RESUMO
BACKGROUND: In the cavum segment the internal carotid artery has more susceptibility formation of aneurysms. The Solitaire™ AB stent is a scaffold that do flow blood diversion and promotes the aneurysms exclusion by thrombosis. CASE REPORT: 63 year old female present pulsatile headache, diplopia, III left cranial nerve paresis and carried a cavum carotid saccular aneurysms of the left carotid artery. By endovascular procedure, we placed a Solitaire™ AB stent. She recovered the III left cranial nerve function in to 2 month and we observed exclusion of the aneurysms by DynaCT in 3 months. CONCLUSION: The reconstruction of an artery by endovascular therapy is an alternative treatment for no ruptured paraclinoid aneurysms.
ANTECEDENTES: La arteria carótida interna a nivel del cavum es más susceptible de formación de aneurismas. El Solitaire™ AB condiciona una redirección del flujo de la sangre que favorece la exclusión por trombosis del aneurisma. CASO CLÍNICO: Mujer de 63 años que presentó cefalea, diplopía, paresia del III nervio craneal y portadora de aneurisma sacular en la arteria carótida interna izquierda a nivel del cavum carotídeo. Se colocó una endoprótesis Solitaire™ AB por procedimiento endovascular. Recuperó la función del III nervio craneal izquierdo a los 2 meses y se observó la exclusión del aneurisma a los 3 meses por DynaCT. CONCLUSIÓN: La endoprótesis para reconstrucción arterial intracraneal es una alternativa terapéutica en aneurismas paraclinoideos no rotos.
Assuntos
Aneurisma Roto , Procedimentos Endovasculares , Aneurisma Intracraniano , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Stents , Resultado do TratamentoRESUMO
This study explores the safety and effect of acute cerebral infarction treatment by microcatheter injection of tirofiban combined with a Solitaire AB stent and/or stent implantation. Emergency cerebral angiograms showing the responsible vascular occlusion of 120 acute cerebral infarction patients who underwent emergency endovascular thrombectomy were included in the study. These patients were randomly divided into two groups using the random number table method: treatment group (n=60) that received thrombectomy (with cerebral artery stents) combined with intracerebral injection of tirofiban and control group (n=60) that only received thrombectomy (with cerebral artery stents alone). The baseline data, cerebral angiography before and after surgery, hospitalization, and follow-up results of patients in these two groups were compared. Furthermore, the incidence of major adverse cerebrovascular events of these two groups was compared (90-day modified Rankin scale, a score of 0-2 indicates a good prognosis). The difference between baseline clinical data and brain angiography between these two groups was not statistically significant. Patients in the treatment group had a higher prevalence of thrombolysis in cerebral infarction grade 2b/3 than patients in the control group (88.3% (53/60) vs 66.7% (40/60), P=0.036). Moreover, the National Institutes of Health Stroke Scale scores 7 days after surgery and the 90-day prognosis were all better for the patients who received tirofiban (P=0.048 and P=0.024). Mechanical thrombectomy with Solitaire AB stents in combination with the injection of tirofiban through a microcatheter appears to be safe and effective for the endovascular treatment of acute ischemic stroke.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Stents , Trombectomia/métodos , Acidente Vascular Cerebral/terapia , Tirofibana/administração & dosagem , Revascularização Cerebral/métodos , Resultado do Tratamento , Terapia CombinadaRESUMO
BACKGROUND AND PURPOSE: Mechanical thrombectomy with stent retrievers has become standard of care for treatment of acute ischemic stroke patients because of large vessel occlusion. The STRATIS registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) aimed to assess whether similar process timelines, technical, and functional outcomes could be achieved in a large real world cohort as in the randomized trials. METHODS: STRATIS was designed to prospectively enroll patients treated in the United States with a Solitaire Revascularization Device and Mindframe Capture Low Profile Revascularization Device within 8 hours from symptom onset. The STRATIS cohort was compared with the interventional cohort of a previously published SEER patient-level meta-analysis. RESULTS: A total of 984 patients treated at 55 sites were analyzed. The mean National Institutes of Health Stroke Scale score was 17.3. Intravenous tissue-type plasminogen activator was administered in 64.0%. The median time from onset to arrival in the enrolling hospital, door to puncture, and puncture to reperfusion were 138, 72, and 36 minutes, respectively. The Core lab-adjudicated modified Thrombolysis in Cerebral Infarction ≥2b was achieved in 87.9% of patients. At 90 days, 56.5% achieved a modified Rankin Scale score of 0 to 2, all-cause mortality was 14.4%, and 1.4% suffered a symptomatic intracranial hemorrhage. The median time from emergency medical services scene arrival to puncture was 152 minutes, and each hour delay in this interval was associated with a 5.5% absolute decline in the likelihood of achieving modified Rankin Scale score 0 to 2. CONCLUSIONS: This largest-to-date Solitaire registry documents that the results of the randomized trials can be reproduced in the community. The decrease of clinical benefit over time warrants optimization of the system of care. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02239640.
Assuntos
Isquemia Encefálica/diagnóstico , Isquemia Encefálica/terapia , Trombólise Mecânica/normas , Sistema de Registros/normas , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Idoso , Isquemia Encefálica/epidemiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Trombólise Mecânica/métodos , Pessoa de Meia-Idade , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Acidente Vascular Cerebral/epidemiologia , Tempo para o Tratamento/normas , Ativador de Plasminogênio Tecidual/administração & dosagem , Resultado do TratamentoRESUMO
Spontaneously hypertensive rats (SHR) display autonomic imbalance and abnormal body temperature (Tb) adjustments. Hydrogen sulfide (H2S) modulates hypoxia-induced hypothermia, but its role in SHR thermoregulation is unknown. We tested the hypothesis that SHR display peculiar thermoregulatory response to hypoxia and that endogenous H2S overproduced in the caudal nucleus of the solitary tract (NTS) of SHR modulates this response. SHR and Wistar rats were microinjected into the fourth ventricle with aminooxyacetate (AOA, H2S-synthezing enzyme inhibitor) or sodium sulfide (Na2S, H2S donor) and exposed to normoxia (21% inspired O2) or hypoxia (10% inspired O2, 30 min). Tb was continuously measured, and H2S production rate was assessed in caudal NTS homogenates. In both groups, AOA, Na2S, or saline (i.e., control; 1 µL) did not affect euthermia. Hypoxia caused similar decreases in Tb in both groups. AOA presented a longer latency to potentiate hypoxic hypothermia in SHR. Caudal NTS H2S production rate was higher in SHR. We suggest that increased bioavailability of H2S in the caudal NTS of SHR enables the adequate modulation of excitability of peripheral chemoreceptor-activated NTS neurons that ultimately induce suppression of brown adipose tissue thermogenesis, thus accounting for the normal hypoxic hypothermia.