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All ICA BBAs that were treated by endosaccular coil embolization exhibited regrowth of the aneurysm. Some of the lesions rebled. The majority of patients who underwent ICA trapping experienced excellent outcomes. Based on the authors' experiences, they suggest that ICA trapping including the lesion segment should be considered as a first option for definitive treatment if a BOT reveals satisfactory results. Regarding trapping methods, endovascular treatment may be preferred because of its convenience and safety.

Agenesis or aplasia of ICA may be entirely harmless. However, associated conditions such as cerebral aneurysm or abnormal collateral channels should alert clinicians to the possibility of deterioration to life-threatening conditions, such as subarachnoid haemorrhage or irreversible ischemia. Other associated anomalies are commonly depicted on the same side as the ICA aplasia and may also give rise to issues of clinical importance.

Background and Purpose-Elevated blood pressure (BP) is commonly observed in acute ischemic stroke and is known to be associated with hemorrhagic transformation (HT). However, the effect of BP variability on the development of HT is not known well. Methods-A consecutive series of patients with acute ischemic stroke, who were hospitalized within 24 hours of onset and showed no HT on initial gradient echo MRI, were enrolled in this study. BP measurements during the first 72 hours were obtained, and BP variability of each patient was described using various summary parameters: SD, maximum (max), minimum (min), difference between max and min (maxϪmin), average squared difference between successive measurements (sv), and maximum sv (svmax). Results-Of 792 patients meeting the eligibility criteria, 70 (8.8%) developed HT. Among BP variability parameters categorized into quartiles, SBP max , SBP min , SBP maxϪmin , SBP svmax , DBP SD , DBP max , DBP min , DBP maxϪmin , and DBP svmax were significantly associated with HT independent of mean SBP, age, interval from onset to arrival, initial stroke severity, diabetes mellitus, stroke subtype, thrombolysis, initial glucose, and total cholesterol (PϽ0.05 on likelihood ratio test of trend). The analyses about the interaction between thrombolysis and variability parameters showed that the effects of BP variability on the development of HT did not differ by whether patients received thrombolysis or not. Conclusions-Our study suggests that we may consider not only the absolute level of BP but also its variability to prevent hemorrhagic transformation. (Stroke. 2010;41:2512-2518.)

Background: This study was designed to investigate the relationship between transient neurological deterioration and changes in cerebral perfusion after superficial temporal artery/middle cerebral artery (STA-MCA) bypass. Methods: Clinical characteristics of the patients with postoperative transient neurological deterioration were analyzed in 120 STA-MCA bypass procedures for ischemic cerebral diseases, such as atherosclerotic disease and moyamoya disease. Serial brain single-photon emission computed tomography (SPECT) was performed on 25 patients before surgery and on the third and tenth postoperative days. The hemispheric perfusion on SPECT was calculated semi-quantitatively using statistical parametric mapping and a probabilistic brain atlas. Results: Among 120 procedures, there were 4 permanent postoperative neurological deficits (3.3%) and 20 postoperative transient neurologic deteriorations with unknown etiology (17%). In 25 patients analyzed for postoperative perfusion changes, cerebral perfusion increased on the third postoperative day and the increased perfusion negatively correlated with preoperative perfusion (correlation coefficient = –0.77; p < 0.001). Temporal changes and the location of transient hyperperfusion on SPECT correlated with the time course and neurological deficits associated with postoperative transient neurological deterioration in 3 patients. Conclusions: Postoperative transient relative hyperperfusion is a common phenomenon and may be one of the causes of postoperative transient neurological deterioration after STA-MCA bypass surgery for ischemic cerebral diseases.

Our study shows that the odds of a worse outcome are increased by a factor of 2 in patients with asymptomatic HT compared with those without HT after acute ischemic stroke.

Although further investigation is required to determine many aspects of this treatment, including indication, safety, and efficacy, the endovascular occlusion of aneurysms on the collateral vessels in moyamoya disease with glue could be an effective treatment option.

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