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Francisco José Arruda Mont`Alverne,Fabricio Oliveira Lima,Felipe de Araújo Rocha,Diego de Almeida Bandeira,Adson Freitas de Lucena,Henrique Coelho Silva,이진수,Raul Gomes Nogueira 대한뇌졸중학회 2020 Journal of stroke Vol.22 No.2
The benefit of mechanical thrombectomy (MT) in acute ischemic stroke (AIS) due to large vessel intracranial occlusions is directly related to the technical success of the procedures in achieving fast and complete reperfusion. While a precise definition of refractoriness is lacking in the literature, it may be considered when there is reperfusion failure, long procedural times, or high number of passes with the MT devices. Detailed knowledge about the causes for refractory MT in AIS is limited; however, it is most likely a multifaceted problem including factors related to the vascular anatomy and the underlying nature of the occlusive lesion amongst other factors. We aim to review the impact of several key unfavorable anatomical factors that may be encountered during endovascular AIS treatment and discuss potential bail-out strategies to these challenging situations.
Endovascular Treatment of Large Vessel Occlusion Strokes Due to Intracranial Atherosclerotic Disease
Jin Soo Lee,Seong-Joon Lee,Ji Man Hong,Francisco José Arruda Mont`Alverne,Fabricio Oliveira Lima,Raul G. Nogueira 대한뇌졸중학회 2022 Journal of stroke Vol.24 No.1
Mechanical thrombectomy (MT) has become the gold-standard for patients with acute large vessel occlusion strokes (LVOS). MT is highly effective in the treatment of embolic occlusions; however, underlying intracranial atherosclerotic disease (ICAD) represents a therapeutic challenge, often requiring pharmacological and/or mechanical rescue treatment. Glycoprotein IIb/IIIainhibitors have been suggested as the best initial approach, if reperfusion can be achieved after thrombectomy, with angioplasty and/or stenting being reserved for the more refractory cases. In this review, we focus on the therapeutic considerations surrounding the endovascular treatment of ICAD-related acute LVOS.
Alessandra Braga Cruz Guedes de Morais,George Nilton Nunes Mendes,Ana Silvia Sobreira Lima Verde,Adson Freitas de Lucena,Francisco José Arruda Mont’Alverne,Fabricio Oliveira Lima,Fernanda Martins Maia 대한신경초음파학회 2023 대한신경초음파학회지 (JNN) Vol.15 No.2
A 40-year-old male presented an episode of severe thunderclap headache with right hemiparesis. Imaging revealed severe stenosis in the left middle cerebral artery, associated with increased mean velocities detected by Transcranial Doppler Ultrasound (TCD). Notably, a distinctive "tin whistle" sound, known as a doppler harmonic effect, near the highest velocity point was observed during the examination. Extensive workup was performed, including CSF analysis and laboratory investigations, and the diagnosis of Reversible Cerebral Vasoconstriction Syndrome (RCVS) was established. Treatment involving medication and daily monitoring led to a decline in the left MCA's velocity, enabling the patient's discharge with no recurrent headaches or neurological deficits. Notably, a follow-up MRI exhibited the disappearance of the left MCA stenosis. This report discusses the rare occurrence of "musical murmurs" in cerebrovascular diseases, underscoring the potential for early diagnosis using techniques like TCD in emergency settings, particularly in conditions like RCVs.