Contrast extravasation after angioplasty for symptomatic stenosis of the middle cerebral artery: A case report

Contrast extravasation is a common phenomenon in acute ischaemic stroke patients who are treated with endovascular therapy, but it is rarely reported in selective angioplasty of intracranial artery stenosis. In this case we present the treatment and follow-up studies of a patient with severe stenosis in the M1 segment of the middle cerebral artery. We observed extravasation of contrast medium in the brain tissue around the stent after the operation by a computed tomography scan taken immediately, but the patient did not experience any neurological deficits during the operation and the 4-year follow-up. Also the contrast extravasation did not transform into haemorrhage or hyperperfusion.

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A novel treatment of a patient with a giant ruptured middle cerebral artery aneurysm by acute coiling followed by scheduled Pipeline flex placement

The Neuroradiology Journal ◽

10.1177/1971400920941192 ◽

2020 ◽

Vol 33 (6) ◽

pp. 517-519

Author(s):

Shikai Liang ◽

Ren Yuan ◽

Xianli Lv

Keyword(s):

Middle Cerebral Artery ◽

Acute Phase ◽

Cerebral Artery ◽

Artery Aneurysm ◽

Aneurysm Rupture ◽

Flow Diversion ◽

Neurological Deficits ◽

Middle Cerebral Artery Aneurysm ◽

Cerebral Artery Aneurysm

Objective Flow diversion in the acute phase of aneurysm rupture or giant aneurysm is limited by the need for dual antiplatelet therapy and the risk of delayed aneurysm rupture. Here, the authors report a scheduled flow-diversion concept for the endovascular treatment of a giant intra-dural aneurysm. Methods A 54-year-old female patient with a ruptured giant middle cerebral artery aneurysm underwent coiling in the acute phase following 1-month scheduled Pipeline flex placement. Results The acutely ruptured giant middle cerebral artery aneurysm was treated by flow diversion scheduled at 1 month after conventional coiling. The patient tolerated this treatment strategy well without any neurological deficits after the procedure and during the 3-month follow-up. The aneurysm showed nearly complete obliteration on 3-month follow-up angiogram, and a 6- to 12-month follow-up was scheduled. Conclusions This strategy may be considered as an option in patients presenting with ruptured or unruptured giant intra-dural aneurysms.

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Republished: Monorail microsnare retrieval of cardiac microcatheter tip embolised to the middle cerebral artery after attempted cardiac ablation procedure

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-015800.rep ◽

2020 ◽

Vol 12 (7) ◽

pp. e6-e6

Author(s):

Michael Young ◽

Ryan Johnson ◽

Hamad Farhat

Keyword(s):

Atrial Fibrillation ◽

Mitral Valve ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Complete Recovery ◽

Neurological Deficits ◽

Ablation Procedure ◽

Cardiac Ablation ◽

The Right

We present a case of a 52-year-old man with previous mitral valve replacement who presented to an outside hospital for planned cardiac ablation for atrial fibrillation. During the procedure, while advancing the microcatheter across the mitral valve, the microcatheter was sheared embolising into the right middle cerebral artery. This retained cardiac microcatheter tip was successfully retrieved with the monorail microsnare technique. The patient made a complete recovery without any neurological deficits or evidence of infarct on follow-up imaging.

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Asymmetry in the brain influenced the neurological deficits and infarction volume following the middle cerebral artery occlusion in rats

Behavioral and Brain Functions ◽

10.1186/1744-9081-4-57 ◽

2008 ◽

Vol 4 (1) ◽

pp. 57 ◽

Cited By ~ 5

Author(s):

Huanmin Gao ◽

Meizeng Zhang

Keyword(s):

Middle Cerebral Artery ◽

Middle Cerebral Artery Occlusion ◽

Cerebral Artery ◽

Artery Occlusion ◽

Neurological Deficits ◽

Infarction Volume ◽

Cerebral Artery Occlusion ◽

The Brain

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Comparison of middle cerebral artery trunk occlusion by silicone cylinder embolization and by trapping

Journal of Neurosurgery ◽

10.3171/jns.1983.58.4.0492 ◽

1983 ◽

Vol 58 (4) ◽

pp. 492-499 ◽

Cited By ~ 16

Author(s):

Yoshikazu Okada ◽

Takeshi Shima ◽

Noboru Yokoyama ◽

Tohru Uozumi

Keyword(s):

Cerebral Infarction ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Clinicopathological Features ◽

Neurological Deficits ◽

Midline Shift ◽

Content Type ◽

Chronic Stage ◽

The Brain ◽

Fine Print

✓ The authors produced occlusion of the middle cerebral artery (MCA) trunk in dogs by two methods: silicone cylinder embolization and trapping. Comparative analyses of the clinicopathological features in these models, extending from the acute to chronic stage, were performed. Within 24 hours after embolization, the brain exhibited swelling without macroscopic infarction. Microangiograms revealed impaired filling in the deep areas of the brain with midline shift. At 4 to 7 days after embolization, the animals showed major neurological deficits, evident deep cerebral infarction, and poorly perfused areas in the deep cerebrum with prominent midline shift. At 3 to 4 weeks after embolization, the neurological deficits improved and the affected regions showed cavities or localized lesions. Microangiograms demonstrated hypervascular areas with abnormal vessels in the affected cerebrum. On the other hand, trapping of the MCA trunk produced mild neurological deficits, although there was no evidence of macroscopic lesions or impairment of filling. This study shows that silicone cylinder embolization in the MCA trunk produces a reliable and reproducible deep cerebral infarction in dogs.

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Monorail microsnare retrieval of cardiac microcatheter tip embolised to the middle cerebral artery after attempted cardiac ablation procedure

BMJ Case Reports ◽

10.1136/bcr-2020-015800 ◽

2020 ◽

Vol 13 (3) ◽

pp. e015800

Author(s):

Michael Young ◽

Ryan Johnson ◽

Hamad Farhat

Keyword(s):

Atrial Fibrillation ◽

Mitral Valve ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Complete Recovery ◽

Neurological Deficits ◽

Ablation Procedure ◽

Cardiac Ablation ◽

The Right

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Keyhole strategy aiming at minimizing hospital stay for surgical clipping of unruptured middle cerebral artery aneurysms

Journal of Neurosurgery ◽

10.3171/2017.10.jns171973 ◽

2019 ◽

Vol 130 (4) ◽

pp. 1359-1366 ◽

Cited By ~ 4

Author(s):

Kentaro Mori ◽

Kojiro Wada ◽

Naoki Otani ◽

Arata Tomiyama ◽

Terushige Toyooka ◽

...

Keyword(s):

Hospital Stay ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Depression Scale ◽

Neurological Deficits ◽

Hamilton Depression Scale ◽

Aneurysm Neck ◽

Unruptured Intracranial Aneurysms ◽

The Mean

OBJECTIVEAneurysms of the middle cerebral artery (MCA) are still most often treated by clipping through standard craniotomy, but a longer hospital stay is one of the main drawbacks of this treatment. The authors developed a pterional keyhole clipping strategy for unruptured MCA aneurysms with the intention of minimizing hospital stay. In this paper, they report on their experience with this approach and analyze the long-term neurological and radiological outcomes.METHODSA total of 160 relatively small unruptured MCA aneurysms (mean 6.4 mm) were clipped through the pterional keyhole approach (19–30 mm, mean 24.6 mm) in 149 patients (aged 34–79 years, mean 62 years). Neurological and cognitive function were examined by several scales, including the modified Rankin Scale (mRS) and Mini–Mental State Examination (MMSE). Patients’ level of depression was assessed using the Beck Depression Inventory and Hamilton Depression Scale. The state of clipping was assessed at 1 year and then every few years after the operation.RESULTSThe mean duration of postoperative hospitalization was 2.3 ± 3.4 days; in 31.3% of the cases, the patients were discharged on the day after the operation (overnight hospital stay) and in 93.2% within 3 days. Of the patients younger than 60 years, 40.4% required only an overnight stay. Complete aneurysm neck clipping was confirmed in 157 cases (98.1%). None of the completely clipped aneurysms showed any recurrence during the mean follow-up period of 5.0 years. The mean length of clinical follow-up was 5.4 years. After 2 (1.3%) of the surgical procedures, the patients showed persistent neurological deficits, defined as mRS score 1, but the overall operative morbidity based on the International Study of Unruptured Intracranial Aneurysms (ISUIA) definition (mRS score ≥ 2 or MMSE score < 24) was 0% at the last examination. Depression scores were significantly improved after surgery, and in 85.6% of the cases the patients were satisfied with their cosmetic results.CONCLUSIONSPterional keyhole clipping is less invasive than clipping via standard craniotomy, minimizes hospital stay, and achieves durable treatment for relatively small unruptured MCA aneurysms.

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Adjuvant use of abciximab for balloon angioplasty of symptomatic middle cerebral artery stenosis

Acta Radiologica ◽

10.1080/02841850510021535 ◽

2005 ◽

Vol 46 (5) ◽

pp. 534-538 ◽

Cited By ~ 1

Author(s):

D. H. Lee ◽

K. D. Jo

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Balloon Angioplasty ◽

Artery Stenosis ◽

Main Trunk ◽

Acute Thrombosis ◽

Proximal Middle Cerebral Artery ◽

Symptomatic Stenosis ◽

Middle Cerebral Artery Stenosis

Purpose: To evaluate the safety of adjuvant intravenous use of abciximab in balloon angioplasty for symptomatic middle cerebral artery stenosis. Material and Methods: Seven patients with symptomatic stenosis at the main trunk ( n = 5), or proximal post-trifurcation portion ( n = 2) of the middle cerebral artery, were enrolled in the study. A bolus dose of abciximab (0.15 mg/kg) was given intravenously immediately before the procedure. The immediate morphologic results as well as the presence of hyperacute thrombosis or hemorrhage after angioplasty were evaluated. Clinical evaluation was performed 1 day and 1 month following angioplasty. Oral antiplatelets were administered during the follow-up period. Follow-up angiography was performed after 7 to 14 (mean 10.4) months. Stenosis of a vessel greater than 50% was considered as restenosis. Results: The procedure was technically successful in all patients. Immediate residual stenosis was insignificant in 4 and mild (less than 50%) in 3 patients. There was no evidence of intimal dissection. Mild gum bleeding was noted in two patients. All study patients were clinically stable at follow-up without newly developed neurological abnormality even though there was one case of occlusion and one case of restenosis on follow-up angiography. Angiographic patency rate was 71%. Conclusion: In performing proximal middle cerebral artery balloon angioplasty, abciximab may be safely used to prevent acute thrombosis. The mid-term patency of the vessels was also acceptable.

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Quercetin attenuates the reduction of parvalbumin in middle cerebral artery occlusion animal model

Laboratory Animal Research ◽

10.1186/s42826-021-00086-0 ◽

2021 ◽

Vol 37 (1) ◽

Author(s):

Dong-Ju Park ◽

Ju-Bin Kang ◽

Fawad-Ali Shah ◽

Phil-Ok Koh

Keyword(s):

Middle Cerebral Artery ◽

Middle Cerebral Artery Occlusion ◽

Cerebral Artery ◽

Neuroprotective Effect ◽

Neuronal Cell ◽

Artery Occlusion ◽

Male Rats ◽

Neurological Deficits ◽

Glutamate Toxicity ◽

Cerebral Artery Occlusion

Abstract Background Calcium is a critical factor involved in modulation of essential cellular functions. Parvalbumin is a calcium buffering protein that regulates intracellular calcium concentrations. It prevents rises in calcium concentrations and inhibits apoptotic processes during ischemic injury. Quercetin exerts potent antioxidant and anti-apoptotic effects during brain ischemia. We investigated whether quercetin can regulate parvalbumin expression in cerebral ischemia and glutamate toxicity-induced neuronal cell death. Adult male rats were treated with vehicle or quercetin (10 mg/kg) 30 min prior to middle cerebral artery occlusion (MCAO) and cerebral cortical tissues were collected 24 h after MCAO. We used various techniques including Western blot, reverse transcription-PCR, and immunohistochemical staining to elucidate the changes of parvalbumin expression. Results Quercetin ameliorated MCAO-induced neurological deficits and behavioral changes. Moreover, quercetin prevented MCAO-induced a decrease in parvalbumin expression. Conclusions These findings suggest that quercetin exerts a neuroprotective effect through regulation of parvalbumin expression.

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The anesthetic approach for endovascular recanalization therapy depends on the lesion site in acute ischemic stroke

Neuroradiology ◽

10.1007/s00234-021-02762-3 ◽

2021 ◽

Author(s):

Kilian Fröhlich ◽

Gabriela Siedler ◽

Svenja Stoll ◽

Kosmas Macha ◽

Thomas M. Kinfe ◽

...

Keyword(s):

Ischemic Stroke ◽

Middle Cerebral Artery ◽

Acute Ischemic Stroke ◽

Cerebral Artery ◽

Posterior Circulation ◽

Neurological Deficits ◽

Stroke Severity ◽

Lesion Volume ◽

Middle Cerebral Artery Territory ◽

Cerebral Lesion

Abstract Purpose Endovascular therapy (EVT) of large-vessel occlusion in acute ischemic stroke (AIS) may be performed in general anesthesia (GA) or conscious sedation (CS). We intended to determine the contribution of ischemic cerebral lesion sites on the physician’s decision between GA and CS using voxel-based lesion symptom mapping (VLSM). Methods In a prospective local database, we sought patients with documented AIS and EVT. Age, stroke severity, lesion volume, vigilance, and aphasia scores were compared between EVT patients with GA and CS. The ischemic lesions were analyzed on CT or MRI scans and transformed into stereotaxic space. We determined the lesion overlap and assessed whether GA or CS is associated with specific cerebral lesion sites using the voxel-wise Liebermeister test. Results One hundred seventy-nine patients with AIS and EVT were included in the analysis. The VLSM analysis yielded associations between GA and ischemic lesions in the left hemispheric middle cerebral artery territory and posterior circulation areas. Stroke severity and lesion volume were significantly higher in the GA group. The prevalence of aphasia and aphasia severity was significantly higher and parameters of vigilance lower in the GA group. Conclusions The VLSM analysis showed associations between GA and ischemic lesions in the left hemispheric middle cerebral artery territory and posterior circulation areas including the thalamus that are known to cause neurologic deficits, such as aphasia or compromised vigilance, in AIS-patients with EVT. Our data suggest that higher disability, clinical impairment due to neurological deficits like aphasia, or reduced alertness of affected patients may influence the physician’s decision on using GA in EVT.

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