Journal of neuroimaging : official journal of the American Society of Neuroimaging
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Observational Study
Black blood MRI in suspected large artery primary angiitis of the central nervous system.
Single case reports suggest that black blood MRI (T1-weighted fat and blood suppressed sequences with and without contrast injection; BB-MRI) may visualize intracranial vessel wall contrast enhancement (CE) in primary angiitis of the central nervous system (PACNS). In this single-center observational pilot study we prospectively investigated the value of BB-MRI in the diagnosis of large artery PACNS. ⋯ Our pilot study demonstrates that vessel wall CE is a frequent finding in PACNS and its mimics. Larger trials will be necessary to evaluate the utility of BB-MRI in the diagnostic workup of PACNS.
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Basilar artery fenestration aneurysms are rare aneurysms, posing unique challenges for endovascular treatment. We report a case of successful treatment of a wide-necked basilar artery fenestration aneurysm with a novel double-barrel stent-assisted coiling technique. ⋯ In the case presented, a double-barrel stent configuration enabled dense coil embolization of the aneurysm as well as preservation of both basilar fenestration limbs and both distal vertebral arteries.
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Comparative Study
Occurrence and prognostic significance of cervical pseudodissection phenomenon associated with acute intracranial internal carotid artery occlusion.
Acute stroke from intracranial internal carotid artery (ICA) occlusion can occasionally resemble angiographic cervical ICA dissection which may cause delays in endovascular acute ischemic stroke treatment. ⋯ Early recognition of pseudodissection in the ICA is important in the setting of acute ischemic stroke to avoid delay in treatment of intracranial ICA occlusion.
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Case Reports
Cerebral embolus following chiropractic manipulation in a patient with a calcified carotid artery.
Dissection of the cervicocranial vessels is the principal cause of ischemic brain injury following cervical spinal manipulation. Cervical spinal manipulation leading to cerebral embolus in the absence of dissection is not described in the literature. Current case documents cerebral embolism originating from extensively calcified internal carotid artery immediately following cervical spinal manipulation in the absence of dissection. ⋯ Calcified carotid artery may be at risk for embolization following cervical spinal manipulation. Our recommendation is that, patients with extensively calcified carotid arteries should refrain from aggressive neck maneuvers and cervical spine manipulation therapy to avoid liberation of cerebral embolus.
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We describe a novel technique for cerebral embolic device placement with inadvertent entrapment and subsequent rescue in the endovascular treatment of innominate artery stenosis. A 62-year-old female presented with symptomatic right-sided subclavian steal syndrome. Single-site access for revascularization of critical innominate artery stenosis with simultaneous cerebral embolic protection performed for this diagnosis has not been previously reported. ⋯ The device was retrieved through snare fixation and resheathing within a 6-French guide catheter navigated through common femoral artery access. Innominate artery balloon-mounted stent angioplasty was performed preceded by the embolic device retrieval, with complete resolution of symptoms. Endovascular distal protection device placement for prevention of cerebral atherothromboembolism during innominate artery stent angioplasty is not without risk and utilization needs to be carefully considered.