OBJECTIVE: To investigate the factors affecting ferric chloride (FeCl₃) - induced carotid artery thrombosis model experiment. METHODS: After the common carotid artery was damaged by FeCl₃, the injured vessels were dissected for fixation, embedding, frozen section, and then processed HE staining. The carotid thrombus area ratio was calculated. We examined the effect of FeCl₃ concentration (5%, 10% and 15%), reaction time (2, 4 and 6 min), and recipient mouse age (4-5, 6-8 and 10 weeks) on the formation and stability of arterial thrombosis model. The model was injected through the post-glomus venous plexus of mouse eyeball with 0.075 μg/g and 0.1 μg/g R300 to verify the accuracy of the FeCl₃-induced model on thrombus formation by adjusting the platelet number. RESULTS: HE staining showed that thrombus formation induced by 10% and 15% FeCl₃ was more stable, dense and larger than 5% FeCl₃-induced thrombosis. 10% FeCl₃ induced the formation of dense and large thrombosis after 4 and 6 minutes of vascular endothelium injury, while the thrombosis induced for 2 minutes were looser and smaller in area. Mouse age can not affect thrombus formation and stability, because there were no significant differences in the formation of dense thrombus and thrombus area induced by 10% FeCl₃ among three different age groups of mice. CONCLUSION Many factors affect the formation and stability of arterial thrombosis model induced by FeCl₃. This optimal experimental conditions for construction of a stable carotid artery thrombosis model are 10% FeCl₃, 4 minutes for injury, and 6-8 week old mice.
Animals ; Mice ; Ferric Compounds/adverse effects* ; Chlorides ; Disease Models, Animal ; Carotid Artery Thrombosis/chemically induced* ; Male

Endoluminal reconstruction with a flow diverter device has emerged as a viable and often preferable alternative to traditional techniques for the treatment of intracranial aneurysms. Precise measurement and device selection are mandatory steps when considering flow diverters usage in order to avoid potential complications. In this sense, incomplete wall-apposition has been described as a predictive factor for immediate in-stent and delayed thrombosis after stent use. One significant usage limitation of flow diverter devices is the parent artery diameter, since the maximum opening of the sizes available are recommended for vessel diameters between 5.2–5.75 mm. Here we present the first clinical use of the largest flow diverter available, the 6×50 mm DERIVO embolization device (Acandis GmbH & Co. KG, Pforzheim, Germany), into the arterial circulation for a cervical internal carotid artery endovascular reconstruction. This is a new device for large or fusiform aneurysms requiring flow diversion, especially located in the vertebrobasilar system or extracranial segments.
Aneurysm ; Arteries ; Carotid Artery, Internal* ; Humans ; Intracranial Aneurysm ; Parents ; Stents ; Thrombosis

BACKGROUND: Retinal artery occlusion can lead to sudden visual loss without pain. The acute management of retinal artery occlusion remains unresolved. CASE REPORT: A 65-year-old male was hospitalized to an emergency room for visual loss on the left side within 6 hours of onset. Combined occlusion at retinal artery and ciliary artery was confirmed by an ophthalmologist and we assessed ophthalmic artery occlusion. However, MRA revealed no significant steno-occlusion of internal carotid artery. Transfemoral cerebral angiography was carried out immediately and showed a movable thrombus at the orifice of the ophthalmic artery. We decided on endovascular thrombectomy to prevent permanent visual loss. Finally, his visual acuity was improved after successful thrombectomy. CONCLUSIONS: Although MRA is intact, small thrombus right at the orifice of the ophthalmic artery can cause a sudden monocular visual loss due to occlusion of the retinal artery. In this setting, urgent endovascular thrombectomy can offer visual improvement.
Aged ; Blindness ; Carotid Artery, Internal ; Cerebral Angiography ; Ciliary Arteries ; Emergency Service, Hospital ; Humans ; Male ; Ophthalmic Artery ; Retinal Artery ; Retinal Artery Occlusion ; Thrombectomy ; Thrombosis ; Visual Acuity

We present 2 cases of complicated mechanical thrombectomy involving tandem cervical internal carotid artery and middle cerebral artery occlusion using the Solitaire FR stent and simultaneous carotid stent angioplasty. During the procedures, the Solitaire stents containing the thrombus were wedged into the open-cell carotid stents, which were already deployed for proximal flow restoration. We describe the methods used to avoid and overcome such complications.
Angiography ; Angioplasty ; Carotid Artery, Internal* ; Infarction, Middle Cerebral Artery* ; Middle Cerebral Artery* ; Stents* ; Thrombectomy* ; Thrombosis ; United Nations*

Craniocervical artery dissection is an uncommon cause of acute ischemic stroke in children, although it is an important cause of stroke in young and middle-aged patients. Among craniocervical artery dissection, internal carotid artery (ICA) dissection usually presents with focal neurologic deficits, such as acute hemiparesis. However, if it presents with only non-localizing signs, such as headache and seizure, ICA dissection may be overlooked in a differential diagnosis. Here we describe an 8-year-old boy who had spontaneous internal carotid artery dissection presenting as a seizure without focal neurologic signs. The patient was admitted to the emergency department because of seizure. On arrival at the emergency department, focal neurologic signs, such as motor weakness, were not observed. The patient had no recent trauma history. Magnetic resonance imaging revealed diffusion-restriction in the left basal ganglia. Magnetic resonance angiography, computed tomography angiography, and cerebral angiography demonstrated occlusion of the left distal ICA with tapered stenosis (so-called “string sign”). The patient was treated with aspirin and oxcarbazepine to prevent thrombosis and further seizures. Three-month follow-up MRA revealed apparent improvement of the occlusion of the left distal internal carotid artery. The patient had no neurologic deficits or further seizures in the outpatient clinic 13 months after discharge. This case demonstrated that acute ischemic stroke resulting from ICA dissection can occur with seizures without focal neurologic signs. In addition, ICA dissection should be considered as a possible cause of acute ischemic stroke even in children with no history of trauma.
Ambulatory Care Facilities ; Angiography ; Arteries ; Aspirin ; Basal Ganglia ; Carotid Artery, Internal* ; Carotid Artery, Internal, Dissection* ; Cerebral Angiography ; Child ; Constriction, Pathologic ; Diagnosis, Differential ; Emergency Service, Hospital ; Follow-Up Studies ; Headache ; Humans ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Male ; Neurologic Manifestations* ; Paresis ; Seizures* ; Stroke ; Thrombosis

Craniocervical artery dissection is an uncommon cause of acute ischemic stroke in children, although it is an important cause of stroke in young and middle-aged patients. Among craniocervical artery dissection, internal carotid artery (ICA) dissection usually presents with focal neurologic deficits, such as acute hemiparesis. However, if it presents with only non-localizing signs, such as headache and seizure, ICA dissection may be overlooked in a differential diagnosis. Here we describe an 8-year-old boy who had spontaneous internal carotid artery dissection presenting as a seizure without focal neurologic signs. The patient was admitted to the emergency department because of seizure. On arrival at the emergency department, focal neurologic signs, such as motor weakness, were not observed. The patient had no recent trauma history. Magnetic resonance imaging revealed diffusion-restriction in the left basal ganglia. Magnetic resonance angiography, computed tomography angiography, and cerebral angiography demonstrated occlusion of the left distal ICA with tapered stenosis (so-called “string sign”). The patient was treated with aspirin and oxcarbazepine to prevent thrombosis and further seizures. Three-month follow-up MRA revealed apparent improvement of the occlusion of the left distal internal carotid artery. The patient had no neurologic deficits or further seizures in the outpatient clinic 13 months after discharge. This case demonstrated that acute ischemic stroke resulting from ICA dissection can occur with seizures without focal neurologic signs. In addition, ICA dissection should be considered as a possible cause of acute ischemic stroke even in children with no history of trauma.
Ambulatory Care Facilities ; Angiography ; Arteries ; Aspirin ; Basal Ganglia ; Carotid Artery, Internal* ; Carotid Artery, Internal, Dissection* ; Cerebral Angiography ; Child ; Constriction, Pathologic ; Diagnosis, Differential ; Emergency Service, Hospital ; Follow-Up Studies ; Headache ; Humans ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Male ; Neurologic Manifestations* ; Paresis ; Seizures* ; Stroke ; Thrombosis

In essential thrombocythemia (ET), cerebral infarction with large cerebral artery occlusion has rarely been reported. A 53-year-old male was admitted with left sided weakness. Brain magnetic resonance images revealed right internal carotid artery (ICA) territory infarction and proximal ICA occlusion. The blood laboratory examination demonstrated continuously increased platelet count (above 617,000/µL). Increased megakaroycytes and JAK2 V617F mutation were confirmed in the bone marrow biopsy. We should consider the possibility of ET in patient with large artery thrombosis and thrombocythemia.
Arteries ; Biopsy ; Bone Marrow ; Brain ; Carotid Artery, Internal* ; Cerebral Arteries ; Cerebral Infarction ; Humans ; Infarction ; Janus Kinase 2 ; Male ; Middle Aged ; Platelet Count ; Stroke* ; Thrombocythemia, Essential* ; Thrombocytosis ; Thrombosis

The dynamic, hemodynamic impact of a cervical dissection on an ipsilateral, intracranial saccular aneurysm has not been well illustrated. This 45-year-old female was found to have a small, supraclinoid aneurysm ipsilateral to a spontaneous cervical internal carotid artery dissection. With healing of the dissection, the aneurysm appeared to have significantly enlarged. Retrospective review of the magnetic resonance imaging (MRI) at the time of the initial dissection demonstrated thrombus, similar in overall morphology to the angiographic appearance of the "enlarged" aneurysm. As the dissection healed far proximal to the intradural portion of the internal carotid artery, this suggested that the aneurysm was likely a typical, saccular posterior communicating artery aneurysm that had thrombosed and then recanalized secondary to flow changes from the dissection. The aneurysm was coiled uneventfully, in distinction from more complex treatment approaches such as flow diversion or proximal occlusion to treat an enlarging, dissecting pseudoaneurysm. This case illustrates that flow changes from cervical dissections may result in thrombosis of downstream saccular aneurysms. With healing, these aneurysms may recanalize and be misidentified as enlarging dissecting pseudoaneurysms. Review of an MRI from the time of the dissection facilitated the conclusion that the aneurysm was a saccular posterior communicating artery aneurysm, influencing treatment approach.
Aneurysm* ; Aneurysm, False ; Carotid Artery, Internal ; Carotid Artery, Internal, Dissection ; Female ; Hemodynamics* ; Humans ; Intracranial Aneurysm ; Magnetic Resonance Imaging ; Middle Aged ; Retrospective Studies ; Thrombosis

The dynamic, hemodynamic impact of a cervical dissection on an ipsilateral, intracranial saccular aneurysm has not been well illustrated. This 45-year-old female was found to have a small, supraclinoid aneurysm ipsilateral to a spontaneous cervical internal carotid artery dissection. With healing of the dissection, the aneurysm appeared to have significantly enlarged. Retrospective review of the magnetic resonance imaging (MRI) at the time of the initial dissection demonstrated thrombus, similar in overall morphology to the angiographic appearance of the "enlarged" aneurysm. As the dissection healed far proximal to the intradural portion of the internal carotid artery, this suggested that the aneurysm was likely a typical, saccular posterior communicating artery aneurysm that had thrombosed and then recanalized secondary to flow changes from the dissection. The aneurysm was coiled uneventfully, in distinction from more complex treatment approaches such as flow diversion or proximal occlusion to treat an enlarging, dissecting pseudoaneurysm. This case illustrates that flow changes from cervical dissections may result in thrombosis of downstream saccular aneurysms. With healing, these aneurysms may recanalize and be misidentified as enlarging dissecting pseudoaneurysms. Review of an MRI from the time of the dissection facilitated the conclusion that the aneurysm was a saccular posterior communicating artery aneurysm, influencing treatment approach.
Aneurysm* ; Aneurysm, False ; Carotid Artery, Internal ; Carotid Artery, Internal, Dissection ; Female ; Hemodynamics* ; Humans ; Intracranial Aneurysm ; Magnetic Resonance Imaging ; Middle Aged ; Retrospective Studies ; Thrombosis

BACKGROUND AND PURPOSE: The outcomes of acute internal carotid artery (ICA) terminus occlusions are poor. We classified ICA terminus occlusions into 2 groups according to the occlusion pattern of the circle of Willis and hypothesized that clinical outcomes would significantly differ between them. METHODS: Consecutive patients with acute ICA terminus occlusions evaluated by baseline computed tomographic angiography were enrolled. We investigated the occlusion patterns in the circle of Willis, retrospectively classified patients into simple ICA terminus occlusion (STO; with good Willisian collaterals from neighboring cerebral circulation) and complex ICA terminus occlusion (CTO; with one or more of A2 anterior cerebral artery, fetal posterior cerebral artery occlusion, or hypoplastic/absent contralateral A1; or with poor collaterals from anterior communicating artery) groups, and compared their baseline characteristics and outcomes. RESULTS: The STO group (n=58) showed smaller infarct volumes at 72 hours than the CTO group (n=34) (median, 81 mL [interquartile range, 38-192] vs. 414 mL [193-540], P<0.001) and more favorable outcomes (3-month modified Rankin Scale 0-3, 44.8% vs. 8.8%, P<0.001; 3-month mortality, 24.1% vs. 67.6%, P<0.001). In multivariable analyses, STO remained an independent predictor for favorable outcomes (odds ratio 6.1, P=0.010). CONCLUSIONS: Favorable outcomes in STO group suggested that the outcomes of acute ICA terminus occlusions depend on Willisian collateral status. Documenting the subtypes on computed tomographic angiography would help predict patient outcome.
Angiography ; Anterior Cerebral Artery ; Carotid Artery Thrombosis ; Carotid Artery, Internal ; Cerebral Infarction ; Circle of Willis ; Collateral Circulation ; Endovascular Procedures ; Humans ; Mortality ; Posterior Cerebral Artery ; Retrospective Studies