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To diagnose VA dissection, MRA or cerebral angiography, which provides information regarding intra-vascular space, has been performed. We report the acquisition of various information about VA dissection using MRI-BPAS, which is a new diagnostic method.

Contralateral carotid artery occlusion is thought to represent a significant risk factor in carotid endarterectomy (CEA). There is also evidence that intraoperative and postoperative hypotention may cause contralateral hemodynamic ischemia. As such, contralateral carotid artery occlusion is regarded as a risk factor for carotid angioplasty and stenting (CAS). In this paper, we report on five cases of severe ICA stenosis with contralateral carotid artery occlusions. Cerebral blood flow(CBF) and cerebral vasore-activity(CVR) of the contralateral carotid artery occlusions were measured before and after CAS. Additionally, the influence that ipsilateral CAS exerted on the occluded side was examined.123I-IMP SPECT was performed before and after CAS, both at rest and at the time of acetazoramide administration. The CBF was evaluated quantitatively using the ARG method. The mean CBF of the treated side rose from 30.0 ± 7.1 ml/100g/min to 34.4 ± 8.3 ml/100g/min (p<0.05), and the mean CBF of the occluded side similarly rose from 28.3 ± 6.1 ml/100g/min to 31.7 ± 6.4 ml/100g/min (p<0.05). Correspondingly, the regional CVR (rCVR) increased from 5.9% ± 16.3% to 35.0% ± 16.4%(p<0.05) on the treated side, and from 3.7% ± 14.7% to 10.7% ± 16.9% (p<0.05) on the occluded side.This demonstrates that ipsilateral CAS seems to improve both CBF and CVR on the contralateral occluded side. The fact that some cases developed cross flow from the anterior communicating artery was both remarkable and significant. Where there was poor cross flow from the anterior communicating artery, improvement in cerebral vaso reactivity was limited.

To examine the long term results of endovascular treatment of cerebral aneurysms with the Guglielmi detachable coil (GDC) system, follow-up (F/U) angiography was performed at 6, 12 and 24 months after the procedure. We analyzed 45 cases, 49 procedures of GDC treated cerebral aneurysms from 1997.6. to 2000.5. Follow-up angiography was achieved at 6M 43/45 (96%), 12M 29/33 (87%) and 24M 22/25 (88%). Angiographical changes were found 23/43 (53%) of the cases at 6M F/U. There were angiographical improvements in 12 cases (CP: complete occlusion, NR: neck remnant, PA: partial occlusion, PA-CP; 8, NR-CP; 1, PA-NR; 3) and angiographical worsening in 11 cases (CP-NR; 5, CP-PA; 3, PA-PA; 3) at 6M F/U. Two cases had been demonstrating progressive angiographical worsening at 6M and 12MF/U (CP-NR-PA). No angiographical change was found at 24MF/U. There was no case of hemorrhage or re-hemorrhage after GDC treatment. In cases of side-wall aneurysm, tight packing of the inflow side of the aneurysm and small neck aneurysm were thought to be causes of the angiographical improvements. In patients with wide neck aneurysms with partial occlusion result were angiographic worsening at the F/U. Other factors of angiographical worsening were improper working angle at the procedure and improper follow-up angle at the angiography and the intraluminal clot in the case of ruptured aneurysm.

We summarize our clinical experience of the local fibrinolysis for the middle cerebral artery (MCA) embolism. We added residual CBF factors of the ischemic territories to the usual criteria for the indication of fibrinolysis by Xe-SPECT CBF measurement. Forty-nine cases of local fibrinolysis for MCA embolism were reviewed and the results were compared with the conservative medical treatment cases.Angiographical improvements were achieved in 38 cases (76%, full reopening 17/49, partial reopening 21/49) and favorable outcomes (good recovery at GOS) were obtained in 32 cases (65%) at three months follow-up outcome. In comparison with the conservative medical treatment, fibrinolysis was superior at good recovery rate, severe disability rate and the resulted large infarction rate with statistical significance.We concluded that the local fibrinolysis with evaluation of the residual CBF of the ischemic territories achieved good results and outcomes and superior to the conservative medical treatment at some points. To keep the therapeutic time window, it is necessary to include the CBF factor to the criteria for the indication of this treatment.

A case of multiple segmental agenesis of the cerebral arteries is presented. Cerebral angiography demonstrated bilateral so-called carotid rete mirabile, a similar “rete” of the right vertebral artery and intradural duplication of the left vertebral artery. These abnormalities are thought to be caused by multiple segmental agenesis of the cerebral arteries as they penetrate the dura mater. the embryological and anatomical significance of these findings is discussed.

Contralateral carotid artery occlusion is thought to represent a significant risk factor in carotid endarterectomy (CEA). There is also evidence that intraoperative and postoperative hypotention may cause contralateral hemodynamic ischemia. As such, contralateral carotid artery occlusion is regarded as a risk factor for carotid angioplasty and stenting (CAS). In this paper, we report on five cases of severe ICA stenosis with contralateral carotid artery occlusions. Cerebral blood flow(CBF) and cerebral vasore-activity(CVR) of the contralateral carotid artery occlusions were measured before and after CAS. Additionally, the influence that ipsilateral CAS exerted on the occluded side was examined.123I-IMP SPECT was performed before and after CAS, both at rest and at the time of acetazoramide administration. The CBF was evaluated quantitatively using the ARG method. The mean CBF of the treated side rose from 30.0 ± 7.1 ml/100g/min to 34.4 ± 8.3 ml/100g/min (p<0.05), and the mean CBF of the occluded side similarly rose from 28.3 ± 6.1 ml/100g/min to 31.7 ± 6.4 ml/100g/min (p<0.05). Correspondingly, the regional CVR (rCVR) increased from 5.9% ± 16.3% to 35.0% ± 16.4%(p<0.05) on the treated side, and from 3.7% ± 14.7% to 10.7% ± 16.9% (p<0.05) on the occluded side.This demonstrates that ipsilateral CAS seems to improve both CBF and CVR on the contralateral occluded side. The fact that some cases developed cross flow from the anterior communicating artery was both remarkable and significant. Where there was poor cross flow from the anterior communicating artery, improvement in cerebral vaso reactivity was limited.

We summarized our clinical experience of thrombolytic therapy for cerebral embolism to evaluate the relation between the prognosis and the occlusion site, and the role of pre-treatment CBF measurement for supratentorial cerebral embolism.56 cases of thrombolysis were analyzed and results were compaired with conservative medical therapy group. For ICA embolism, we stopped thrombolysis in the early period because of its poor collateral circulation. MCA embolism seemed to be a good candidate for this treatment and results were significantly better than the conservative medical therapy group in good recovery rate, severe disablity rate and large size infarction rate. In basilar artery embolism, thrombolysis seemed to be the most effective treatment in spite of the high mortality rate.Pre-treatment CBF measurement was important and useful to estimate the severity of ischemia, and it could make it possible to avoid severe hemorrhagic complications.