculty Vascular neurologists, in collaboration with Vascular neurology fellows and Neurology residents. Those cases with a diagnosis of stroke recrudescence were reviewed in detail for the extent of neuroimaging they underwent, as well as for identified causes of recrudescence. Results: Records of 3,998 consecutive CB activations were reviewed. 2.1% (n=85) were found after screening to have clinical diagnosis of recrudescence or chronic stroke. Of these 85 patients, 29.4% (n=25) were not found to have a causative etiology for recrudescent neurologic deficit. Of these 25 patients, 36.0% (n=9) did not undergo MRI to evaluate for interval ischemic lesion, as compared to 46.6% of those whom a causative etiology was identified. This difference (10.6%, 95% CI -12.30 to 30.67%, p=0.3719) was not significant. Discussion: At our comprehensive stroke center, recrudescent stroke is an uncommon diagnosis amongst all CB evaluations, despite being commonly considered. Despite a diagnosis of recrudescence, MRI brain is not always performed to rule out acute ischemic stroke. Standardized neuroimaging protocols should be considered in making the diagnosis of stroke recrudescence.

Cerebral angiography using transauricular access in a rabbit model: a new technique

2020 ◽  
pp. 028418512091567
Author(s):  
Hak Jin Kim ◽  
Seon Hee Choi ◽  
So-Hyeon Kim ◽  
Yong-Woo Kim ◽  
Byung Hak Jhun ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Femoral Artery ◽  
Cerebral Angiography ◽  
Guide Wire ◽  
Cerebral Arteries ◽  
Rabbit Model ◽  
Cardiac Chamber ◽  
A New Technique ◽  
The Right ◽  
Selection Of

Background Cerebral angiography in a rabbit model is widely used in the field of interventional radiology. Conventionally, the femoral artery is used for cerebral angiography in radiology departments. However, angiographic studies require surgical cutdown of the femoral artery, which is technically difficult. Purpose To evaluate a new cerebral angiography technique involving a transauricular approach in a rabbit model. Material and Methods In each of 10 rabbits, central auricular arteries were punctured in the right or left ear with a 20-gauge i.v. catheter. A microcatheter (2.0 F) with a 0.016-inch guide wire was introduced through the i.v. catheter and advanced to the aortic arch. The microcatheter and guide wire were advanced selectively into cerebral arteries and angiography was performed. Results Central auricular arteries were successfully punctured with 20-gauge i.v. catheters. After approaching the aortic arch, microcatheter tips and guide wires were advanced manually to cerebral arteries on both sides. Difficulties in selecting the carotid arteries were resolved by using a looping technique within the cardiac chamber. Microcatheter loops within the cardiac chamber disappeared or remained during artery superselection. Conclusion Transauricular cerebral angiography appears to be a feasible technique for brain or carotid intervention studies in rabbits. In addition, vertebral angiography using a transauricular approach is possible using the looping technique. Selection of carotid or vertebral arteries on each side was not difficult when the microcatheter and guide wire were looped within the cardiac chamber. The ear chosen for the initial puncture does not appear to be important.

scholarly journals Clinical factors contributing to high cost hospitalizations in a Canadian tertiary care centre

2017 ◽  
Vol 17 (1) ◽  
Author(s):  
Babak Rashidi ◽  
Daniel M. Kobewka ◽  
David J. T. Campbell ◽  
Alan J. Forster ◽  
Paul E. Ronksley
Keyword(s):  
Tertiary Care ◽  
Care Centre ◽  
Clinical Factors ◽  
Tertiary Care Centre

scholarly journals Total Endovascular Aortic Arch Repair with Branched Graft

Aorta ◽  
2019 ◽  
Vol 07 (04) ◽  
pp. 121-124
Author(s):  
Ilaria Franzese ◽  
Giuseppe Petrilli ◽  
Giovanni Puppini ◽  
Daniela Bacich ◽  
Vincenzo Giambruno ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Clinical Course ◽  
Computed Tomography Scan ◽  
Aortic Arch Replacement ◽  
Total Aortic Arch Replacement ◽  
Custom Made ◽  
Aortic Arch Repair ◽  
Branched Graft ◽  
Bovine Aortic Arch ◽  
Tomography Scan

AbstractIn selected cases, the utilization of branched endografts for the treatment of aortic arch aneurysms could be a safe and advantageous alternative to high-risk procedures such as open total aortic arch replacement or hybrid arch repair. We present the case of a 70-year-old man with saccular aneurysm of a bovine aortic arch which was endovascularly treated using a double-branched custom-made aortic endoprosthesis based on the Relay NBS (Non-Bare Stent) Plus platform intended for zone 0 deployment. The postoperative clinical course was uneventful. The postoperative computed tomography scan showed a good result of the implant. The patient was discharged 6 days after the procedure.

scholarly journals Bovine Arch and Stroke Laterality

2020 ◽  
Vol 9 (13) ◽  
Author(s):  
Jason D. Matakas ◽  
Menachem M. Gold ◽  
Jonathan Sterman ◽  
Linda B. Haramati ◽  
Michael T. Allen ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Univariate Analysis ◽  
Cardioembolic Stroke ◽  
Anterior Circulation ◽  
Chi Square ◽  
Brachiocephalic Trunk ◽  
Ischemic Infarct ◽  
Bovine Aortic Arch ◽  
Final Cohort ◽  
Bovine Arch

Background Left‐hemispheric strokes are more frequent and often have a worse outcome than their right‐hemispheric counterparts. This study aimed to evaluate whether cardioembolic stroke laterality is affected by anatomical characteristics of the aortic arch. We hypothesized that laterality varies between patients with bovine versus standard arch. Methods and Results We retrospectively identified 1598 acute cardioembolic strokes in patients with atrial fibrillation from our institutional stroke database (2009–2017). Inclusion criteria were acute anterior circulation ischemic infarct and availability of both arch and brain imaging (magnetic resonance imaging or computed tomography). Alternative causes of stroke and anomalous arch were excluded. Imaging was reviewed for stroke characterization and laterality and arch branching pattern. Bovine arch denotes a common origin of the brachiocephalic trunk and left common carotid artery. Strokes were classified as bilateral (left or right). Univariate analysis was performed using chi‐square tests. The final cohort comprised 615 patients, mean age 77 years ( SD 11.8 years) with 376 women (61%) and 33% white, 30% black, and the remainder mixed/Hispanic. Standard arch (n=424) stroke distribution was left 43.6% (185), right 45.1% (191), and bilateral 11.3% (48). Bovine arch (n=191) stroke distribution was left 51.3% (98), right 35.6% (68), and bilateral 13.1% (25). Bovine arches were associated with more left‐sided strokes compared with standard arches ( P =0.018). There was an association between black race and bovine arch ( P =0.0001). Conclusions Bovine aortic arch configuration is associated with left hemispheric laterality of cardioembolic stroke. This study enriches the understanding that arch anatomy influences stroke laterality and highlights the need for further research into the causative hemodynamic factors.

scholarly journals A hospital based cross sectional study on comorbid psychiatric problems in persons with epilepsy from north eastern part of India

2017 ◽  
Vol 04 (01) ◽  
pp. 031-035 ◽  
Author(s):  
Sajjadur Rehman ◽  
Kamal Kalita ◽  
Aparajeeta Baruah
Keyword(s):  
Psychiatric Comorbidity ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Clinical Factors ◽  
Cross Sectional ◽  
Psychiatric Comorbidities ◽  
Psychiatric Disturbances ◽  
Long Duration ◽  
North Eastern ◽  
Long Time

Abstract Context The relationship between epilepsy and psychiatric disorders has been recognized for a long time. Psychiatric disturbances like depression, anxiety disorder, psychosis, panic disorder, suicidal behavior etc are associated with epilepsy. Different demographic and clinical factors are associated with the onset of these psychiatric disturbances. Aims To study the prevalence of psychiatric comorbidity in persons with epilepsy. Also assess the different demographic and clinical factors and its relation with the presence of psychiatric comorbidity in persons with epilepsy. Settings and design It was a cross sectional observational study. Methods and material Diagnosed cases of epilepsy, attending Epilepsy Clinic, fulfilling the inclusion and exclusion criteria were recruited for the study. Patients were evaluated with Mini International Neuropsychiatric Interview (MINI) to see their psychiatric comorbidities and also the socio-demographic and clinical factors were assessed Statistical analysis used SPSS version 23.0 for Windows and Graph Pad InStat software trial version 3.1 was used for analysis. Results Psychiatric comorbidity was seen in 50% subjects with comorbid with epilepsy. Depression 18%, Psychosis 14% and Anxiety Disorders 11%, were the most commonly found psychiatric morbidities. Presence of partial seizures, frequent seizures, long duration of epilepsy and poor compliance to antiepileptic drug were significantly associated with presence of psychiatric comorbidity in persons with epilepsy. Conclusions Psychiatric comorbidities are very common in epilepsy. Psychosis associated with epilepsy is seen more in hospital settings. Depression and anxiety though commonly reported in studies are less commonly presented to tertiary care settings.

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