scholarly journals Digital intravascular pressure wave recording during endovascular treatment reveals abnormal shunting flow in vertebral venous fistula of the vertebral artery: illustrative case

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Yoshiteru Shimoda ◽  
Shinya Sonobe ◽  
Kuniyasu Niizuma ◽  
Toshiki Endo ◽  
Hidenori Endo ◽  
...  
Keyword(s):  
Blood Flow ◽  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Resistance Index ◽  
Illustrative Case ◽  
Limb Weakness ◽  
Dicrotic Notch ◽  
The Central Nervous System ◽  
Venous Fistula ◽  
The Right

BACKGROUND An arteriovenous fistula is an abnormal arteriovenous shunt between an artery and a vein, which often leads to venous congestion in the central nervous system. The blood flow near the fistula is different from normal artery flow. A novel method to detect the abnormal shunting flow or pressure near the fistula is needed. OBSERVATIONS A 76-year-old woman presented to the authors’ institute with progressive right upper limb weakness. Right vertebral angiography showed a fistula between the right extracranial vertebral artery (VA) and the right vertebral venous plexus at the C7 level. The patient underwent endovascular treatment for shunt flow reduction. Before the procedure, blood pressures were measured at the proximal VA, distal VA near the fistula, and just at the fistula and drainer using a microcatheter. The blood pressure waveforms were characteristically different in terms of resistance index, half-decay time, and appearance of dicrotic notch. The fistula was embolized with coils and N-butyl cyanoacrylate solution. LESSONS During endovascular treatment, the authors were able to digitally record the vascular pressure waveform from the tip of the microcatheter and succeeded in calculating several parameters that characterize the shunting flow. Furthermore, these parameters could help recognize the abnormal blood flow, allowing a safer endovascular surgery.

Usefulness of Intravascular Doppler Flow Measurements in Cerebral Endovascular Treatment

1996 ◽  
Vol 2 (2) ◽  
pp. 103-110 ◽  
Author(s):  
K. Fukui ◽  
M. Negoro ◽  
I. Takahashi ◽  
K. Fukasaku ◽  
K. Nakabayashi ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Endovascular Treatment ◽  
Transcranial Doppler Sonography ◽  
Resistance Index ◽  
Flow Measurements ◽  
Doppler Flow ◽  
Carotid Stenoses ◽  
Blood Flow Measurements ◽  
Carotid Cavernous Fistulas

Measurement of cerebral blood flow in cerebral endovascular procedures is useful for the assessment of treatment effects. We used transcranial Doppler sonography (TCD) and Doppler guide wires (SmartWire®, Cardiometrics Co.) in intravascular treatment. The cases were 6 brain arteriovenous malformations (AVM), 2 carotid cavernous fistulas (CCF), 2 facial angiomas, and 2 carotid stenoses. Intravascular cerebral blood flow measurements with the SmartWire were performed during the endovascular procedure. TCD was used pre- and post-endovascular treatment, and velocity, pulsatility index (PI) and resistance index (RI) were compared with the SmartWire. For both TCD and SmartWire, blood velocity of the main artery decreased, and PI and RI were improved after embolisation of AVM. In angioplasty cases, post stenotic flow velocity, as measured by SmartWire, was improved, and the flow of MCA measured with TCD was also improved after treatment. The SmartWire is useful to assess cerebral blood flow changes during the neuroendovascular procedure. Combined with repeated follow up with TCD, Doppler flow measurements are useful to assess the effect of endovascular treatment.

scholarly journals Is there any influence of breastfeeding on the cerebral blood flow? A review of 256 healthy newborns

2012 ◽  
Vol 45 (5) ◽  
pp. 263-266 ◽  
Author(s):  
Alexandra Maria Vieira Monteiro ◽  
Claudio Marcio Amaral de Oliveira Lima ◽  
Paula Medina
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Pulsatility Index ◽  
Cerebral Blood Flow Velocity ◽  
Resistance Index ◽  
Left Middle Cerebral Artery ◽  
Mean Velocity ◽  
The Right

OBJECTIVE: To investigate whether breastfeeding influence the cerebral blood-flow velocity. MATERIALS AND METHODS: The present study included 256 healthy term neonates, all of them with appropriate weight for gestational age, 50.8% being female. Pulsatility index, resistance index and mean velocity were measured during breastfeeding or resting in the anterior cerebral artery, in the left middle cerebral artery, and in the right middle cerebral artery of the neonates between their first 10 and 48 hours of life. The data were analyzed by means of a paired t-test, Brieger's f-test for analysis of variance and linear regression, with p < 0.01 being accepted as statistically significant. RESULTS: Mean resistance index decreased as the mean velocity increased significantly during breastfeeding. Pulsatility index values decreased as much as the resistance index, but in the right middle cerebral artery it was not statistically significant. CONCLUSION: Breastfeeding influences the cerebral blood flow velocities.

scholarly journals Reversal of Blood Flow in the Right Vertebral Artery Accompanying Occlusion of the Innominate Artery

1965 ◽  
Vol 161 (3) ◽  
pp. 353-356 ◽  
Author(s):  
WILLIAM S. BLAKEMORE ◽  
WILLIAM H. HARDESTY ◽  
JOHN E. BEVILACQUA ◽  
THEODORE A. TRISTAN
Keyword(s):  
Blood Flow ◽  
Vertebral Artery ◽  
Innominate Artery ◽  
The Right

scholarly journals Microsurgical Treatment Strategy of Vertebral Artery Fusiform Aneurysm—From the Standpoint of Hemodynamic Integrity and Perforator Preservation

2021 ◽  
Vol 12 ◽  
Author(s):  
Sho Tsunoda ◽  
Tomohiro Inoue
Keyword(s):  
Blood Flow ◽  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Treatment Strategy ◽  
Fusiform Aneurysm ◽  
Microsurgical Technique ◽  
Microsurgical Treatment ◽  
Distal Branch ◽  
Clip Application ◽  
The Ideal

During treatment of vertebral artery (VA) fusiform aneurysms, it is critical to preserve peripheral perforators and anterograde blood flow of the VA and to reduce hemodynamic load to the contralateral VA. Even in the era of endovascular treatment, there are still many benefits to using microsurgical treatments with appropriate clip application and preservation of the perforators around the aneurysm, in conjunction with various bypass techniques. The ideal microsurgical technique involves reconstructive clipping that obliterates the aneurysm but preserves anterograde blood flow of the VA, followed by isolation of the aneurysm and VA reconstruction. If these two methods are unavailable, proximal clipping of the aneurysm combined with flow-augmentation bypass to the distal branch can be considered as an alternative surgical management. We discuss the microsurgical treatment of unruptured VA fusiform aneurysms in our surgical cases on the basis of a review of the current literature.

scholarly journals Large cavernous carotid artery aneurysm with spontaneous thrombosis: is there more to a change in morphology than there seems to be? Illustrative case

2021 ◽  
Vol 2 (7) ◽  
Author(s):  
Yoriko Kato ◽  
Wataro Tsuruta ◽  
Hisayuki Hosoo ◽  
Tetsuya Yamamoto
Keyword(s):  
Carotid Artery ◽  
Endovascular Treatment ◽  
Laboratory Data ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Illustrative Case ◽  
Hemorrhagic Diathesis ◽  
Unruptured Cerebral Aneurysm ◽  
Cavernous Carotid Artery ◽  
The Right

BACKGROUND The pathogenesis and endovascular treatment strategy for spontaneously thrombosed unruptured cerebral aneurysms have not yet been comprehensively described. OBSERVATIONS The authors reported on a 78-year-old woman who had large bilateral unruptured cavernous carotid artery aneurysms that induced chronic disseminated intravascular coagulation and acquired factor XIII deficiency. The right aneurysm was symptomatic and partially thrombosed. Hemorrhagic diathesis and abnormal values of laboratory data improved after administration of recombinant human thrombomodulin followed by endovascular treatment in which three pipeline embolization devices were deployed for the right aneurysm. LESSONS To the best of the authors’ knowledge, this was the first report of an unruptured cerebral aneurysm leading to coagulation disorders with clinical manifestation that was treated successfully by endovascular intervention after intensive perioperative management.

scholarly journals Carotid-Vertebral or Carotid-Subclavian Transpositions in Supra-Aortic Steno-Occlusive Diseases When Endovascular Therapy Is Unfeasible or Unsuccessful

2021 ◽  
Vol 105 (1-3) ◽  
pp. 455-463
Author(s):  
Jian Wang ◽  
Jie Chu ◽  
Lihua Zhang ◽  
Juan Chen ◽  
Yi Zheng ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Subclavian Artery ◽  
Endovascular Intervention ◽  
Treatment Modalities ◽  
Left Vertebral Artery ◽  
Severe Stenosis ◽  
Brachiocephalic Trunk ◽  
The Right

Background and purpose Despite advances in endovascular therapies, some patients experience vertebral artery stenosis or subclavian artery occlusion and may not benefit from less-invasive angioplasty/stenting. This study described 4 cases in which carotid-vertebral transposition (CVT) or carotid-subclavian transposition (CST) was adapted when endovascular treatment was unfeasible or unsuccessful. Presentation Case 1: A 65-year-old woman presented with severe stenosis of the right vertebral artery ostium, dysplastic left vertebral artery, and aneurysmal dilatation of proximal right subclavian artery and brachiocephalic trunk. Case 2: A 23-year-woman had severe stenosis at the first portion of left vertebral artery caused by Takayasu's arteritis. Because endovascular intervention was unfeasible, CVTs were performed in cases 1 and 2. Case 3: A 73-year-old man presented with total occlusion of the proximal right subclavian artery and severe stenosis of the right internal carotid artery. Case 4: A 58-year-old man experienced complete occlusion of the left subclavian artery and severe stenosis of the left common carotid artery. Duplex ultrasonography showed reverse flow in the vertebral artery in keeping with vertebral steal syndrome. Endovascular treatment was unsuccessful because the wire did not cross the occlusion of the subclavian artery. CSTs were performed with concurrent ipsilateral carotid endarterectomy in cases 3 and 4. Conclusion The present case series demonstrated that CST and CVT were effective treatment modalities for subclavian or vertebral artery lesions. Although endovascular stenting and angioplasty have been advocated as first-line management, CST and CVT should be considered as the remedy when endovascular intervention is unsuccessful or unfeasible.

scholarly journals Atypical presentation of rotational vertebral artery insufficiency: illustrative case

2021 ◽  
Vol 1 (9) ◽  
Author(s):  
Pranish A. Kantak ◽  
Sarv Priya ◽  
Girish Bathla ◽  
Mario Zanaty ◽  
Patrick W. Hitchon
Keyword(s):  
Vertebral Artery ◽  
Facet Joint ◽  
Head Rotation ◽  
Rotational Instability ◽  
Anatomical Location ◽  
Illustrative Case ◽  
Vertebrobasilar Insufficiency ◽  
Course Of Action ◽  
Heterogeneous Nature ◽  
The Right

BACKGROUNDRotational vertebral artery insufficiency (RVAI), also known as bow hunter’s syndrome, is an uncommon cause of vertebrobasilar insufficiency that leads to signs of posterior circulation ischemia during head rotation. RVAI can be subdivided on the basis of the anatomical location of vertebral artery compression into atlantoaxial RVAI (pathology at C1-C2) or subaxial RVAI (pathology below C2). Typically, RVAI is only seen with contralateral vertebral artery pathologies, such as atherosclerosis, hypoplasia, or morphological atypia.OBSERVATIONSThe authors present a unique case of atlantoaxial RVAI due to rotational instability, causing marked subluxation of the C1-C2 facet joints. This case is unique in both the mechanism of compression and the lack of contralateral vertebral artery pathology. The patient was successfully treated with posterior C1-C2 instrumentation and fusion.LESSONSWhen evaluating patients for RVAI, neurosurgeons should be aware of the variety of pathological causes, including rotational instability from facet joint subluxation. Due to the heterogeneous nature of the pathologies causing RVAI, care must be taken to decide if conservative management or surgical correction is the right course of action. Because of this heterogeneous nature, there is no set guideline for the treatment or management of RVAI.

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.

Differential arterial blood flow response of splanchnic and renal organs during low-intensity cycling exercise in women

2008 ◽  
Vol 294 (5) ◽  
pp. H2322-H2326 ◽  
Author(s):  
Masako Yamaoka Endo ◽  
Rie Suzuki ◽  
Naomi Nagahata ◽  
Naoyuki Hayashi ◽  
Akira Miura ◽  
...  
Keyword(s):  
Blood Flow ◽  
Resistance Index ◽  
Arterial Blood Flow ◽  
Cycling Exercise ◽  
Low Intensity ◽  
Flow Response ◽  
Arterial Blood ◽  
Abdominal Organs ◽  
The Right ◽  
Splenic Vessels

To investigate the regional hemodynamic responses of abdominal arteries at the onset of exercise and to focus on their transient responses, eight female subjects (21–30 yr) performed ergometer cycling exercise at 40 W for 4 min in a semi-supine position. Mean blood velocities (MBVs) in the right renal (RA), superior mesenteric (SMA), and splenic (SA) arteries were measured by pulsed echo-Doppler ultrasonography, with beat-by-beat measurements of heart rate (HR) and mean arterial pressure (MAP). The vascular resistance index (RI) of each artery was calculated from MBV/MAP. MAP (76 ± 9 to 83 ± 8 mmHg at 4 min) and HR (60 ± 7 to 101 ± 9 beats/min at 4 min) increased during exercise ( P < 0.05). The MBV of RA and SA rapidly decreased after the onset of exercise (30 s; −19 ± 5% and −19 ± 12%, respectively), reaching −27 ± 7% and −27 ± 15% at the end of exercise ( P < 0.05). RI did not change during the initial 30 s of exercise, reflecting a reduction in MAP, and increased toward the end of the exercise (+55 ± 21% and +59 ± 39%, respectively). In contrast, both the MBV and RI in the SMA remained constant throughout the exercise. The results indicate that, whereas the responses of renal and splenic vessels changed similarly throughout the protocol, the vascular response of SMA that mainly supplies blood to the intestinal tract was unchanged during exercise. We, therefore, conclude that low-intensity cycling exercise resulted in differential blood flow responses in arteries supplying the abdominal organs.

Monitoring of the lateral spread response in the endovascular treatment of a hemifacial spasm caused by an unruptured vertebral artery aneurysm

2004 ◽  
Vol 101 (5) ◽  
pp. 861-863 ◽  
Author(s):  
Hiroatsu Murakami ◽  
Tadashi Kawaguchi ◽  
Masafumi Fukuda ◽  
Yasushi Ito ◽  
Hitoshi Hasegawa ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Hemifacial Spasm ◽  
Artery Aneurysm ◽  
Endovascular Surgery ◽  
Lateral Spread ◽  
Content Type ◽  
Lateral Spread Response ◽  
The Right ◽  
Fine Print

✓ The lateral spread response (LSR) is used in the electrophysiological diagnosis of a hemifacial spasm or for monitoring during microvascular decompression. The authors used LSRs for intraoperative monitoring during endovascular surgery in a rare case of vertebral artery (VA) aneurysm that caused intractable hemifacial spasm. A 49-year-old woman presented with a right hemifacial spasm that had persisted for 9 months. No other clinical symptom was observed. Vertebral artery angiography revealed a saccular aneurysm of the right VA. Magnetic resonance (MR) imaging demonstrated that the aneurysm was compressing the root exit zone of the right facial nerve. Endovascular treatment of the VA aneurysm was performed while monitoring the patient's LSRs. During occlusion of the VA at sites distal and proximal to the aneurysm, the LSRs temporarily disappeared and then reappeared with a higher amplitude than those measured preceding their disappearance. The hemifacial spasm alleviated gradually and disappeared completely 6 months after treatment. The LSRs changed in parallel with the improvement in the patient's hemifacial spasms and eventually disappeared. No recurrence of symptoms has been noticed as of 18 months postoperatively. This is the first report of the use of LSR monitoring during endovascular surgery for an intracranial aneurysm that causes hemifacial spasm. Intraoperative and postoperative changes in the LSRs provided useful information regarding the pathophysiology of hemifacial spasm.

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