Obstruction Of Internal Carotid Artery Research Articles

Ocular ischemic syndrome – case report and literature analysis

Abstract Introduction Ocular ischemic syndrome (OIS) is a rare condition associated with ocular hypoperfusion caused by carotid artery occlusive disease. This article describes the case of a patient who was admitted to the Department of Ophthalmology at UCK in Katowice, Poland, due to significant loss of visual acuity and pain in the right eye. Materials and Methods Retrosopective case report. Results Patient showed up in the ophthalmological emergency department complaining of significant loss of visual acuity and pain in the right eye persisting for 2 weeks. The patient had a history of type II diabetes mellitus, hypertension, status post ACS and PCI, and long-term nicotinism. Examination of the right eye revealed ocular irritation, mixed conjunctival injection, hyphema in the anterior chamber, iris neovascularization, and discrete central retinal fading. Additional examinations were performed, including an angioCT, which showed a long-standing obstruction of the right internal carotid artery, a ballooning thrombus in the lumen of the brachiocephalic trunk, and suspected critical stenosis of the left vertebral artery. A neurologist and vascular surgeon were consulted, and treatment was instituted to limit further complications from the underlying disease. The patient remains under close supervision of the vascular surgeon and neurologist. Conslusions OIS is a rare but potentially blinding condition and should be considered in the differential diagnosis of transient visual acuity reduction or vision loss.

Reversed flow in the ophthalmic artery due to internal carotid artery obstruction

Reversed flow in the ophthalmic artery due to internal carotid artery obstruction

Moyamoya Disease Complicating Ebstein's Anomaly.

Ebstein's anomaly is an uncommon congenital disorder affecting the tricuspid valve. We herein report a 38-year-old woman who experienced consciousness and sensory disturbance during treatment for heart failure caused by Ebstein's anomaly. Urgent magnetic resonance imaging and cerebral angiography demonstrated acute cerebral infarction and internal carotid artery obstruction with the development of collateral arteries. We diagnosed her with multiple cerebral infarctions due to moyamoya disease. Ebstein's anomaly concomitant with moyamoya disease is extremely rare. However, we should consider the possibility of this rare but important concurrence when treating patients with heart failure due to Ebstein's anomaly to avoid excessive diuresis and vasodilation and irreversible brain injury.

Life-Threatening Sinonasal Invasive Aspergillosis Easily Misdiagnosed

Background and Objectives Invasive fungal sinusitis is extremely rare. Yet the consequences of this infection may be fatal if not diagnosed correctly at an early stage. We discuss three cases of Aspergillosis sphenoid sinusitis that were misdiagnosed and have led to fatal consequences.Subjects and Method This is a retrospective analysis of cases diagnosed as invasive fungal sinusitis of sphenoid sinus.Results All three cases were of men who had immunocompromised medical histories that included leukemia and diabetes mellitus. The patients presented symptoms that included fever, chronic headache, weakness on one side, and facial edema. In the first case, CT showed no suspicious lesions that indicated fungal infection. However, five days after being prescribed antibiotics, the patient suffered obstruction of the right internal carotid artery (ICA) and right cavernous sinus. In the second case, CT showed total obstruction in the left ICA and a soft tissue mass in the left sphenoid sinus that extended and involved the left cavernous sinus. In the last case, CT showed soft density progression in the right sphenoid sinus with bone erosion when compared to images taken eight days earlier. In each of these cases, we performed emergency endoscopic sinus surgery. One case was confirmed to be invasive aspergillosis by histology whereas the other two cases were suspected to be invasive aspergillosis based on their past medical histories, clinical findings and image studies.Conclusion Clinicians must take great care to rule out invasive aspergillosis in immunocompromised patients with sinusitis.

Cerebral Infarction from Compression of the Internal Carotid Artery - A Rare Presentation of Pituitary Apoplexy

A 42-year-old female presented with sudden onset of headaches, left hemiplegia and bitemporal hemianopia. Radiological investigations revealed right anterior circulation infarction from mechanical obstruction of the right internal carotid artery by Pituitary Apoplexy. She underwent an urgent transsphenoidal decompression of the sella and had gradual resolution of symptoms.

Carotid Stump Pressure and Contralateral Internal Carotid Stenosis Ratio During Carotid Endarterectomies: 1D-0D Hemodynamic Simulation of Cerebral Perfusion.

Objective: We selectively place carotid shunting when ipsilateral mean stump pressure is less than 40 mmHg during carotid endarterectomy (CEA). This study aimed to assess the validity of our selective shunting criterion by 1D-0D hemodynamic simulation technology.Materials and Methods: We retrospectively reviewed 88 patients (95 cases) of CEA and divided them into two groups based on the degree of contralateral internal carotid artery (ICA) stenosis ratio, which was determined as severe when the peak systolic velocity ratio of the ICA to the common carotid artery was ≥4 by carotid duplex ultrasonography. Patients with severe stenosis or occlusion in contralateral ICA were classified as hypoperfusion group, and those without such contralateral ICA obstruction were classified as control group.Results: Perioperatively, the mean carotid stump pressures were 33 mmHg in hypoperfusion group and 46 mmHg in the control group (P=0.006). We simulated changes in carotid stump pressure according to the changes in the contralateral ICA stenosis ratio. 1D-0D simulation indicated a sharp decline in carotid stump pressure when the contralateral stenosis ratio was >50%, while peripheral pressure of the middle cerebral arteries declined sharply at a ≥70% contralateral stenosis ratio. At this ratio, the direction of the ipsilateral cerebral arterial flow became inverted, the carotid stump pressure became dependent on the basilar artery circulation, and the ipsilateral middle cerebral artery became hypoperfused.Conclusion: Our clinical and computer-simulated results confirmed the validation of our carotid shunting criterion and suggested that contralateral ICA stenosis ratio over 70% is a safe indication of selective shunting during CEA.

Case Report of Ocular Ischemic Syndrome, Taif, Saudi Arabia

Background: Ocular ischemic syndrome (OIS) is more prevalent among male aged more than 50 years. Various disorders such as diabetes, hypertension, and peripheral vascular diseases are major risk factors responsible for OIS in aged male. Case report: This case study involves a 57-year-old male patient having history of diabetes, hypertension, slurred speech, hemiparesis and hypoesthesia of the right side of the body. The patient came with complain of red eye, pain and decreased vision in left eye. Complete left internal carotid artery obstruction, rubeosis iridis of the left eye, dots of hyphema of the left eye, bilateral hard exudates, significant macular edema and non-proliferative diabetic retinopathy were observed in the patient. In this case, in consultation with ophthalmology, surgery and medicine departments multidrug treatment procedure was followed. This multi-drug based therapy successfully controlled the condition of patient and improved the vision of patient.

Manual aspiration thrombectomy with a Penumbra catheter for acute anterior cerebral artery occlusion

Purpose The purpose of this article is to assess the efficacy and safety of manual aspiration thrombectomy (MAT) using a Penumbra catheter in patients with anterior cerebral artery (ACA) occlusions. Materials and methods From January 2012 to March 2016, 16 patients underwent MAT with Penumbra catheters using a proximal and distal supporting technique to treat ACA occlusions. We evaluated immediate angiographic results and clinical outcomes by reviewing patient electrical medical records. Results Of these patients, 11 had a complete obstruction of the distal internal carotid artery (ICA) and five had ACA and middle cerebral artery (MCA) occlusions. All patients achieved successful recanalization of the distal ICA or MCA (Thrombolysis in Cerebral Infarction (TICI) grade ≥2b). Overall the recanalization rate for ACA occlusions (TICI grade≥2b) was 93.7% (15/16). The median procedure time was 45 minutes (range: 35-65 minutes). No patients were observed to have a procedure-related subarachnoid hemorrhage. Four patients (25.0%) died during hospitalization because of massive symptomatic hemorrhage, brain edema, or herniation. At discharge, the median NIHSS score for surviving patients was 6 (range: 1-17). Five patients had favorable clinical outcomes (modified Rankin scale ≤2). Conclusion MAT appears to be safe and successfully achieves recanalization in patients with ACA occlusions.

Evaluation of Fundus Blood Flow in Normal Individuals and Patients with Internal Carotid Artery Obstruction Using Laser Speckle Flowgraphy.

PurposeWe investigated whether laser speckle flowgraphy (LSFG) results are comparable in both eyes and whether it is useful in the diagnosis of disparity in ocular ischemic syndrome (OIS) patients.MethodsWe compared the mean blur rate (MBR) value for various fundus regions in both eyes of 41 healthy subjects and 15 internal carotid artery occlusion (ICAO) cases. We calculated the standard value of the Laterality Index (LI), which was the MBR comparison of both eyes in each of the regions, in the control subjects. We then investigated the correlation between both eyes for the LIs in the entire fundus, the degree of ICAO and visual function.ResultsThe disparity of the LIs in both eyes was least in the entire area of the fundus in control subjects and there was a significant correlation between both eyes of the 41 healthy individuals (P = 0.019). Significant correlations were found for the LI, visual acuity and degree of ICAO. The specificity and sensitivity of LI in the entire area was 93.8% and 100%, respectively.ConclusionsLSFG revealed normal individuals have symmetrical fundus blood flow. LSFG could detect OIS and might be a useful tool for detecting disparities in fundus blood flow.

Congenital horner syndrome with heterochromia iridis associated with ipsilateral internal carotid artery hypoplasia.

BackgroundHorner syndrome (HS), also known as Claude-Bernard-Horner syndrome or oculosympathetic palsy, comprises ipsilateral ptosis, miosis, and facial anhidrosis.Case ReportWe report herein the case of a 67-year-old man who presented with congenital HS associated with ipsilateral hypoplasia of the internal carotid artery (ICA), as revealed by heterochromia iridis and confirmed by computed tomography (CT).ConclusionsCT evaluation of the skull base is essential to establish this diagnosis and distinguish aplasia from agenesis/hypoplasia (by the absence or hypoplasia of the carotid canal) or from acquired ICA obstruction as demonstrated by angiographic CT.

Predictors of Functional Outcome after Emergency Carotid Artery Stenting and Intra-Arterial Thrombolysis for Treatment of Acute Stroke Associated with Obstruction of the Proximal Internal Carotid Artery and Tandem Downstream Occlusion

Patients who develop severe stroke symptoms due to acute internal carotid artery occlusion eventually in combination with a thromboembolic obstruction of the middle cerebral artery incur a major risk of developing extensive MCA infarction with a poor outcome. The purpose of this study was to evaluate the outcome for patients with tandem occlusions in the MCA and/or distal ICA, retrospectively, who had undergone stent implantation in the proximal segment of the ICA in addition to intra-arterial thrombolysis. Thirty-five patients with tandem occlusions of the MCA and/or distal ICA and acute occlusion of the proximal ICA underwent stent implantation for the proximal ICA occlusion and IAT for the tandem occlusion. Clinical outcome measures were assessed on admission and at discharge by using the National Institutes of Health Stroke Scale as well as 3 months after treatment by using the modified Rankin Scale. The median NIHSS score on admission was 12 (range, 6-22). All patients had patent flow into the M1 and ICA after carotid artery stent placement and IAT. After the procedure, 19 patients (54.3%) were TICI grade III; 7 (20.0%), TICI grade IIb; and 9 (25.7%), TICI grade IIa. Symptomatic intracerebral hemorrhage occurred in 1 patient (2.9%). The overall mortality rate was 11.4% (4/35). At 3-month follow-up, the median NIHSS score was 4 (range, 1-17). NIHSS score at admission and TICI grade were all found to be independently associated with an unfavorable outcome at 3 months. Initial stroke severity, degree of successful revascularization, and the side of ischemia were found to independently predict the functional outcome at 3 months after treatment.

顎顔面外傷に続発した外傷性内頸動脈血栓症の1例

Traumatic internal carotid artery obstruction developing after maxillofacial trauma is difficult to diagnose.We report the case of 16-year-old woman with traumatic internal carotid artery obstruction following a mandibular fracture. She was hospitalized for a mandibular fracture after getting involved in a traffic accident. Although her condition was satisfactory immediately after hospitalization, she suddenly developed disturbed consciousness and exhibited symptoms of left-sided paralysis 12 hours after injury. Magnetic resonance angiography (MRA) revealed obstruction of the internal carotid and middle cerebral arteries on the right side. She was transferred to an emergency care center 15 hours after injury and underwent thrombectomy and hemostasis for cerebral hemorrhe. The mandibular fracture was monitored given her unstable physical condition and signs of restlessness accompanying disturbed consciousness. She recovered fully without any pronounced dysfunction or cosmetic disturbance.This case shows that traumatic injury resulting in cervical hyperextension or hyperflexion can cause internal carotid artery obstruction. These findings underscore the importance of careful follow-up in patients with mandibular fracture, regardless of whether they present with apparent head injury, given the possibility of traumatic internal carotid artery obstruction.

Infective Endocarditis due toStreptococcus Agalactiaein Young and Immunocompetent Woman: A Case of Structurally Normal Valve Endocarditis Presented with Major Stroke

We describe here a 26-year-old woman who presented confusion and right hemiparesis due to embolic obstruction of left internal carotid artery and middle cerebral artery. Transthoracic echocardiography showed structurally normal mitral valve with hypermobile echogenic material suggesting vegetation. The vegetation was disappeared after antimicrobial treatment without surgery.

The Benefits of Intravenous Thrombolysis Relate to the Site of Baseline Arterial Occlusion in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET)

In ischemic stroke, the site of arterial obstruction has been shown to influence recanalization and clinical outcomes. However, this has not been studied in randomized controlled trials, nor has the impact of arterial obstruction site on reperfusion and infarct growth been assessed. We studied the influence of site and degree of arterial obstruction patients enrolled in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET). EPITHET was a prospective, randomized, placebo-controlled trial of intravenous tissue plasminogen activator (tPA) in the 3- to 6-hour time window. Arterial obstruction site and degree were rated on magnetic resonance angiography blinded to treatment allocation and outcomes. In 101 EPITHET patients, 87 had adequate quality magnetic resonance angiography, of whom 54 had baseline arterial obstruction. Infarct growth attenuation was greater in those with tPA treatment compared to placebo among patients with middle cerebral artery (MCA) obstruction (P=0.037). The treatment benefit of tPA over placebo in attenuating infarct growth was greater for MCA than internal carotid artery (ICA) obstruction (P=0.060). With tPA treatment, good clinical outcome was more likely with MCA than with ICA obstruction (P=0.005). Most patients with ICA obstruction did not achieve good clinical outcome, whether treated with tPA (100%) or placebo (77%). The study was underpowered to prove any treatment benefit of tPA among patients with any or severe degree of arterial obstruction. Arterial obstruction site strongly predicts outcomes. ICA obstruction carries a uniformly poor prognosis, whereas good outcomes with MCA obstruction are associated with tPA therapy.

Abstract No. 68: Acute Stroke Associated with Obstruction of Proximal Internal Carotid Artery: Effect of Carotid Stent and Intraarterial Thrombolysis

Abstract No. 68: Acute Stroke Associated with Obstruction of Proximal Internal Carotid Artery: Effect of Carotid Stent and Intraarterial Thrombolysis

Cerebral dysautoregulation and the risk of ischemic events in occlusive carotid artery disease

Dynamic cerebral autoregulation assessed from blood pressure transients can be considerably impaired in severe internal carotid artery (ICA) obstruction. It is unknown whether impaired autoregulation indicates an increased risk of subsequent ischemic events in this situation. 165 patients with ICA stenosis (> 70 %) or occlusion were prospectively followed until anterior circulation stroke, transient ischemic attack, carotid recanalization without prior event, death or study end. Transcranial Doppler sonography was used to determine autoregulation in both middle cerebral arteries from spontaneous blood pressure fluctuations (correlation coefficient indices Dx and Mx) and respiratory- induced 0.1 Hz oscillations (phase). Standard CO(2) reactivity (CO(2)R) was additionally assessed. All indices were classified as impaired vs. preserved according to reference values from 79 agematched controls. During median follow-up of 24.5 months, there were 16 ischemic events over ipsilateral sides. Competing risk analysis revealed a significant predictive effect on ipsilateral ischemic events for impaired Dx (rate ratio 8.2 [95 % confidence interval 1.7-39], p = 0.0079), phase (5.0 [2-13], p = 0.0007) and CO(2)R (9.4 [2.2-40], p = 0.0025). Restricting analysis to severe stenosis alone (n = 103), only impaired phase (rate ratio 8.6 [1.6-45], p = 0.01) remained as a significant predictor. In a continuous statistical model, only Dx and Mx were significant predictors of ischemic events (p = 0.012 and p = 0.016). In conclusion, impaired dynamic cerebral autoregulation indicates an increased risk of subsequent ischemic events in severe obstructive ICA disease. Its clinical application might thus be of help in identifying higher risk patients.

Assessment of Intracranial Collateral Flow by Using Dynamic Arterial Spin Labeling MRA and Transcranial Color-Coded Duplex Ultrasound

To evaluate the potential of a new dynamic MRA sequence (DynAngio) based on arterial spin labeling for the assessment of intracranial collateral flow. Twelve patients with unilateral internal carotid artery obstruction were investigated. Different patterns of collateral flow were compared between DynAngio, transcranial color-coded duplex ultrasound, and time-of-flight MRA. There was a good agreement between the methods, with sensitivities between 80% and 90%. Small collateral vessels were detected more frequently with DynAngio compared to time-of-flight MRA. DynAngio provides anatomic and similar to transcranial color-coded duplex ultrasound functional information on collateral flow for the assessment of intracranial hemodynamics.

Moyamoya disease associated with positive findings for rheumatoid factor and myeloperoxidase-anti-neutrophil cytoplasmic antibody

A 39-year old female suddenly fell into a state of unconsciousness. She had no significantpast medical history. A computed tomography scan of the head demonstrated a massive left putaminal haemorrhage with a ventricular perforation, low density areas in the right frontal lobe, corona radiata and occipital lobe. A single emergency burr hole drainage of the haematoma was performed. Bilateral common carotid arteriograms showed stenosis of the right internal carotid artery and a complete obstruction of left internal carotid artery which were both accompanied by moyamoya vessels. The biochemical studies indicated serological positive findings for RF and MPO-ANCA. She was transferred to another hospital for nursing care in a vegetative state on the 163nd hospital day. This case indicates that immunological factors, inflammation or vasculitis might have possibly been associated with the development of either an obstruction or stenosis of the intracranial internal carotid arteries.

Symptomatic Carotid Artery Occlusion: Flow Territories of Major Brain-Feeding Arteries

To prospectively investigate the extent of flow territories of the contralateral internal carotid artery (ICA) and vertebrobasilar arteries in patients with symptomatic ICA occlusion. Ethics committee approval and informed consent were obtained. Flow territory mapping of the ICA contralateral to the occluded ICA and mapping of the vertebrobasilar arteries were performed by using selective arterial spin-labeling magnetic resonance imaging in 23 functionally independent patients (22 men, one woman; mean age, 58 years +/- 8 [standard deviation]) with symptomatic ICA occlusion. The control group consisted of 68 subjects (57 men, 11 women; mean age, 59 years +/- 9) without hemodynamically significant ICA obstruction. Voxel-based chi(2) testing with Bonferroni correction was performed to analyze significant differences in the extent of the flow territories. Flow territory maps in patients with symptomatic ICA occlusion showed significant differences in the flow territories of the contralateral ICA and vertebrobasilar arteries compared with those in control subjects (P < .05). In functionally independent patients with symptomatic ICA occlusion, the middle cerebral artery flow territory ipsilateral to the occluded ICA is mainly supplied by the vertebrobasilar arteries, whereas the anterior cerebral artery flow territory on the occluded side is mainly supplied by the contralateral ICA.

口腔内外傷後に続発した内頸動脈閉塞症例

Internal carotid artery obstruction due to oropharyngeal trauma was originally reported by Caldwell in 1936. And the number of reports has been limited to seven in the Japanese literature. We report the case of a two-year-old girl who sustained oropharyngeal wall trauma from a tooth brush. After the characteristic period of several hours, hemiplegia developed on her left side. MRA revealed obstruction of the internal carotid and middle cerebral arteries on her right side. Although pediatric oropharyngeal trauma is a common injury, it is important to consider traumatic blunt carotid injury, even if there are initially no neurologic findings. Therefore, informed consent and careful observation are clinically significant in oropharyngeal trauma cases.