INDIRECT CEREBRAL REVASCULARIZATION ON OPTHALMIC ARTERY BY USING A DRUG-ELUTING BALLON FOR SUSPECTED MOYAMOYA DISEASE

Moyamoya disease (MMD) is a rare idiopathic progressive vaso-occlusive disease causing multiple occlusion of cerebral vessels lead to ischemic stroke. Asian population is the most common race to be affected. We present a male patient 33-years old with suspected MMD with right hemiparesis and neurocognitive changes. On digital substraction angiography (DSA) there was appearance of ‘puff of smoke’ on his right hemisphere, stenosis middle cerebral arteries M1 bilaterally, stenosis of right opthalmic artery (OA), stenosis of left anterior cerebral artery (ACA) and aplasia of right ACA. Ballon angioplasty was performed on right OA that supply the contralateral symptomatic stenosis area (left A1) indirectly through anterior ethmoidal artery and anterior falcine artery (OA-ACA collateral). While no guidelines for the management of MMD, cerebral revascularization by using drug-eluting ballon (DEB) in right opthalmica artery is potentially effective treatment that could allow the brain to have good blood supply (gives good collateral to both ACA), reduces burden of the fragile moya-moya vessels to be ruptured followed by improvement of clinical results. Patient’s selection by understanding the stage, its progressivity and collateral formation are crucial before decision is made.

Luseogliflozin, a sodium-glucose co-transporter 2 inhibitor, reverses cerebrovascular dysfunction and cognitive impairments in 18-month-old diabetic animals

Diabetes mellitus (DM) is a leading risk factor for age-related dementia, but the mechanisms involved remain to be elucidated. We previously discovered that hyperglycemia-induced impaired myogenic response (MR) and cerebral blood flow (CBF) autoregulation in 18-month-old DM rats associated with blood-brain barrier (BBB) leakage, impaired neurovascular coupling, and cognitive impairment. In the present study, we examined whether reduction of plasma glucose with a sodium-glucose co-transporter 2 inhibitor (SGLT2i) luseogliflozin can ameliorate cerebral vascular and cognitive function in diabetic rats. Plasma glucose and HbA1c levels of 18-month-old DM rats were reduced, and blood pressure was not altered after treatment with luseogliflozin. SGLT2i treatment restored the impaired MR of middle cerebral arteries (MCAs) and parenchymal arterioles, and surface and deep cortical CBF autoregulation in DM rats. Luseogliflozin treatment also rescued neurovascular uncoupling, reduced BBB leakage and cognitive deficits in DM rats. However, SGLT2i did not have direct constrictive effects on vascular smooth muscle cells and MCAs isolated from normal rats, although it decreased reactive oxygen species production in cerebral vessels of DM rats. These results provide evidence that normalization of hyperglycemia with an SGLT2i can reverse cerebrovascular dysfunction and cognitive impairments in rats with long-standing hyperglycemia, possibly by ameliorating oxidative stress-caused vascular damage.

Effects of LI11 Acupuncture on CO2 reactivity in the anterior and middle cerebral arteries during hyperventilation-induced hypocapnia in normal subjects: A before and after study

Objectives: The LI11 (Quchi) acupuncture point has always been included in the Seven acupoints for stroke; however, additional LI11 acupuncture research is needed. In this study, the effect of LI11 acupuncture on cerebral blood flow of the anterior cerebral arteries (ACA) and middle cerebral arteries (MCA) was investigated.Method: This study included 10 healthy young male subjects. Cerebral blood flow velocity and cerebrovascular reactivity were measured using transcranial Doppler sonography. Changes in hyperventilation-induced carbon dioxide (CO2) reactivity and modified ACA and MCA blood flow velocity at 40 mmHg (CV40), blood pressure, and heart rate were observed before and after LI11 acupuncture treatment.Results: A statistically significant increase in contralateral anterior cerebral artery CO2 reactivity (p=0.036) and decrease in contralateral middle cerebral artery CV40 (p=0.047) were observed. No significant difference in mean blood pressure was shown. A statistically significant increase in heart rate occurred after LI11 acupuncture; however, it was not clinically significant as there were negligible changes in the heart rhythm.Conclusions: LI11 acupuncture treatment could improve cerebral blood flow velocity. These results might be explained by regulating endothelium-dependent vessel dilation in the anterior cerebral artery region.Trial registration: This trial has been registered with Clinical Research Information Service, a service of the Korea Centers for Disease Control and Prevention: KCT0004494 (retrospectively registered). https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=15359

A sex specific approach of ophthalmic and middle cerebral arteries Doppler in smokers

Vascular dysfunctions can progress and lead to stroke and cardiovascular disease, especially in smokers. The presence of particular vascular changes according to sex has been described and they can be identified by the Doppler method. This study evaluated Doppler velocimetry parameters of the Ophthalmic Artery (OA) and the Middle Cerebral Artery (MCA) according to sex in smokers regarding a non-smoker group. This cross-sectional observational study included 178 subjects: 93 women and 85 men. Doppler parameters were assessed in OA and MCA. Student’s t-test was used, with p < 0.05. There were no significant differences in OA and MCA Doppler velocimetry data between male non-smokers and smokers. However, female smokers presented several differences compared with non-smokers: lower pulsatility index (PI) and higher peak ratio in OA, and higher PI and resistance index and lower end diastolic velocity in MCA. There were different brain vascular waveforms in the group of female smokers compared with non-smokers. Cigarette smoking also led to opposite arterial patterns in OA and MCA in the female group, with signs of falling impedance in OA and increased impedance in MCA. An individualized approach regarding arterial changes according to sex is desirable.

Clinical and neuroimaging analysis of carotid infarction in the acute ischemic stroke

Background. The assessment of clinical manifestations in patients with acute pre-circular infarction is important for verification of the lesion, the choice of the treatment program, prediction of the stroke consequences. The purpose is to investigate the clinical, neurological, and neuroimaging features of lacunar and non-lacunar carotid infarctions in acute ischemic stroke and to assess their short-term consequences. Materials and methods. There was performed a clinical and radiological analysis of carotid infarction in 540 patients with acute ischemic stroke, which were divided into two groups: 155 patients were verified for infarcts in the cortex and white matter of the brain in the vasculature of the anterior and middle cerebral artery; in 385 patients, infarct foci were found in the area of the deep hemispheres of the brain (subcortical-capsular infarcts). Results. Clinical neuroimaging analysis of patients with ischemic stroke in the vasculature of the cortical branches of the anterior and middle cerebral arteries of the anterior circulatory basin showed that acute cerebral circulatory disorders caused the development of small cortical infarctions in 89 (57.4 %) patients and 65 (41 %) — lacunar infarction, in one patient (0.7 %) with occlusion of the proximal anterior cerebral artery — total infarction. The neurological clinical picture of infarcts of varying localization, which was determined by the location and size of the lesion, was described. Conclusions. The obtained results showed that the consequences of anterior circular infarctions depended on the localization of the lesion of the arterial area, the caliber of the infarction of the dependent artery, the size of the infarct locus. For the most part, these factors determined the background severity of neurological deficit after the development of acute ischemic stroke.

Effect of the loading dose of magnesium sulfate on the Doppler velocimetry parameters in the uterine, umbilical and fetal middle cerebral arteries in severe preeclampsia

Background Preeclampsia is pregnancy-specific syndrome of reduced organ perfusion secondary to vasospasm and endothelial activation. Aim of the Work to assess the effect of injecting magnesium sulfate on Doppler parameters of uterine artery, umbilical and fetal middle cerebral arteries (MCA) in women with severe preeclampsia. Patients and Methods This study included eighty pregnant with severe preeclampsia or eclampsia who were given magnesium sulphate therapy in Ain Shams University Maternity hospital. The Study group included 80 pregnant patients Doppler flow velocity parameters (resistance index [RI], pulsatility index [PI] and systolic/diastolic [S/D] ratio) were evaluated in the uterine, fetal umbilical and middle cerebral arteries before and 20 minutes after intravenous administration of 6 grams of magnesium sulfate (Loading dose). Results Magnesium sulfate had significant hemodynamic effects with significant reduction of systolic and diastolic blood pressure. Regarding the Doppler studies, it was found that after administration of magnesium sulfate there was significant reduction in the Doppler velocimetry parameters (Resistance index[RI], Pulsatility index[PI] and systolic/diastolic[S/D] ratio) in the uterine, umbilical and fetal middle cerebral arteries denoting decreased vascular resistance with increased blood flow in these vessels. Conclusion Intravenous administration of magnesium sulfate in pregnant women with severe preeclampsia and eclampsia resulted in a decrease in uterine artery, fetal umbilical and middle cerebral arteries Doppler indices with reduced resistance to blood flow in these vessels.

Increased cerebral endothelium-dependent vasodilation in rats in the postcardiac arrest period

This is the first study, to our knowledge, to demonstrate enhanced endothelium-dependent vasodilation in middle cerebral arteries in a cardiac arrest rat model. The increased endothelium-dependent vasodilation was a result of potentiated endothelium-derived hyperpolarization and endothelial nitric oxide pathways. Immunofluorescence microscopy confirmed the presence of relevant receptors and eNOS in cerebral arteries, whereas qPCR showed altered mRNA expression of guanylyl cyclase and eNOS. Altered endothelium-dependent vasoregulation may contribute to disturbed cerebral blood flow in the postcardiac arrest period.