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Patterns of ischemic posterior circulation strokes: A clinical, anatomical, and radiological review.International Journal of Stroke :... Aug 2022Posterior circulation and anterior circulation strokes share many clinical, pathogenetic and radiological features, although some clinical signs are highly specific to... (Review)
Review
BACKGROUND
Posterior circulation and anterior circulation strokes share many clinical, pathogenetic and radiological features, although some clinical signs are highly specific to posterior circulation strokes. Arterial stenosis and occlusions occur in significant numbers in both acute posterior circulation and anterior circulation strokes, making them good candidates for endovascular treatment. Among posterior circulation strokes, basilar artery occlusions stand out because of the diagnostic and acute treatment challenges.
METHODS
We reviewed the literature on clinical stroke syndromes and neuroimaging findings and systematically describe for each anatomical site of stroke the detailed clinical and radiological information (anatomical representation, diffusion weighted imaging and angiographic sequences). The principles of neuroimaging of posterior circulation strokes and the prognosis for each stroke localization are also discussed.
REVIEW SUMMARY
Stroke syndromes in the territories of the vertebral, basilar, cerebellar, and posterior cerebral arteries are presented. Features typical of posterior circulation strokes are highlighted, including patterns of basilar artery occlusions. Clinical severity and prognosis of posterior circulation strokes are highly variable, and given that they are more difficult to detect on CT-based neuroimaging, magnetic resonance imaging is the technique of choice in suspected posterior circulation strokes. Rapid identification of arterial occlusion patterns may provide prognostic information and support acute revascularization decisions.
CONCLUSIONS
Posterior circulation stroke syndromes tightly reflect lesion localization and arterial occlusion patterns. Although many clinical and pathogenetic features are similar to anterior circulation strokes, notable differences exist in terms of clinical presentation, stroke mechanism, prognosis, and response to acute recanalization.
Topics: Arterial Occlusive Diseases; Basilar Artery; Humans; Ischemic Stroke; Retrospective Studies; Stroke; Syndrome; Vertebrobasilar Insufficiency
PubMed: 34581223
DOI: 10.1177/17474930211046758 -
Turk Kardiyoloji Dernegi Arsivi : Turk... Jun 2021
Topics: Arterial Occlusive Diseases; Coronary Angiography; Humans; Radial Artery; Ultrasonography, Interventional
PubMed: 34106057
DOI: 10.5543/tkda.2021.21114 -
JACC. Cardiovascular Interventions May 2022
Topics: Arterial Occlusive Diseases; Catheterization, Peripheral; Humans; Radial Artery; Treatment Outcome
PubMed: 35589233
DOI: 10.1016/j.jcin.2022.04.003 -
La Tunisie Medicale Jun 2023The conventional radial approach (CRA), the gold standard approach for percutaneous coronary interventions (PCI), is associated with the risk of radial artery occlusion... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
The conventional radial approach (CRA), the gold standard approach for percutaneous coronary interventions (PCI), is associated with the risk of radial artery occlusion (RAO). The distal radial approach (DRA) is an effective alternative with fewer complications.
AIM
To evaluate the efficacy in terms of puncture success and safety by RAO rate of the DRA in elective PCI in Tunisian patients.
METHODS
It was a randomized controlled non-inferiority trial including patients hospitalized for elective PCI. The protocol was previously published (Tunis Med 2022; 100(3): 192-202). The primary endpoints were puncture success and RAO rate at 30 days.
RESULTS
Overall, 250 patients were included and the groups were comparable. The preprocedural examination of the radial pulse and the Barbeau test were similar. The majority of PCIs were coronary angiography (82%). In ITT, respectively in CRA versus DRA, puncture success rates were similar (97.6% versus 96.8%; p≤0.500). RAO rates were similar (2.4% versus 3.2%; p≤0.500). Crossovers were similar. PCI through DRA lasted longer but was not more irradiating, however it required more contrast. Overall bleeding and vascular complications were similar.
CONCLUSION
This study demonstrated the non-inferiority of DRA compared to CRA for elective PCIs in a Tunisian population regarding puncture success and RAO rate at 30 days. Multicenter trials including urgent PCI with systematic ultrasound screening for RAO are needed.
Topics: Humans; Percutaneous Coronary Intervention; Coronary Angiography; Ultrasonography; Hemorrhage; Arterial Occlusive Diseases; Treatment Outcome
PubMed: 38372550
DOI: No ID Found -
International Journal of Molecular... Dec 2021Vascular occlusive diseases such myocardial infarction, peripheral artery disease of the lower extremities, or stroke still represent a substantial health burden...
Vascular occlusive diseases such myocardial infarction, peripheral artery disease of the lower extremities, or stroke still represent a substantial health burden worldwide [...].
Topics: Angiogenesis Inducing Agents; Arterial Occlusive Diseases; Blood Circulation; Early Diagnosis; Humans; Neovascularization, Pathologic; Neovascularization, Physiologic
PubMed: 34948041
DOI: 10.3390/ijms222413244 -
Arteriosclerosis, Thrombosis, and... Apr 2021[Figure: see text]. (Review)
Review
[Figure: see text].
Topics: Animals; Antineoplastic Agents; Arterial Occlusive Diseases; Blood Coagulation; Endothelium, Vascular; Humans; Molecular Targeted Therapy; Neoplasms; Platelet Activation; Risk Assessment; Risk Factors; Signal Transduction; Thrombosis; Venous Thrombosis
PubMed: 33567864
DOI: 10.1161/ATVBAHA.120.314378 -
International Journal of Molecular... Aug 2021Cardiovascular diseases lead to retinal ischemia, one of the leading causes of blindness. Retinal ischemia triggers pathological retinal glial responses and functional...
Cardiovascular diseases lead to retinal ischemia, one of the leading causes of blindness. Retinal ischemia triggers pathological retinal glial responses and functional deficits. Therefore, maintaining retinal neuronal activities and modulating pathological gliosis may prevent loss of vision. Previously, pemafibrate, a selective peroxisome proliferator-activated receptor alpha modulator, was nominated as a promising drug in retinal ischemia. However, a protective role of pemafibrate remains untouched in cardiovascular diseases-mediated retinal ischemia. Therefore, we aimed to unravel systemic and retinal alterations by treating pemafibrate in a new murine model of retinal ischemia caused by cardiovascular diseases. Adult C57BL/6 mice were orally administered pemafibrate (0.5 mg/kg) for 4 days, followed by unilateral common carotid artery occlusion (UCCAO). After UCCAO, pemafibrate was continuously supplied to mice until the end of experiments. Retinal function (a-and b-waves and the oscillatory potentials) was measured using electroretinography on day 5 and 12 after UCCAO. Moreover, the retina, liver, and serum were subjected to qPCR, immunohistochemistry, or ELISA analysis. We found that pemafibrate enhanced liver function, elevated serum levels of fibroblast growth factor 21 (FGF21), one of the neuroprotective molecules in the eye, and protected against UCCAO-induced retinal dysfunction, observed with modulation of retinal gliosis and preservation of oscillatory potentials. Our current data suggest a promising pemafibrate therapy for the suppression of retinal dysfunction in cardiovascular diseases.
Topics: Animals; Arterial Occlusive Diseases; Benzoxazoles; Butyrates; Carotid Artery, Common; Disease Models, Animal; Male; Mice; Mice, Inbred C57BL; Retinal Diseases
PubMed: 34502311
DOI: 10.3390/ijms22179408 -
Neurology India 2019
Topics: Brain; Female; Humans; Magnetic Resonance Imaging; Retinal Artery Occlusion; Susac Syndrome; Young Adult
PubMed: 31512675
DOI: 10.4103/0028-3886.266278 -
JACC. Cardiovascular Interventions May 2022
Topics: Arterial Occlusive Diseases; Cardiac Catheterization; Catheterization, Peripheral; Humans; Radial Artery; Treatment Outcome
PubMed: 35331685
DOI: 10.1016/j.jcin.2022.03.008 -
The Journal of International Medical... Sep 2023Central retinal artery occlusion (CRAO) is a catastrophic ophthalmic emergency that severely impairs a patient's visual function, often reducing visual acuity to... (Review)
Review
Central retinal artery occlusion (CRAO) is a catastrophic ophthalmic emergency that severely impairs a patient's visual function, often reducing visual acuity to counting fingers or worse. Progress in CRAO research has provided new information regarding its epidemiological characteristics and led to useful assessments through various ophthalmic examinations. Additional insights about CRAO have been gained through studies of its pathophysiological mechanisms, improving intervention timing and enhancing patient prognosis. Treatment for CRAO has evolved, particularly with assistance from surgical instruments and surgical robots. Although surgical treatment is now possible, this option is not widely recognized by ophthalmologists. Conservative therapies have limited benefits compared with the natural course of disease. Recently, pars plana vitrectomy plus endovascular surgery has received considerable interest among ophthalmologists because of its potential efficacy in the treatment of CRAO. Considering the inconsistencies in rationale and efficacy of CRAO treatment modalities, it is important to distinguish between treatment effects and the natural courses of various CRAO subclasses. This narrative review explores progress in CRAO epidemiology, pathophysiology, ophthalmic examination, and treatment.
Topics: Humans; Retinal Artery Occlusion; Eye; Conservative Treatment; Face; Fingers
PubMed: 37712755
DOI: 10.1177/03000605231198388