scholarly journals Perioperative Cerebral Ischemic Complications after Carotid Endarterectomy Without Shunting: A Series of 400 Consecutive CEA Evaluated by Intraoperative Monitoring and Post-operative Diffusion-weighted Imaging

2012 ◽  
Vol 40 (2) ◽  
pp. 94-99 ◽  
Author(s):  
Kazuya NAKASHIMA ◽  
Hideyuki OHNISHI ◽  
Yoshihiro KUGA ◽  
Yuuji KODAMA ◽  
Takashi TOMINAGA ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Intraoperative Monitoring ◽  
Diffusion Weighted Imaging ◽  
Diffusion Weighted ◽  
Ischemic Complications ◽  
Cerebral Ischemic

Perioperative Ischemic Complications of the Brain After Carotid Endarterectomy

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 286-294 ◽  
Author(s):  
Matthew O. Hebb ◽  
Joseph E. Heiserman ◽  
Kirsten P. N. Forbes ◽  
Joseph M. Zabramski ◽  
Robert F. Spetzler
Keyword(s):  
Cerebral Ischemia ◽  
Carotid Endarterectomy ◽  
Diffusion Weighted Imaging ◽  
Safe Procedure ◽  
Carotid Revascularization ◽  
Diffusion Weighted ◽  
Marginal Mandibular Nerve ◽  
Ischemic Complications ◽  
The Brain ◽  
Radiological Studies

Abstract BACKGROUND The potential morbidity of cerebral ischemia after carotid endarterectomy (CEA) has been recognized, but its reported incidence varies widely. OBJECTIVE To prospectively evaluate the development of cerebral ischemic complications in patients treated by CEA at a high-volume cerebrovascular center. METHODS Fifty patients with moderate or severe carotid stenosis awaiting CEA were studied with perioperative diffusion-weighted imaging of the brain and standardized neurological evaluations. Microsurgical CEA was performed by 1 of 2 vascular neurosurgeons. Radiological studies were evaluated by faculty neuroradiologists who were blinded to the details of the clinical situation. RESULTS Preoperative diffusion-weighted imaging studies were performed within 24 hours of surgery. A second study was obtained within 24 (92% of patients), 48 (4% of patients), or 72 (4% of patients) hours after surgery. Intraluminal shunting was used in 1 patient (2%), and patch angioplasty was used in 2 patients (4%). No patient had diffusion-weighted imaging evidence of procedure-related cerebral ischemia. Nonischemic complications consisted of postoperative confusion in an 87-year-old man with a urinary tract infection and a marginal mandibular nerve paresis in another patient. Radiological studies were normal in both patients. CONCLUSION CEA is a relatively safe procedure that may be performed with an acceptable risk of cerebral ischemia in select patients. The low rate of ischemic complications associated with CEA sets a standard to which other carotid revascularization techniques should be held. The current results are presented with a discussion of the senior author's preferred surgical technique and a brief review of the literature.

Incidence and Risk Factors for Diffusion-Weighted Imaging (+) Lesions After Intracranial Stenting and Its Relationship With Symptomatic Ischemic Complications

Stroke ◽  
2014 ◽  
Vol 45 (11) ◽  
pp. 3298-3303 ◽  
Author(s):  
Keun Young Park ◽  
Byung Moon Kim ◽  
Dong Joon Kim ◽  
Dong Ik Kim ◽  
Ji Hoe Heo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diffusion Weighted Imaging ◽  
Intracranial Stenting ◽  
Diffusion Weighted ◽  
Ischemic Complications

scholarly journals Magnetic Resonance Imaging of Acute Stroke

1998 ◽  
Vol 18 (6) ◽  
pp. 583-609 ◽  
Author(s):  
Alison E. Baird ◽  
Steven Warach
Keyword(s):  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Acute Stroke ◽  
Perfusion Imaging ◽  
Diffusion Weighted Imaging ◽  
Mr Angiography ◽  
Great Promise ◽  
Proton Density ◽  
Diffusion Weighted ◽  
Cerebral Ischemic

In the investigation of ischemic stroke, conventional structural magnetic resonance (MR) techniques (e.g., T1-weighted imaging, T2-weighted imaging, and proton density-weighted imaging) are valuable for the assessment of infarct extent and location beyond the first 12 to 24 hours after onset, and can be combined with MR angiography to noninvasively assess the intracranial and extracranial vasculature. However, during the critical first 6 to 12 hours, the probable period of greatest therapeutic opportunity, these methods do not adequately assess the extent and severity of ischemia. Recent developments in functional MR imaging are showing great promise for the detection of developing focal cerebral ischemic lesions within the first hours. These include (1) diffusion-weighted imaging, which provides physiologic information about the self-diffusion of water, thereby detecting one of the first elements in the pathophysiologic cascade leading to ischemic injury; and (2) perfusion imaging. The detection of acute intraparenchymal hemorrhagic stroke by susceptibility weighted MR has also been reported. In combination with MR angiography, these methods may allow the detection of the site, extent, mechanism, and tissue viability of acute stroke lesions in one imaging study. Imaging of cerebral metabolites with MR spectroscopy along with diffusion-weighted imaging and perfusion imaging may also provide new insights into ischemic stroke pathophysiology. In light of these advances in structural and functional MR, their potential uses in the study of the cerebral ischemic pathophysiology and in clinical practice are described, along with their advantages and limitations.

Incidence of ischemic complications and technical nuances of arteries protection for insular gliomas resection.

2021 ◽  
Author(s):  
Zonggang Hou ◽  
Zhenxing Huang ◽  
Zhenye Li ◽  
Gen Li ◽  
Yaokai Xu ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Diffusion Weighted Imaging ◽  
Motor Evoked Potentials ◽  
Tumor Resection ◽  
Neurological Deficits ◽  
Motor Deficits ◽  
Acute Ischemia ◽  
Critical Ischemia ◽  
Diffusion Weighted ◽  
Ischemic Complications

Abstract Insular gliomas remain surgically challenge due to their complex anatomical position and microvascular supply. The incidence of ischemic complications is a risk that should not be ignored. The goal of this study was to analyze the incidence of ischemia and its risk factors, and also describe a single surgeon's arteries protection experience of insular gliomas resection. The authors studied 75 consecutive cases of insular gliomas that underwent transcortical tumor resection in their division. Analysis included pre- and postoperative demographic, clinical, radiological including diffusion weighted imaging (DWI), as well as intraoperative neurophysiology data, and functional outcomes. Strategies such as “Residual Triangle”, “Basal Ganglia Reconstruction” and “Sculpting Technique” were used to protect lateral lenticulostriate arteries and main branches of M2 for maximal tumor resection according to the different classification of Berger-Sinai. Postoperative diffusion-weighted imaging showed acute ischemia in 44 patients, only 9 of whom developed new motor deficits. Flat inner edge (OR 0.144 95% CI 0.024, 0.876), and motor evoked potentials (MEPs) (<50%) (OR 18.182, 95% CI 3.311, 100.00) were determined to have significant associations with postoperative Critical Ischemia, which located in the posterior limb of the internal capsule or corona radiata. For insular gliomas resection, the protection of main branches of MCA is important. Insular gliomas resection might be with high incidence of ischemia uncovered by DWI which not always result in neurological deficits. Their own strategies maybe the feasible technical nuances allow the surgeon to achieve a thorough and safe resection. Motor evoked potentials is essential for its resection.

scholarly journals Microembolization During Carotid Endarterectomy and Diffusion Weighted Imaging

Stroke ◽  
2005 ◽  
Vol 36 (6) ◽  
pp. 1110-1112
Author(s):  
Nishath Altaf ◽  
Dorothee P. Auer ◽  
John Gladman ◽  
Shane T. MacSweeney
Keyword(s):  
Carotid Endarterectomy ◽  
Diffusion Weighted Imaging ◽  
Diffusion Weighted ◽  
And Diffusion

scholarly journals Cerebral Ischemic Lesions on Diffusion-Weighted Imaging Are Associated With Neurocognitive Decline After Cardiac Surgery

Stroke ◽  
2008 ◽  
Vol 39 (5) ◽  
pp. 1427-1433 ◽  
Author(s):  
P. Alan Barber ◽  
Sylvia Hach ◽  
Lynette J. Tippett ◽  
Linda Ross ◽  
Alan F. Merry ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Diffusion Weighted Imaging ◽  
Diffusion Weighted ◽  
Cerebral Ischemic ◽  
Neurocognitive Decline
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