ABSTRACT. Antegrade recanalisation of a completely occluded internal carotid artery (ICA) via the vasa vasorum is extremely rare. Here, we report such a case after proximal endovascular coiling in a case of dissected (i.e. non-atherosclerotic) ICA. A 42-year-old man presented with thromboembolic stroke of the left frontal lobe owing to pseudoocclusion of the left ICA manifesting as motor aphasia and right hemiparesis. There were abundant floating thrombi in the petrous portion of the left ICA. Because of good collateral flow in the left middle cerebral artery territory through the anterior communicating artery and external carotid artery system, endovascular coil embolisation of the left ICA was performed for prevention of further thromboembolic stroke. The patient showed progressive recovery following endovascular treatment, and was discharged with mild right hemiparesis 1 month later. He maintained a regimen of aspirin and physical rehabilitation. At follow-up, 38 months later, the patient was asymptomatic. Angiography demonstrated occlusion of the left ICA and multiple serpiginous vessels originating from the proximal internal and external carotid arteries and which filled the ICA distal to the occlusion. This case suggests that an ICA occluded by proximal coil embolisation-even in a non-atherosclerotic case-might be recanalised via the vasa vasorum. The vasa vasorum supply the arterial blood to the adventitia and outer third of the media in large arteries, whereas diffusion across the endothelial layer supplies oxygen and other nutrients to the endothelium and inner media [1,2]. Atherosclerotic changes cause an increase in the vasa vasorum, which form a dense vascular network within the plaque [3,4], and vessels originating from the arterial lumen may develop and communicate with the vasa vasorum [3,5]. However, after complete occlusion of the internal carotid artery (ICA), recanalisation via the vasa vasorum is rare, with only a few reported cases [5][6][7][8][9][10][11][12].We describe a case of recanalisation of the ICA occluded by endovascular coiling. It seems that collateralisation via the vasa vasorum developed in the 3 year follow-up period. Case reportA 42-year-old man was admitted to the neurology department of a local hospital on 17 August 2005. He had experienced sudden onset of weakness of the right extremities and speech disturbance. CT and MRI of the brain revealed left cerebral infarction, and antiplatelet and anticoagulation therapy (aspirin 100 mg day 21 and argatroban 60 mg day 21 ) was initiated. His neurological symptoms improved satisfactorily but suddenly deteriorated on the third day from onset. Repeat MRI/magnetic resonance angiography (MRA) suggested an increase in cerebral infarction because of the left ICA occlusion, and he was immediately transferred to our department. On admission, his Glasgow coma scale score was 9 (E3V1M5). He had right hemiplegia and motor aphasia. Laboratory data revealed no definitive abnormality. A CT scan showed a low-density area in the left frontal lobe...
It has been frequently reported that while myocardial viability is neglected in conventional methods of diagnosis such as left ventriculography, ECG, and exercise thallium-201 myocardial scintigraphy (Ex-Tl), revascularization often results in improving left ventricular wall motility. In the present study, the authors contrived a method to accurately evaluate the viability of the myocardium by means of exercise rehabilitation, and tested the method in clinical cases. Among patients with myocardial infarction, we selected a patient with negative viability in the diseased area as determined by chronic ECG, left ventriculography (LVG), coronary angiography and Ex-Tl. This patient went through two weeks of active exercise rehabilitation gauged with an ergometer, and was then re-examined by Ex-Tl. After the evaluation, revascularization was performed for the patient who demonstrated viability of the infarcted myocardium in EX-Tl after rehabilitation, and significant improvement in contractility was shown in the chronic LVG. These findings indicate that our method of detecting potential viability of the infarcted myocardium is of clinical significance.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.