scholarly journals Spaceflight-associated increase in middle cerebral vein velocity: collapse, collateral flow, or hyperemia?

2021 ◽  
Vol 131 (4) ◽  
pp. 1392-1393
Author(s):  
Grant Alexander Bateman ◽  
Alexander Robert Bateman
Keyword(s):  
Cerebral Vein ◽  
Collateral Flow

Abstract WP31: Asymmetrical Internal Veins Sign In Acute Ischemic Stroke: A New Marker For Poor Collateral Circulation.

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Lavinia Dinia ◽  
David Carrera ◽  
Delgado-Mederos Raquel ◽  
Martí-Fàbregas Joan ◽  
Josep Lluis Munuera Del Cerro
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Collateral Circulation ◽  
Ct Perfusion ◽  
High Specificity ◽  
Venous Drainage ◽  
Stroke Severity ◽  
Cerebral Vein ◽  
Collateral Flow ◽  
Anterior Circulation

INTRODUCTION: Changes in venous drainage imaging have been directly related to parenchymal damage in acute ischemic stroke during endovascular treatment. Venous asymmetry assessed by CT prior to treatment may be directly related to delayed flow in the hypoperfused territory. We investigated the prevalence of asymmetry in internal cerebral vein (AIV) drainage and its correlation with collateral flow in patients with acute ischemic stroke by a multimodal CT protocol. Subjects and methods: We retrospectively evaluated clinical and radiological data of 29 consecutive patients with acute anterior circulation ischemic stroke within 6 hours from symptoms onset. Collateral status was graded as good or poor depending on the extent of contrast visualized distal to the occlusion on CT angiography (CTA). Presence and AIV (analyzed by density units, time to peak and volume) and arterial collateral score were blinded assessed on CT perfusion (PCT), CTA source images (CTASI) and MIP reconstructions. Results: We included 29 patients, with a median age of 77 ± 15 y, and 31% of them were men. Median baseline NIHSS was 11 ± 7. Mean infarct ASPECTS was 9.3 ± 1 and size 2 cm3 ± 4. Asymmetrical veins were present in 33% of patients. This sign was more prevalent in patients with proximal occlusions than in distal occlusions (67% versus 33%) and in patients with poor collaterals compared to those with good collaterals (62% versus 29%). AIV was significantly associated with increasing age (p= 0.03), increasing baseline NIHSS (p= 0.02) and poor collaterals (p=0.01). Presence of AIV reached high specificity (93%) and good sensitivity (66%) for poor arterial collaterals prediction (p=0.001). Conclusion: Impairment of venous circulation, assessed by means of AIV, is present in one third of the patients and was associated with stroke severity and low effectiveness of collateral flow. Presence of internal veins asymmetry is highly specific in detecting poor collateral circulation in acute stroke and may be a predictor of clinical and radiological severity, possibly useful for patients selection in planning reperfusion therapy strategies.

Oral Contraceptives Are a Risk Factor for Cerebral Vein Thrombosis

1996 ◽  
Vol 76 (03) ◽  
pp. 477-478 ◽  
Author(s):  
I Martinelli ◽  
F R Rosendaal ◽  
J P Vandenbroucke ◽  
P M Mannucci
Keyword(s):  
Risk Factor ◽  
Oral Contraceptives ◽  
Cerebral Vein ◽  
Cerebral Vein Thrombosis ◽  
Vein Thrombosis

Thigh Cuff Effects on Venous Flow Redistribution During 4 Days in Dry Immersion

2020 ◽  
Vol 91 (9) ◽  
pp. 697-702
Author(s):  
Philippe Arbeille ◽  
Danielle Greaves ◽  
Laurent Guillon ◽  
Stephane Besnard
Keyword(s):  
Left Ventricle ◽  
Ejection Fraction ◽  
Jugular Vein ◽  
Residual Effect ◽  
Cerebral Vein ◽  
Fluid Shift ◽  
Venous Flow ◽  
Additional Measure ◽  
Dry Immersion ◽  
Vein Diameter

PURPOSE: The objective was to quantify the venous redistribution during a 4-d dry immersion (DI) and evaluate the effect of thigh cuffs.METHODS: The study included nine control (Co) and nine subjects wearing thigh cuffs during the daytime (CU). Ultrasound measures were performed Pre-DI, on day 4 AM (D4 AM) and D4 PM: left ventricle stroke volume and ejection fraction (SV, EF), jugular vein volume (JVvol), portal vein diameter (PV), and middle cerebral vein velocity (MCVv). An additional measure of JVvol was performed on Day 1 after 2 h in DI.RESULTS: After 2 h in DI, JVvol increased significantly from Pre in both groups, but increased more in the Co compared to the CU subjects (Co: 0.27 0.15 cm3 to 0.94 0.22 cm3; CU: 0.32 0.13 cm3 to 0.64 0.32 cm3). At D4 AM, SV and EF decreased from Pre (SV: 111 23 cm3 to 93 24 cm3; EF: 0.66 0.07 to 0.62 0.07). JVvol was slightly increased (Co: 0.47 0.22 cm3 CU: 0.35 014 cm3). MCVv and PV remained unchanged from Pre-DI. No difference was found between the two groups for any of the parameters measured. From D4 AM to PM, no significant change was observed for any parameter.CONCLUSION: The results confirm that DI induces, during the first 2-3 h, a significant cephalic fluid shift as observed in spaceflight. During this early phase, the thigh cuffs reduced the amplitude of the fluid shift toward the head, but after 4 d in DI there was only a slight memory (residual) effect of DI on the jugular volume and no residual effect of the thigh cuffs.Arbeille P, Greaves D, Guillon L, Besnard S. Thigh cuff effects on venous flow redistribution during 4 days in dry immersion. Aerosp Med Hum Perform. 2020; 91(9):697702.

scholarly journals Longitudinal Reproducibility of CO2-Triggered BOLD MRI for the Hemodynamic Evaluation of Adult Patients with Moyamoya Angiopathy

2021 ◽  
pp. 1-7
Author(s):  
Constantin Roder ◽  
Uwe Klose ◽  
Helene Hurth ◽  
Cornelia Brendle ◽  
Marcos Tatagiba ◽  
...  
Keyword(s):  
Intraclass Correlation ◽  
Collateral Flow ◽  
Surgical Revascularization ◽  
Bold Mri ◽  
Promising Tool ◽  
Hemodynamic Evaluation ◽  
Group 2 ◽  
Group 1

<b><i>Background and Purpose:</i></b> Hemodynamic evaluation of moyamoya patients is crucial to decide the treatment strategy. Recently, CO<sub>2</sub>-triggered BOLD MRI has been shown to be a promising tool for the hemodynamic evaluation of moyamoya patients. However, the longitudinal reliability of this technique in follow-up examinations is unknown. This study aims to analyze longitudinal follow-up data of CO<sub>2</sub>-triggered BOLD MRI to prove the reliability of this technique for long-term control examinations in moyamoya patients. <b><i>Methods:</i></b> Longitudinal CO<sub>2</sub> BOLD MRI follow-up examinations of moyamoya patients with and without surgical revascularization have been analyzed for all 6 vascular territories retrospectively. If revascularization was performed, any directly (by the disease or the bypass) or indirectly (due to change of collateral flow after revascularization) affected territory was excluded based on angiography findings (group 1). In patients without surgical revascularization between the MRI examinations, all territories were analyzed (group 2). <b><i>Results:</i></b> Eighteen moyamoya patients with 39 CO<sub>2</sub> BOLD MRI examinations fulfilled the inclusion criteria. The median follow-up between the 2 examinations was 12 months (range 4–29 months). For 106 vascular territories analyzed in group 1, the intraclass correlation coefficient was 0.784, <i>p</i> &#x3c; 0.001, and for group 2 (84 territories), it was 0.899, <i>p</i> &#x3c; 0.001. Within the total follow-up duration of 140 patient months, none of the patients experienced a new stroke. <b><i>Conclusions:</i></b> CO<sub>2</sub> BOLD MRI is a promising tool for mid- and long-term follow-up examinations of cerebral hemodynamics in moyamoya patients. Systematic prospective evaluation is required prior to making it a routine examination.

scholarly journals Impact of Early Blood Pressure Lowering in Patients Presenting with Acute Ischemic Stroke

2021 ◽  
Vol 23 (6) ◽  
Author(s):  
A. Maud ◽  
G. J. Rodriguez ◽  
A. Vellipuram ◽  
F. Sheriff ◽  
M. Ghatali ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Negative Impact ◽  
Systemic Blood Pressure ◽  
Hemodynamic Response ◽  
Collateral Flow ◽  
Early Management ◽  
Ischemic Tissue

Abstract Purpose of Review In this review article we will discuss the acute hypertensive response in the context of acute ischemic stroke and present the latest evidence-based concepts of the significance and management of the hemodynamic response in acute ischemic stroke. Recent Findings Acute hypertensive response is considered a common hemodynamic physiologic response in the early setting of an acute ischemic stroke. The significance of the acute hypertensive response is not entirely well understood. However, in certain types of acute ischemic strokes, the systemic elevation of the blood pressure helps to maintain the collateral blood flow in the penumbral ischemic tissue. The magnitude of the elevation of the systemic blood pressure that contributes to the maintenance of the collateral flow is not well established. The overcorrection of this physiologic hemodynamic response before an effective vessel recanalization takes place can carry a negative impact in the final clinical outcome. The significance of the persistence of the acute hypertensive response after an effective vessel recanalization is poorly understood, and it may negatively affect the final outcome due to reperfusion injury. Summary Acute hypertensive response is considered a common hemodynamic reaction of the cardiovascular system in the context of an acute ischemic stroke. The reaction is particularly common in acute brain embolic occlusion of large intracranial vessels. Its early management before, during, and immediately after arterial reperfusion has a repercussion in the final fate of the ischemic tissue and the clinical outcome.

Cardiovascular magnetic resonance to predict clinical outcome in chronic total coronary artery occlusion

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Khedr Abdelaty ◽  
C Budgeon ◽  
G.S Gulsin ◽  
S Hetherington ◽  
K Khunti ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Coronary Artery ◽  
Magnetic Resonance ◽  
Clinical Outcome ◽  
Composite Endpoint ◽  
Coronary Artery Occlusion ◽  
Stress Perfusion ◽  
Funding Source ◽  
Collateral Flow ◽  
Cmr Imaging

Abstract Background Chronic total coronary artery occlusions (CTOs) are present in approximately 20–30% of patients undergoing invasive angiography. Despite their prevalence, the optimum management strategy of CTOs remains uncertain. A potential limitation in published trials of CTO revascularisation is their failure to incorporate systematic assessment of ischaemia/viability in informing revascularisation decisions. Aim We sought to determine the prognostic utility of ischaemia/viability assessment by cardiovascular magnetic resonance (CMR) in a large, contemporaneous, real-world CTO population. Methods We retrospectively studied consecutive adult patients with≥1angiographically identified CTO who were referred for clinical CMR imaging during a consecutive 8-year period in our centre (2010–2018). Multi-parametric CMR comprised functional assessment, adenosine-stress perfusion and scar imaging. For perfusion assessment, images were analysed qualitatively with a concurrent examination of scar images. Myocardial segments were assigned to CTO or non-CTO territories according to standard criteria, taking into account coronary dominance. Significant ischaemia was defined as ≥10% and/or ≥2 contiguous myocardial segments with hibernation. Angiographic collateral flow to the CTO territory was graded using the Rentrop classification and the Collateral Connection (CC) Score. Significant CAD in non-CTO vessels was defined angiographically as ≥50% stenosis in any epicardial coronary artery/branch with diameter ≥2mm. The composite clinical endpoint comprised all-cause mortality, myocardial infarction and heart failure hospitalisation. Results From a total of 27,201 invasive angiograms performed during the study period, 389 patients were diagnosed with CTO and underwent CMR imaging (mean age 65.0±11.0 years, 84% male). CTO was present most frequently in the right coronary artery (59% of subjects, 229/389), with left circumflex (LCx) artery involvement in 29% (112/389) and left anterior descending (LAD) artery in 29% (111/389). Collaterals with CC grade ≥2 were identified in 186 subjects (48%), and Rentrop score ≥2 in 300 (77%). Significant ischaemia was present in 61% of patients, and infarction in 71% (median infarction 8.6% [interquartile range (IQR) 4.5–14.1]. With a median follow-up time of 3.30 years [IQR 0.04–8.64], 65 (17%) met the composite endpoint. On multivariate analysis, neither significant ischaemia nor infarction was associated with the composite endpoint. However, non-CTO territory ischaemia was independently predictive of adverse outcome (hazard ratio 1.93; 95% CI 1.16–3.21; p=0.0113). Conclusion CTO-territory ischaemia and infarction are not predictive of adverse clinical outcome, challenging the assertion that CTO revascularisation may be guided by ischaemia assessment. The finding that non-CTO territory ischaemia is associated with adverse cardiovascular events warrants further investigation. Kaplan-Meier curves_CTO Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): British Heart Foundation

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