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

Four patients with symptoms and signs of brain stem ischemia due to occlusive disease of the vertebrobasilar system and one patient with similar cerebrovascular disease who was thought to be prone to brain stem stroke underwent a microvascular anastomosis between the occipital artery and the caudal loop of the posterior inferior cerebellar artery. There was no morbidity of mortality and neurologically all patients improved. Post-operative angiograms showed patent anastomosis in all the patients and improved circulation in three. This new operation may prove beneficial in a selected group of stroke patients who suffer from vertebrobasilar insufficiency and cannot be treated with gross surgical techniques.
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PMID:Possible prevention of brain stem stroke by microvascular anastomosis in the vertebrobasilar system. 87 Oct 22

In 6 patients with vertebrobasilar insufficiency (VBI), precordialgia and autonomic-nervous-system manifestation such as diaphoresis and tachycardia were associated with the symptoms of VBI. Investigation ruled out cardiac and gastrointestinal causes. Possible mechanisms are discussed on the basis of intermitent ischemia of the central autonomic centers supplied by the posterior circulation.
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PMID:Precordialgia as a manifestation of vertebrobasilar insufficiency. 90 46

The origin of the vertebral artery is a frequent site for the development of stenosing lesions. The flow deficit caused by the stenosis of one vertebral artery is normally compensated for by intracranial anastomosis between the carotid and basilar arteries or by the opposite vertebral artery. A number of patients, however, have inadequate intracranial anastomosis and hypoplasia or stenosis of the opposite vertebral artery, and symptoms of brain ischemia develop. We describe here four cases in which a new technique, a subclavian vertebral artery autogenous vein bypass graft, was used to deal with the diseased segment of the vertebral artery. Transient postoperative problems included lymphocele and Horner syndrome. All four bypasses were patent at the time of angiography one week postoperatively. All four patients were relieved of symptoms of vertebrobasilar insufficiency.
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PMID:Vertebral artery bypass. 94 61

30 patients with megadolichobasilar artery, explored by angiography, are reported; 23 among them were first studied by computerized tomography and 4 by magnetic resonance. From the clinical point of view, 9 had transient ischemic attacks or definitive ischemia, 7 had subarachnoid or intracerebral hemorrhage, and 7 had deficits of the cranial nerves; in the other 7 cases the condition was incidentally discovered as isolated asymptomatic anomaly or with other unrelated lesions. Among the patients with ischemic symptoms, vertebrobasilar insufficiency and pontine infarction were the most common clinico-radiological findings. Among the patients with intracranial hemorrhage, four had associated aneurysm or arteriovenous malformations. CT and MR allow a correct diagnosis of this anomaly. MR seems to be superior to CT in delineating the relationship of the anomalous artery with the nervous structures, and the coexisting pathology.
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PMID:Megadolichobasilar anomaly. Clinical and diagnostic considerations on 30 cases. 129 2

From 1980 to 1990, 18 patients underwent trans-sternal repair for occlusive disease of the brachiocephalic artery. The mean age was 57 years (43-72). Most of the patients were women (n = 10). All but two patients had one or more symptoms related to the stenosis of the brachiocephalic trunk: right-sided upper limb ischemia (n = 7), transient ischemic attacks (n = 8), vertebrobasilar insufficiency (n = 6), left sided minor stroke (n = 1). Only two patients were asymptomatic before operation. Angiography revealed a tight stenosis (n = 14) or an occlusion (n = 3); in one patient it concerned an ulcerated non-stenotic plaque of the brachiocephalic artery. Eleven patients had coexistent involvement of other supraaortic vessels. Angiographically, clinically and intraoperatively, there was evidence of Takayasu arteritis in three female patients. All patients had direct repair by trans-sternal approach. Six patients with short lesions had thromboendarterectomy with patch angioplasty of the innominate artery. In eleven cases, aorto-brachiocephalic bypass grafting was performed. In one patient, aortic calcification precluded proximal anastomosis, and a carotid-to-carotid bypass was done. In five patients, simultaneous revascularization of subclavian (n = 3), left common carotid (n = 2) or internal carotid artery (n = 2) completed the procedure. In one patient, concomitant coronary revascularization was done. There was no operative mortality. Postoperative morbidity was limited to pulmonary infection (n = 2), transient neurologic deficit (n = 1) and renal insufficiency (n = 1). All patients had relief of symptoms. Duplex echo scan confirmed patency of all reconstructions at a mean follow-up of 46 months.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Brachiocephalic arterial reconstruction. 155 48

To determine whether flow through the subclavian artery might be affected during extracorporeal membrane oxygenation (ECMO), 40 neonates were examined with color Doppler ultrasound during and after ECMO. Retrograde flow in the right vertebral artery, noted in 12 of the 40 neonates (30%), was consistent with vertebral steal. Brachial systolic velocity was significantly less (P less than .01) on the right than on the left side in neonates both with and without vertebral steal. When the arterial cannula was removed after ECMO, vertebral artery flow became antegrade with symmetric velocity. Brachial velocities became symmetric in infants without vertebral steal, but mild asymmetry persisted in neonates who had had vertebral steal. Only one neonate had clinical signs of arm ischemia, which resolved promptly after removal of the cannula. No surviving neonates (n = 11) had neurologic findings related to the vertebrobasilar insufficiency over a 12-22-month period of observation. Vertebral steal appears to be common during ECMO and is resolved after removal of the cannula.
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PMID:Cannula-induced vertebral steal in neonates during extracorporeal membrane oxygenation: detection with color Doppler US. 173 74

A 59-year-old hypertensive patient presented with transient global amnesia without neurological signs or symptoms. During the following 3 years, he experienced several attacks of vertebrobasilar insufficiency and a cerebellar infarction. CT scan and MRI found a partially thrombosed dolichoectatic basilar artery but no significant lesion within the limbic system. These data suggest transient global amnesia was due to a transient ischemia in the basilar artery distribution.
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PMID:Transient global amnesia followed by vertebrobasilar ischemia in a case of dolichoectatic basilar artery. 208 87

From August 1979 to August 1989, carotid-subclavian bypass or transposition procedures were performed on 18 women and 13 men ranging in age from 19 to 75 (mean, 58.2) years. Indications for surgery included symptoms of vertebrobasilar insufficiency in 16 (52%), upper extremity ischemia in six (19%), both vertebrobasilar insufficiency and extremity ischemia in four (13%), and stroke and/or hemispheric transient ischemic attacks in four (13%) patients. One patient (3%) had angina pectoris caused by "coronary-subclavian steal." Formal bypass grafts were performed in 28 (90%) cases by means of polyterafluoroethylene (24), Dacron (2), or saphenous vein (2), and carotid-subclavian transposition was performed in three (10%) cases. Synchronous procedures included carotid endarterectomy (4), carotid-carotid bypass (1), and axillobrachial bypass (1). There was no operative mortality. Thirty-day primary patency was 97%. Follow-up has ranged from 1 to 121 (mean, 42) months. Three grafts (polytetrafluoroethylene) have occluded during follow-up yielding long-term primary patency of 92% at 5 years and 83% at 8 years. Relief of symptoms was initially achieved in 30 (97%) patients. Recurrent symptoms have developed in six (20%) patients from 2 to 55 (mean, 26) months after surgery, including two with occluded and four with patent grafts. Symptom-free survival is 89% at 1 year, 84% at 2 years, and 71% at 7 years of follow-up. Six patients have died during follow-up yielding overall survival of 88% at 5 years, and 48% at 10 years.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Carotid-subclavian bypass--a decade of experience. 214 42

Symptoms compatible with vertebrobasilar ischemia have been reported in patients with unilateral or bilateral carotid occlusive disease. Intracranial steal phenomena have been proposed to explain the symptoms. In a review of 54 patients with angiographically documented severe bilateral carotid stenosis (less than or equal to 2 mm residual lumen) or occlusion, eight had symptoms suggesting vertebrobasilar insufficiency. Five patients were identified retrospectively, and the other three were evaluated prospectively. Symptoms included various combinations of hemodynamically mediated, transient bilateral motor, sensory, or visual impairment. Dysarthria, dysphagia, and diplopia were generally absent. Each patient also described additional symptoms compatible with transient hemispheric or retinal ischemia. The anatomic regions subserving the bilateral vertebrobasilar-like symptoms could be correlated with angiographically estimated arterial border zones in both hemispheres and may thus represent bilateral hemispheric border zone ischemia rather than brain stem ischemia. An intracranial steal need not be invoked.
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PMID:The syndrome of bilateral hemispheric border zone ischemia. 226 72

The authors' initial experience with intracranial revascularization of vertebrobasilar insufficiency, reported previously, fortunately yielded reasonably good results with high patency rates but in some cases there were significant, albeit temporary, complications. Since that time, major brain-stem strokes have occurred in two patients following superficial temporal to superior cerebellar artery bypass procedures. This occurrence has caused the authors to reassess their experience with this procedure and review the published literature with regard to complications. This review and the results of the international bypass study on anterior circulation ischemia suggest that a very cautious and conservative approach should be taken prior to considering intracranial bypass to the superior cerebellar or posterior cerebral artery.
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PMID:Complications of intracranial bypass for vertebrobasilar insufficiency. 264 87


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