scholarly journals Collateral status evaluation coupled with time window by dynamic axial computed tomographic angiography with a focus on the middle cerebral artery for mechanical thrombectomy

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Takahisa Mori ◽  
Kazuhiro Yoshioka ◽  
Wataru Mori ◽  
Yuhei Tanno
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Time Window ◽  
Computed Tomographic Angiography ◽  
Ct Scanner ◽  
Computed Tomographic ◽  
Upper Limit ◽  
Mca Occlusion ◽  
Tomographic Angiography

Abstract Background Dynamic axial computed tomographic angiography (dynax–CTA), covering a thin width, with a focus on the bilateral middle cerebral artery (MCA), can quickly visualize the internal carotid artery (ICA) or MCA occlusion. We aimed to investigate whether dynax–CTA appropriately evaluated the collateral status coupled with the upper limit of the onset-to-reperfusion (OtR) time to achieve a major neurological improvement (MNI) at a 24-h follow-up examination after mechanical thrombectomy (MT). Methods We included acute ischemic stroke patients admitted from 2018 to 2020 who underwent dynax–CTA on admission and emergent MT for ICA or MCA occlusion. We performed dynax–CTA using an 80-row CT scanner and acquired 25 volume scans, consisting of 40 images of 1-mm thickness and 4-cm width. We classified the collateral status as good, intermediate, and poor based on MCA branch opacification. We evaluated the collateral status and the upper OtR time limit to achieve MNI. Results Forty-eight patients met our inclusion criteria. Dynax–CTA findings demonstrated MCA and ICA occlusion in 30 and 18 patients, respectively. The collateral status was good, intermediate, and poor in four, 25, and 19 patients, respectively. The upper limits of the OtR time for MNI were 3.63, 8.08, and 8.67 h in patients with poor, intermediate, and intermediate or good collateral status, respectively. Conclusions Dynax–CTA appropriately evaluated the collateral status coupled with the upper limit of the OtR time before performing MT.

Lenticulostriate infarctions after successful mechanical thrombectomy in middle cerebral artery occlusion

2016 ◽  
Vol 9 (3) ◽  
pp. 234-239 ◽  
Author(s):  
Justus F Kleine ◽  
Ebba Beller ◽  
Claus Zimmer ◽  
Johannes Kaesmacher
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Symptom Onset ◽  
Predictive Value ◽  
False Positive ◽  
Mechanical Thrombectomy ◽  
Time Window ◽  
Vascular Anatomy ◽  
Statistical Measures ◽  
Mca Occlusion

BackgroundIn stroke due to middle cerebral artery (MCA) occlusion, collaterals may sustain tissue in the peripheral MCA territory, extending the time window for recanalizing therapies. However, MCA occlusions often block some or all of the ‘lenticulostriate’ (LS) arteries originating from the M1 segment, eliminating blood flow to dependent territories in the striatum, which have no collateral supply. This study examines whether mechanical thrombectomy (MTE) can avert imminent striatal infarction in patients with acute MCA occlusion.Methods279 patients with isolated MCA occlusion subjected to MTE were included. Actual LS occlusions and infarctions were assigned to predefined ‘LS occlusion’ and ‘LS infarct’ patterns derived from known LS vascular anatomy. The predictive performance of LS occlusion patterns regarding ensuing infarction in striatal subterritories was assessed by standard statistical measures.ResultsLS occlusion patterns predicted infarction in associated striatal subterritories with a positive predictive value (PPV) of 91% and a negative predictive value of 81%. In 15 of the 22 patients who did not develop the predicted striatal infarctions, reassessment of angiographies revealed LS vascular supply variants that explained these ‘false positive’ LS occlusion patterns, raising the PPV to 96%. Symptom onset to recanalization times were relatively short, but this alone could not account for the false positive LS occlusion patterns in the remaining seven of these patients.ConclusionsWith currently achievable symptom onset to recanalization times, striatal infarctions are determined by MCA occlusion sites and individual vascular anatomy, and cannot normally be averted by MTE, but there are exceptions. Further study of such exceptional cases may yield important insights into the determinants of infarct growth in the hyperacute phase of infarct evolution.

A New, More Accurate Classification of Middle Cerebral Artery Aneurysms

Neurosurgery ◽  
2013 ◽  
Vol 73 (1) ◽  
pp. 94-102 ◽  
Author(s):  
Ahmed Elsharkawy ◽  
Martin Lehečka ◽  
Mika Niemelä ◽  
Romain Billon-Grand ◽  
Hanna Lehto ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Computed Tomographic Angiography ◽  
Group Classification ◽  
Intracerebral Hematoma ◽  
Computed Tomographic ◽  
Common Location ◽  
Lenticulostriate Artery ◽  
Tomographic Angiography

Abstract BACKGROUND: Classification of middle cerebral artery (MCA) aneurysms is sometimes difficult because the identification of the main MCA bifurcation, the key for accurate classification of MCA aneurysms, is inconsistent and somewhat subjective. OBJECTIVE: To use the meeting point of the M1 and M2 trunks as an objective, generally accepted, and angiographically evident hallmark for identification of MCA bifurcation and more accurate classification of MCA aneurysms. METHODS: We reviewed the computed tomographic angiography data of 1009 consecutive patients with 1309 MCA aneurysms. The M2 trunks were followed proximally until their meeting with the M1 trunk at the main MCA bifurcation. The aneurysms were classified according to their relative location: proximal, at, or distal to the MCA bifurcation. The M1 aneurysms were further subgrouped into M1 early cortical branch aneurysms and M1 lenticulostriate artery aneurysms, extending the classic 3-group classification of MCA aneurysms into a 4-group classification. RESULTS: The main MCA bifurcation was the most common location for MCA aneurysms, harboring 829 aneurysms (63%). The 406 M1 aneurysms comprised 242 M1 early cortical branch aneurysms (60%) and 164 M1 lenticulostriate artery aneurysms (40%). We found 106 MCA aneurysms (8%) at the origin of large early frontal branches simulating M2 trunks liable to be misclassified as MCA bifurcation aneurysms. Even though 51% of the 407 ruptured MCA aneurysms were associated with an intracerebral hematoma, this did not affect the classification. CONCLUSION: Studying MCA angioarchitecture and applying the 4-group classification of MCA aneurysms is practical and facilitates the accurate classification of MCA aneurysms, helping to improve surgical outcome.

scholarly journals Rare case of a ruptured distal middle cerebral artery fusiform aneurysm: a neurosurgical challenge.

2018 ◽  
Vol 5 (2) ◽  
pp. 3550-3552
Author(s):  
Jagminder Singh ◽  
Amit Mittal ◽  
Rakesh Kumar Kaushal ◽  
Rupinder Kaur ◽  
Simran Kaur ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Surgical Intervention ◽  
Computed Tomographic Angiography ◽  
Fusiform Aneurysm ◽  
Computed Tomographic ◽  
Tomographic Angiography ◽  
Middle Cerebral Artery Aneurysms ◽  
Distal Middle Cerebral Artery ◽  
Early Surgical Intervention

Distal ruptured fusiform middle cerebral artery (MCA) M4 segment aneurysms are rare and their management is a challenge to the neurosurgeon. Fusiform aneurysm of M4 part of is even rarer. Patient usually presents with headache or neurological deficit. Computed tomographic angiography helps to confirm diagnosis. Treatment involves micro-neurosurgical clipping or trapping and excision of aneurysm. Early surgical intervention of distal middle cerebral artery aneurysms favours better outcome. We report a case of 20 year old female patient who presented with complaint of severe headache. Neuroimaging was suggestive of right M4 middle cerebral artery fusiform aneurysm with intracerebral haemorrhage. Patient was managed by trapping and excision of aneurysm and recovered well. 

scholarly journals Successful recanalization using the Embolus Retriever with Interlinked Cage for acute stroke due to calcified cerebral emboli

2018 ◽  
Vol 24 (6) ◽  
pp. 674-677 ◽  
Author(s):  
Hyo S Kwak ◽  
Jung S Park
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Thrombolytic Agent ◽  
Mechanical Thrombectomy ◽  
Computed Tomographic Angiography ◽  
Sudden Onset ◽  
Aspiration Thrombectomy ◽  
Computed Tomographic ◽  
Tomographic Angiography ◽  
Left Middle

Mechanical thrombectomy is a safe and effective treatment in patients with acute ischemic stroke caused by large vessel occlusions. However, in rare cases, the procedure may be challenging due to the composition of the embolus. We describe a case of a mechanical thrombectomy with the Embolus Retriever with Interlinked Cage (ERIC) device in a patient with an acute ischemic stroke due to calcified cerebral emboli in the middle cerebral artery. The procedure was done after a failed recanalization attempt with manual aspiration thrombectomy. An 82-year-old woman presented to the emergency department with a sudden onset of right-sided weakness. A computed tomographic angiography showed left middle cerebral (M1 branch) calcified emboli. After the administration of an intravenous thrombolytic agent, the patient was transferred to the angiographic suite for a mechanical thrombectomy. After failure to recanalize the vessel with manual aspiration thrombectomy, successful recanalization was achieved via mechanical thrombectomy using the ERIC device. Mechanical thrombectomy with an ERIC device can be a useful option in cases of acute ischemic stroke caused by calcified cerebral emboli.

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