Abstract TP349: Incidence of Cerebral Ischemia Associated Seizures in Patients With Narrowing or Occlusion of the Ipsilateral Internal Carotid or Middle Cerebral Artery: The EC/IC Bypass Study

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Muhammad Shah Miran ◽  
Ahmed A Malik ◽  
M.Fareed K Suri ◽  
Adnan I Qureshi
Keyword(s):  
Diabetes Mellitus ◽  
Relative Risk ◽  
Cerebral Ischemia ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Factors Affecting ◽  
Ischemic Attack ◽  
Patients Experience

Background: Cerebral ischemia associated seizures are well recognized in patients with internal carotid or middle cerebral artery stenosis or occlusion although the incidence is not well documented. Methods: We analyzed the data that was collected on 1377 patients with recent hemisphere strokes, retinal infarction, or transient ischemic attacks with atherosclerotic narrowing or occlusion of the ipsilateral internal carotid or middle cerebral artery who were enrolled in the EC/IC Bypass Study. The patients were followed for an average of 55.8 months and any seizures related to cerebral ischemia based on clinical and imaging criteria were ascertained. We calculated the relative risk in pre-defined patient subgroups: Age (<55 and ≥55 years), gender, presenting symptom (transient ischemic attack and ischemic stroke), allocated treatment (bypass surgery and medical treatment), site of stenosis/occlusion (internal carotid artery and middle cerebral artery), and presence or absence of hypertension and diabetes mellitus. Results: A total of 64 patients experience one or more cerebral ischemia associated seizures during follow up: first seizure was focal and generalized in 33 and 31 patients, respectively. The incidence of cerebral ischemia associated seizures was 1.7 per 100 person observation years. The relative risk of seizures was higher among patients aged <55 years (relative risk 1.36, 95% confidence interval [CI] 0.8-2.2), women (relative risk 1.1, 95% CI 0.6-2.1), with stroke as presenting symptom (RR 1.9, 95% CI 1.1-3.3), with medical group as allocated treatment (RR 1.2,95%CI 0.7-2.0), with middle cerebral artery as site of stenosis/occlusion(RR 1.13, 95% C.I 0.6-2.0), with diabetes mellitus (RR 1.7, 95% CI 0.96-3.0) or hypertension (RR 1.1, 95% CI 0.7-1.8). Conclusions: We provide the incidence of and factors affecting occurrence of cerebral ischemia associated seizures in patients with narrowing or occlusion of the ipsilateral internal carotid or middle cerebral artery

Abstract 134: Endovascular Revascularization Is Associated With Better Outcomes Than Systemic Throbmolysis Alone For Tandem Internal Carotid And Middle Cerebral Artery Occlusion

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Joshua Pepper ◽  
Rashmi Pashankar ◽  
Joseph Schindler ◽  
Ketan Bulsara
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Endovascular Therapy ◽  
Internal Carotid ◽  
Complication Rates ◽  
Modified Rankin Scale ◽  
Systemic Thrombolysis ◽  
Iatrogenic Complications ◽  
Significant Difference

Background and Purpose: Tandem Internal Carotid Artery and Middle Cerebral Artery or “TIM” occlusions are highly resistant to conventional therapy (systemic thrombolysis) and independently predicts poor patient outcome. Recent evidence suggests that patients treated more aggressively with either endovascular stenting of occluded carotid arteries and/or intra-arterial tissue plasminogen activator (tPA) may have superior outcomes. Here we evaluate all the available data to help assess the best intervention for this patient population that currently has limited treatment options. Methods: Data from Medline and the Cochrane database of systemic reviews was searched. The search terms used includes (tandem OR combined) AND (middle cerebral OR internal carotid) AND (OCCLU* or lesion or stenos* or blocka*). All studies had to be in English. All duplicates were identified and removed. To be included the studies needed to report on three key aspects: 1) baseline characteristics (age; NIHSS at presentation); 2) treatment (time to treatment; modality); and 3) outcome (report of patient state at discharge or follow up on the Modified Rankin Scale). Patients were grouped according to whether they received endovascular intervention or stand alone IV tPA. Patients were considered independent if they had a Modified Rankin Scale score of ≤ 2 at follow up or discharge. Results: Over 2,500 studies were evaluated. Seventeen studies met the inclusion criteria, with a total of 219 patients. Patients treated with endovascular therapy (n=60) (stenting and/or intra-arterial tPA) were 32% more likely to be independent (p<0.0001) and 28% less likely to have a significant disability (p= 0.0004) compared to patients given systemic thrombolysis (n=139). There was no significant difference in mortality or complication rates between the groups. Conclusion: Endovascular therapy appears to be superior compared with systemic thrombolysis in treating patients with TIM occlusions. The risk of iatrogenic complications with more aggressive intervention does not appear to outweigh the outcome benefit. Further and larger studies are needed to assess the benefits and risks of endovascular therapy in patients with TIM lesions.

Embolization of a Superficial Temporal Artery to Middle Cerebral Artery Bypass: Case Report

Neurosurgery ◽  
1983 ◽  
Vol 12 (3) ◽  
pp. 342-345 ◽  
Author(s):  
Frances K. Conley
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Bilateral Carotid ◽  
History Of ◽  
Internal Carotid Arteries ◽  
Bilateral Carotid Artery

Abstract This case history of a man with bilateral carotid artery occlusions presents angiographic documentation of the embolization of a superficial temporal-middle cerebral artery bypass. The embolic source was thrombotic and/or atheromatous debris that had collected in the persistent stump of one of the occluded internal carotid arteries.

scholarly journals Predictive anatomical factors for rupture in middle cerebral artery mirror bifurcation aneurysms

2018 ◽  
Vol 128 (6) ◽  
pp. 1799-1807 ◽  
Author(s):  
Homajoun Maslehaty ◽  
Crescenzo Capone ◽  
Roman Frantsev ◽  
Igor Fischer ◽  
Ramazan Jabbarli ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Rupture Risk ◽  
Significance Level ◽  
Ruptured Aneurysms ◽  
Regular Shape ◽  
The Moment ◽  
The One ◽  
Aneurysm Shape

OBJECTIVEThe aim of this study was to define predictive factors for rupture of middle cerebral artery (MCA) mirror bifurcation aneurysms.METHODSThe authors retrospectively analyzed the data in patients with ruptured MCA bifurcation aneurysms with simultaneous presence of an unruptured MCA bifurcation mirror aneurysm treated in two neurosurgical centers. The following parameters were measured and analyzed with the statistical software R: neck, dome, and width of both MCA aneurysms—including neck/dome and width/neck ratios, shape of the aneurysms (regular vs irregular), inflow angle of both MCA aneurysms, and the diameters of the bilateral A1 and M1 segments and the frontal and temporal M2 trunks, as well as the bilateral diameter of the internal carotid artery (ICA).RESULTSThe authors analyzed the data of 44 patients (15 male and 29 female, mean age 50.1 years). Starting from the usual significance level of 0.05, the Sidak-corrected significance level is 0.0039. The diameter of the measured vessels was statistically not significant, nor was the inflow angle. The size of the dome was highly significant (p = 0.0000069). The size of the neck (p = 0.0047940) and the width of the aneurysms (p = 0.0056902) were slightly nonsignificant at the stated significance level of 0.0039. The shape of the aneurysms was bilaterally identical in 22 cases (50%). In cases of asymmetrical presentation of the aneurysm shape, 19 (86.4%) ruptured aneurysms were irregular and 3 (13.6%) had a regular shape (p = 0.001).CONCLUSIONSIn this study the authors show that the extraaneurysmal flow dynamics in mirror aneurysms are nonsignificant, and the aneurysmal geometry also does not seem to play a role as a predictor for rupture. The only predictors for rupture were size and shape of the aneurysms. It seems as though under the same conditions, one of the two aneurysms suffers changes in its wall and starts growing in a more or less stochastic manner. Newer imaging methods should enable practitioners to see which aneurysm has an unstable wall, to predict the rupture risk. At the moment one can only conclude that in cases of MCA mirror aneurysms the larger one, with or without shape irregularities, is the unstable aneurysm and that this is the one that needs to be treated.

scholarly journals Balloon-expandable stents for treatment of symptomatic middle cerebral artery stenosis: Clinical outcomes during long-term follow-up

2018 ◽  
Vol 24 (6) ◽  
pp. 666-673 ◽  
Author(s):  
Sung Hyun Baik ◽  
Hyo Sung Kwak ◽  
Gyung Ho Chung ◽  
Seung Bae Hwang
Keyword(s):  
Middle Cerebral Artery ◽  
Clinical Outcomes ◽  
Cerebral Artery ◽  
Reperfusion Therapy ◽  
Stent Insertion ◽  
Recurrence Rates ◽  
Long Term Follow Up ◽  
Ischemic Events

Background Insertion of a balloon-expandable stent (BES) in patients with symptomatic intracranial atherosclerosis is a treatment option for reperfusion therapy. In this study, we retrospectively reviewed clinical outcomes during long-term follow-up after insertion of balloon-expandable stents in patients with symptomatic middle cerebral artery (MCA) stenosis. Methods Institutional review board approval was obtained for retrospective review of patient data. Thirty-four patients (15 men, 19 women; median age, 67.5 years) with symptomatic MCA stenosis underwent balloon-expandable stent insertion between June 2008 and December 2010. Patient records were reviewed for angiographic findings and clinical outcomes during long-term follow-up. Results Of these patients, 22 presented with acute ischemic stroke with underlying MCA atherosclerosis and had good clinical outcomes (modified Rankin Scale score (mRS): 0–2) after reperfusion therapy. Indications for stenting for the remaining 12 patients were recurrent transient ischemic attacks (TIAs) refractory to medical therapy and MCA stenosis greater than 70%. During the poststenting follow-up period, which ranged from 61 to 108 months (median, 67.5 months), a TIA occurred in five patients. Of these five patients, one experienced a complete reocclusion of the MCA stent, and three had symptomatic restenosis. The remaining 29 patients did not experience any further ischemic events or restenosis during the follow-up period. Conclusions In our study, treatment with balloon-expandable stents in patients with symptomatic MCA stenosis resulted in low recurrence rates for both ischemic events and restenosis during long-term follow-up.

scholarly journals Tumor necrosis factor-α inhibition attenuates middle cerebral artery remodeling but increases cerebral ischemic damage in hypertensive rats

2014 ◽  
Vol 307 (5) ◽  
pp. H658-H669 ◽  
Author(s):  
Paulo W. Pires ◽  
Saavia S. Girgla ◽  
Guillermo Moreno ◽  
Jonathon L. McClain ◽  
Anne M. Dorrance
Keyword(s):  
Cerebral Ischemia ◽  
Tumor Necrosis Factor ◽  
Infarct Size ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Tumor Necrosis ◽  
Myogenic Tone ◽  
Hypertensive Rats ◽  
Tnf Α ◽  
Necrosis Factor

Hypertension causes vascular inflammation evidenced by an increase in perivascular macrophages and proinflammatory cytokines in the arterial wall. Perivascular macrophage depletion reduced tumor necrosis factor (TNF)-α expression in cerebral arteries of hypertensive rats and attenuated inward remodeling, suggesting that TNF-α might play a role in the remodeling process. We hypothesized that TNF-α inhibition would improve middle cerebral artery (MCA) structure and reduce damage after cerebral ischemia in hypertensive rats. Six-week-old male stroke-prone spontaneously hypertensive rats (SHRSP) were treated with the TNF-α inhibitor etanercept (ETN; 1.25 mg·kg−1·day−1 ip daily) or PBS (equivolume) for 6 wk. The myogenic tone generation, postischemic dilation, and passive structure of MCAs were assessed by pressure myography. Cerebral ischemia was induced by MCA occlusion (MCAO). Myogenic tone was unchanged, but MCAs from SHRSP + ETN had larger passive lumen diameter and reduced wall thickness and wall-to-lumen ratio. Cerebral infarct size was increased in SHRSP + ETN after transient MCAO, despite an improvement in dilation of nonischemic MCA. The increase in infarct size was linked to a reduction in the number of microglia in the infarct core and upregulation of markers of classical macrophage/microglia polarization. There was no difference in infarct size after permanent MCAO or when untreated SHRSP subjected to transient MCAO were given ETN at reperfusion. Our data suggests that TNF-α inhibition attenuates hypertensive MCA remodeling but exacerbates cerebral damage following ischemia/reperfusion injury likely due to inhibition of the innate immune response of the brain.

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