Duplex scanning exploration of the ophthalmic artery for the detection of the hemodynamically significant ICA stenosis.
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BACKGROUND AND PURPOSE: The North American and the European Carotid Endarterectomy Trials demonstrated a significant benefit of surgery in preventing stroke for patients with symptomatic hemodynamically significant internal carotid artery (ICA) stenosis. Because the 3 angiographic methods of measuring carotid stenosis provide discrepant results, the indication for surgery depends on the method used for the evaluation of the angiogram. The goal of this study was to verify whether color duplex scanning of the ophthalmic artery alone might be reliable for detection of the extracranial hemodynamically significant ICA stenosis. METHODS: Three groups of patients (351 total patients) with transient ischemic attack or minor stroke referred for possible carotid endarterectomy were examined by means of color duplex scanning of the ICA, transcranial Doppler, color duplex scanning of the ophthalmic artery, and angiography of the ICA. RESULTS: In the first group (n=31) the comparison of findings from each method and the direct measurement of the residual lumen of plaque removed "en bloc" showed that the findings of the ophthalmic artery color duplex scanning, subdivided into 5 categories--NP (normal positive), LP (low positive), NF (no flow), REV (reverse flow), PP (pathological positive)--were associated with the best overall agreement (96.7%). The accuracy of the various categories of the ophthalmic artery color duplex scanning signals was studied in the second group of patients (n=200). The results pointed out that all but low positive categories were associated with high diagnostic accuracy. Finally, the results obtained in the third group (n=120) showed that a significant increase in the specificity of the low positive signal could be obtained by processing this signal in terms of pulsatility index and of transmission of pulsatility index. CONCLUSIONS: Our results suggest that the diagnostic capacity of color duplex scanning for the detection of ICA critical stenosis can be appropriately increased if it is performed also at the level of the ophthalmic artery and if the Doppler signals are processed on the basis of criteria we applied. (+info)
Assessment of ocular perfusion after carotid endarterectomy with color-flow duplex scanning.
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PURPOSE: The purpose of this study was to assess the effect of carotid endarterectomy (CEA) on ocular perfusion with the measurement of the ophthalmic artery (OA) and the central retinal artery (CRA) flow velocities with color-flow ocular duplex scanning (ODS). Ocular hemodynamics also were examined in a subset of patients with visual symptoms in an attempt to characterize the origin of the ocular symptoms and their response to surgery. METHODS: Twenty-five patients with internal carotid artery stenoses (>/=70%) underwent 29 CEAs. All the patients underwent ODS for the measurement of the peak systolic velocity (PSV) in the OA and the CRA of the ipsilateral eye before and after CEA. The preoperative and postoperative flow velocities were compared in all the patients and in the patients with and without visual symptoms. RESULTS: The preoperative PSV in the OA was 21.6 +/- 2.2 cm/s and in the CRA was 7.7 +/- 0.7 cm/s. These values were reduced as compared with normative values (OA, 37.8 cm/s; CRA, 10.7 cm/s). After CEA, the PSV increased significantly in both vessels (postoperative OA, 38.6 +/- 2.5 cm/s, P <.0001; postoperative CRA, 12.1 +/- 0.9 cm/s, P =.0008). Fifteen of the 29 CEAs were performed for visual symptoms. The patients with ocular symptoms had significantly lower preoperative PSVs in the CRA as compared with those patients without visual symptoms (CRA with ocular symptoms, 6.5 +/- 0.8 cm/s; CRA with no ocular symptoms, 9.4 +/- 0.9 cm/s; P =.02). The PSV in the OA was not significantly lower in the patients with ocular symptoms. Eight patients (28%) were found to have reversed OA flow before surgery, but only three patients had ocular symptoms. All eight patients had normal antegrade flow in the OA after surgery. CONCLUSION: Severe carotid stenosis may be associated with reduced ocular perfusion, which can be quantitatively evaluated with ODS. Reduced OA and CRA flow velocities are corrected with successful CEA. The patients with ocular symptoms were observed to have significant reductions in CRA flow velocities. Reversed flow in the OA was not a marker for ocular symptoms in this study. ODS can identify global ocular ischemia and may be helpful in the evaluation of patients with atypical visual symptoms or with amaurosis fugax and no evidence of retinal emboli. (+info)
Long-term histopathologic findings in two cerebral aneurysms embolized with Guglielmi detachable coils.
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We present gross pathologic autopsy findings of a patient who was treated for two aneurysms with Guglielmi detachable coils (GDCs), and who died 33 months after the procedure. Histologic findings are also presented. In both aneurysms, the coils were firmly attached to the aneurysmal wall, making it impossible to remove them from the sac. The ostium of one aneurysm was covered by collagenous tissue and a single layer of endothelium. (+info)
Superselective intraarterial fibrinolysis in central retinal artery occlusion.
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Intraarterial fibrinolysis was performed in three patients with acute central retinal artery occlusion using recombinant tissue plasminogen activator as a fibrinolytic agent. In two cases the ophthalmic artery was selectively catheterized, and in the other a thrombolytic drug was infused into the ophthalmic artery by way of the meningeal collaterals. All patients experienced visual improvement. Fibrinolysis can produce better results than obtained from conservative treatment. A good prognosis can be achieved if the treatment starts within the first 4 to 5 hours after occlusion. (+info)
Multiple dural arteriovenous shunts in a 5-year-old boy.
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We describe a rare case of multiple dural arteriovenous shunts (DAVSs) in a 5-year-old boy. MR imaging performed at 1 year of age showed only a dilated anterior part of the superior sagittal sinus; however, angiography at 5 years of age revealed an infantile-type DAVS there and two other DAVSs of the adult type. The pathophysiological evolution of DAVSs in children and their treatment strategies are discussed. (+info)
High-resolution ultrasonic imaging of blood flow in the anterior segment of the eye.
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PURPOSE: To develop a noninvasive technique to visualize and measure blood flow in the iris and ciliary body. METHODS: Echo data from 50-MHz ultrasound scans of the iris and ciliary body of rabbits were digitized using a new "swept scan" modality. The method makes use of spatial oversampling to identify regions with scatterers whose range changes with time. The data allowed construction of high-resolution B-mode images with embedded flow information. Pulsatility over the cardiac cycle was evaluated by sending a series of pulses along a single line of sight containing a vessel of interest. Local blood flow and changes over the cardiac cycle before and after application of atropine were quantified. RESULTS: Flow was identified in the radial vessels and major arterial circle of the iris. Vessels with lumens as small as 40 microm in diameter and flow velocities as low as 0.6 mm/sec were measured. Change in blood velocity over the cardiac cycle was determined to be approximately 27%. Peak systolic velocity after administration of topical atropine increased by 72%. CONCLUSIONS: This technique allowed visualization of flow using the same type of very-high-frequency transducer now widely used for imaging the anterior segment. The technique can also be used at lower frequencies for more posterior tissues with similar improvement of resolution over Doppler. The ability to examine flow in the anterior segment of the eye offers a new tool for study of glaucoma, hypotony, tumors, and other disorders. (+info)
Microvasculature of the rat optic nerve head.
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PURPOSE: To describe the arterial blood supply, capillary bed, and venous drainage of the rat optic nerve head. METHODS: Ocular microvascular castings from 6 Wistar rats were prepared by injection of epoxy resin through the common carotid arteries. After polymerization, tissues were digested with 6 M KOH, and the castings washed, dried, and coated for scanning electron microscopy. RESULTS: Immediately posterior to the globe, the ophthalmic artery trifurcates into the central retinal artery and two posterior ciliary arteries. The central retinal artery directly provides capillaries to the nerve fiber layer and only contributes to capillary beds in the neck of the nerve head. The remainder is supplied by branches of the posterior ciliary arteries that are analogous to the primate circle of Zinn-Haller. Arterioles arising from these branches supply the capillaries of the transitional, or laminar, region of the optic nerve head. These capillaries are continuous with those of the neck and retrobulbar optic nerve head. All optic nerve head capillaries drain into the central retinal vein and veins of the optic nerve sheath. A flat choroidal sinus communicates with the central retinal vein, the choriocapillaris, and with large veins of the optic nerve sheath. CONCLUSIONS: The microvasculature of the rat optic nerve head bears several similarities to that of the primate, with a centripetal blood supply from posterior ciliary arteries and drainage into the central retinal and optic nerve sheath veins. Association of nerve sheath veins with the choroid represents an important difference from the primate. (+info)
Neurogenic vasoconstriction as affected by cholinergic and nitroxidergic nerves in dog ciliary and ophthalmic arteries.
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PURPOSE: To determine the involvement of noradrenergic and other vasoconstrictor nerves in the contraction of ocular arteries and the modification by cholinergic and nitroxidergic nerves of vasoconstrictor nerve function. METHODS: Changes in isometric tension were recorded in helical strips of the canine posterior ciliary and external ophthalmic arteries denuded of the endothelium, which were stimulated by transmurally applied electrical pulses (5 Hz). Vasoconstrictor mediators were analyzed by pharmacological antagonists, such as prazosin, alpha,beta-methylene ATP, a P2alpha-purinoceptor antagonist, and BIBP3226, a neuropeptide Y receptor antagonist. RESULTS: Transmural electrical stimulation produced contractions that were potentiated by N(G)-nitro-L-arginine (L-NA), a nitric oxide (NO) synthase inhibitor. The contraction was partially inhibited by prazosin and abolished by combined treatment with alpha,beta-methylene ATP but was not influenced by BIBP3226. Stimulation-induced contraction was attenuated by physostigmine and potentiated by atropine. Contractions induced by exogenous ATP were reversed to relaxations by alpha,beta-methylene ATP. In the strips treated with L-NA, prazosin, and alpha,beta-methylene ATP, the addition of L-arginine elicited relaxations by nerve stimulation. The ATP-induced relaxation was attenuated by aminophylline, whereas neurogenic relaxation was unaffected. CONCLUSIONS: Ciliary and ophthalmic arterial contractions by nerve stimulation are mediated by norepinephrine and ATP, which stimulate alpha1-adrenoceptor and P2X purinoceptor, respectively. ATP from the nerve is unlikely involved in vasodilatation. Acetylcholine derived from the nerve impairs the neurogenic contraction, possibly by interfering with the release of vasoconstrictor transmitters, and neurogenic NO also inhibits the contraction postjunctionally by physiological antagonism. (+info)