Subarachnoid hemorrhage from intracranial dissecting aneurysms of the anterior circulation. Two case reports.
(17/1425)
Two rare cases of intracranial dissecting aneurysms of the anterior circulation associated with subarachnoid hemorrhage (SAH) are described. A 56-year-old female presented with a dissecting aneurysm in the proximal segment of the left middle cerebral artery. Proximal occlusion of the affected artery and a superficial temporal artery-middle cerebral artery anastomosis were performed, but the outcome was poor. A 61-year-old male presented with a dissecting aneurysm in the proximal segment of the left anterior cerebral artery. Clipping was enhanced by a piece of fascia lata, allowing patency of the affected artery with a satisfactory outcome. Dissecting aneurysm of the carotid system should be considered in a patient with SAH but no evidence of berry aneurysm. (+info)
Balloon reconstructive technique for the treatment of a carotid cavernous fistula.
(18/1425)
Endovascular treatment of carotid cavernous fistulas (CCFs) presents many technical difficulties and hazards, some unique to each patient. This report details some of the difficulties encountered in the treatment of a 63-year-old patient with a CCF and an ipsilateral internal carotid artery dissection. After failure of conventional techniques using a detachable balloon, complete closure of the CCF was achieved by transvenous coil embolization while the arterial lumen was protected by a nondetachable balloon catheter. (+info)
Mutations in the COL5A1 coding sequence are not common in patients with spontaneous cervical artery dissections.
(19/1425)
BACKGROUND AND PURPOSE: The dermal connective tissue of most patients with spontaneous cervical artery dissections (sCAD) contains abnormal collagen fibers. This suggests a predisposing connective tissue defect. The ultrastructural abnormalities in the skin of patients with sCAD have similarity with the morphological alterations in patients with Ehlers-Danlos syndrome type II, a dominant hereditary disorder that has been correlated in some patients to mutations within the genes encoding type V collagen. The aim of this study was to assess the alpha 1 chain of type V collagen (COL5A1) as a candidate gene for sCAD. METHODS: We searched for mutations in the COL5A1 gene in cDNA from cultured fibroblasts of 19 patients with sCAD using single-strand conformational polymorphism analysis and nucleotide sequence analysis of polymerase chain reaction-amplified fragments of the whole COL5A1 coding sequence. RESULTS: We detected 1 missense mutation leading to a predicted amino acid (192D/N) substitution within the N-terminal propeptide in 2 siblings. All other patients showed regular COL5A1 sequences with some silent polymorphisms. CONCLUSIONS: Mutations in the COL5A1 gene do not appear to be a major factor in the etiology of sCAD. (+info)
Survival and complication free survival in Marfan's syndrome: implications of current guidelines.
(20/1425)
OBJECTIVE: To evaluate survival and complication free survival in patients with Marfan's syndrome and to assess the possible influence of recently revised guidelines for prophylactic aortic root replacement in these patients. METHODS: 130 patients who had been attending one institution over 14 years were evaluated. Kaplan-Meier analysis was performed in 125 patients who did not present with aortic root dissection as the first sign of Marfan's syndrome, with the end points: death, aortic root dissection, and prophylactic aortic root replacement after diagnosis. In the patients developing aortic root dissection, current guidelines for prophylactic aortic root replacement were retrospectively applied to investigate the number of dissections that could theoretically have been prevented. The guidelines were: (1) aortic root diameter >/= 55 mm, (2) positive family history of aortic dissections and aortic root diameter >/= 50 mm, and (3) aortic root growth >/= 2 mm/year. Outcomes following emergency surgery (15 patients) and prophylactic surgery of the aortic root (30 patients) were compared. RESULTS: Five and 10 year survival after diagnosis was 95% and 88%, and the five and 10 year complication free survival was 78% and 66%, respectively. Thirteen patients developed dissection, 30 underwent prophylactic repair, and 82 had an uncomplicated course. Eleven dissections could theoretically have been prevented by application of the current guidelines. Five year survival following emergency and prophylactic repair of the aortic root was 51%, and 97%, respectively. CONCLUSIONS: Survival in the Marfan's syndrome in the past 14 years seems satisfactory; with application of current guidelines, it has probably even improved. However, because of the high fatality rate in Marfan patients developing aortic root dissection, more extensive screening for Marfan's syndrome and a search for additional risk factors are desirable. (+info)
Acute type A aortic dissection involving the left main trunk of the coronary artery--a report of two successful cases.
(21/1425)
This report describes 2 cases of a type A acute aortic dissection combined with myocardial infarction caused by a retrograde dissection into the left main trunk of the coronary artery. Successful surgical treatments, including the replacement of the ascending aorta, aortic valve resuspension and coronary artery bypass grafting, were performed in both patients, and they recovered well from cardiogenic shock. However, left ventricular function of both patients remained depressed postoperatively, which limited their quality of life. Because no definite method for salvaging infarcted myocardium has yet been established, either more timely surgery or the preoperative placement of a perfusion catheter in the left main coronary artery is mandatory. (+info)
Endovascular arterial occlusion accomplished using microcoils deployed with and without proximal flow arrest: results in 19 patients.
(22/1425)
BACKGROUND AND PURPOSE: Prior to their relatively recent FDA approval, detachable balloons for endovascular arterial occlusion had been available on only a limited basis. We evaluated the feasibility of permanent endovascular carotid and vertebral artery occlusion using microcoils deployed with and without proximal flow arrest in 19 patients. METHODS: Permanent endovascular occlusion was performed in 19 arteries of 19 patients. The treated lesions included nine aneurysms, one carotid-cavernous fistula/pseudoaneurysm, seven neoplasms, and two dissections. Nondetachable balloons were used to arrest proximal blood flow during occlusion of only six arteries. Anticoagulation (heparin, 5000 U IV) was used during occlusion of 18 arteries. Three to 88 coils were used per lesion. Complex fibered platinum microcoils were used for all cases, and GDCs were also used in two patients. RESULTS: Sixteen patients had no new neurologic deficits after arterial occlusion. No patient had an acute event that suggested an embolic complication. Coils provided rapid and durable arterial occlusion in 17 patients. In both patients with acute carotid artery rupture, large numbers of coils placed during flow arrest failed to produce complete occlusion, which was accomplished subsequently with detachable balloons. One of these patients incurred a fatal hemispheric infarct after occlusion. One patient treated for a ruptured posterior inferior cerebellar artery aneurysm by vertebral artery occlusion continued to have progressive neurologic deficits. One patient with a cavernous aneurysm had upper extremity weakness and mild dysphasia 24 hours after internal carotid artery occlusion. CONCLUSION: In our small series, microcoils were found to be safe and effective for neurovascular occlusion. When both intravenous heparin (5000 U IV bolus) and heparinized catheter flush solutions (5000 U/L) are used, flow arrest during coil placement is unnecessary to prevent clinically apparent embolic complications. (+info)
Preliminary experience using contrast-enhanced MR angiography to assess vertebral artery structure for the follow-up of suspected dissection.
(23/1425)
BACKGROUND AND PURPOSE: Important advances have been made recently in MR angiography with the use of contrast medium injection, which has proved valuable for the imaging of vertebral arteries (VAs) obtained during short scanning times. Our purpose was to assess the feasability of contrast-enhanced fast 3D MR angiography for imaging VAs and to evaluate the long-term follow-up of VA dissections. METHODS: Sixteen consecutive patients with 18 angiographically documented VA dissections (seven occlusive dissections and 11 stenotic dissections, including two each with a pseudoaneurysm) were followed up using both contrast-enhanced 3D MR angiography and cervical T1-weighted MR imaging at a median delay of 22 months. Ten patients underwent MR imaging at the acute phase as well, and nine underwent early follow-up angiography at a median delay of 3 months. MR angiographic findings were determined by consensus, focussing on image quality, presence of residual stenosis, luminal irregularities, and occlusion. RESULTS: Of the 32 VAs, a segment of the artery was not assessable on contrast-enhanced MR angiography in each of four small VAs. A central signal void artifact of cervical arteries was seen in one patient and motion artifacts were seen in two, but images could be interpreted. A venous enhancement was detected in 10 of 16 examinations, but this did not prevent image analysis. Ten of 11 stenotic dissections returned to normal, whereas one stenotic dissection progressed to occlusion. Two pseudoaneurysms detected by initial angiography resolved spontaneously; one was revealed only by delayed MR angiography, and one was detected on an early MR angiogram and proved resolved on a late MR angiogram. Of the seven initially occluded VAs, five reopened, with a hairline residual lumen in each of three. CONCLUSION: This preliminary experience showed that contrast-enhanced MR angiography is a promising tool for imaging VAs; it allows the assessment of VA dissection changes over time. Most lesions tended to heal spontaneously, but persisting occlusion or pseudoaneurysm could be detected during the late course. (+info)
Diagnosis and treatment of concomitant aortic and coronary disease: a retrospective study and brief review.
(24/1425)
Coronary arteriosclerosis seriously complicates the surgical treatment of aortic diseases. The aim of our retrospective study was to determine the incidence of coronary artery disease among our surgical patients in treatment for aortic dissection or aneurysm, and to determine whether coronary intervention before aortic surgery appears to affect outcomes. Between 1 January 1993 and 1 March 1998, our center treated 253 patients for aortic dissection or aneurysm. We examined these cases retrospectively for information on diagnostic and treatment methods, both for the aortic lesions and for concomitant coronary arteriosclerosis. Aortic dissection had been detected in 86 (33.9%) patients and aortic aneurysm in 167 (66.1%). Coronary angiography was performed to search for concomitant coronary artery disease in 29 (33.8%) patients with dissection and in 112 (67.1%) patients with aneurysm; of these, 11 (12. 7%) and 54 (32.3%), respectively, were found to have coronary disease. Among 43 patients with abdominal aortic aneurysm in whom coronary angiography was performed, concomitant coronary disease was detected in 36 (83.7%). Coronary artery bypass surgery was performed in 10 patients who had dissection and in 30 patients who had aneurysm; percutaneous transluminal coronary angioplasty was performed in 7 patients who had aneurysm. Perioperative mortality rates in the dissection and aneurysm groups, overall, were 23.2% and 13.8%, respectively Unfortunately, the prospective, random clinical study that would be necessary to prove the case for or against preoperative coronary angiography among subsets of patients in need of aortic repair would raise ethical questions, given the strength of the information already in our possession, gathered by less formal methods. Our study reinforces existing evidence that preoperative angiography can reduce mortality and morbidity in the elective repair of aortic aneurysm, especially thoracic or abdominal aneurysm. However, angiography should not be performed routinely in cases of aortic dissection and should be withheld in cases of type A dissection. (+info)