Stanford Type A, Debakey Type I Aortic Dissection Involving the Internal Carotid and Femoral Arteries Presenting as Left Middle Cerebral Artery Acute Ischemic Stroke

Abstract OBJECTIVE AND IMPORTANCE Intra-arterial thrombolysis has been demonstrated to improve recanalization and outcomes among patients with acute ischemic stroke. However, thrombolytic agents have limited effectiveness and are associated with a significant risk of bleeding. Bivalirudin is a direct thrombin inhibitor that has been demonstrated in the cardiology literature to have a more favorable efficacy and bleeding profile than other antithrombotic medications. We report the use of bivalirudin during endovascular treatment of acute stroke, when hemorrhagic complications are not uncommon. CLINICAL PRESENTATION A 71-year-old woman with atrial fibrillation presented with right hemiparesis and aphasia and was found to have a National Institutes of Health Stroke Scale score of 10. Computed tomographic scans revealed no evidence of intracranial hemorrhage, aneurysm, or ischemic stroke. Cerebral angiography revealed thromboembolic occlusion of the superior division of the left middle cerebral artery. INTERVENTION For anticoagulation, a loading dose of bivalirudin was intravenously administered before the interventional procedure, followed by continuous infusion. Attempts to remove the clot with an endovascular snare failed to induce recanalization of the vessel. Bivalirudin was then administered intra-arterially. Immediate postprocedural angiography demonstrated restoration of flow in the left middle cerebral artery. Repeat computed tomographic scans demonstrated no intracranial hemorrhage. The patient's hemiparesis and aphasia were nearly resolved and her National Institutes of Health Stroke Scale score was 2 at the time of her discharge 5 days later. CONCLUSION To our knowledge, this is the first report of the use of bivalirudin for treatment of acute ischemic stroke. Bivalirudin may be a useful agent for intravenous anticoagulation and intra-arterial thrombolysis in this setting.

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Adverse Outcome of Early Recurrent Ischemic Stroke Secondary to Atrial Fibrillation after Repeated Systemic Thrombolysis

Case Reports in Vascular Medicine ◽

10.1155/2013/371642 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

Luciano A. Sposato ◽

Valeria Salutto ◽

Diego E. Beratti ◽

Paula Monti ◽

Patricia M. Riccio ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Neurological Outcome ◽

Left Middle Cerebral Artery ◽

Cerebrovascular Event ◽

Middle Cerebral Artery Infarction ◽

Systemic Thrombolysis ◽

Left Middle

Background. Recurrent ischemic stroke is associated with adverse neurological outcome in patients with atrial fibrillation. There is very scarce information regarding the neurological outcome of atrial fibrillation patients undergoing repeated systemic thrombolysis after early recurrent ischemic stroke.Clinical Case and Discussion. We describe a case of a 76-year-old woman with known paroxysmal atrial fibrillation who was admitted because of an acute right middle cerebral artery ischemic stroke and who underwent repeated systemic thrombolysis within 110 hours. The patient underwent systemic thrombolysis after the first ischemic stroke with almost complete neurological recovery. On the fourth day after treatment, an acute left middle cerebral artery ischemic stroke was diagnosed and she was treated with full-dose intravenous recombinant tissue plasminogen activator. A hemorrhagic transformation of the left middle cerebral artery infarction was noted on follow-up cranial computed tomographic scans. The patient did not recover from the second cerebrovascular event and died 25 days after admission.Conclusion. To the best of our knowledge, this is the second case reporting the adverse neurological outcome of a patient with diagnosis of atrial fibrillation undergoing repeated systemic thrombolysis after early recurrent ischemic stroke. Our report represents a contribution to the scarce available evidence suggesting that repeated systemic thrombolysis for recurrent ischemic stroke should be avoided.

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Mechanical thrombectomy utilising a collateral pathway in a patient with dysgenesis of the internal carotid artery

Interventional Neuroradiology ◽

10.1177/1591019918799303 ◽

2018 ◽

Vol 25 (1) ◽

pp. 54-57

Author(s):

Jun Tsukano ◽

Satoshi Kurabe ◽

Tsutomu Sugai ◽

Manabu Wada ◽

Takashi Kumagai

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Internal Carotid ◽

Mechanical Thrombectomy ◽

Left Middle Cerebral Artery ◽

Collateral Pathway ◽

Guiding Catheter ◽

Left Middle

We describe a case of acute middle cerebral artery occlusion in a patient with ipsilateral internal carotid artery dysgenesis successfully treated with mechanical thrombectomy utilising a collateral pathway. During the procedure, a triaxial system using a balloon guiding catheter, flexible large lumen aspiration catheter and stent retriever was advanced from the left vertebral artery to the occluded left middle cerebral artery through the left posterior communicating artery. Because proximal aspiration from the balloon guiding catheter alone might have insufficient suction force due to the retrograde blood flow from large vascular communications (e.g. vertebral artery union), the tip of the flexible large lumen aspiration catheter was set at the proximal left middle cerebral artery, and distal aspiration was added during stent retrieval. A thrombolysis in cerebral infarction 2b result was achieved after the first pass. In this case, identification of carotid canal hypoplasia on computed tomography allowed for an immediate attempt of this alternative approach, avoiding a delay in the time to reperfusion.

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A Case of Occlusive Radiation Vasculopathy Presenting as Bilateral Internal Carotid Artery, Left Middle Cerebral Artery Occlusion and Literature Review

Case Reports in Neurology ◽

10.1159/000501902 ◽

2020 ◽

Vol 12 (Suppl. 1) ◽

pp. 91-96

Author(s):

Yung-Chuan Huang ◽

Shin-Leh Huang ◽

Hon-Man Liu ◽

Hou-Chang Chiu

Keyword(s):

Carotid Artery ◽

Literature Review ◽

Internal Carotid Artery ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Internal Carotid ◽

Tongue Cancer ◽

Artery Occlusion ◽

Left Middle Cerebral Artery ◽

Left Middle

Radiation vasculopathy is one of the rare causes of ischemic stroke. Carotid stenosis with large volume infarction may occur years after radiation therapy for head or neck cancer. We report a case of a patient with bilateral internal carotid artery occlusion presenting with left middle cerebral artery infarct 10 years after receiving treatment for tongue cancer. A literature review and discussion of treatment for such patients are presented.

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A RARE CASE OF RUPTURED ANEURYSM AT THE ORIGIN OF INFERIOR PART OF DUPLICATED MIDDLE CEREBRAL ARTERY

MNJ (Malang Neurology Journal) ◽

10.21776/ub.mnj.2021.007.02.13 ◽

2021 ◽

Vol 7 (2) ◽

pp. 146-148

Author(s):

Achmad Firdaus Sani ◽

Dedy Kurniawan

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Internal Carotid ◽

Anatomical Variation ◽

Ruptured Aneurysm ◽

Endovascular Coiling ◽

Left Middle Cerebral Artery ◽

History Of ◽

Head Computed Tomography ◽

Left Middle

Duplicated middle cerebral artery (DMCA) is an anomalous vessel arises from the internal carotid artery (ICA). This anatomical variation is rare. Aneurysm with this anatomical variation and unusual form was very rare. Even though this kind of aneurysm is rare, it was often ruptured. In this paper, we report a case of 40-years old female with abrupt decreased of consciousness as a chief complaint, along with severe headache one day earlier, no history of head trauma, and there was nuchal rigidity. She didn’t had history of hypertension before. Head computed tomography showed subarachnoid hemmorrhage (SAH) mostly on the left sylvian fissure with Hunt and Hess scale was 3 and Fisher scale was 2, while the cerebral angiography showed duplication of the left middle cerebral artery in which the inferior part of the MCA duplication has ruptured aneurysm at the origin. Treatment option for this aneurysm is endovascular coiling with preserved of the inferior part of duplicated MCA. Result of this treatment shows a good outcome.

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A patient with right internal carotid artery territory infarctionduring intravenous recombinant tissue plasminogen activator treatment for left middle cerebral artery territory ischemic stroke

Nosotchu ◽

10.3995/jstroke.34.351 ◽

2012 ◽

Vol 34 (5) ◽

pp. 351-355

Author(s):

Hiroyuki Arakawa ◽

Yasuhisa Akaiwa ◽

Etsuji Saji ◽

Takayoshi Shimohata ◽

Masatoyo Nishizawa

Keyword(s):

Ischemic Stroke ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Cerebral Artery ◽

Internal Carotid ◽

Recombinant Tissue Plasminogen Activator ◽

Left Middle Cerebral Artery ◽

Middle Cerebral Artery Territory ◽

Tissue Plasminogen ◽

Left Middle

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Does the side of middle cerebral artery compromise matters in the mortality after thrombolysis in ischemic stroke?

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20150079 ◽

2015 ◽

Vol 73 (8) ◽

pp. 644-647 ◽

Cited By ~ 2

Author(s):

Renata Dal-Prá Ducci ◽

Marcos Christiano Lange ◽

Carla Heloísa Moro ◽

Rodrigo Harger ◽

Alexandre Luiz Longo ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Univariate Analysis ◽

Intravenous Thrombolysis ◽

Left Middle Cerebral Artery ◽

Affected Side ◽

The Impact ◽

Left Middle

The impact of the side in middle cerebral artery (MCA) ischemic stroke is not well established. Our aim was to analyze the differences between right (RMCA) and left middle cerebral artery (LMCA) stroke in patients submitted to intravenous thrombolysis and the influence of the affected side in the patient’s mortality after 3 months. Method Patients with MCA ischemic stroke submitted to intravenous thrombolysis from March 2010 to December 2011 at two Brazilian Stroke Centers were included. Differences between patients with RMCA and LMCA stroke were identified by univariate analysis. Results Forty-five patients with RMCA stroke and 67 with LMCA stroke were analyzed. Patients with LMCA had a higher incidence of atrial fibrillation (p = 0.031), although patients with RMCA more often had a previous ischemic stroke (p = 0.034). The mortality over 3 months was similar for either side (OR = 1.20 ;0.37 - 4.29, p = 0.772). Conclusion The side of the MCA ischemic stroke did not influence the patients mortality.

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Association of Cerebral Artery Stenosis With Post-stroke Depression at Discharge and 3 Months After Ischemic Stroke Onset

Frontiers in Psychiatry ◽

10.3389/fpsyt.2020.585201 ◽

2020 ◽

Vol 11 ◽

Author(s):

Xiuli Qiu ◽

Jinfeng Miao ◽

Yan Lan ◽

Wenzhe Sun ◽

Yuxi Chen ◽

...

Keyword(s):

Ischemic Stroke ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Artery Stenosis ◽

Stroke Onset ◽

Left Middle Cerebral Artery ◽

Basilar Artery Stenosis ◽

Post Stroke Depression ◽

Middle Cerebral Artery Stenosis ◽

Left Middle

Background: Post-stroke depression (PSD) is one of the most common complications after stroke, which seriously affects patients' recovery outcome. Although vascular depression has been extensively studied, the relationship between cerebral artery stenosis and PSD has not been clarified so far.Methods: Two hundred ninety-eight patients with ischemic stroke (72 women, 226 men) with computed tomography angiography (CTA) or magnetic resonance angiography (MRA) were included in this study. Cerebral artery stenosis ≥50% was used as the cut-off value. The DSM-V diagnostic criteria of PSD was met and the 17-item Hamilton Rating Scale for Depression (HAMD-17) score over 7 at discharge and 3 months after stroke onset was regarded as the primary outcome. The χ2-test, Mann-Whitney U-test, and t-test were used to check for statistical significance.Results: At discharge, Barthel index (p < 0.001), left middle cerebral artery stenosis (p = 0.019), drinking history (p = 0.048), basilar artery stenosis (p = 0.037) were significantly associated with PSD. At 3 months after ischemic stroke onset, Barthel index (p = 0.011), left middle cerebral artery stenosis (p = 0.012), female gender (p = 0.001) were significantly associated with PSD.Conclusions: The findings demonstrated that left middle cerebral artery and basilar artery stenosis are associated with PSD. It was suggested that cerebral artery stenosis was a risk factor of PSD and should be recognized and intervened early.Registration Number: ChiCTR-ROC-17013993.

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Aortogenic Left Middle Cerebral Artery Ischemic Stroke

The Neurohospitalist ◽

10.1177/1941874412445099 ◽

2012 ◽

Vol 2 (3) ◽

pp. 106-106

Author(s):

Frederic N. Nguyen ◽

Jitesh Kar ◽

Vivek Misra

Keyword(s):

Ischemic Stroke ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Left Middle Cerebral Artery ◽

Left Middle

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