We aimed to evaluate whether virtual non-contrast cerebral computed tomography (VNCCT) reconstructed from intravenous contrast-enhanced dual-energy CT (iv-DECT) could replace non-contrast CT (NCCT) in patients with suspected acute cerebral ischemia.
Bilateral and simultaneous occlusion of the anterior circulation is a rare event in patients with acute ischemic stroke. Although endovascular treatment is feasible and safe, the endovascular strategy to be used remains a subject of debate.To assess the different endovascular strategies proposed for the treatment of a bilateral, simultaneous anterior circulation occlusion following acute ischemic stroke.We present a retrospective study of the clinical and radiological records of all patients with a bilateral, simultaneous anterior circulation occlusion treated at our center between January 2019 and December 2022. Following the PRISMA guidelines, we also conducted a systematic review of the literature.Two patients with a bilateral and simultaneous middle cerebral artery occlusion were treated at our center during the study period. A TICI score ≥2b was obtained in 4 out of 4 occlusions. Modified Rankin Scale (mRS) at 90 days was 0 and 4, respectively. The literature review retrieved reports on 22 patients. The most frequent bilateral occlusion sites were internal carotid artery-middle cerebral artery. The clinical presentation was severe in most patients. A combined thrombectomy technique proved to have the highest number of first-pass recanalization. A TICI ≥2b was obtained in 95% of patients and an mRS ≤2 was found in 31.8% of patients.In patients with bilateral and simultaneous occlusion of the anterior circulation, endovascular treatment using a combined technique appears to be rapid and effective. The clinical evolution of this patient population strongly depends on the severity of the onset symptoms.
A posterior perforating artery originating from the dome of a basilar tip aneurysm is reported. The exact origin of this perforator was identified by selective aneurysmography only. This observation provides an argument favoring the consideration of aneurysmographic studies before treatment of large aneurysms located in proximity to areas of normal perforating arteries.
Current available minimal invasive endovascular technology allows for percutaneous treatment of cerebral aneurysms and of vasospasm, the associated disease fo cerebral arteries secondary to subarachnoid hemorrhage. Multicentric evaluation of standardized treatment techniques using platinum coils have shown that a high success rate is now obtained for certain forms of aneurysms, mostly those which have a small base (4 mm or less) of implantation of the vessel. Treatment of arterial vasospasm by techniques including angioplasty using soft silicon balloons, or intraarterial application of spasmolytics, or both may be very successful, when performed prior to establishment of irreversible ischemic damage to the brain tissue. An intensive patient monitoring during the posthemorrhagic period is therefore critical for the correct timing of such a procedures.
Unusual caudal terminations of the inferior petrosal sinus (IPS) characterized by an extracranial extension joining the internal jugular vein up to 40 mm below the external skull base are reported. This variation was observed bilaterally on an anatomical specimen and unilaterally on four patients during diagnostic cerebral angiography. It may be considered an accessory internal jugular vein and, if present, may allow for an alternate endovascular access to the IPS.
Preoperative angiography of the coeliac trunk and superior mesenteric artery is routinely performed before liver resections and transplantations. For this purpose, it is usual to inject each branch of the coeliac trunk separately. Selective angiographic studies, however, may lead to overlooking surgically essential anatomic variations of the hepatic blood supply, as demonstrated by the present report. A case of a duplicated hepatic artery is presented, its radiologic and surgical implications discussed, and the relevant literature reviewed. This uncommon and particularly evocative feature illustrates the clinical importance of a sound knowledge of anatomical variants.
