Effects of intermittent reperfusion during temporal focal ischemia

1992 ◽  
Vol 77 (6) ◽  
pp. 911-916 ◽  
Author(s):  
Marc S. Goldman ◽  
Robert E. Anderson ◽  
Fredric B. Meyer
Keyword(s):  
Arterial Occlusion ◽  
Vessel Occlusion ◽  
Content Type ◽  
Mca Occlusion ◽  
Ischemic Period ◽  
Occlusion Technique ◽  
Barrier Breakdown ◽  
Aneurysm Repair ◽  
Blood Brain Barrier Breakdown

✓ There is controversy regarding the role of intermittent reperfusion employed as a cerebroprotective measure when temporary arterial occlusion is necessary during repair of difficult aneurysms. The intraluminal suture middle cerebral artery (MCA) occlusion technique was used in 23 Wistar rats under barbiturate anesthesia to induce 60, 90, or 120 minutes of uninterrupted MCA occlusion. The total infarcted areas obtained were compared to those occurring in 27 animals subjected to identical cumulative ischemic periods but with 5 minutes of reperfusion after every 10-minute ischemic period. The mean total infarcted areas in the groups with 60-minute (1.8 ± 0.89 sq mm), 90-minute (1.08 ± 1.02 sq mm), and 120-minute (8.72 ± 5.89 sq mm) intermittent reperfusion were significantly smaller than those occurring in the 60-minute (12.02 ± 3.10 sq mm), 90-minute (11.54 ± 2.68 sq mm), or 120-minute (30.43 ± 6.51 sq mm) control groups, respectively (p < 0.05). Furthermore, there was no difference in the occurrence of blood-brain barrier breakdown, intraparenchymal hemorrhage, hemispheric edema, or seizures between control and intermittent reperfusion groups. The results support the hypothesis that intermittent reperfusion is beneficial if vessel occlusion is required during aneurysm repair.

Decompressive craniectomy in a rat model of “malignant” cerebral hemispheric stroke: experimental support for an aggressive therapeutic approach

1996 ◽  
Vol 85 (5) ◽  
pp. 853-859 ◽  
Author(s):  
Arnd Doerfler ◽  
Michael Forsting ◽  
Wolfgang Reith ◽  
Christian Staff ◽  
Sabine Heiland ◽  
...  
Keyword(s):  
Cerebral Ischemia ◽  
Decompressive Craniectomy ◽  
Control Group ◽  
Acute Ischemia ◽  
Vessel Occlusion ◽  
Content Type ◽  
Time Points ◽  
Infarction Size ◽  
Mca Occlusion ◽  
Fine Print

✓ Acute ischemia in the complete territory of the carotid artery may lead to massive cerebral edema with raised intracranial pressure and progression to coma and death due to uncal, cingulate, or tonsillar herniation. Although clinical data suggest that patients benefit from undergoing decompressive surgery for acute ischemia, little data about the effect of this procedure on experimental ischemia are available. In this article the authors present results of an experimental study on the effects of decompressive craniectomy performed at various time points after endovascular middle cerebral artery (MCA) occlusion in rats. Focal cerebral ischemia was induced in 68 rats using an endovascular occlusion technique focused on the MCA. Decompressive cranioectomy was performed in 48 animals (in groups of 12 rats each) 4, 12, 24, or 36 hours after vessel occlusion. Twenty animals (control group) were not treated by decompressive craniectomy. The authors used the infarct volume and neurological performance at Day 7 as study endpoints. Although the mortality rate in the untreated group was 35%, none of the animals treated by decompressive craniectomy died (mortality 0%). Neurological behavior was significantly better in all animals treated by decompressive craniectomy, regardless of whether they were treated early or late. Neurological behavior and infarction size were significantly better in animals treated very early by decompressive craniectomy (4 hours) after endovascular MCA occlusion (p < 0.01); surgery performed at later time points did not significantly reduce infarction size. The results suggest that use of decompressive craniectomy in treating cerebral ischemia reduces mortality and significantly improves outcome. If performed early after vessel occlusion, it also significantly reduces infarction size. By performing decompressive craniectomy neurosurgeons will play a major role in the management of stroke patients.

scholarly journals Osmotic Demyelination: From an Oligodendrocyte to an Astrocyte Perspective

2019 ◽  
Vol 20 (5) ◽  
pp. 1124 ◽  
Author(s):  
Charles Nicaise ◽  
Catherine Marneffe ◽  
Joanna Bouchat ◽  
Jacques Gilloteaux
Keyword(s):  
Glial Cells ◽  
Serum Sodium ◽  
Brain Regions ◽  
Osmotic Demyelination Syndrome ◽  
Brain Areas ◽  
Osmotic Demyelination ◽  
Central Myelin ◽  
Barrier Breakdown ◽  
Blood Brain Barrier Breakdown

Osmotic demyelination syndrome (ODS) is a disorder of the central myelin that is often associated with a precipitous rise of serum sodium. Remarkably, while the myelin and oligodendrocytes of specific brain areas degenerate during the disease, neighboring neurons and axons appear unspoiled, and neuroinflammation appears only once demyelination is well established. In addition to blood‒brain barrier breakdown and microglia activation, astrocyte death is among one of the earliest events during ODS pathology. This review will focus on various aspects of biochemical, molecular and cellular aspects of oligodendrocyte and astrocyte changes in ODS-susceptible brain regions, with an emphasis on the crosstalk between those two glial cells. Emerging evidence pointing to the initiating role of astrocytes in region-specific degeneration are discussed.

Selective endovascular techniques in the treatment of cerebral mycotic aneurysms

1993 ◽  
Vol 78 (4) ◽  
pp. 661-665 ◽  
Author(s):  
Mazen H. Khayata ◽  
Armand Aymard ◽  
Alfredo Casasco ◽  
Denis Herbreteau ◽  
France Woimant ◽  
...  
Keyword(s):  
Standard Procedure ◽  
Endovascular Embolization ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Content Type ◽  
Mycotic Aneurysms ◽  
Distal Localization ◽  
Risk Of Hemorrhage

✓ The aim of this study was to evaluate the role of endovascular treatment for intracranial mycotic aneurysms. The clinical and angiographic features of three patients with endocarditic vegetation (two with Streptococcus viridans and one with Staphylococcus) were reviewed retrospectively. Patients were selected for this treatment according to the clinical setting and aneurysm location. In two cases, selective catheterization of a distal middle cerebral and posterior cerebral artery branch with a microcatheter followed by superselective amobarbital testing of the parent vessel was preliminary to the occlusion of that vessel with autologous clot or glue. The third patient was treated by selective occlusion of the aneurysm by intra-aneurysmal placement of platinum minicoils. Two patients presented with intracranial hemorrhage and in one the lesion was found on computerized tomography. All three aneurysms had been excluded from the circulation at the 6-month follow-up review. The only complication from the procedure, despite the septic nature and distal localization, was balloon deflation in one patient, who was successfully retreated with coils. Endovascular embolization is indicated in patients who are at risk of hemorrhage and cannot undergo the standard procedure. The superselective amobarbital test allows selection of patients who will tolerate distal vessel occlusion. This endovascular procedure represents a safe and effective treatment for these lesions.

scholarly journals The Role of Th17 in Neuroimmune Disorders: Target for CAM Therapy. Part II

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Aristo Vojdani ◽  
Jama Lambert
Keyword(s):  
Th17 Cells ◽  
Inflammatory Infiltration ◽  
Blood Brain ◽  
Bacterial Endotoxins ◽  
Pathogenic Factors ◽  
Progressive Neurodegeneration ◽  
Barrier Breakdown ◽  
Blood Brain Barrier Breakdown ◽  
Brain Barriers

Decades of research went into understanding the role that Th1 autoreactive T-cells play in neuroinflammation. Here we describe another effector population, the IL-17-producing T-helper lineage (Th17), which drives the inflammatory process. Through the recruitment of inflammatory infiltration neutrophils and the activation of matrix metalloproteinases, IL-17, a cytokine secreted by Th17 cells, contributes to blood-brain barrier breakdown and the subsequent attraction of macrophages and monocytes into the nervous system. The entry of cells along with the local production of inflammatory cytokines leads to myelin and axonal damage. This activation of the inflammatory response system is induced by different pathogenic factors, such as gut bacterial endotoxins resulting in progressive neurodegeneration by Th17 cells. Through the understanding of the role of bacterial endotoxins and other pathogenic factors in the induction of autoimmune diseases by Th17 cells, CAM practitioners will be able to design CAM therapies targeting IL-17 activity. Targeted therapy can restore the integrity of the intestinal and blood-brain barriers using probiotics,N-acetyl-cysteine,α-lipoic acid, resveratrol and others for their patients with autoimmunities, in particular those with neuroinflammation and neurodegeneration.

Abstract WMP26: Endovascular Arterial Deconstruction with a Combination of Onyx and Coils: Technique, Feasibility, and Complications

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Nohra Chalouhi ◽  
Robert M Starke ◽  
Stavropoula Tjoumakaris ◽  
Pascal Jabbour ◽  
L Fernando Gonzalez ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Arterial Occlusion ◽  
New Technique ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Balloon Test Occlusion ◽  
Distal Migration ◽  
Parent Vessel Occlusion ◽  
Occlusion Technique ◽  
A New Technique

Object: Permanent vessel deconstruction has become routine for the management of aneurysms, pseudoaneurysms, tumors, and carotid blowouts. We describe a new technique for carotid and vertebral artery deconstruction using a combination of Onyx and coils, and assess its feasibility, safety, and efficacy. Methods: Between 2008 and 2012, a total of 41 patients underwent carotid or vertebral artery deconstruction with a combination of Onyx and coils in our institution. A few coils were initially deployed in the parent vessel under proximal flow arrest followed by Onyx embolization directly into the coil mass. Results: A total of 26 internal carotid arteries and 15 vertebral arteries were treated. In all but one patient, a balloon test occlusion was performed prior to permanent arterial occlusion. The mean number of coils used was only 6.8 (range, 2-19). The total volume of Onyx used was 1.3 ml on average (range, 0.2-5.2 ml). All 41 (100%) parent arteries were successfully occluded. No distal migration of Onyx or coils was noted. Periprocedural complications occurred in 14.6% (6/41) of cases causing permanent morbidity in 7.3% (3/41). All were the result of delayed ischemic events after vessel deconstruction; none were related to the occlusion technique. No patient developed a recurrence during the follow-up period (mean, 14 months). Conclusions: Parent vessel occlusion with a combination of Onyx and coils is feasible, safe, and effective and results in significant savings in terms of cost, operative time, and fluoroscopy time. Importantly, no complications related to the technique itself were encountered in the series. This new technique should replace the traditional deconstruction technique with coils alone.

Abstract T P174: Intra-Arterial Signal on Arterial Spin Labeling Perfusion MRI Can Identify Stagnant Flow in Patients with Acute Middle Cerebral Artery Occlusion

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Junichiro Satomi ◽  
Yoshiteru Tada ◽  
Takashi Abe ◽  
Kazuyuki Kuwayama ◽  
Shu Sogabe ◽  
...  
Keyword(s):  
High Intensity ◽  
Arterial Spin Labeling ◽  
Arterial Occlusion ◽  
Spin Labeling ◽  
Vessel Occlusion ◽  
Mca Occlusion ◽  
Asymptomatic Patients ◽  
Major Vessel ◽  
High Intensity Signal ◽  
Stagnant Flow

Introduction: T2*-weighted imaging (T2*WI) can detect acute endovascular clots by the susceptibility vessel sign (SVS). Stagnant flow in front of middle cerebral artery (MCA) occlusion sites may contribute to intra-arterial high-intensity signal on arterial spin labeling (ASL) magnetic resonance imaging (MRI), making it another potential marker of MCA occlusion. We compared intra-arterial high-intensity signal and SVS in patients with symptomatic and asymptomatic MCA occlusion and patients without major vessel occlusion. Methods: We identified transient ischemic attack or ischemic stroke patients by (a) 3-T MRI, diffusion-weighted imaging, ASL, T2*WI, and magnetic resonance angiography (MRA) performed within 24 h after stroke onset and (b) the presence of MCA occlusion (n=34 patients) or the absence of major vessel occlusion (n=24 patients). We included asymptomatic patients with MCA occlusion (n=6). The presence or absence of intra-arterial high-intensity signal and SVS was recorded as was its coincidence with the presence of MCA occlusion on MRA. Results: In patients with acute ischemic stroke the sensitivity of intra-arterial high-intensity signal was significantly higher than of the SVS (88% vs 50%; p<0.05). The accuracy of intra-arterial high-intensity signal was also higher than of the SVS (93% vs 71%; p<0.05). Neither the intra-arterial high-intensity signal nor the SVS was observed in patients without major vessel occlusion. The presence or absence of intra-arterial high-intensity signal was highly consistent with the presence or absence of MCA occlusion on MRA (κ=0.74). Positivity for the intra-arterial high signal was higher in symptomatic than asymptomatic patients with MCA occlusion (88% vs 17%; p<0.05), suggesting that acute rather than chronic arterial occlusion contributes to the visibility of the intra-arterial high-intensity signal. Conclusions: The intra-arterial high-intensity signal on ASL could identify stagnant flow in front of occlusion sites due to acute arterial occlusion.

LINAC radiosurgery: an animal model

1993 ◽  
Vol 78 (4) ◽  
pp. 638-644 ◽  
Author(s):  
Roberto Spiegelmann ◽  
William A. Friedman ◽  
Frank J. Bova ◽  
Daniel P. Theele ◽  
J. Parker Mickle
Keyword(s):  
Evans Blue ◽  
Biological Effects ◽  
Lesion Size ◽  
Blue Staining ◽  
Normal Brain ◽  
Content Type ◽  
Linac Radiosurgery ◽  
Vascular Proliferation ◽  
Barrier Breakdown ◽  
Blood Brain Barrier Breakdown

✓ Fifteen cats were irradiated with an animal LINAC (linear accelerator) radiosurgery device. After 6 months, they were studied with gadolinium-enhanced magnetic resonance (MR) imaging, gross pathology after Evans blue perfusion, and histopathology. The lesion size was relatively constant in the cats receiving a dose of 7500, 10,000, 12,500, or 15,000 cGy to the 84% isodose line of a 1-cm collimator. The composition of the lesion correlated with dose: the lower-dose lesions were found histologically to contain areas of edema, demyelination, reactive gliosis, and vascular proliferation; the higher-dose lesions contained increasing amounts of hemorrhage and coagulative necrosis. The borders of the lesions were sharply demarcated from surrounding normal brain. Gadolinium-enhanced MR studies correlated well with areas of blood-brain barrier breakdown, as confirmed by areas of Evans blue staining. This model could serve as the basis for further studies of the biological effects of LINAC radiosurgery.

Abstract 2226: Predictors Of tPA Non-responders According To Location Of Vessel Occlusion

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Nuno Mendonça ◽  
David Rodríguez-Luna ◽  
Sandra Boned-Riera ◽  
Marta Rubiera ◽  
Marc Ribó ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Arterial Occlusion ◽  
Vessel Occlusion ◽  
Mca Occlusion ◽  
History Of ◽  
Hemodynamic Profile ◽  
Ica Stenosis ◽  
Selection Of Patients ◽  
Iv Tpa ◽  
Selection Of

Background and purpose: Information on the clinical and hemodynamic profile of IV tPA non-responders, at different location of arterial occlusion, may improve the selection of candidates for rescue reperfusion therapies. Therefore, we aimed to investigate predictors of failing IV tPA therapy according to occluded vessel and location of clot. Methods: We prospectively evaluated consecutive patients with an acute ischemic stroke admitted within the first 6 hours of onset. Five hundred and forty-eight patients with documented intracranial occlusion were included. Patients were categorized according to site of vessel occlusion into 4 distinct groups: proximal MCA occlusion (n=251), distal MCA occlusion (n=194), ICA T occlusion (n=61) and BA occlusion (n=42). Recanalization was assessed on TCD at 1 hour of tPA bolus. Results: Among patients with proximal MCA occlusion, the presence of severe extracranial ICA stenosis or occlusion (OR 2.36, 95% CI 1.15-4.84, p=0.02) and age >74 years (OR 1.84, 95% CI 1.02-3.31, p=0.04) independently predicted no recanalization (NR). No independent predictors of NR were identified in patients with distal MCA occlusion. In patients with ICA T occlusion, history of hypertension (OR 12.77, 95% CI 2.12-76.88, p=0.05) and absence of atrial fibrillation (OR 0.12, 95% CI 0.02-0.71, p=0.02) emerged as independent predictors of NR. Similarly, among patients with BA occlusion, atrial fibrillation was as an independent predictor of NR (OR 0.13, 95% CI 0.03-0.72, p=0.02). Conclusions: Absence of atrial fibrillation independently predicts persistent occlusion at 1-h after tPA bolus in patients with ICA T and BA occlusions. The use of relevant predictors of NR and a rapid neurovascular evaluation may improve the selection of patients for more aggressive rescue strategies.

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