scholarly journals Basilar artery dissection with rupture 6 years after accidental detection: A case report

2021 ◽  
Vol 12 ◽  
pp. 4
Author(s):  
Yoshimichi Sato ◽  
Kuniyasu Niizuma ◽  
Hideki Ota ◽  
Hidenori Endo ◽  
Teiji Tominaga
Keyword(s):  
Conservative Treatment ◽  
Basilar Artery ◽  
Treatment Options ◽  
Artery Dissection ◽  
Imaging Features ◽  
Internal Elastic Lamina ◽  
Intimal Flap ◽  
Weakened Condition ◽  
Elastic Lamina

Background: Chronic basilar artery dissection (BAD) is a rare pathology, and only a few reports have been mentioned in the literature. The imaging features of chronic BAD, especially those that develop into a subarachnoid hemorrhage (SAH), are unknown. Case Description: We report a unique case of a chronic BAD with a split intimal flap that developed into an SAH. A 74-year-old man was diagnosed with BAD. After considering all treatment options, conservative treatment was selected for the patient. We continued imaging follow-up of the patient in our outpatient clinic once a year. The BA gradually dilated and the internal flap split. The patient and his family refused surgical treatment; therefore, conservative treatment was continued. Six years and 2 months from the first diagnosis, he developed a massive SAH and died. Conclusion: In the case of this patient, the weakened condition of the internal elastic lamina may have caused dissection of the intimal flap between the intima and media. Furthermore, the dissection may have developed and connected the true lumen to the pseudolumen and induced BA rupture. Thereby, split of the internal flap could be a risk factor for rupture in chronic BAD.

scholarly journals Stent treatment for basilar artery dissection: A single-center experience of 21 patients

2016 ◽  
Vol 22 (3) ◽  
pp. 260-265 ◽  
Author(s):  
Li Li ◽  
Tianxiao Li ◽  
Jiangyu Xue ◽  
Ziliang Wang ◽  
Weixing Bai ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Artery Dissection ◽  
High Morbidity ◽  
Single Center Experience ◽  
Post Operation ◽  
Pre Treatment ◽  
Group 2 ◽  
Partially Occluded ◽  
Group 1

Basilar artery dissection is a rare disease with high morbidity and mortality. No well-established management strategy exists for this lesion. Endovascular reconstructive therapy using stents (with or without coiling) may be the optimum strategy. We describe our center’s experience for this treatment strategy in 21 patients with basilar artery dissection from January 2009 to July 2014 (17 men, four women; age range, 18–70 years; median age, 56 years). We divided patients into two groups: Group 1 patients received stent-assisted coiling treatment, and Group 2 patients received stent-only treatment. Pre-treatment, peri-operation and follow-up evaluation were investigated for complications, clinical outcome and angiographic results. The median follow-up time was 20 months (range, 3–67 months). All patients were treated endovascularly by stent-assisted coiling (14 patients) or stent only (seven patients). Immediate angiography showed: in Group 1, five of 14 lesions were completely occluded, five were partially occluded, four revealed retention of contrast media; in Group 2, all patients (seven of seven) had contrast retention. At the follow-up visit (median seven months, 3–29 months), the aneurysms were angiographically improved in five of 13 patients in Group 1 compared with immediately post-operation, while six of sevenimproved in Group 2. Five patients (all in Group 1) had ischemic or hemorrhage peri-operation complications. Long-term good clinical outcomes (modified Rankin Scale score (mRS) ≤ 2) were achieved in all patients except three death cases (two in Group1, one in Group 2). In our experience, endovascular reconstructive therapy using stents (with or without coiling) for basilar artery dissection is effective and safe. Stent-only treatment seems have a better safety profile during the peri-operation period.

scholarly journals Nowadays treatment of testicular appendix torsion in children

2021 ◽  
Vol 24 (6) ◽  
pp. 370-376
Author(s):  
D. N. Shedrov ◽  
M. V. Grigoryeva ◽  
I. S. Shormanov ◽  
O. O. Saruhanyan ◽  
E. N. Gasanova ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Treatment Options ◽  
Diagnostic Error ◽  
Diagnostic Techniques ◽  
Diagnostic Tools ◽  
Surgical Trauma ◽  
Aseptic Inflammation ◽  
Conservative Care ◽  
Homogeneous Groups

Introduction. Currently, a modern tactics as to the treatment of testicular appendix torsion in children is not an indisputable axiom but it is a subject of discussion in domestic and foreign literature. Modern diagnostic tools, wide implementation of expert-class equipment as well as gaining more experience have reduced, to a minimum , the risk of diagnostic error with fatal consequences for the gonad. So, it impels to revise the existing algorithms and to consider the conservative treatment as the method of choice in uncomplicated testicular appendix torsion.Objective. To analyze the gained experience in treating testicular appendix torsion and to suggest reasonable algorithms which correspond to modern diagnostic techniques and treatment options. Material and methods. 2875 cases with testicular appendix torsion have been analyzed. Of these, 2 069 (71.96%) patients were operated on; 755 (26.26%) patients had conservative treatment and 51 (1.78%) had to be operated on despite conservative treatment.Results. The material obtained in three statistically homogeneous groups has been аnalyzed. When comparing clinical and ultrasound criteria, it was found out that the incidence of orchalgia in the surgical group is slightly higher than in the conservative one. It may indicate that the adhesive process in the scrotal cavity after surgical trauma is more frequent than after a possible aseptic inflammation. Asymmetry of gonad volumes with smaller diseased testicle was seen in all groups. The decrease in testicular volume is minimal in all cases and is not statistically significant. The incidence of heterogeneity in the testicular and appendage echo structure, which indicates sclerotic changes in the parenchyma, is also not statistically significant in the analyzed groups. Patients who were operated despite their conservative care do not have much worse outcomes after long-lasting follow-up period than groups with other curative options.Conclusion. Torsion of the testicular appendix in children is a challenging problem that is far from being solved. There is no consensus as to the indications for surgical treatment and to the assessment of postoperative outcomes. Modern diagnostic and monitoring techniques allow to dynamically monitor the scrotal organs in conservative treatment. The conservative treatment of testicular appendix torsion is an effective and safe method. The conservative tactics which was changed for surgical one does not lead to gonad deterioration.

scholarly journals Bilateral Sudden Hearing Loss Caused by Basilar Artery Dissection: A Case Report

2021 ◽  
Vol 20 (4) ◽  
pp. 151-155
Author(s):  
Ho Byung Lee ◽  
Jieun Roh ◽  
Hyun Min Lee ◽  
Jae-Hwan Choi
Keyword(s):  
Hearing Loss ◽  
Basilar Artery ◽  
Pure Tone Audiometry ◽  
Sudden Hearing Loss ◽  
Artery Dissection ◽  
Vertebrobasilar Ischemia ◽  
Left Posterior ◽  
Retrograde Blood Flow ◽  
Antegrade Flow

Bilateral sudden sensorineural hearing loss (SNHL) is rare, but a possible symptom of vertebrobasilar ischemia. A 69-year-old female patient with hypertension and atrial fibrillation presented with bilateral sudden hearing loss and vertigo without other neurological symptoms. On examination, she had left-beating horizontal nystagmus with positive head impulse on the left side. Pure tone audiometry revealed severe SNHL on both sides. Brain computed tomography angiography showed a dissection in the proximal portion of the basilar artery (BA) with occlusion of the mid-BA and bilateral anterior inferior cerebellar arteries (AICA), which confirmed on transfemoral cerebral angiography (TFCA). Left common carotid angiography demonstrated retrograde blood flow into the BA and right AICA via the left posterior communicating artery. During TFCA, her right hearing loss dramatically improved. Nine days later, follow-up TFCA showed an improvement of antegrade flow of the BA and AICA. We suggest that vertebrobasilar ischemia can be suspected in patients with bilateral sudden SNHL who present with risk factors for stroke.

scholarly journals Endovascular Treatment of Intracranial Artery Dissection: Clinical and Angiographic Follow-Up

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Reza Mohammadian ◽  
Ali Akbar Taheraghdam ◽  
Ehsan Sharifipour ◽  
Reza Mansourizadeh ◽  
Ali Pashapour ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Treatment Options ◽  
Artery Dissection ◽  
Parent Artery ◽  
Intracranial Artery ◽  
Anterior Circulation ◽  
Stent Occlusion ◽  
Parent Artery Occlusion ◽  
Endovascular Approach

Background. Intracranial artery dissections are rare and many controversies exist about treatment options. The aim of this study was to evaluate the efficacy and safety of the endovascular approach in patients with an intracranial dissection presenting with different symptoms.Methods. We prospectively evaluated the clinical features and treatment outcomes of 30 patients who had angiographically confirmed nontraumatic intracranial dissections over 4 years. Patients were followed up for 17 months, and their final outcomes were assessed by the modified Rankin Score (mRS) and angiography.Results. Sixteen (53.3%) patients had a dissection of the anterior circulation, whereas 14 (46.7%) had a posterior circulation dissection. Overall, 83.3% of the patients suffered a subarachnoid hemorrhage (SAH). Grade IV Hunt and Hess score was seen in 32% of the SAH presenting cases. Parent artery occlusion (PAO) with coil embolization was used in 70% of the cases. The prevalence of overall procedural complications was 23.3%, and all were completely resolved at the end of follow-up. No evidence of in-stent occlusion/stenosis or rebleeding was observed in our cases during follow-up. Angiography results improved more frequently in the PAO with coil embolization group (100%) than in the stent-only-treated group (88.9%) (P=0.310) and the unruptured dissection group (5/5, 100%) in comparison with the group that presented with SAH (95.8%) (P=0.833).Conclusion. Favorable outcomes were achieved following an endovascular approach for symptomatic ruptured or unruptured dissecting aneurysms. However, the long-term efficacy and durability of these procedures remain to be determined in a larger series.

Republished: Rete mirabile associated with pial arteriovenous fistula: imaging features with literature review

2017 ◽  
Vol 9 (9) ◽  
pp. e36-e36 ◽  
Author(s):  
Prabath Kumar Mondel ◽  
Rashmi Saraf ◽  
Uday S Limaye
Keyword(s):  
Arteriovenous Fistula ◽  
Treatment Options ◽  
Imaging Features ◽  
Rete Mirabile ◽  
Bilateral Carotid ◽  
Normal Human ◽  
Pial Arteriovenous Fistula ◽  
Neurologically Normal ◽  
The Brain

A rete mirabile is a vascular network of intercommunicating small arteries or arterioles that replace the definitive adult artery supplying the brain. It supplies the brain in lower mammals but is not seen in normal human embryological development. A 26-year-old man presented with worsening tinnitus that was interfering with his sleep. On CT and digital subtraction angiography he was found to have a temporal lobe pial arteriovenous fistula with bilateral carotid and vertebral rete mirabile. The patient was offered open surgical and endovascular treatment options for pial arteriovenous fistula but he refused both and opted for conservative medical management. At 6-month follow-up he continued to have pulsatile tinnitus but was otherwise neurologically normal. We present the first described association of rete mirabile with pial arteriovenous fistula and discuss its clinical presentation and imaging features, with a review of the literature for bilateral carotid and vertebral rete mirabile.

Endovascular treatment of isolated spontaneous celiac artery dissection

Vascular ◽  
2012 ◽  
Vol 20 (2) ◽  
pp. 118-120 ◽  
Author(s):  
Tao Zhang ◽  
Xiaoming Zhang ◽  
Xuemin Zhang ◽  
Jingjun Jiang ◽  
Bingying Zhou
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Treatment Options ◽  
Celiac Artery ◽  
Artery Dissection ◽  
Selective Angiography ◽  
Entry Site ◽  
Diagnostic Modalities

This report presents the case of a patient with isolated spontaneous celiac artery dissection. The patient developed acute abdominal pain that was induced by eating. Computed tomography and selective angiography revealed an intimal flap that separated the true and false lumens located 3 cm from the origin of the celiac artery. We treated the patient with a stent that was deployed endovascularly into the celiac artery to seal the entry site. Postoperative angiography revealed that the graft was patent and the follow-up period was uneventful. The etiology, clinical features, diagnostic modalities and treatment options of isolated spontaneous celiac artery dissection are reported.

Basilar artery dissection

2005 ◽  
Vol 102 (3) ◽  
pp. 476-481 ◽  
Author(s):  
Yuhei Yoshimoto ◽  
Katsumi Hoya ◽  
Yoshihiro Tanaka ◽  
Takanori Uchida
Keyword(s):  
Basilar Artery ◽  
Treatment Options ◽  
Disease Onset ◽  
Clinical Manifestations ◽  
Artery Dissection ◽  
Recurrent Hemorrhage ◽  
Content Type ◽  
Clinical Presentations ◽  
Brainstem Compression ◽  
Fine Print

Object. Little is understood about the clinical manifestations of basilar artery (BA) dissections, which can present with subarachnoid hemorrhage (SAH), brainstem compression, or ischemia. In any instance, the prognosis seems poorer than that for vertebral artery (VA) dissection. The authors analyzed clinical presentations and radiological features of BA dissection with and without rupture. Methods. Between 1998 and 2003, the authors treated 10 patients (eight men and two women, ranging in age from 32–78 years; mean age 54 years) with BA dissection. Diagnosis was based on clinical and radiological findings, including those from magnetic resonance imaging and cerebral angiography studies. Of the 10 patients, five had impaired consciousness at disease onset. Among four patients presenting with SAH, two were treated conservatively and had fair outcomes without recurrent hemorrhage. The other two patients with SAH were treated using unilateral endovascular VA occlusion, but one of them subsequently suffered fatal rebleeding. A fifth patient presented with progressive signs of a mass involving the brainstem, whereas the remaining five patients showed brainstem ischemia; all were treated conservatively. Four patients could not return to their previous daily activities. Conclusions. Basilar artery dissections are rare lesions associated with significant morbidity and death. The natural course of and the treatment options for BA dissection differ considerably from those for VA dissections. Management of these lesions is controversial and difficult, and requires particular care.

scholarly journals Morphological Subtypes of Intracranial Internal Carotid Artery Arteriosclerosis and the Risk of Stroke

Stroke ◽  
2021 ◽  
Author(s):  
Tim C. van den Beukel ◽  
Janine E. van der Toorn ◽  
Meike W. Vernooij ◽  
Maryam Kavousi ◽  
Ali C. Akyildiz ◽  
...  
Keyword(s):  
Cox Regression ◽  
Population Based ◽  
Internal Elastic Lamina ◽  
Intracranial Arteriosclerosis ◽  
Increased Risk ◽  
Prevalent Subtype ◽  
Grading Scale ◽  
Noncontrast Computed Tomography ◽  
Elastic Lamina

Background and Purpose: Accumulating evidence highlights the existence of distinct morphological subtypes of intracranial carotid arteriosclerosis. So far, little is known on the prevalence of these subtypes and subsequent stroke risk in the general population. We determined the prevalence of morphological subtypes of intracranial arteriosclerosis and assessed the risk of stroke associated with these subtypes. Methods: Between 2003 and 2006, 2391 stroke-free participants (mean age 69.6, 51.7% women) from the population-based Rotterdam Study underwent noncontrast computed tomography to visualize calcification in the intracranial carotid arteries as a proxy for intracranial arteriosclerosis. Calcification morphology was evaluated according to a validated grading scale and categorized into intimal, internal elastic lamina (IEL), or mixed subtype. Follow-up for stroke was complete until January 1, 2016. We used multivariable Cox regression to assess associations of each subtype with incident stroke. Results: The prevalence of calcification was 82% of which 39% had the intimal subtype, 48% IEL subtype, and 13% a mixed subtype. During a median follow-up of 10.4 years, 155 participants had a stroke. All 3 subtypes were associated with a higher risk of stroke (adjusted hazard ratio [95% CI] for intimal: 2.11 [1.07–4.13], IEL: 2.66 [1.39–5.11], and mixed subtype 2.57 [1.18–5.61]). The association of the IEL subtype with stroke was strongest among older participants. The association of the intimal subtype with stroke was noticeably stronger in women than in men. Conclusions: Calcification of the IEL was the most prevalent subtype of intracranial arteriosclerosis. All 3 subtypes were associated with an increased risk of stroke, with noticeable age and sex-specific differences.

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