Immediate and long-term results of stenting of vertebral arteries in patients with asymptomatic chronic brain ischemia

2021 ◽  
Vol 10 (2) ◽  
pp. 47-59
Author(s):  
Z. Kh. Shugushev ◽  
S. M. Karasev ◽  
D. A. Maximkin ◽  
A. G. Chepurnoj
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Medical Therapy ◽  
Vertebral Arteries ◽  
Cerebral Complications ◽  
Stent Restenosis ◽  
Atherosclerotic Lesions ◽  
Chronic Brain Ischemia ◽  
Group 2 ◽  
Group 1

Highlights. The efficiency of the endovascular treatment combined with medical therapy versus medical therapy has been proven to prevent strokes in patients with vertebral artery atherosclerotic lesions and asymptomatic chronic cerebral ischemia.Aim. To assess the efficiency of endovascular treatment in patients with asymptomatic vertebral artery atherosclerotic lesions as an approach for secondary prevention of strokes.Methods. Group 1 patients (n = 44) underwent stenting of the vertebral arteries combined with the medical therapy to prevent strokes, whereas group 2 patients (n = 56) received the medical therapy alone. Group 1 was then subdivided into two subgroups -subgroups 1a and 1b. Subgroup 1a patients underwent (n = 22) stenting using the embolic protection devices, while Subgroup 1b patients (n = 22) - embolic protection devices were not used. The follow-up was up to 36 months with regular visits at 12, 24, and 36 months. The inclusion criteria were as follows: asymptomatic vertebral artery stenosis of 50-95%; the diameter of the vertebral arteries of less than 3.0 and not more than 5 mm; the presence of cerebral and focal symptoms corresponding to asymptomatic chronic brain ischemia (according to E.V. Schmidt).Results. The overall incidence of spasm and dissection during endovascular intervention was 20% and 4.5% in Subgroup 1a and 1b, respectively (p = 0.0367). 2 (4.5%) patients had transient ischemic attack in Subgroup 1a. There were no perioperative strokes in Subgroup 1b. The overall rate of major cerebral complications over 36 months was 4.5% in Group 1 versus 37.5% in Group 2 (x2 = 15.101; p <0.0001). The rate of adverse cardiac events was 9.1% and 19.6%, in Groups 1 and 2, respectively (x2 = 14.784; p <0.0001). In-stent restenosis occurred in 38.67% of patients in Group I, who underwent stenting using various generations of stents. In-stent restenosis did not affect the incidence of major cerebral complications in the long-term period (x2 = 0.1643; p = 0.735).Conclusion. Endovascular treatment combined with medical therapy allowed preventing cerebral complications associated with the instability of atherosclerotic plaques in patients with asymptomatic vertebral artery stenosis. It has proved to be an effective method for the secondary prevention of strokes.

scholarly journals Endovascular treatment of the vertebral artery origin stenosis by using the closed-cell, self-expandable Carotid Wallstent

2020 ◽  
Vol 26 (6) ◽  
pp. 805-813
Author(s):  
Jun-Kyeung Ko ◽  
Chang-Hwa Choi ◽  
Lee Hwangbo ◽  
Hie-Bum Suh ◽  
Tae-Hong Lee ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Good Alternative ◽  
Minor Stroke ◽  
Stent Restenosis ◽  
Vertebrobasilar Ischemia ◽  
Closed Cell ◽  
Carotid Wallstent ◽  
Permanent Neurological Deficit

Background Endovascular treatment has been considered a good alternative to surgery for symptomatic vertebral artery origin stenosis (VAOS) due to the high risk of morbidity associated with surgery. The purpose of this study was to evaluate the feasibility and efficacy of insertion of the closed-cell, self-expandable Carotid Wallstent for the treatment of VAOS. Methods The records of 72 patients with VAOS refractory to adequate medication who were treated by endovascular treatment with the Carotid Wallstent from December 2006 to November 2018 were retrospectively evaluated. Results Of the 72 patients, 43 presented with transient ischemic attacks. Forty-seven patients (65.3%) manifested other brachiocephalic stenoses; of these, 40 patients had occlusion, hypoplasia, or stenosis of the contralateral vertebral artery. Overall technical success (defined as 20% or less residual stenosis) was 100%. Procedure-related complications ( n = 8, 11.1%) included sudden asystole ( n = 1), acute in-stent thrombosis ( n = 3), minor stroke ( n = 3), and stent shortening ( n = 1). All complications were resolved without permanent neurological deficit. Angiographic follow-up (mean, 13.0 months) was achieved in 49 patients and revealed in-stent restenosis in 1 patient (2.0%) and stent malposition by shortening in 2 patients (4.1%). Follow-up records were available in 57 patients (mean 15.6 months). Three of the 57 patients ( n = 3, 5.3%) had recurrent symptoms of vertebrobasilar ischemia and none was retreated. Conclusions Endovascular treatment of symptomatic VAOS using the closed-cell, self-expandable Carotid Wallstent is technically feasible and effective in alleviating patient symptoms and for improving vertebrobasilar blood flow.

scholarly journals Drug-eluting balloon treatment in femoropopliteal in-stent restenosis of different lengths

2020 ◽  
Vol 28 (3) ◽  
pp. 460-466
Author(s):  
Berkan Özpak
Keyword(s):  
Stent Restenosis ◽  
Significant Difference ◽  
Stent Length ◽  
Drug Eluting ◽  
Group 3 ◽  
Group 2 ◽  
Drug Eluting Balloon ◽  
One Year ◽  
In Stent Restenosis ◽  
Group 1

Background: In this study, we present one-year results of drug-eluting balloon treatment of femoropopliteal in-stent restenosis. Methods: A total of 62 patients (48 males, 14 females; mean age 64.2±9.1 years; range, 54 to 81 years) who underwent drug-eluting balloon stenting for femoropopliteal in-stent restenosis between August 2013 and October 2017 were included in the study. The patients were classified into three groups based on the narrowing length of stenosis in the stents. Group/Class 1 (n=17): narrowing <1/2 of the stent length; Group/Class 2 (n=22): narrowing >1/2 of the stent length, not totally occluded; and Group/Class 3 (n=23): totally occluded. In-stent restenosis was treated with drug-eluting balloon treatment. Results: There was a significant difference among all classes in terms of in-stent restenosis. The length of stenosis was a predictor for in-stent restenosis. The mean stent length was 107.7±24.6 mm in Group 1, 164.6±17.9 mm in Group 2, and 180±19.3 mm in Group 3. For non-occluded in-stent restenosis, restenosis rate at one year after balloon angioplasty was 47.1% in Group 1, 86.4% in Group 2, and 95.7% in Group 3. Femoropopliteal bypass was performed in five patients in whom treatment failed. None of the patients required amputation. Conclusion: The length of in-stent restenosis in the femoropopliteal arterial stents is an important predictor for recurrent stenosis, when re-flow is achieved with drug-eluting balloons.

scholarly journals Effects of Pituitary Surgery and High-Dose Cabergoline Therapy on Metabolic Profile in Patients With Prolactinoma Resistant to Conventional Cabergoline Treatment

2021 ◽  
Vol 12 ◽  
Author(s):  
Rosa Pirchio ◽  
Renata S. Auriemma ◽  
Domenico Solari ◽  
Mauro Arnesi ◽  
Claudia Pivonello ◽  
...  
Keyword(s):  
Medical Therapy ◽  
Metabolic Profile ◽  
Ldl Cholesterol ◽  
Fasting Glucose ◽  
Pituitary Surgery ◽  
High Dose ◽  
Fasting Insulin ◽  
Beneficial Impact ◽  
Group 2 ◽  
Group 1

ObjectiveControl of prolactin excess is associated with the improvement in gluco-insulinemic and lipid profile. The current study aimed at investigating the effects of pituitary surgery and medical therapy with high dose cabergoline (≥2mg/week) on metabolic profile in patients with prolactinoma resistant to cabergoline conventional doses (&lt;2mg/week).DesignThirty-four patients (22 men, 12 women, aged 33.9 ± 12.5 years) with prolactinoma (4 microadenomas and 30 macroadenomas) were included in the present study. Among them 17 (50%) received pituitary surgery (PS, Group1) and 17 (50%) medical therapy with high dose cabergoline (Group 2).MethodsIn the whole patient cohort, anthropometric (weight, BMI) and biochemical (fasting glucose and insulin, triglycerides, total, HDL and LDL-cholesterol, HOMA-IR, HOMA-β and ISI0) parameters were evaluated before and within 12 months after treatment.ResultsIn Group 1, prolactin (p=0.002), total cholesterol (p=0.012), and triglycerides (p=0.030) significantly decreased after pituitary surgery compared to the baseline. Prolactin significantly correlated with fasting glucose (r=0.056, p=0.025). In Group 2, fasting insulin (p=0.033), HOMA-β (p=0.011) and ISI0 (p=0.011) significantly improved compared to baseline. Postoperative cabergoline dose significantly correlated with Δfasting glucose (r=-0.556, p=0.039) and ΔLDL cholesterol (r=- 0.521, p=0.046), and was the best predictor of ΔLDL cholesterol (r2 = 0.59, p=0.002) in Group 1.ConclusionsThe rapid decrease in PRL levels induced by PS might improve lipid metabolism, whereas HD-CAB might exert a beneficial impact on both insulin secretion and peripheral sensitivity, thus inducing a global metabolic improvement.

scholarly journals Endovascular Treatment of ACom Intracranial Aneurysms

2010 ◽  
Vol 16 (1) ◽  
pp. 7-16 ◽  
Author(s):  
S. Finitsis ◽  
R. Anxionnat ◽  
A. Lebedinsky ◽  
P.C. Albuquerque ◽  
M.F. Clayton ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Additional Treatment ◽  
Anterior Communicating Artery ◽  
Anticoagulation Management ◽  
Unruptured Aneurysms ◽  
Anterior Communicating Artery Aneurysms ◽  
Group 2 ◽  
Group 1

The immediate and long-term outcomes, complications, recurrences and the need for retreatment were analyzed in a series of 280 consecutive patients with anterior communicating artery aneurysms treated with the endovascular technique. From October 1992 to October 2001 280 patients with 282 anterior communicating artery aneurysms were addressed to our center. For the analysis, the population was divided into two major groups: group 1, comprising 239 (85%) patients with ruptured aneurysms and group 2 comprising of 42 (15%) patients with unruptured aneurysms. In group 1, 185 (77.4%) patients had a good initial pre-treatment Hunt and Hess grade of I-III. Aneurysm size was divided into three categories according to the larger diameter: less than 4 mm, between 4 and 10 mm and larger than 10 mm. The sizes of aneurysms in groups 1 and 2 were identical but a less favorable neck to depth ratio of 0.5 was more frequent in group 2. Endovascular treatment was finally performed in 234 patients in group 1 and 34 patients in group 2. Complete obliteration was more frequently obtained in group 2 unlike a residual neck or opacification of the sac that were more frequently seen in group 1. No peri-treatment complications were recorded in group 2. In group 1 the peri-treatment mortality and overall peri-treatment morbidity were 5.1% and 8.1% respectively. Eight patients (3.4%) in group 1 presented early post treatment rebleeding with a mortality of 88%. The mean time to follow-up was 3.09 years. In group 1, 51 (21.7%) recurrences occurred of which 14 were minor and 37 major. In group 2, eight (23.5%) recurrences occurred, five minor and three major. Two patients (0.8%) presented late rebleeding in group 1. Twenty-seven second endovascular retreatments were performed, 24 (10.2%) in group 1 and three (8.8%) in group 2, seven third endovascular retreatments and two surgical clippings in group 1 only. There was no additional morbidity related to retreatments. Endovascular treatment is an effective method for the treatment of anterior communicating artery aneurysms allowing late rebleeding prevention. Peri-treatment rebleeding warrants caution in anticoagulation management. This is a single center experience and the follow-up period is limited. Patients should be followed-up in the long-term as recurrences may occur and warrant additional treatment.

scholarly journals Intracoronary Injection of CD133-Positive Enriched Bone Marrow Progenitor Cells Promotes Cardiac Recovery After Recent Myocardial Infarction

Circulation ◽  
2005 ◽  
Vol 112 (9_supplement) ◽  
Author(s):  
Jozef Bartunek ◽  
Marc Vanderheyden ◽  
Bart Vandekerckhove ◽  
Samer Mansour ◽  
Bernard De Bruyne ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Bone Marrow ◽  
Progenitor Cells ◽  
Left Ventricular ◽  
Recent Myocardial Infarction ◽  
Stent Restenosis ◽  
Intracoronary Administration ◽  
Group 2 ◽  
In Stent Restenosis ◽  
Group 1

Background— Bone marrow CD133-postive (CD133 + ) cells possess high hematopoietic and angiogenic capacity. We tested the feasibility, safety, and functional effects of the use of enriched CD133 + progenitor cells after intracoronary administration in patients with recent myocardial infarction. Methods and Results— Among 35 patients with acute myocardial infarction treated with stenting, 19 underwent intracoronary administration of CD133 + progenitor cells (12.6±2.2×10 6 cells) 11.6±1.4 days later (group 1) and 16 did not (group 2). At 4 months, left ventricular ejection fraction increased significantly in group 1 (from 45.0±2.6% to 52.1±3.5%, P <0.05), but only tended to increase in case-matched group 2 patients (from 44.3±3.1% to 48.6±3.6%, P =NS). Likewise, left ventricular regional chordae shortening increased in group 1 (from 11.5±1.0% to 16.1±1.3%, P <0.05) but remained unchanged in group 2 patients (from 11.1±1.1% to 12.7±1.3%, P =NS). This was paralleled by reduction in the perfusion defect in group 1 (from 28.0±4.1% to 22.5±4.1%, P <0.05) and no change in group 2 (from 25.0±3.0% to 22.6±4.1%, P =NS). In group 1, two patients developed in-stent reocclusion, 7 developed in-stent restenosis, and 2 developed significant de novo lesion of the infarct-related artery. In group 2, four patients showed in-stent restenosis. In group 1 patients without reocclusion, glucose uptake shown by positron emission tomography with 18 fluorodeoxyglucose in the infarct-related territory increased from 51.2±2.6% to 57.5±3.5% ( P <0.05). No stem cell-related arrhythmias were noted, either clinically or during programmed stimulation studies at 4 months. Conclusion— In patients with recent myocardial infarction, intracoronary administration of enriched CD133 + cells is feasible but was associated with increased incidence of coronary events. Nevertheless, it seems to be associated with improved left ventricular performance paralleled with increased myocardial perfusion and viability.

Out-of-hospital opioid therapy of palliative care patients with “acute dyspnoea”: A retrospective multicenter investigation

2018 ◽  
Vol 5 (2) ◽  
pp. 115 ◽  
Author(s):  
Christoph H. R. Wiese, MD ◽  
Utz E. Bartels, MD ◽  
Bernhard M. Graf, MD ◽  
Gerd G. Hanekop, MD
Keyword(s):  
Palliative Care ◽  
Medical Therapy ◽  
Group 4 ◽  
Emergency Medical ◽  
Acute Dyspnoea ◽  
Group 3 ◽  
Group 5 ◽  
Group 2 ◽  
Oxygen Group ◽  
Group 1

Background: Prehospital emergency physicians (EP) are often confronted with the acute care of palliative care patients. Dyspnoea is a frequent acute symptom and its causes often differ from the generally known emergency medical causes. Till now, there have been no relevant concepts for emergency care of palliative care patients for their specific symptoms.Methods: Over a 24-month period, the authors retrospectively investigated all out-of-hospital emergency medical services for palliative care patients with acute dyspnoea at four emergency physician support points. The evaluation of these services was followed retrospectively on the basis of the therapy carried out by the EP (Group 1: therapy with morphine and oxygen; Group 2: therapy with morphine, bronchodilator effective drugs and oxygen; Group 3: therapy with bronchodilator effective drugs and oxygen; Group 4: therapy with oxygen; Group 5: no medical treatment). Moreover, EPs were interviewed about their actions and their uncertainties in the treatment of palliative care patients.Results: The diagnosis of acute dyspnoea in palliative care patients occurred 121 times (116 patients were integrated in the present investigation) within the defined period. In total, 116 patients were included (Group 1: 21, Group 2: 29, Group 3: 31, Group 4: 28, and Group 5: 7). Dyspnoea was satisfactorily treated in 41 percent of the patients (Group 1: 67 percent, Group 2: 52 percent, Group 3: 22 percent, Group 4: 18 percent, and Group 5: 71 percent). Most EPs (70 percent) revealed uncertainties in emergency medical therapy for patients at the end of life.Conclusions: The current investigation showed a significant relief of acute dyspnoea when using opioids, in contrast with the established out-of-hospital emergency medical therapy for acute dyspnoea. Therefore, opioids should be recommended for emergency medical therapy of dyspnoea in palliative care patients. Clinical studies that recommend the use of effective opioids for the treatment of dyspnoea in palliative care patients are supported by the current retrospective study. Most EPs felt uncertain in the treatment of palliative care patients. Therefore, advanced training in palliative care medicine and endof-life care should be integrated into emergency medical training.

Abstract 2627: Outcomes After Endovascular Treatment For Anterior Circulation Stroke Presenting Beyond 8 Hours Of Time Last Seen Well Do Not Differ In Wake-up Strokes Vs. Witnessed Onset Beyond 8 Hours

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Amin Aghaebrahim ◽  
Carlos Leiva-Salinas ◽  
Syed Zaidi ◽  
Mouhammad Jumaa ◽  
Xabi Urra ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Clinical Outcomes ◽  
Favorable Outcome ◽  
Late Time ◽  
Lesion Volume ◽  
Anterior Circulation ◽  
Tandem Occlusion ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Objective: Patients with wake-up stroke are thought to have different outcomes compared to patients with known late time of onset. We thought to verify this hypothesis by determining clinical outcomes, mortality and rate of parenchymal hematoma (PH) in patients with anterior circulation large vessel occlusion stroke (ACLVOS) treated with endovascular therapy at our center. Methods: Retrospective review of a prospectively acquired database from consecutive patients meeting the following criteria: (1) ACLVOS, (2) endovascular treatment initiated beyond 8hrs from time last seen well (TLSW). Treatment selection was based on the presence of a small infarct core/large penumbra assessed through visual inspection on MRI or CTP by the treating physician. In patients undergoing MRI (n=55) pre-procedure infarct volumes on DWI were measured through automated volumetric analysis. Results: We identified 130 patients (mean age 64; mean baseline NIHSS 14, male gender 55%). Patients were divided into three groups. Group 1: patients with wake-up stroke (39%, n=51). Group 2: patients with witnessed onset beyond 8hrs from TLSW (55%, n=72). Group 3: patients without witnessed onset but TLSW>8hrs (5%, n=7). Occlusion locations were as follows: M1-55%, M2-12%, ICA terminus-32% and ICA origin (tandem occlusion)-28%. Successful recanalization (TIMI 2/3) was achieved in 109 patients (84%). The rate of 90 day favorable outcome (modified Rankin score (mRS) ≤ 2) was 55% (n=68/124). PH occurred in 15/130 (12%) patients and the 3 month mortality rate was 18% (n= 22/124). Favorable outcome rates amongst Group 1 (50%, n=24/48), Group 2 (59.5%, n=41/69) and Group 3 (42.9%, n=3/7) were not significantly different (p=0.49, by ANOVA). Mean pre-procedure DWI lesion volume was 18.7 cc in Group 1 vs. 18.3 cc in group 2 (p=0.9). No difference was noted between Group 1, Group 2 and Group3 regarding PH (13.7%, 8.3%, 13.3% respectively, p nonsignificant) or mortality at 3 months (18.7%, 17.4%, 14.3% respectively, p nonsignificant). Multivariate logistic regression model identified only successful recanalization (OR 2.9, p 0.001, CI 1.59-5.44) and age (OR 0.96, p 0.03, CI 0.93-0.99) as predictors of favorable outcome. Conclusion: In patients with ACLVOS presenting beyond 8 hours from TLSW who are selected based on similar imaging characteristics, clinical outcomes following endovascular treatment do not seem to differ according to mode of presentation relative to TLSW.

Abstract WP12: Impact of the Introduction of Endovascular Treatment on Acute Ischemic Stroke Therapy in a Rural Broad Region in Japan

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Taichiro Imahori
Keyword(s):  
Ischemic Stroke ◽  
Medical Treatment ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Group 2 ◽  
Revascularization Therapy ◽  
Standard Medical Treatment ◽  
Iv Tpa ◽  
Broad Region ◽  
Group 1

Background: Endovascular treatment (EVT) has been proven to be effective for selected patients with acute ischemic stroke (AIS). We evaluated the effect of the introduction of EVT on outcome of AIS therapy in a rural broad region in Japan, covering an area within a radius of 80km by air ambulance. Methods: Between January 2014 and July 2016, 210 consecutive patients with acute large vessel occlusion (189 patients in the anterior circulation and 21 in the posterior circulation) admitted to our institute were analyzed. EVT was introduced into the AIS therapy at our institute in April 2015. We compared the outcome of the patients during the period before (group 1: standard medical treatment including intravenous [IV] tPA) and after (group 2: standard medical treatment including IV tPA with or without EVT) the introduction of EVT. Results: In the group 1, all 87 patients (median age, 81 years; NIHSS, 20; ASPECTS, 8; onset to door, 237min; IV tPA 24%) were treated medically (Table 1). In the group 2, among 123 patients (age, 82 years; NIHSS, 20; ASPECTS, 8; onset to door, 149min; IV tPA 16%), 47 patients were treated medically, and the remaining 76 patients underwent EVT (TICI 2b or 3, 84%). Although the median transfer distance increased (23km in the group 1 vs 30km in the group 2, p=0.028), the median time from call to admission was equivalent (42min vs 43min, p=0.93) because of the increase in the proportion of the helicopter transfer (30% vs 41%, p=0.14). The rates of patients who underwent revascularization therapy with IV tPA or EVT (24% vs 66%, p<0.001) and good outcome (mRS 0 to 2) at discharge (11% vs 24%, p=0.021) increased significantly after the introduction of EVT approach. Conclusions: Our study showed that the introduction of EVT improved the outcome of the AIS therapy with significant increase in the number of patients receiving revascularization therapy. EVT in collaboration with air ambulance might expand the target area for revascularization therapy in a rural broad region.

scholarly journals Cervicocranialgia: rationale for and evaluation of the clinical efficiency of therapy with the Russian generics of dexketoprofen and tolperisone

2019 ◽  
Vol 11 (4) ◽  
pp. 94-99
Author(s):  
M. N. Dadasheva ◽  
G. I. Nurullina ◽  
R. V. Gorenkov
Keyword(s):  
Muscle Tone ◽  
Good Tolerability ◽  
Vertebral Arteries ◽  
Clinical Efficiency ◽  
Patient Groups ◽  
Group 3 ◽  
The Common ◽  
Group 2 ◽  
Carotid And Vertebral Arteries ◽  
Group 1

Objective: to comparatively evaluate the clinical efficiency of cervicocranialgia therapy with dexketoprofen (flamadex) and tolperisone (calmyrex), as well as with their combination. Patients and methods. The investigation enrolled 90 patients aged 30–60 years with cervicocranialgia, who were randomized into three equal groups. Group 1 included 7 men and 23 women who took dexketoprofen; Group 2 consisted of 13 men and 17 women who were prescribed dexketoprofen and tolperisone; Group 3 comprised 18 men and 12 women who used tolperisone. The three patient groups underwent assessment of the intensity of pain on a visual analogue scale and the degree of muscle tone on a 3-point scale and evaluation of the efficiency of therapy and the hemodynamic effect of the drugs in the common carotid and vertebral arteries. Results and discussion. In all the groups, their treatment reversed neck pain, headache, and dizziness, normalized muscle tone, and improved hemodynamics in the carotid and vertebral arteries. The effect was more pronounced in patients receiving combination treatment (Group 2). The therapy showed a high safety and a good tolerability. Conclusion. Dexketoprofen and tolperisone have been demonstrated to be effective and safe in treating cervicocranialgia.

scholarly journals Endovascular treatment of a patient with traumatic dissection lesions of both vertebral arteries obtained during chiropractic manipulation

2018 ◽  
Vol 24 (2) ◽  
pp. 77-86
Author(s):  
Yu.V. Cherednychenko ◽  
A.Yu. Miroshnychenko ◽  
L.A. Dzyak ◽  
N.A. Zorin ◽  
S.P. Grygoruk ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Cerebral Angiography ◽  
Left Vertebral Artery ◽  
Chiropractic Manipulation ◽  
Vertebral Arteries ◽  
Coordination Disorders ◽  
Cerebellar Artery ◽  
The Right ◽  
The Brain

The observation of endovascular treatment of a 34-year-old woman with bilateral dissection lesions of vertebral arteries in V4-segments with occlusion of the right vertebral artery and right posterior inferior cerebellar artery, severe stenosis of the left vertebral artery caused by chiropractic manipulation in the neck region is described. There are intensive staticolocomotor and dynamic coordinating insufficiency, severe neck pain, headache, severe dizziness, Wallenberg syndrome, moderate central tetraparesis. MRI of the brain on the DWI Isotropic identified the hyperintensive round-shaped foci in the right hemisphere of the cerebellum, in the right side of cerebellum worm, in the right side of the medulla oblongata and in the right side of the pons (DWI BSS 3). Selective cerebral angiography was performed an hour after the clinic manifestation. Simultaneously, balloon angioplasty of severe dissection stenosis was performed in the V4-segment of the left vertebral artery by the compliant balloon-catheter Scepter C. In 18 hours from the development of vertebral artery dissection, self-expending stent LVIS was implanted into the left vertebral artery in the zone of dissection lesion. On the control angiograms: the left vertebral artery patency is restored without stenosis all along. The stent is fully opened. A second contrast contour is determined outside the stent in the dissection zone. All the arteries of the vertebrobasilar basin above the vertebrobasilar junction are passable. The V4-segment of the right vertebral artery is contrasted through the vertebrobilar junction. There was a rapid regression of neurological symptoms in the postoperative period. Only mild hypoesthesia on the right side in the outer Sölder’s zone, light coordination disorders on the right were remained. Control selective cerebral angiography revealed recanalization of the right vertebral artery and the right posterior cerebellar artery. But distal basin of the right posterior cerebellar artery is very poorly. The left vertebral artery is passable all over, but in the place of the former dissection, two equivalent arterial «sleeves» were formed according to the fenestration type. One «sleeve» is formed by a stent, the other — outside. All arteries of the vertebrobasilar basin are contrasted. The mild hemihepesthesia on the right side of the face in the outer Sölder’s zone, light coordination disorders on the right are remained. Implantation of the self-expanding stent LVIS allowed to restore the dominant vertebral artery and restrict ischemic brain damage in the brain stem and cerebellum in a patient with a both vertebral arteries dissection lesion caused by chiropractic neck manipulations.

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