The carotid stump is a known source of cerebral embolisms. Direct ultrasound sonographic visualization of a thrombus in the common carotid stump after development of a cerebral infarction is rare. We report a case of a 69-year-old man who presented with acute ipsilateral ischemic stroke with occlusion of the left common carotid artery, forming a stump proximal to the carotid bifurcation. Carotid duplex sonography revealed a mobile thrombus in the stump. An ipsilateral microembolic signal was observed by transcranial Doppler imaging.
Aged ; Carotid Artery, Common ; Cerebral Infarction ; Embolism ; Humans ; Intracranial Embolism ; Stroke ; Thromboembolism ; Thrombosis ; Ultrasonography, Doppler

BACKGROUND: Acute intracranial large-artery occlusions (AILAOs) are detected frequently and cause severe neurological disabilities. Most studies in this field do not focus on the natural history of AILAOs, but on the individual prognosis for each intervention. The aim of this study was to elucidate the clinical profiles and outcomes of AILAOs. METHODS: A consecutive series of patients hospitalized between January 2004 and October 2007 due to AILAO within 24 hours from onset were recruited. Based on a prospective stroke registry, their clinical profiles were collected. AILAO was defined as an intracranial internal carotid artery (ICA), middle cerebral artery (MCA), or basilar artery (BA) occlusion that could be confirmed by angiography, with relevant lesions on diffusion-weighted imaging (DWI). The modified Rankin Scale (MRS) score at 3 months and the recanalization rate within 14 days were recorded as outcomes. RESULTS: Among 1,047 patients with acute ischemic stroke who were examined within 24 hours of onset, 189 [18.1%; 101 men, 88 women; age 68.6+/-13.0 years (mean+/-SD); median National Institutes of Health Stroke Scale (NIHSS) score=11]. Occlusion sites were MCA M1, MCA M2, distal ICA, and BA in 99 (52.4%), 50 (26.5%), 20 (10.6%), and 20 (10.6%) of cases,respectively. Embolic sources were found in 103 (54.5%) cases. MRS scores were available for 184 (97.4%) of the patients, of which 78 had a favorable outcome (MRS: 0.2). Follow-up angiography was performed in 122 (64.6%) cases, with recanalization observed in 88 (72.1%) of these. Thrombolysis, occlusion site, presence of an embolic source, and initial glucose level were predictors of early recanalization (p<0.001). Recanalization status and initial NIHSS score were strongly correlated with a favorable outcome (p<0.005). CONCLUSIONS: This is the first report of the clinical profiles, outcomes, and their predictors in a cohort of Korean patients with AILAO.
Angiography ; Arteries ; Basilar Artery ; Carotid Artery, Internal ; Cerebrovascular Disorders ; Cohort Studies ; Follow-Up Studies ; Glucose ; Humans ; Intracranial Embolism and Thrombosis ; Male ; Middle Cerebral Artery ; National Institutes of Health (U.S.) ; Natural History ; Prognosis ; Prospective Studies ; Stroke

BACKGROUND AND PURPOSE: The goal of stent retriever-based thrombectomy is removal of embolic clots in patients with intracranial large artery occlusion. However, outcomes of stent retrieval may differ between acute arterial occlusions due to intracranial atherosclerotic disease (IAD) and those due to embolism. This case series describes the outcomes of stent retriever-based thrombectomy and rescue treatments in 9 patients with IAD-related occlusion. METHODS: Among patients who underwent endovascular treatment for acute intracranial large artery occlusion, those in whom stent retrieval was attempted as first-line treatment were included in this review. IAD was defined as significant fixed focal stenosis at the occlusion site, which was evident on final angiographic assessment or observed during endovascular treatment. RESULTS: Median number of stent retriever passes was 2 (range, 1-3), and temporary bypass was seen in all patients. Immediate partial recanalization (arterial occlusive lesion grade 2-3) was observed in 7 patients. Immediate modified thrombolysis in cerebral infarction grade 2b-3 was seen in 6 patients, but the lesions often required rescue treatment due to reocclusion or flow insufficiency. In terms of rescue treatments, angioplasty and intra-arterial tirofiban infusion seemed to be effective. CONCLUSIONS: Our findings suggest that stent retrieval can effectively remove thrombi from stenotic lesions and achieve partial recanalization despite the tendency toward reocclusion in most patients with IAD-related occlusion. Further research into the use of rescue treatments, such as tirofiban infusion and angioplasty, is warranted.
Angioplasty ; Arteries* ; Cerebral Infarction ; Constriction, Pathologic ; Embolism ; Humans ; Intracranial Arteriosclerosis ; Intracranial Embolism and Thrombosis ; Mechanical Thrombolysis ; Stents* ; Thrombectomy

BACKGROUND AND PURPOSE: The goal of stent retriever-based thrombectomy is removal of embolic clots in patients with intracranial large artery occlusion. However, outcomes of stent retrieval may differ between acute arterial occlusions due to intracranial atherosclerotic disease (IAD) and those due to embolism. This case series describes the outcomes of stent retriever-based thrombectomy and rescue treatments in 9 patients with IAD-related occlusion. METHODS: Among patients who underwent endovascular treatment for acute intracranial large artery occlusion, those in whom stent retrieval was attempted as first-line treatment were included in this review. IAD was defined as significant fixed focal stenosis at the occlusion site, which was evident on final angiographic assessment or observed during endovascular treatment. RESULTS: Median number of stent retriever passes was 2 (range, 1-3), and temporary bypass was seen in all patients. Immediate partial recanalization (arterial occlusive lesion grade 2-3) was observed in 7 patients. Immediate modified thrombolysis in cerebral infarction grade 2b-3 was seen in 6 patients, but the lesions often required rescue treatment due to reocclusion or flow insufficiency. In terms of rescue treatments, angioplasty and intra-arterial tirofiban infusion seemed to be effective. CONCLUSIONS: Our findings suggest that stent retrieval can effectively remove thrombi from stenotic lesions and achieve partial recanalization despite the tendency toward reocclusion in most patients with IAD-related occlusion. Further research into the use of rescue treatments, such as tirofiban infusion and angioplasty, is warranted.
Angioplasty ; Arteries* ; Cerebral Infarction ; Constriction, Pathologic ; Embolism ; Humans ; Intracranial Arteriosclerosis ; Intracranial Embolism and Thrombosis ; Mechanical Thrombolysis ; Stents* ; Thrombectomy

We present a 61-year-old female with an unruptured intracranial aneurysm on the left superior hypophyseal artery. The patient was treated with endovascular management, stent-assisted coil embolization. Multiple embolic infarction and total occlusion of the left internal carotid artery (ICA) was occurred one day later. At 14 days of heparinization, complete recanalization of the ICA and full recovery of neurologic symptoms were achieved. Stent-assisted coil embolization is not without risk of instent thrombosis and the subsequent embolism. The cause of subacute in-stent thrombosis and natural course were uncertain; however, the clinical course may potentially be fatal. Therefore, rapid diagnosis and proper treatment are recommended.
Arteries ; Carotid Artery, Internal ; Embolism ; Female ; Heparin ; Humans ; Infarction ; Intracranial Aneurysm ; Middle Aged ; Neurologic Manifestations ; Thrombosis

Intracranial hemorrhage is common and is caused by diverse pathology, including trauma, hypertension, cerebral amyloid angiopathy, hemorrhagic conversion of ischemic infarction, cerebral aneurysms, cerebral arteriovenous malformations, dural arteriovenous fistula, vasculitis, and venous sinus thrombosis, among other causes. Neuroimaging is essential for the treating physician to identify the cause of hemorrhage and to understand the location and severity of hemorrhage, the risk of impending cerebral injury, and to guide often emergent patient treatment. We review CT and MRI evaluation of intracranial hemorrhage with the goal of providing a broad overview of the diverse causes and varied appearances of intracranial hemorrhage.
Arteriovenous Malformations ; Central Nervous System Vascular Malformations ; Cerebral Amyloid Angiopathy ; Cerebral Infarction ; Craniocerebral Trauma ; Hematoma, Subdural ; Hemorrhage ; Humans ; Hypertension ; Intracranial Aneurysm ; Intracranial Hemorrhages* ; Magnetic Resonance Imaging ; Neuroimaging ; Pathology ; Sinus Thrombosis, Intracranial ; Subarachnoid Hemorrhage ; Vasculitis

Intracranial atherosclerosis-related occlusion (ICAS-O) is frequently encountered at the time of endovascular revascularization treatment (ERT), especially in Asian countries. However, because baseline angiographic findings are similar between ICAS-O and embolism-related occlusion (EMB-O), it is difficult to differentiate the etiologies before the ERT procedure. Moreover, despite successful randomized trials on ERT, results from studies examining the optimal treatment protocol in ICAS-O patients remain unclear. In this review, we describe the clinical and imaging factors that may possibly differentiate ICAS-O from EMB-O. We will also discuss some current hurdles for treating ICAS-O in the hyperacute period and suggest the optimal ERT strategy for ICAS-O patients.
Asian Continental Ancestry Group ; Clinical Protocols ; Diagnosis ; Endovascular Procedures ; Humans ; Intracranial Arteriosclerosis ; Intracranial Embolism ; Intracranial Thrombosis

Congenital sinus of Valsalva (SOV) aneurysm is a rare cardiac abnormality. Rarely the aneurysm enlarges without rupture, cause symptoms of the mass effect by compressing the adjacent structures, obstruction of the right ventricular outflow with tricuspid regurgitation, infectious endocarditis, thrombus formation and myocardial ischemia/infarction. And SOV aneurysm can also be a source of embolism. We observed a patient with cerebral infarction in whom a huge SOV aneurysm, was diagnosed as the presumed source of cerebral embolism and the cause of hypoplastic tricuspid valve.
Aneurysm* ; Cerebral Infarction ; Embolism ; Endocarditis ; Humans ; Intracranial Embolism* ; Rupture ; Sinus of Valsalva* ; Thrombosis ; Tricuspid Valve Insufficiency ; Tricuspid Valve*

OBJECTIVE: Few studies have reported the outcome of mechanical thrombectomy with Solitaire stent retrival (MTSR) in subtypes of acute ischemic stroke. The purpose of this study was to evaluate the efficacy and result of MTSR in acute cardioembolic stroke. METHODS: Twenty consecutive patients with acute cardioembolic stroke were treated by MTSR. The angiographic outcome was assessed by thrombolysis in cerebral infarction (TICI) grade. TICI grade 2a, 2b, or 3 with a measurable thrombus that was retrieved was considered as a success when MTSR was performed in the site of primary vessel occlusion, and TICI grade 2b or 3 was considered as a success when final result was reported. Clinical and radiological results were compared between two groups divided on the basis of final results of MTSR. Persistent thrombus compression sign on angiogram was defined as a stenotic, tapered arterial lumen whenever temporary stenting was performed. The clinical outcomes were assessed by the modified Rankin Scale (mRS) at 3 months. RESULTS: The failure rate of MTSR was 20% (4/20) and other modalities, such as permanent stenting, were needed. Final successful recanalization (TICI grade 2b or 3) was 80% when other treatments were included. The rate of good outcome (mRS≤2) was 35% at the 3-month follow-up. Failure of MTSR was significantly correlated with persistent thrombus compression sign (p=0.001). CONCLUSION: Some cases of cardioembolic stroke are resistant to MTSR and may need other treatment modalities. Careful interpretation of angiogram may be helpful to the decision.
Cerebral Infarction ; Follow-Up Studies ; Humans ; Intracranial Embolism ; Mechanical Thrombolysis ; Stents* ; Stroke* ; Thrombectomy* ; Thrombosis

Pentoxifylline (Trental(R)) is a drug which blocks pathophysiologic process of cerebrovascular disease by inhibiting platelet aggregation, improving cerebral microcirculation preventing development of cerebral edema. In an attempt to evaluate the effect of pentoxifylline for the treatment of 25 patients (male 17 cases, female 8 cases) with cerebrovasculaar disease, we administered pentoxifylline 600mg daily in devided dosage for 1 to 7 months. Most of them were patients with cerebral thrombosis (52%), cerebral embolism (24%), cerebral hemorrhage (12%) and transient ischemic attack (12%). Clinical effects were evaluated at least 1 month later by the criteria using scoring method of serverity of symptoms. In summary, definite effect was found in 15 cases (60%), mild effect in 6 cases (24%) and no efect or aggravation in 4 cases (16%), especially in patients with cerebral hemorrhage. During treatment there was no significant side effect except mild elevation of serum creatinine in one case who was associated with chronic renal failure.
Brain Edema ; Cerebral Hemorrhage ; Creatinine ; Female ; Humans ; Intracranial Embolism ; Intracranial Thrombosis ; Ischemic Attack, Transient ; Kidney Failure, Chronic ; Microcirculation ; Pentoxifylline* ; Platelet Aggregation ; Research Design