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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A total of 289 carotid endarterectomies were performed in 204 patients. A decision to place a temporary shunt during carotid endarterectomy in this series was made entirely on the basis of intraoperative EEG monitoring. Retrospectively, the correlation between stump pressures and the results of intraoperative EEG monitoring in each case was determined. Evidence of ischemia developed in 6% of the total series on intraoperative EEG monitoring despite a stump pressure of greater than 50 mm Hg. The degree of disagreement between stump pressure and EEG varied according to clinical category in this series. In those endarterectomies performed for completed stroke, all cases requiring shunting had stump pressures less than 50 mm Hg. In those cases performed for symptoms of vertebral basilar insufficiency, however, 77% of the cases requiring an intraoperative shunt had stump pressures greater than 50 mm Hg. A review of the complication rate in the various study groups indicates that the use of intraoperative EEG is a safe indicator of cerebral ischemia during carotid endarterectomy regardless of stump pressure.
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PMID:Failure of carotid stump pressures. Its incidence as a predictor for a temporary shunt during carotid endarterectomy. 53 56

Ninety seven patients (mean age: 58 years) with lesions involving the subclavian artery were studied to determine the relationship between clinical symptoms, angiographic lesions and Doppler-detected hemodynamic disorders. Ninety patients had vertebro-basilar insufficiency (VBI) and 7 had hemispheric manifestations or upper limb ischemia. Of the 105 lesions of the subclavian artery, we observed 76 stenoses greater than 50% and 29 complete occlusions. Thirty seven patients presented a unilateral subclavian lesion and 63 multiple lesions. Doppler examination of the vertebral artery including an upper limb hyperaemic test allowed classification of the patients into three stages: stage 1 "pre-subclavian steal" (35 patients): sudden decrease in the systolic vertebral flow with complete interruption during hyperaemia; stage 2 "intermittent subclavian steal" (18 patients): transient inversion of vertebral during systole with permanent inversion for 1 or 2 minutes after hyperaemia; stage 3 "permanent subclavian steal" (33 patients): complete inversion of the vertebral flow without diastolic flow and increase of flow during hyperaemia. The clinical, hemodynamic and angiographic findings were compared. In stage 1, 65.7% of the patients presented severe VBI (at least two signs) and 66% had a 50 to 70% stenosis of the subclavian artery. In stage 2, 66.6% of the patients presented severe VBI and 78% had a 75 to 95% stenosis. In stage 3, 72.7% of the patients had severe VBI and 73% had either subtotal or complete occlusion of the subclavian artery. There was no correlation between the severity of VBI and the hemodynamic stages but a strong correlation between the hemodynamic grades and the anatomical lesions.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Subclavian artery stenosis: hemodynamic aspects and surgical outcome. 193 24

Four cases of basilar artery occlusion with a follow-up from 7 to 12 years are reported. The first patient, a 60 year old woman, had a proximal occlusion which was revealed by an acute brain stem ischemia. The second case was a 63 year old man with an aortic aneurysm who had a single episode of vertebro-basilar insufficiency. Cerebral angiography demonstrated a lower basilar artery occlusion. The third patient, a 60 year-old woman, had been operated from right carotid artery and left vertebral artery stenosis; 8 years later, without clinical manifestations, a left carotid artery stenosis and an occlusion of the lower part of the basilar artery were discovered. The evolution was eventless after a left carotid endarterectomy. The last case was a 60 year old man who had a lower basilar artery occlusion associated with a left internal carotid occlusion. There was a full recovery after a hemiplegic stroke. From our personal cases and the review of the literature, long term survival after basilar artery occlusion may occur in occlusions restricted to the lower or middle part of the basilar artery and with a good collateral supply from carotid and cerebellar arteries.
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PMID:[Long term survival after basilar artery occlusion. 4 cases]. 259 68

A broad range of neuro-ophthalmologic signs occurs with the rostral basilar artery syndrome (RBAS) and transient ischemia or infarction of the midbrain, thalamus, hypothalamus, paramedian diencephalon, and posterior temporal and occipital lobes. The pattern of affected neuroanatomic regions results in diverse patterns of interrelated functional disabilities in the areas of vertical gaze, nystagmus, oculomotor function, pupillary reactivity, visual fields, color vision, and visual illusions. With increasing recognition of more clinically benign forms of RBAS, it has become apparent that the vascular syndrome is often improperly diagnosed and may be associated with remediable occult medical disorders. To facilitate the acquisition of accurate diagnostic and therapeutic information, neuro-ophthalmologic signs were prospectively assessed in 61 patients with RBAS. The clinicoanatomic correlates of these diverse ocular manifestations are presented.
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PMID:The neuro-ophthalmologic spectrum of the rostral basilar artery syndrome. 341 27

A 5-year experience with 562 carotid endarterectomies, using electroencephalogram (EEG) monitoring and selective shunting, was reviewed. EEG changes occurred in 102 patients (18%). The frequency of EEG changes, as related to cerebral vascular symptoms, was as follows: transient ischemic attacks, seven per cent (19/259); completed strokes, 37% (36/98); vertebral basilar insufficiency, 24% (32/135); asymptomatic, 21% (15/71). Patients with contralateral carotid occlusion exhibited EEG changes in 37% (28/76) of operations. Fifteen patients suffered perioperative strokes (2.6%). Nine of the 15 were associated with a technical problem of either thrombosis of the internal carotid artery (five) or emboli (four). Technical problems were more common when shunts were used (five per cent) than when they were not (0.9%). Patients who suffered strokes prior to surgery were more at risk to develop a perioperative stroke (three per cent) than those not suffering prior strokes (0.3%). The EEG did not change in three patients who had lacunar infarcts prior to surgery and who awoke with a worsened deficit. Our series does not clearly establish the advantages of EEG monitoring, which is expensive (+375/patient) and may not detect ischemia in all areas of the brain. However, the use of shunts may introduce a risk of stroke due to technical error that is equal or greater than the risk of stroke due to hemodynamic ischemia. Since the need for protection is unpredictable by angiographic or clinical criteria, the benefit of EEG monitoring may be in reducing the incidence of shunting in those patients whose tracing remains normal after clamping. The decision to shunt, however, when there is electrical dysfunction after carotid clamping should be based not only on the EEG but also on the clinical signs and computed tomography (CT) scan. Our data does not show a net benefit in selective shunting unless the patient has sustained a stroke prior to surgery.
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PMID:Benefits, shortcomings, and costs of EEG monitoring. 392 54

Manual compression of the vertebral artery is used in routine clinical practice for diagnosis of positional hemodynamic vertebro-basilar insufficiency (VBI). The supraclavicular and suboccipital areas were carefully dissected in 20 cadavers. Anatomical variations observed on dissection were compared to angiographic data from 150 patients and data from the literature. Objective results of manual compression of the vertebral artery can be obtained by sonography. In patients with VBI, such compression induces signs of reversible cerebellar or brain stem ischemia, whereas no signs are observed in patients without VBI.
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PMID:Anatomical study of digital compression of the vertebral artery at its origin and at the suboccipital triangle. 404 Dec 76

The natural history of extracranial cerebrovascular disease and available alternatives in its treatment are reviewed. An evaluation of the evidence suggests that carotid endarterectomy is the treatment of choice in patients with transient ischemic deficits, provided that an anatomically appropriate lesion can be identified. These patients have a 25-38% chance of stroke if untreated, which can be reduced to 5-10% by carotid endarterectomy. Patients with asymptomatic carotid stenosis who are good operative risks are also candidates for surgery, although this issue remains controversial. Patients with small asymptomatic ulcerated carotid plaques have a relatively benign prognosis and should not undergo preventive carotid surgery. Carotid surgery is occasionally indicated in patients with vertebral basilar insufficiency and carotid stenoses, fibromuscular dysplasia, or carotid kinks associated with symptoms of ischemia. Carotid endarterectomy may be performed with an overall mortality of 1-2% and morbidity of 2-5% if the patients are carefully selected and the surgical team is expert.
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PMID:The current status of carotid artery surgery. 709 1

The incidence of subclavian steal syndrome is poorly documented in recent literature; however, there is general agreement that it is a relatively uncommon diagnosis. The actual occurrence of a subclavian steal is more common than the associated syndrome. Symptoms of arm ischemia and vertebral-basilar insufficiency secondary to a subclavian steal can become quite disabling in some patients. Through astute observation and assessment, nurses may be the first to identify a patient with subclavian steal syndrome. Subclavian steal may be identified by nurses during routine history and physical examination. All patients initially seen with discrepant arm blood pressures or a diminished or weakened radial pulse unilaterally should have the diagnosis of subclavian steal considered during their evaluation. In addition, patients with vertebral-basilar symptoms or arm ischemia should have the diagnosis of subclavian steal ruled out. This article presents a review of the history, pathogenesis, current treatment modalities, and nursing care of patients with a subclavian steal.
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PMID:Subclavian steal syndrome: a review. 870 95

We investigated the efficiency of analysis by magnetic resonance imaging (MRI) in cases of hemodynamic vertebro-basilar insufficiency (VBI). We enrolled 76 cases of hemodynamic VBI who had visited our clinic in the Department of Otolaryngology, Nara Medical University, from 1994 to 1996. The evaluation of MRI was classified according to the degree of ventricular dilatation, callosal degeneration, and lacunar infarction, and the evaluation of MR angiography (MRA) was classified according to the degree of pathological change of the blood vessels. There was a significant difference in lacunar infarction on the MRI findings between VBI cases and normal controls, and there were also significant differences in side differences in the vertebral artery between VBI cases and peripheral vertigo and normal control patients. We propose an etiology for hemodynamic VBI: a functional cerebral circulation disorder causes ischemia of the basal ganglia and leads to lacunar infarctions; furthermore, the side difference between the two vertebral arteries causes a circulation disorder in the vertebrobasilar system.
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PMID:Magnetic resonance imaging (MRI) test in hemodynamic vertebro-basilar insufficiency. 965 13

In case of changes occurring within the extracranial sections of the common and internal carotid artery the operative procedure has become a generally accepted surgical method. Another reason of brain ischemia is the vertebro-basilar insufficiency caused by external pressure on the vertebral artery in a channel formed by transverse processes of cervical vertebrae. The author presents the clinical experience with 54 cases that have been treated surgically from 1994 to 2003 due to the above mentioned reasons. In all patients an anastomosis between the distal vertebral artery and external carotid artery gave good or very good results.
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PMID:[Long-term results of operative treatment of the vertebro-basilar syndrome]. 1648 2


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