scholarly journals Showered Calcific Emboli to the Brain, the ‘Salted Pretzel’ Sign, Originating From the Ipsilateral Internal Carotid Artery Causing Acute Cerebral Infarction

Stroke ◽  
2009 ◽  
Vol 40 (5) ◽  
Author(s):  
Brett A. Christian ◽  
Daniel J. Kirzeder ◽  
Jim Boyd ◽  
Jeffery Laing ◽  
Judson R. Gash
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Infarction ◽  
Internal Carotid ◽  
Acute Cerebral Infarction ◽  
The Brain

scholarly journals Mechanical thrombectomy and carotid artery stenting for stenosis of the internal carotid artery with free-floating thrombosis: illustrative case

2021 ◽  
Vol 2 (9) ◽  
Author(s):  
Ryuta Tomoyose ◽  
Tomoyuki Tsumoto ◽  
Kenta Hara ◽  
Yuichi Miyazaki ◽  
So Tokunaga ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Infarction ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Acute Cerebral Infarction ◽  
Reversal Flow ◽  
Ica Stenosis

BACKGROUND The authors report a case in which mechanical thrombectomy and carotid artery stenting (CAS) were performed for acute cerebral infarction with free-floating thrombosis (FFT) in left internal carotid artery (ICA) stenosis. Good results were obtained. OBSERVATIONS A 63-year-old man developed sudden disturbance of consciousness and right hemiplegia. He was transported to the authors’ hospital by an emergency vehicle. Head magnetic resonance imaging showed acute cerebral infarction in the left middle cerebral artery region, and magnetic resonance angiography showed poor vascular flow beyond the left ICA. Emergency angiography revealed severe stenosis at the origin of the left ICA and a free-floating thrombus attached to the stenosis and extending to the peripheral side. Percutaneous transluminal angioplasty (PTA) was performed on the stenosis with proximal protection, the thrombus was aspirated under reversal flow, and CAS was performed without exacerbation of clinical symptoms. LESSONS PTA, thrombus aspiration, and CAS under reversal flow may be effective treatments for FFT caused by ICA stenosis.

Abstract TP242: Internal Carotid Artery Angle and the Risk of Floating Mural Thrombosis in Acute Cerebral Infarction Patients

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Yuko Abe ◽  
Yohei Mima ◽  
Yoshiki Esa ◽  
Aimi Tanaka ◽  
Naoko Ueda ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Infarction ◽  
Internal Carotid ◽  
Acute Cerebral Infarction

scholarly journals Nasopharyngeal Carcinoma Presenting as a Dual Territory Stroke: The Hyperdense Artery Sign

2011 ◽  
Vol 26 (2) ◽  
pp. 37-38
Author(s):  
Ian C. Bickle
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Infarction ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Ct Imaging ◽  
The Body ◽  
Attenuation Value ◽  
The Brain

This 63 year-old chinese female, with both diabetes and hypertension, underwent CT imaging of the brain after presenting with a progressive left sided hemiplegia.  The ‘hyperdense artery sign’ is a generic description that can be evident in any artery of the body on unenhanced CT, occurring due to the presence of intraluminal thrombosis (Figure 1).  It is a well-established sign, most commonly described in CT imaging of the brain, where it is visualised in the vast majority of cases in the middle cerebral artery in the context of an acute cerebral infarction.1   It occurs uncommonly elsewhere, with the internal carotid artery (ICA) and basilar artery being other clinically significant sites. The ‘hyperdense ICA’ sign has been reported to be a reliable and highly specific marker of thromboembolic occlusion of the internal carotid artery.2  The ‘hyperdense artery sign’ is related to the attenuation value of intraluminal thrombus.  The CT attenuation value (Hounsfield unit or HU) of normal blood is dependent on the haematocrit, ranging from 20 to 30 HU.  As the process of thrombus retraction occurs, its water content decreases, increasing the concentration of haemoglobin within the clot.  As a result this raises the attenuation value of the thrombus to 50–80 H. So the term ‘hyperdense’ is given.3 In this case, it proved to be the presenting symptom for an undiagnosed nasopharyngeal tumour, the thrombus likely developing as a complication of the surrounding tumour within the nasopharyngeal recess.  The resultant outcome was a dual territory cerebral infarction of the anterior and middle cerebral artery territories, both supplied by branches of the internal carotid artery (Figures 2a & 2b).  

Blood-brain barrier transport of neuropeptides: analysis with a metabolically stable dermorphin analogue

1994 ◽  
Vol 267 (1) ◽  
pp. E124-E131 ◽  
Author(s):  
A. Samii ◽  
U. Bickel ◽  
U. Stroth ◽  
W. M. Pardridge
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Intravenous Injection ◽  
Internal Carotid ◽  
Lipid Solubility ◽  
Permeability Surface ◽  
Bbb Permeability ◽  
The Brain ◽  
Artery Perfusion ◽  
Internal Carotid Artery Perfusion

To avoid the confounding effect of metabolic degradation, the stable mu-opioid peptide agonist [D-Arg2,Lys4]-dermorphin analogue (DALDA) was used to quantitate blood-brain barrier (BBB) permeability by intravenous injection and internal carotid artery perfusion techniques. With intravenous injection, the BBB permeability-surface area products for [3H]DALDA (0.84 +/- 0.13 microliters.min-1.g-1) and [14C]sucrose (0.39 +/- 0.05 microliters.min-1.g-1) correlated with the lipid solubility of the two molecules: the 1-octanol-Ringer partition coefficient for DALDA was approximately 2 log orders greater than that for sucrose. The brain delivery of [3H]DALDA at 30 min after intravenous administration was 0.019 +/- 0.002% of the injected dose per gram, and analgesia was induced with a 5-mg/kg dose administered systemically. In contrast to the result after intravenous injection, the BBB permeability-surface area product for DALDA estimated with the internal carotid artery perfusion technique was manyfold greater. This was due to nonspecific absorption of the peptide into the cerebral microvasculature, which precluded use of the capillary depletion technique to study transcytosis through the BBB after internal carotid artery perfusion. The present studies show that the brain delivery of a metabolically stable peptide, such as DALDA, is comparable to that for sucrose, correlates with lipid solubility, and is mediated by a nonsaturable mechanism, probably free diffusion.

First Pass Effect With Neurothrombectomy for Acute Ischemic Stroke: Analysis of the Systematic Evaluation of Patients Treated With Stroke Devices for Acute Ischemic Stroke Registry

Stroke ◽  
2021 ◽  
Author(s):  
Ashutosh P. Jadhav ◽  
Shashvat M. Desai ◽  
Osama O. Zaidat ◽  
Raul G. Nogueira ◽  
Tudor G. Jovin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Infarction ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Internal Carotid ◽  
Systematic Evaluation ◽  
Stroke Registry ◽  
First Pass

Background and Purpose: Achieving complete revascularization after a single pass of a mechanical thrombectomy device (first pass effect [FPE]) is associated with good clinical outcomes in patients with acute ischemic stroke due to large vessel occlusion. We assessed patient characteristics, outcomes, and predictors of FPE among a large real-world cohort of patients (Systematic Evaluation of Patients Treated with Stroke Devices for Acute Ischemic Stroke registry). Methods: Demographics, clinical outcomes, and procedural characteristics were analyzed among patients in whom FPE (modified Thrombolysis in Cerebral Infarction 2c/3 after first pass) was achieved versus those requiring multiple passes (MP). Modified FPE and modified MP included patients achieving modified Thrombolysis in Cerebral Infarction 2B-3. Primary outcomes included 90-day modified Rankin Scale (mRS) score and mortality. Results: Among 984 Systematic Evaluation of Patients Treated with Stroke Devices for Acute Ischemic Stroke patients, 930 had complete 90-day follow-up. FPE was achieved in 40.5% (377/930) of patients and MP in 20.0% (186/930). Baseline characteristics were similar across all groups. The FPE group had fewer internal carotid artery occlusions compared with MP ( P =0.029). The FPE group had faster puncture to recanalization time ( P ≤0.001), higher rates of 90-day mRS score of 0 to 1 (52.6% versus 38.6%, P =0.003), mRS score of 0 to 2 (65.4% versus 52.0%, P =0.003), and lower 90-day mortality compared with the MP group (12.0% versus 18.7%, P =0.038). Similarly, compared with modified MP patients, the modified FPE group had fewer internal carotid artery occlusions ( P =0.004), faster puncture to recanalization time ( P ≤0.001), and higher rates of 90-day mRS score of 0 to 1 ( P =0.002) and mRS score of 0 to 2 ( P =0.003). Conclusions: Our findings demonstrate that FPE and modified FPE are associated with superior clinical outcomes.

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