scholarly journals Double-barrel STA-MCA bypass and partial trapping of a ruptured mycotic MCA aneurysm with flash fluorescence technique

2022 ◽  
Vol 6 (1) ◽  
pp. V15
Keyword(s):  
Vessel Wall ◽  
Cerebrovascular Lesions ◽  
Septic Emboli ◽  
Mycotic Aneurysms ◽  
Brain Aneurysms ◽  
Intracranial Arteries ◽  
Mca Aneurysm ◽  
Cortical Distribution ◽  
Partial Trapping ◽  
Elastic Lamina

Mycotic brain aneurysms are rare and unusual cerebrovascular lesions arising from septic emboli that degrade the elastic lamina and vessel wall of intracranial arteries, which results in pathologic dilatation. Mycotic aneurysms are nonsaccular lesions that are not often suitable for clipping and instead require bypass, trapping, and flow reversal. This case demonstrates the use of indocyanine green “flash fluorescence” to identify the cortical distribution supplied by an aneurysm’s outflow, facilitating safe treatment with a double-barrel extracranial-intracranial bypass and partial trapping and conversion of a deep bypass to a superficial one. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21163

Blood vessels and the endothelium

2010 ◽  
pp. 2593-2603
Author(s):  
Patrick Vallance ◽  
Keith Channon
Keyword(s):  
Blood Vessels ◽  
Vessel Wall ◽  
Single Layer ◽  
Vasa Vasorum ◽  
Blood Vessel Wall ◽  
Internal Elastic Lamina ◽  
Perivascular Adipose Tissue ◽  
The Media ◽  
Elastic Laminae ◽  
Elastic Lamina

The blood vessel wall consists of the intima, the media, and the adventitia. Not all vessels have each layer, and the layers vary in size and structure between vessels. (1) The intima is made up of a single layer of endothelial cells on a basement membrane, beneath which—depending on vessel size—there may be a layer of fibroelastic connective tissue and an internal elastic lamina that provides both structure and flexibility. Embedded in the intima are pericytes. (2) The media is made up of smooth muscle cells, elastic laminae and extracellular matrix. (3) The adventitia is the outermost part of the vessel, composed mainly of fibroelastic tissue but also containing nerves, small feeding blood vessels (the vasa vasorum), and lymph vessels. The adventitia is directly related to the surrounding perivascular adipose tissue....

Republished: Intracranial vessel occlusion preceding the development of mycotic aneurysms in patients with endocarditis

2020 ◽  
Vol 12 (2) ◽  
pp. e1-e1
Author(s):  
Ezequiel Goldschmidt ◽  
Amir H Faraji ◽  
David Salvetti ◽  
Benjamin M Zussman ◽  
Ashutosh Jadhav
Keyword(s):  
Infectious Endocarditis ◽  
Intravenous Drug Use ◽  
Vessel Occlusion ◽  
Cerebral Angiogram ◽  
Septic Emboli ◽  
Intracranial Vessel ◽  
History Of ◽  
Mycotic Aneurysms ◽  
Vascular Occlusions

Mycotic aneurysms (MA) are an uncommon complication of infectious endocarditis. Septic emboli are thought to be the precipitating event in their development, but the evidence for this is sparse. We present three cases in which septic embolic occlusion preceded MA development at the occlusion site, suggesting that documented angiographic emboli in patients with infectious endocarditis and bacteremia constitute a risk factor for MA formation. Two adult patients with a history of intravenous drug use and one child with congenital heart disease are described. They were all diagnosed with infectious endocarditis and developed neurological symptoms during their hospital course. Initial catheter-based cerebral angiograms demonstrated vascular occlusions, which were followed by the development of MA at the same sites within 1 month. Septic emboli, documented on cerebral angiogram, in patients with infectious endocarditis may precede the appearance of MA. Patients with angiographic occlusions in the setting of endocarditis warrant close follow-up.

scholarly journals Vessel wall imaging in intracranial aneurysms

2019 ◽  
Vol 11 (11) ◽  
pp. 1105-1112 ◽  
Author(s):  
Edgar A Samaniego ◽  
Jorge A Roa ◽  
David Hasan
Keyword(s):  
Vessel Wall ◽  
Intracranial Aneurysms ◽  
Vessel Wall Imaging ◽  
Current Evidence ◽  
Clinical Use ◽  
Quantitative Susceptibility Mapping ◽  
Aneurysm Wall ◽  
Brain Aneurysms ◽  
Wall Imaging

High-resolution vessel wall imaging (HR-VWI) is becoming a useful tool in the characterization and identification of unstable unruptured brain aneurysms. However, it has not been validated for clinical use. The current evidence on HR-VWI techniques for characterization of brain aneurysms is described in this review. Specific imaging approaches such as aneurysm wall contrast enhancement, MRI-quantitative susceptibility mapping, and 7T MRI are described in detail.

scholarly journals Spatial Distribution of Intracranial Vessel Wall Enhancement in Hypertension and Primary Angiitis of the CNS

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Jae W. Song ◽  
Haochang Shou ◽  
Emmanuel C. Obusez ◽  
Scott B. Raymond ◽  
Samuel D. Rafla ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spatial Distribution ◽  
Vessel Wall ◽  
Image Interpretation ◽  
Laboratory Data ◽  
Intracranial Vessel ◽  
Intracranial Atherosclerotic Disease ◽  
Primary Angiitis ◽  
Intracranial Arteries ◽  
Diagnosis Of Hypertension

AbstractWe hypothesized a difference in the spatial distribution of intracranial vessel wall enhancement between CNS vasculitis and risk factors for intracranial atherosclerotic disease (ICAD). Fifty-five vessel wall MR imaging (VWI) exams were included in this retrospective observational study. Intracranial arteries were evaluated for vessel wall enhancement by branching pattern (e.g., primary, secondary, and tertiary segments). Demographic and laboratory data as well as ICAD risk factors, including a diagnosis of hypertension, were collected. A diagnosis of primary angiitis of the CNS (PACNS) was confirmed by biopsy or clinical assessment by a stroke neurologist. Univariate and multivariate Poisson regression models were fit for the outcomes. In multivariate analyses, hypertension showed significant associations with primary (β = 1.31, 95% CI 0.78–1.88, p < 0.0001) and secondary (β = 1.15, 95% CI 0.29–2.18, p = 0.05) segments, contrasting with PACNS which showed a distal spatial distribution with significant associations with secondary (β = 0.77, 95% CI 0.14–1.39, p = 0.05) and tertiary (β = 1.34, 95% CI 0.68–2.01, p < 0.0001) segments. Our results suggest the spatial distribution of vessel wall enhancement is an important consideration when interpreting VWI exams, particularly in patients with a comorbid diagnosis of hypertension. Given the global prevalence of hypertension, these results are impactful and may improve image interpretation of VWI in stroke patients.

Abstract T P171: Impaired Brachial Flow-mediated Dilatation in Patients With Symptomatic Nontraumatic Intracranial Arterial Dissections

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Tomonori Iwata ◽  
Takahisa Mori ◽  
Yuichi Miyazaki ◽  
Yuhei Tanno ◽  
Shigen Kasakura ◽  
...  
Keyword(s):  
Endothelial Function ◽  
Ankle Brachial Index ◽  
Superior Cerebellar Artery ◽  
Internal Elastic Lamina ◽  
Cerebellar Artery ◽  
Atherosclerotic Change ◽  
Flow Mediated Dilatation ◽  
Intracranial Arteries ◽  
Atherosclerotic Risk Factors ◽  
Elastic Lamina

Background: Non-traumatic intracranial arterial dissections (IADs) are characterized by the sudden disruption of the internal elastic lamina in intracranial arteries. It is still unknown why IADs occurs. There are few reports concerned with relationship between the endothelial function and IADs. Purpose: The purpose of our retrospective study was to investigate whether or not patients with nontraumatic IADs had normal endothelial function. Methods: Included for retrospective analysis were patients with symptomatic nontraumatic IADs (1) who were admitted to our institution from 2012 to 2013 and (2) who underwent an endothelial function test during hospitalization. Headache patients admitted to outpatient clinic were selected as a control matched for sex and age. The endothelial function was assessed using flow-mediated dilatation (FMD). We investigated ankle brachial index (ABI) and pulse wave velocity (PWV) to determine the degree of atherosclerosis. Patients’ characteristics, brachial FMD, ABI and PVW were assessed in two groups. Results: During study periods, there were 14 patients (median age 45.5 years, IQR 38-53.5 years) with nontraumatic IADs. Fourteen patients of the control had median age of 47 years (IQR: 44-53.5 years). The locations of IADs were the vertebral artery (n=10), the internal carotid artery (n=3) and the superior cerebellar artery (n=1). Between two groups, there were no significant differences of clinical features, atherosclerotic risk factors, ABI and PWV except FMD, indicating that most of them did not suffer from atherosclerosis. However, FMD in IADs was significantly lower than in control (4.85 vs. 7.4, p<0.01) Conclusion: ur results suggest that the endothelial function of intracranial arteries might be impaired in patients with symptomatic nontraumatic IADs in spite of no atherosclerotic change.

scholarly journals A Novel Swine Model to Evaluate Arterial Vessel Injury after Mechanical Endovascular Thrombectomy

2013 ◽  
Vol 19 (2) ◽  
pp. 147-152 ◽  
Author(s):  
B. Gory ◽  
D. Bresson ◽  
A. Rouchaud ◽  
C. Yardin ◽  
C. Mounayer
Keyword(s):  
Animal Model ◽  
Vessel Wall ◽  
Arterial Injury ◽  
Swine Model ◽  
Histopathological Changes ◽  
Endovascular Thrombectomy ◽  
Vessel Injury ◽  
Intracranial Arteries ◽  
Device Interaction

Few animal models have been reported to evaluate and compare mechanical endovascular thrombectomy (MET) devices used to treat human ischemic stroke. These models may contribute to the understanding of arterial injury induced by a MET device and potentially by extrapolation to human intracranial arteries. We have developed a novel swine model for MET that allows visualization of the thrombus/device interaction and characterization of mechanical impact on the vessel wall. Twenty superficial femoral arteries were occluded with radiopaque thrombus, and 20 without thrombus were treated with thrombectomy devices. Acute histopathological changes were evaluated. The swine femoral artery, which is comparable in size to the human middle cerebral artery or basilar artery, may offer a useful animal model for the study of histologic alterations induced by MET.

scholarly journals Differences in atheroma between Caucasian and Asian subjects with anterior stroke: A vessel wall MRI study

2020 ◽  
pp. svn-2020-000370
Author(s):  
Hiroko Watase ◽  
Mi Shen ◽  
Binbin Sui ◽  
Peiyi Gao ◽  
Dong Zhang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Ischaemic Stroke ◽  
Racial Differences ◽  
Vessel Wall ◽  
Artery Stenosis ◽  
Anterior Circulation ◽  
Extracranial Carotid Artery ◽  
Significant Difference ◽  
Intracranial Arteries ◽  
Chinese Subjects

Background and purposeWhile extracranial carotid artery stenosis is more common among Caucasians and intracranial artery stenosis is more common among Asians, the differences in atherosclerotic plaque characteristics have not yet been extensively examined. We sought to investigate plaque location and characteristics within extracranial carotid and intracranial arteries in symptomatic Caucasians and Chinese using vessel wall MRI.MethodsSubjects with recent anterior circulation ischaemic stroke were recruited and imaged at two sites in the USA and China using similar protocols. Both extracranial carotid and intracranial arteries were reviewed to determine plaque location and characteristics.ResultsThe prevalence of extracranial carotid plaque in Caucasians and Chinese was 73.1% and 49.1%, respectively (p=0.055). Prevalence of intracranial plaque was 38.5% and 69.1% in Caucasians and Chinese, respectively (p=0.02). Furthermore, 42% of Caucasians and 16% of Chinese had high-risk plaque (HRP) features (intraplaque haemorrhage, luminal surface disruption) in the extracranial carotid artery (p=0.03). The prevalence of HRP features in intracranial arteries was not significantly different between the two cohorts (4% vs 11%; p=0.42).ConclusionsDifferences in the location and characteristics of cerebrovascular atherosclerosis were identified by vessel wall MRI in US Caucasian and Chinese subjects with recent anterior circulation ischaemic stroke. Extracranial carotid plaques with HRP features were more common in Caucasians. Intracranial plaques were more common in Chinese subjects, but no significant difference between the two cohorts in intracranial HRP prevalence was found. Larger studies using vessel wall imaging to investigate racial differences in cerebrovascular disease may inform underlying mechanisms of HRP development and may ultimately help guide appropriate therapy.

Fevers in a Patient with Valve Replacement

2016 ◽  
Author(s):  
Ji Y. Chong ◽  
Michael P. Lerario
Keyword(s):  
Ischemic Stroke ◽  
Infective Endocarditis ◽  
Acute Ischemic Stroke ◽  
Valve Replacement ◽  
Intravenous Thrombolysis ◽  
Neurological Complications ◽  
Vascular Imaging ◽  
Septic Emboli ◽  
Hemorrhagic Complications ◽  
Mycotic Aneurysms

Infective endocarditis can cause neurological complications, including stroke, hemorrhage, and mycotic aneurysms. Patients with endocarditis and neurological complications need vascular imaging to evaluate for aneurysm formation. Patients with acute ischemic stroke from septic emboli may not respond to conventional intravenous thrombolysis and have higher rates of hemorrhagic complications.

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