scholarly journals Emergent stenting after intravenous thrombolysis for isolated basilar artery dissection in a patient with acute ischemic stroke: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Toshiaki Goda ◽  
Naoki Oyama ◽  
Takanori Iwamoto ◽  
Hiroki Takai ◽  
Shunji Matsubara ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Basilar Artery ◽  
Brain Magnetic Resonance Imaging ◽  
Intravenous Thrombolysis ◽  
Japanese Woman ◽  
Artery Dissection ◽  
Ischemic Lesion ◽  
Disturbance Of Consciousness ◽  
Old Japanese

Abstract Background Isolated basilar artery dissection (IBAD) is a rare but important cause of ischemic stroke. Anti-thrombotic therapy is often used to treat IBAD-related ischemic stroke, but selected cases might need more aggressive treatment. There is no previous report of emergent stenting for IBAD-related ischemic stroke after intravenous thrombolysis. Case presentation A 53-year-old Japanese woman was admitted to our hospital with disturbance of consciousness, right hemiplegia, severe dysarthria, and total gaze paralysis. Brain magnetic resonance imaging revealed no ischemic lesion, but magnetic resonance angiography showed stenosis in the basilar artery. After initiation of intravenous thrombolysis, her neurological symptoms dramatically improved. Five hours later, however, her symptoms deteriorated again. Cerebral angiography showed IBAD. Emergent stenting was successfully performed. At 90 days after stroke onset, she had no significant disability, with a modified Rankin scale score of 1. Conclusions Emergent stenting can be an effective treatment for patients with IBAD-related ischemic stroke who are resistant to IV-rtPA.

scholarly journals Compliant balloon angioplasty for the treatment of internal carotid artery dissection

2018 ◽  
Vol 25 (1) ◽  
pp. 47-50
Author(s):  
Nicolas Bricout ◽  
Nasreddine Nouri ◽  
Hilde Henon ◽  
Laurent Estrade ◽  
Fakhreddine Boustia ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Balloon Angioplasty ◽  
Internal Carotid ◽  
Brain Magnetic Resonance Imaging ◽  
Intravenous Thrombolysis ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Internal Carotid Artery Dissection

This report describes the innovative management of a severe haemodynamic stroke related to an occlusive extracranial internal carotid artery dissection. Intravenous thrombolysis combined with endovascular treatment were undertaken on the basis of a total mismatch profile (National Institutes of Health stroke scale (NIHSS) score of 27 and infarct volume on diffusion-weighted imaging of 0 mL). Balloon angioplasty using a long and compliant balloon microcatheter allowed complete recovery of the intracranial blood flow. The patient showed dramatic clinical improvement (day 1, NIHSS 5) and favourable functional outcome (day 90, modified Rankin scale score 2). Day 90 follow-up brain magnetic resonance imaging revealed no ischaemic change and magnetic resonance angiography assessed the patency of the internal carotid artery.

scholarly journals Magnetic Resonance Imaging and Clinical Factors Associated With Ischemic Stroke in Patients Suspected of Cervical Artery Dissection

Stroke ◽  
2018 ◽  
Vol 49 (10) ◽  
pp. 2337-2344 ◽  
Author(s):  
J. Scott McNally ◽  
Peter J. Hinckley ◽  
Akihiko Sakata ◽  
Laura B. Eisenmenger ◽  
Seong-Eun Kim ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Resonance Imaging ◽  
Clinical Factors ◽  
Factors Associated ◽  
Cervical Artery

scholarly journals The computer and magnetic resonance imaging in the early assessment of the clinical course of ischemic stroke

2019 ◽  
Vol 18 (2) ◽  
pp. 35-40
Author(s):  
R. Kh. Aldatov ◽  
V. A. Fokin
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Intravenous Thrombolysis ◽  
Neurological Symptoms ◽  
Limiting Factor ◽  
Resonance Imaging ◽  
Early Assessment ◽  
Stage Of Development ◽  
The Moment

The most important benefit that imaging provides to a patient with ischemic stroke is the rapid identification of those patients who are most likely to benefit from emergency treatment. This group includes patients who suffer from severe neurological symptoms due to the occlusion of the main artery, and those who are candidates for recanalization by intravenous thrombolysis or intra-arterial intervention to remove blockage.Objective – to assess the sensitivity and significance of computed tomography and magnetic resonance imaging in early diagnosis of infarction foci.Material and methods. The results of radiologic studies of 89 patients with a clinical picture, suspected of acute ischemic cerebral circulation disorders, received in the first 24 hours from the moment of development of neurological symptoms were analyzed.Results. As a result of our study, it was shown that in the first group of patients received in the first 4.5 h from the moment of development of neurological symptoms of CT-signs of stroke were not detected in 16 (76 %) of 21 patients, while those received in the first 24 h from the moment of development of neurological symptoms of CT-signs of stroke were not detected in 14 (28 %) of 50 patients, determined by the symptom of strengthening of the artery, loss of differentiation between gray and white matter of the brain, smoothness of cortical furrows and the appearance of a zone of reduced densitometric density brain substances (<22HU). The difficulties of diagnosis in some patients on CT were the size and localization of ischemic areas (lacunar, stem strokes). In group II of 18 patients of the study, native MRI revealed signs of ischemic areas in 10 patients out of 10, complex CT and MRI to determined areas of hypoperfusion in 8 patients out of 8.Conclusion. CT is the most widely used imaging technique for cerebral infarction with high sensitivity to intracerebral hemorrhage, high specificity in ischemia, but low sensitivity to the detection of ischemic changes is a limiting factor. The data obtained confirm that MRI is a reliable method of diagnosing ischemic stroke. The most sensitive in the diagnosis of ischemic changes in the acute stage of development by using DWI (b1000).

scholarly journals Pattern of white matter degeneration in remote brain areas from the basal ganglion lesion of ischemic stroke patients with motor impairment

2020 ◽  
Author(s):  
xuejin cao ◽  
Zan Wang ◽  
Xiaohui Chen ◽  
Yanli Liu ◽  
Xi Yang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Basal Ganglia ◽  
Diffusion Tensor ◽  
Brain Magnetic Resonance Imaging ◽  
Motor Dysfunction ◽  
Stroke Patients ◽  
Brain Areas ◽  
Ischemic Lesion ◽  
Structural Network

Abstract Background Diffusion tensor imaging (DTI) studies have revealed distinct white matter characteristic of brain following diseases. Beyond the lesion-symptom mapping, recent studies have demonstrate extensive structural and functional alterations of remote areas to local lesions caused by stroke in the brain. Here, we investigated the influences further from a global level by multivariate pattern analysis (MVPA) and network-based statistic (NBS). Methods Ten ischemic stroke patients with basal ganglia lesion and motor dysfunction and eleven demographically matched adults underwent brain Magnetic Resonance Imaging scans. DTI data was processed to obtain fractional anisotropy (FA) map and MVPA was used to explore brain regions that play an important role in classification based on FA map. White matter (WM) structural network was constructed by the deterministic fiber tracking approach according to the Automated Anatomical Labeling (AAL) atlas. NBS was used to explore differences of structural network between groups. Results MVPA applied to FA images correctly identified stroke patients with a statistically significant accuracy of 100% (P ≤ 0.001). Compared with the controls, the patients showed an FA reduction in the perilesional basal ganglia and brainstem, with a few in bilateral frontal lobes. Using NBS, we found the significant decreased FA-weighted WM subnetwork in stroke patients. Conclusions We identified some patterns of WM degeneration in the affected brain areas remote from the ischemic lesion, revealed the abnormal topological organization of WM network in stroke patients, which may be helpful for understanding of the neural mechanism of stroke sequela.

scholarly journals Patients With Acute Ischemic Stroke Who Receive Brain Magnetic Resonance Imaging Demonstrate Favorable In‐Hospital Outcomes

2020 ◽  
Vol 9 (20) ◽  
Author(s):  
Hwan Lee ◽  
Yifeng Yang ◽  
Baoqiong Liu ◽  
Simon A. Castro ◽  
Tiantian Shi
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Hospital Stay ◽  
Acute Ischemic Stroke ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Control Group ◽  
Inpatient Mortality ◽  
Resonance Imaging

Background Use of inpatient brain magnetic resonance imaging (MRI) in patients with acute ischemic stroke is highly institution dependent and has been associated with increased length and cost of hospital stay. We examined whether inpatient brain MRI in patients with acute ischemic stroke is associated with improved clinical outcomes to justify its resource requirements. Methods and Results The National Inpatient Sample database was queried retrospectively to find 94 003 patients who were admitted for acute ischemic stroke and then received inpatient brain MRI between 2012 and 2014. Multivariable regression analysis was performed with respect to a control group to assess for differences in the rates of inpatient mortality and complications, as well as the length and cost of hospital stay based on brain MRI use. Inpatient brain MRI was independently associated with lower rates of inpatient mortality (1.67% versus 3.09%; adjusted odds ratio [OR], 0.60; 95% CI, 0.53–0.68; P <0.001), gastrostomy (2.28% versus 2.89%; adjusted OR, 0.82; 95% CI, 0.73–0.93; P <0.001), and mechanical ventilation (1.97% versus 2.82%; adjusted OR, 0.68; 95% CI, 0.60–0.77; P <0.001). Brain MRI was independently associated with ≈0.32 days (8%) and $1131 (11%) increase in the total length ( P <0.001) and cost ( P <0.001) of hospital stay, respectively. Conclusions Inpatient brain MRI in patients with acute ischemic stroke is associated with substantial decrease in the rates of inpatient mortality and complications, at the expense of marginally increased length and cost of hospitalization.

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