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Titolo:
Improved cerebral perfusion after stenting of a petrous carotid stenosis: Technical case report
Autore:
Fessler, RD; Lanzino, G; Guterman, LR; Miletich, RS; Lopes, DK; Hopkins, LN;
Indirizzi:
SUNY Buffalo, Sch Med & Biomed Sci, Dept Neurosurg, Buffalo, NY 14209 USA SUNY Buffalo Buffalo NY USA 14209 , Dept Neurosurg, Buffalo, NY 14209 USA SUNY Buffalo, Sch Med & Biomed Sci, Toshiba Stroke Res Ctr, Buffalo, NY 14209 USA SUNY Buffalo Buffalo NY USA 14209 a Stroke Res Ctr, Buffalo, NY 14209 USA SUNY Buffalo, Sch Med & Biomed Sci, Dept Nucl Med, Buffalo, NY 14209 USA SUNY Buffalo Buffalo NY USA 14209 i, Dept Nucl Med, Buffalo, NY 14209 USA SUNY Buffalo, Sch Med & Biomed Sci, Dept Neurol, Buffalo, NY 14209 USA SUNY Buffalo Buffalo NY USA 14209 Sci, Dept Neurol, Buffalo, NY 14209 USA
Titolo Testata:
NEUROSURGERY
fascicolo: 3, volume: 45, anno: 1999,
pagine: 638 - 642
SICI:
0148-396X(199909)45:3<638:ICPASO>2.0.ZU;2-T
Fonte:
ISI
Lingua:
ENG
Soggetto:
ARTERY STENOSIS; STROKE; ANGIOPLASTY; BYPASS; ENDARTERECTOMY; EMBOLISM; PRESSURE; DISEASE;
Keywords:
atherosclerosis; coronary artery bypass graft; single-photon emission computed tomography; stent; stroke;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
27
Recensione:
Indirizzi per estratti:
Indirizzo: Fessler, RD SUNY Buffalo, Sch Med & Biomed Sci, Dept Neurosurg, 3 Gates Circle, Buffalo, NY 14209 USA SUNY Buffalo 3 Gates Circle Buffalo NY USA 14209 NY 14209 USA
Citazione:
R.D. Fessler et al., "Improved cerebral perfusion after stenting of a petrous carotid stenosis: Technical case report", NEUROSURGER, 45(3), 1999, pp. 638-642

Abstract

OBJECTIVE AND IMPORTANCE: Atherosclerotic occlusive disease of the intracranial vasculature is associated with increased risk of systemic vascular occlusive disease and stroke. Therapeutic options have included anticoagulation therapy, antiplatelet therapy, or, in a limited number of patients, extracranial-intracranial vascular bypass procedure. We report a patient who had improved cerebral perfusion with silent watershed zone infarctions after endovascular stenting of a severe petrous segment carotid stenosis. CLINICAL PRESENTATION: A 73-year-old man with severe coronary artery disease and unstable angina was referred for treatment of a 90% right petrous carotid artery stenosis before coronary artery bypass grafting. A brain single-photon emission computed tomographic scan using Tc-99m-bicisate revealed diminished perfusion throughout the right internal carotid artery territory, particularly in posterior watershed zones. TECHNIQUE: The patient underwent transfemoral placement of a 7-French introducer sheath, followed by a 7-French guide catheter. Urokinase (225,000 U)was infused through a microcatheter placed proximal to the lesion. No changes were noted in lesion morphology after this infusion. A microguidewire was navigated across the lesion. Subsequent balloon angioplasty with a coronary artery balloon was performed twice, followed by placement of a 4- x 12-mm coronary stent. CONCLUSION: Selective internal carotid artery angiography after stenting revealed markedly improved flow. A brain Tc-99m-bicisate single-photon emission computed tomographic scan performed within 24 hours of stent placement,revealed significantly improved perfusion within the right internal carotid artery territory. Two perfusion voids suggestive of embolic stroke were noted; both were clinically silent. The patient had uncomplicated coronary artery bypass grafting 72 hours later. Five months postoperatively, he remains at home, living independently and with intact neurological function. Intracranial stenting for severe atherosclerotic stenosis is technically possible. However, its ultimate clinical role remains to be determined.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 26/09/20 alle ore 18:23:22