scholarly journals Ipsilateral hypoperfusion caused by intracerebral steal phenomenon after carotid artery stenting: a case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhizhong Yan ◽  
Zhonghua Shi ◽  
Yuhai Wang ◽  
Chunlei Zhang ◽  
Huize Liu ◽  
...  

Abstract Background Abnormal hypoperfusion on the surgical side after carotid artery stenting is rare. Neurological deterioration caused by it is deceptive, which can easily lead to misdiagnosis. The mechanism of hypoperfusion has rarely been demonstrated. We present here a fully studied case with a high probability of intracerebral steal phenomenon. Case presentation A 68-year-old male with severe right internal carotid artery stenosis and left internal carotid artery occlusion underwent right stenosis stent implantation. Restlessness and left limb hemiplegia occurred within 24 h after the procedure, which was similar to hyperperfusion syndrome. However, postoperative computerized tomography perfusion (CTP) revealed abnormal hypoperfusion in the right hemisphere. Transcranial Doppler (TCD) also showed decreased flow velocity in the right middle cerebral artery, and increased flow velocity in the right anterior cerebral artery. We considered that intracerebral steal phenomenon might be the cause, then hypervolemic therapy was accepted and the symptoms completely resolved after 3 days. Conclusions Ipsilateral hypoperfusion is rarely seen after carotid artery stenting. Intracerebral steal phenomenon may be the underlying mechanism. CTP or TCD is helpful for the early detection of this adverse event.

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Omer Kaya ◽  
Cengiz Yilmaz ◽  
Bozkurt Gulek ◽  
Gokhan Soker ◽  
Gokalp Cikman ◽  
...  

A 42-year-old female patient, who had been diagnosed with an occlusion of her left internal carotid artery (ICA) following Doppler ultrasonographic (US) and digitally-subtracted angiographic (DSA) examinations performed in an outer healthcare center in order to eliminate the underlying cause of her complaint of amorosis fugax, later applied to our hospital with the same complaint. At Doppler US performed in our hospital’s radiology department, her right common carotid artery (CCA) was normal, but her left CCA was hypoplastic. The right internal artery (ICA) was validated as normal. At the left side, however, the ICA was apparent only as a stump and it did not demonstrate a continuity. The diagnosis of ICA agenesis was confirmed by the utilization of Doppler US, CT, and DSA imaging, and it was concluded also that ipsilateral CCA hypoplasia could be evaluated as an important clue to the diagnosis of ICA agenesis.


2020 ◽  
Vol 13 (6) ◽  
pp. e015581
Author(s):  
Mark Alexander MacLean ◽  
Thien J Huynh ◽  
Matthias Helge Schmidt ◽  
Vitor M Pereira ◽  
Adrienne Weeks

We report the case of a patient with subarachnoid hemorrhage and three aneurysms arising from the posterior communicating artery (Pcomm)-P1 complex, treated with endovascular coiling and competitive flow diversion. The largest and likely ruptured Pcomm aneurysm was treated with traditional coiling. Two smaller potentially ruptured aneurysms arose from the distal right posterior cerebral artery (PCA) P1 segment. After a failed attempt to treat with conventional flow diversion across the PCA-P1 segment, the P1 aneurysms were successfully treated with competitive flow diversion distal to the PCA-P1 segment from Pcomm to the P2 segment. Over 12 months, competitive flow diversion redirected flow to the right PCA territory via the internal carotid artery-Pcomm-P2, reducing the size of the PCA-P1 segment and obliterating the P1 aneurysms. Competitive flow diversion treatment should be considered for aneurysms occurring at the circle of Willis when traditional methods are not feasible. Herein, we introduce a novel classification for competitive flow diversion treatment.


Author(s):  
Omer Abdul Hamid ◽  
Paul Klimo ◽  
Asim F. Choudhri ◽  
Namrata Shah

AbstractThe study aimed to describe a case of a 7-year-old Caucasian girl who developed isolated chorea in her right upper and lower extremities progressively increasing over 2 years. This study is a case report and conducted at tertiary care center. A 7-year-old Caucasian girl who gradually developed worsening choreiform movements in her right upper and lower extremities over the course of 2 years until medical attention was sought. Literature review of children presenting with chorea as the only manifestation in moyamoya disease. A 7-year-old right-handed Caucasian girl presented with progressively worsening choreiform movements in her right upper and lower extremities affecting her fine motor skills and gait impairment There was no weakness, hyperreflexia, or spasticity on her neurological exam. Neuroimaging studies showed “ivy sign,” asymmetric prominence of vessels within the subarachnoid spaces overlying the left cerebral hemisphere with corresponding serpiginous T2 fluid-attenuated inversion recovery abnormality, but no parenchymal volume loss or diffusion restriction. Magnetic resonance angiography showed focal moderate-to-severe stenosis at the junction of the paraophthalmic and supraclinoid segments of the left internal carotid artery, with poststenotic dilatation. Angiography demonstrated focal stenosis involving the ophthalmic segment of the left internal carotid artery with 50% stenosis. There was compensation through a medium sized left posterior communicating artery as well as posterior cerebral artery to middle cerebral artery and anterior cerebral artery collateralization. Brain single-photon emission computerized tomography scan showed no evidence of perfusion defects in the cerebral hemispheres, basal ganglia, or thalami. She underwent successful revascularization procedure (left pial synangiosis) with resolution of her choreiform movements and normalization of her gait. Our case demonstrates that moyamoya disease should be suspected when evaluating a child with hemichorea and describes resolution of symptoms after revascularization surgery. Neuroimaging and vascular studies should be obtained in children with unilateral movement disorder.


2011 ◽  
Vol 114 (4) ◽  
pp. 1104-1109 ◽  
Author(s):  
Masataka Takahashi ◽  
Zhen-Du Zhang ◽  
R. Loch Macdonald

Object Sphenopalatine ganglion stimulation activates perivascular vasodilatory nerves in the ipsilateral anterior circle of Willis. This experiment tested whether stimulation of the ganglion could reverse vasospasm and improve cerebral perfusion after subarachnoid hemorrhage (SAH) in monkeys. Methods Thirteen cynomolgus monkeys underwent baseline angiography followed by creation of SAH by placement of autologous blood against the right intradural internal carotid artery, the middle cerebral artery (MCA), and the anterior cerebral artery. Seven days later, angiography was repeated, and the right sphenopalatine ganglion was exposed microsurgically. Angiography was repeated 15 minutes after exposure of the ganglion. The ganglion was stimulated electrically 3 times, and angiography was repeated during and 15 and 30 minutes after stimulation. Cerebral blood flow (CBF) was monitored using laser Doppler flowmetry, and intracranial pressure (ICP) was measured throughout. The protocol was repeated again. Evans blue was injected and the animals were killed. The brains were removed for analysis of water and Evans blue content and histology. Results Subarachnoid hemorrhage was associated with significant vasospasm of the ipsilateral major cerebral arteries (23% ± 10% to 39% ± 4%; p < 0.05, paired t-tests). Exposure of the ganglion and sham stimulation had no significant effects on arterial diameters, ICP, or CBF (4 monkeys, ANOVA and paired t-tests). Sphenopalatine ganglion stimulation dilated the ipsilateral extracranial and intracranial internal carotid artery, MCA, and anterior cerebral artery compared with the contralateral arteries (9 monkeys, 7% ± 9% to 15% ± 19%; p < 0.05, ANOVA). There was a significant increase in ipsilateral CBF. Stimulation had no effect on ICP or brain histology. Brain water content did not increase but Evans blue content was significantly elevated in the MCA territory of the stimulated hemisphere. Conclusions Sphenopalatine ganglion stimulation decreased vasospasm and increased CBF after SAH in monkeys. This was associated with opening of the blood-brain barrier.


2013 ◽  
Vol 26 (1) ◽  
pp. 84-88 ◽  
Author(s):  
A. Wetter ◽  
Mi-Rim Shin ◽  
D. Meila ◽  
F. Brassel ◽  
M. Schlunz-Hendann

We describe a case of combined mechanical thrombectomy of the right middle cerebral artery and stent angioplasty of the right internal carotid artery in a severe stroke caused by arterio-arterial embolism due to a traumatic dissection of the internal carotid artery. The patient was admitted with an NIHSS score of 19 and was discharged from hospital with a score of 2. Three months later neurological examination disclosed no pathological findings. The case demonstrates the crucial role of interventional procedures in the treatment of severe stroke where intravenous thrombolysis has little prospect of success.


1977 ◽  
Vol 46 (5) ◽  
pp. 677-680 ◽  
Author(s):  
Antti Servo

✓ A case is reported with congenital absence of the left internal carotid artery associated with an aneurysm on the contralateral carotid syphon. Eight similar cases are reviewed in brief. The possibility of hemodynamic abnormality as the cause of the aneurysm is discussed.


2018 ◽  
Vol 44 (1) ◽  
pp. 7
Author(s):  
Juliana Voll ◽  
Rui Campos

Background: Trachemys scripta elegans, in Brazil, has been considered an exotic and invasive turtle; it competes with autochthon species for habitat and food, threatening biodiversity. These animals have been exported to Brazil as pets; however, despite of the commercial interest in the last years, there are only few reports about the turtle central nervous system vascularization. Therefore, this study had the objective to describe and systematize the middle cerebral artery at the brain surface of the turtle (Trachemys scripta elegans), determining a standard model of irrigation and the main ramifications and territory, in this species.Materials, Methods & Results: Thirty turtles received pre-anesthetic medication composed of ketamine (80 mg/kg) and midazolam (2 mg/kg) followed by euthanasia with a sodium thiopental (100 mg/kg) overdose. The aortic arches were cannulated through the single ventricle, the cranial cava veins were incised and the vascular system washed with saline solution and heparin, and then filled with latex. Pieces remained immersed in running water and a bone window was opened in the cranial vault. Samples were fixed with formaldehyde and each brain with a spinal cord segment was removed from the cranial vault, the duramater was removed and the arteries dissected. Results were recorded and it was observed that the middle cerebral artery, collateral branch of the rostral branch of the internal carotid artery, varied between one to three components. These vessels anastomosed, originating a net that was projected from the base of the brain dorsorostralwards, reaching the convex surface of the olfactory bulb. Their lateral ramifications formed the convex hemispheric arteries, which ascended to the convex surface of the cerebral hemisphere and reached, caudally, the proximities of the caudal pole, anastomosing with the occipital hemispheric branches of the caudal cerebral artery and, dorsally, anastomosed with the caudal medial hemispheric branches of the caudal inter-hemispheric artery. Rostrally, its terminal branches, dorsal and ventral, formed a vascular ring around the coronal sulcus, which separated the cerebral hemisphere from the sessile olfactory bulb together with the rostral medial hemispheric branches of the rostral inter-hemispheric artery, branch of the rostral cerebral artery. The arteries of the olfactory bulb were originated from this ring. The middle cerebral artery in 63.4% of the samples to the right and in 56.7% to the left was double. But in 33.3% to the right and 20% to the left was triple, whereas in 3.3% to the right and in 23.3% to the left was a single vessel.Discussion: Authors reported that the middle cerebral artery, in reptiles, was originated as a single trunk, which subdivided into several arteries or was formed from several short trunks that ramified towards the convex surface of the cerebral hemisphere. In a study about turtles, the middle cerebral artery presented single origin and was emitted from the rostral branch of the internal carotid artery, emitting secondary branches that irrigated a portion of the dorsolateral surface of the cerebral hemispheres. In alligators, the rostral branch of the internal carotid artery originated a large middle cerebral artery, which emitted secondary branches towards the lateral surface of the cerebral hemisphere, continuing as rostral cerebral artery. In Cayman, the middle cerebral artery consisted of a formation of a net originated from one to five vessels, which was projected in sequence as collateral branches of the rostral branch of the internal carotid artery. This pattern of the middle cerebral artery was also observed in Trachemys, however, the net formation of the middle cerebral artery was after the emission of one to three vessels.


Sign in / Sign up

Export Citation Format

Share Document