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Introduction: Carotid artery stenting is an alternative interventional treatment to carotid endarterectomy. However, preprocedural considerations and anatomical risk factor analyses for carotid artery stenting are currently insufficient. Therefore, we investigated the high-risk anatomical appearance of carotid artery stenting from the neurointerventionist perspective to predict periprocedural complications. Materials and methods: We retrospectively reviewed patients with carotid stenosis who underwent carotid artery stenting at a comprehensive stroke center between January 2012 and December 2021. We compared the demographic characteristics, medical history, and anatomical appearance of the stenotic segment in patients with and without complications. Results: We analyzed a total of 148 patients (64 women [43.2%]; median age, 73.0 [interquartile range, 65.5-79.0]). Complications occurred in 39 of the 148 patients, primarily minor and transient. Of baseline or procedural characteristics, a high initial National Institutes of Health Stroke Scale score (p = 0.04), symptomatic stenosis (p = 0.01), and curve-centered plaque of the proximal ICA (p = 0.01) were significantly associated with carotid artery stenting complications in unadjusted analysis. Curve-centered plaque remained an independent risk factor for carotid artery stenting complications after adjustment (odds ratio 2.23[1.02-4.88], p = 0.04). Conclusion: High-risk vascular anatomical features, such as curve-centered plaque, are associated with a high frequency of periprocedural complications of carotid artery stenting. Tailored patient selection for carotid stenosis is crucial to prevent complications. Patients with curve-centered plaque should consider alternative treatment options such as carotid endarterectomy to achieve optimal clinical results. [ABSTRACT FROM AUTHOR]

The NeVa stent retriever is a newly designed mechanical thrombectomy device for the treatment of acute ischemic stroke caused by large vessel occlusion. We investigate the procedural characteristics and patients' clinical outcomes at discharge and at 90 days of follow-up. We retrospectively reviewed a cohort of 75 patients (median age, 74 years) treated with the NeVa device for acute large vessel occlusion stroke. Per pass modified Treatment in Cerebral Infarction (mTICI) scores, procedural complications, and clinical outcome parameters including the National Institutes of Health Stroke Scale (NIHSS) score, modified Rankin Scale (mRS) score, and mortality were analyzed, based on patients' electronic medical records. Complete first pass effect was observed in 24 patients (32%). Vasospasm, repeated re-thrombosis, failure to advance the NeVa device through the microcatheter, and symptomatic intracranial hemorrhage were observed in 2, 1, 1, and 2 patient(s) respectively. The rate of complete (mTICI 2c–3) reperfusion was achieved in 61 patients (81.33%), with a median number of 2 passes (1–3). Median NIHSS score on admission, after 24 hours, and after 5–10 days or at discharge was 19 (15–23), 11 (4–19), and 3 (2–13.5), respectively. The number of patients with a functional mRS score (0–2) at 90 days follow-up was 29 (39%). Endovascular stroke management with use of the NeVa-Vesalio stent retriever may be associated with a 90-day functional mRS score in nearly 40% of treated patients. [ABSTRACT FROM AUTHOR]

Introduction: Carotid body tumors (CBTs) are certainly unusual. They are vascular lesions originating from paraganglionic cells, located at the common carotid artery (CCA) bifurcation. They represent less than 0.5% of head and neck tumors, approximately 1-3 cases per million. Malignant CBTs are extremely rare; in the literature, published rates on average are < 10%. The diagnostic criteria for malignancy should be based on the finding of distant metastasis. Due to its unpredictable nature and its malignant potential, diagnosis before metastasis and complete surgical resection are the keys to a favorable prognosis. Case Report: Given little experience in CBTs, its biology and treatment remain uncertain. We present the case of a 48-years-old patient, with a mass on the left side of the neck that was found to be a vast CBT with suspicious histopathology. Its size, rare location, pathologic findings, and management strategy applied for its treatment, illustrate an unusual case that highlights the importance of its publication. Conclusions: CBT is rare, but subject to cure lesion if resected without metastatic or residual disease. This is why surgery should be performed whenever possible and why it is so necessary to study this pathology thoroughly and to take it into account in the differential diagnosis. [ABSTRACT FROM AUTHOR]

Background: We have evaluated the feasibility of concomitant carotid angiography after coronary angiography with the same catheter, and the practicality, safety and success of image acquisition with respect to conventional catheters. Method: 248 patients have been enrolled in the study, who have been evaluated with both carotid and coronary angiography in a time period between 2010 and 2017. 117 of them were evaluated with right diagnostic catheters and 131 of them were evaluated with handmade S shaped (HMS) catheters. Basic parameters were similar in both of the groups. Total procedural time (7.34 +- 1.10 vs 9.56 +- 3.59 minutes, p < 0.001), fluoroscopy use time (6.08 +- 1.72 vs 5.23 +- 1.00 minutes, p < 0.001), used contrast media volume (50.2 +- 15.6 mL vs 62.3 +- 17.9 mL, p < 0.001) were all lower in the HMS catheter group. Conclusion: There is strong correlation between coronary and carotid artery disease (62%). Many Cardiologists perform concomitant carotid angiography when performing coronary angiography using right diagnostic catheters (JR). The JR catheters tip can be reshaped like to S to enhance its safety and efficacy during carotid imaging. Our experience supports this. Imaging of the carotid arteries is advantageous for the patients with severe coronary artery disease, when performing coronary angiography. For this purpose, the same catheter used for coronary imaging can be used after it is reshaped at hand, in place of a special catheter. This method is both efficient and safe.

Purpose: Duplex scanning is a useful noninvasive screening tool for the detection of carotid bifurcation disease. Internal carotid artery (ICA) peak systolic velocity (PSV) and ICA/common carotid artery (CCA) PSV ratios are proven metrics determining 70%-99% ICA stenosis. A potential disadvantage of using dramatically increasing systolic velocity measurements in areas of critical arterial stenosis is flow aliasing. Diastolic velocity should be less influenced by this flow artifact. We evaluate ICA and CCA end diastolic velocity (EDV) metrics in predicting severe ICA stenosis and document the prevalence of an aliasing artifact in a population of patients with critical ICA stenosis. Methods: Consecutive patients undergoing carotid duplex assessments and contrast angiography were compared (n = 140). ICA and CCA PSV and EDV were recorded as was evidence of the flow aliasing of ICA waveforms. ICA/CCA PSV and EDV ratios were calculated. Duplex parameters were compared with angiographic ICA measurements. Receiver-operator characteristic curve (ROC) analysis was used to determine optimal criteria to identify ICA stenosis of 70% to 99%. Results: Of 256 carotid bifurcation duplex studies, critical angiographic stenosis was present in 105 arteries. Only four completed arterial duplex scans demonstrated flow aliasing. In three of these patients, systolic metrics were non-diagnostic versus ICA/CCA EDV ratios. An ICA/CCA EDV ratio of 2.3 provided the best combination of sensitivity 73.8% and specificity 75.18%. Conclusion: ICA/CCA diastolic ratios reliably determine 70% or greater ICA stenosis. Flow aliasing infrequently complicates ICA PSV.

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Contrast-induced nephropathy (CIN) is acute kidney failure that occurs after exposure to contrast agent. There is no sensitive biomarker to predict the development of CIN. In a retrospective study, we investigated the predictive value of the fibrinogen to albumin ratio (FAR) to determine the risk of CIN in patients (N = 246) who underwent carotid angiography. Contrast-induced nephropathy was defined as a 0.5 mg/dL or 25% increase in serum creatinine levels 48 to 72 hours following exposure to a radiocontrast agent. Patients were grouped according to whether they developed CIN or not, that is, CIN(–) and CIN(+) groups, respectively. Contrast-induced nephropathy developed in 39 (15.8%) of all the patients. The fibrinogen levels, neutrophil to lymphocyte ratio (NLR), and FAR in the CIN (+) group were higher than in the CIN (−) group (P < .001). Multivariate analysis showed that age, diabetes, NLR, platelet–lymphocyte ratio, and FAR were independent risk factors for CIN. The area under the curve (AUC) of FAR was 0.800 for the prediction of CIN, and the best cutoff value was 57.4 with sensitivity, specificity, positive predictive value, and negative predictive value of 74.4%, 60.8%, 26.4%, and 92.7%, respectively. The FAR may be useful as a predictor of CIN. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the prevalence of incidental pulmonary embolism (IPE) in suspected stroke patients receiving carotid computed tomography angiography (CTA) and its characteristics.Materials and methods: A total of 4873 cases receiving carotid CTA between January 2013 and December 2016 were retrospectively reassessed by one radiologist. Patients with previous or suspected PE were excluded. The remaining prior contrast-enhanced carotid CTA studies were regarded as a “potentially incidental” IPE when a filling defect was found in one or more pulmonary arteries and subjected to the other two thoracic radiologists independently for reviewing and assessing for characteristics of the IPE and the image quality of the PE. The differences were noted between inpatients and outpatients in prevalence of IPE. Characteristics of the patients with IPE were also studied in terms of gender, age, as well as clinical indication.Results: The prevalence of IPE among these suspected stroke patients was 0.8% on carotid CT angiography, and 24 (96%) of all IPEs had not been previously diagnosed by the original reporting radiologists. Most of the IPEs were at the lobar or segmental levels, single and in right upper lobe of pulmonary arteries. In most of the cases, the reviewing radiologists judged the contrast bolus as good. The outpatient group had a lower percentage of patients with IPE when compared with the inpatient counterpart (p = 0.024). The prevalence of IPE in patients with suspected stroke was higher with the increasing of age (p = 0.013).Conclusions: IPE can occur in suspected stroke patients on carotid CT angiography, and most of them have been previously neglected in clinical practice. Radiologists should check the higher pulmonary arterial vasculature carefully on the contrast-enhanced carotid CTA scans. [ABSTRACT FROM AUTHOR]

Se describen 3 casos clínicos de pacientes ingresados en el Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba por sospecharse la presencia de aneurismas cerebrales, teniendo en cuenta las manifestaciones neurológicas que presentaban. Mediante los estudios de resonancia magnética y angiorresonancia realizados, se observaron las imágenes de la lesión vascular, las cuales fueron confirmadas por angiografía carotídea.Three clinical cases of patients admitted in "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba due to the suspicious presence of cerebral aneurysms are described, keeping in mind the neurological manifestations they presented. By means of the studies of magnetic resonance and angiographic resonance carried out, the images of the vascular lesion were observed, which were confirmed by carotid angiography.

Background: This study was conducted with an aim of assessing the angiographic incidence of carotid artery stenosis (CAS) in patients undergoing coronary angiography for the diagnosis of coronary artery disease (CAD). Methods: This single centre study included 50 patients with stable CAD or acute coronary syndromes, undergoing coronary angiography for diagnostic or therapeutic indications, who gave consent for concomitant carotid digital subtraction angiography (DSA). Significant CAD was defined as ≥ 50% diameter stenosis in at least one major coronary artery or its first order branches, and was categorized as single vessel disease (SVD), double vessel disease (DVD), or triple vessel disease (TVD) according to number of vessels involved. Significant CAS was defined as a diameter stenosis of ≥50% in the common carotid artery, the carotid bifurcation, or the internal carotid artery. For statistical analysis, patients were divided into two groups i.e. patients without or with CAS. Patient characteristics in these groups were then analysed and compared to each other. Results: The mean age of study group was 58.72 ± 9.03 years. Out of 50 patients studied 33 (66%) were males and 17 (34%) were females. Risk factors included hypertension, smoking, diabetes mellitus and dyslipidemia in 82%, 50%, 48% and 28% patients respectively. CAD was present in 62% patients; with 24%, 14% and 24% patients having SVD, DVD and TVD respectively. CAS was present in 10 (20%) patients, all of whom had TVD on coronary angiography (p≤0.0001). Patients with CAS were more likely to be older than those without CAS (p=0.065). Additionally, 80% of patients with CAS were males and all of them were hypertensive. Conclusion: Significant CAS is found in substantial proportion of patients with CAD, especially multi vessel disease. A strategy of concomitant carotid DSA at the time of coronary angiography may allow superior risk stratification and better planning of management in these patients. [ABSTRACT FROM AUTHOR]

Atherosclerosis is one of the leading causes of mortality in the western world. Computed tomography angiography (CTA) is the conventional imaging method used for pre-surgery assessment of the blood flow within the carotid vessel. In this paper, we present a proof of concept of a novel, fast and operator independent protocol for the automatic detection (seeding) of the carotid arteries in CTA in the thorax and upper neck region. The dataset is composed of 14 patients' CTA images of the neck region. The performance of this method is compared with manual seeding by four trained operators. Inter-operator variation is also assessed based on the dataset. The minimum, average and maximum coefficient of variation among the operators was (0, 2, 5 %), respectively. The performance of our method is comparable with the state of the art alternative, presenting a detection rate of 75 and 71 % for the lowest and uppermost image levels, respectively. The mean processing time is 167 s per patient versus 386 s for manual seeding. There are no significant differences between the manual and automatic seed positions in the volumes (p = 0.29). A fast, operator independent protocol was developed for the automatic detection of carotid arteries in CTA. The results are encouraging and provide the basis for the creation of automatic detection and analysis tools for carotid arteries. [ABSTRACT FROM AUTHOR]

Retinal artery obstruction is an ocular emergency which usually carries a poor visual prognosis. Restoration of fruitful vision depends on the underlying cause and the immediate start of treatment. However, none of the known treatment modalities, have so far, assured positive results consistently. Retinal artery obstructions are forewarners of possible systemic emboli/infarcts. Thus, it is imperative for ophthalmologists to identify the disease and get a thorough systemic examination done, preferably by a cardiologist, so as to prevent serious systemic morbidity. It is to be noted that in our case report, in spite of having delayed presentations, both the patients were subjected to thorough cardiovascular examinations. In clinical practice, patients are not further investigated, once the chances of visual recovery are bleak. Our case report highlights the importance of subjecting these patients to complete cardiovascular work ups, even though a poor visual recovery is expected, which can lead to detection of various cerebrovascular infarcts.

Purpose: To determine the value of a metal artefact reduction (MAR) algorithm with iterative reconstructions for dental hardware in carotid CT angiography. Methods: Twenty-four patients (six of which were women; mean age 70 ± 12 years) with dental hardware undergoing carotid CT angiography were included. Datasets were reconstructed with filtered back projection (FBP) and using a MAR algorithm employing normalisation and an iterative frequency-split (IFS) approach. Three blinded, independent readers measured CT attenuation values and evaluated image quality and degrees of artefacts using axial images, multi-planar reformations (MPRs) and maximal intensity projections (MIP) of the carotid arteries. Results: CT attenuation values of the internal carotid artery on images with metal artefacts were significantly higher in FBP (324 ± 104HU) datasets compared with those reconstructed with IFS (278 ± 114HU; P < 0.001) and with FBP on images without metal artefacts (293 ± 106HU; P = 0.006). Quality of IFS images was rated significantly higher on axial, MPR and MIP images ( P < 0.05, each), and readers found significantly less artefacts impairing the diagnostic confidence of the internal carotid artery ( P < 0.05, each). Conclusion: The MAR algorithm with the IFS approach allowed for a significant reduction of artefacts from dental hardware in carotid CT angiography, hereby increasing image quality and improving the accuracy of CT attenuation measurements. Key points: • CT angiography of the neck has proven value for evaluating carotid disease • Neck CT angiography images are often degraded by artefacts from dental implants • A metal artefact reduction algorithm with iterative reconstruction reduces artefacts significantly • Visualisation of the internal carotid artery is improved [ABSTRACT FROM AUTHOR]

Three clinical cases of patients admitted in "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba due to the suspicious presence of cerebral aneurysms are described, keeping in mind the neurological manifestations they presented. By means of the studies of magnetic resonance and angiographic resonance carried out, the images of the vascular lesion were observed, which were confirmed by carotid angiography. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To retrospectively review the safety of arch aortography and compare complication rates with published figures for selective catheter angiography. Methods: The medical records of patients undergoing arch aortography over the last 3 years (n=311; 180 male, 131 female; mean±SD age 71.0±9.2 years, range 42–90 years) were retrospectively reviewed. Any peri-procedural (0–48h) complications were recorded. A certified neurologist (MSR/GSV) classified all questionable neurological events. Results: There were no focal neurological events or deaths (n=0; 0%; CI: 0–0.96%). Non-focal neurological events included mild disorientation (n=2; 0.6%; CI: 0.176–2.31) and unequal pupils (n=1; 0.3%; CI: 0.056–1.79%). Cardiovascular events included symptomatic hypotension (n=4; 1.3%; CI: 0.50–3.25%), angina (n=1; 0.3%; CI: 0.056–1.79%) and arrhythmia (n=4; 1.3%; CI: 0.50–3.25). There were 27 minor access site complications (8.7%; CI: 6.0–12.3). None of these complications extended hospital stay. None of the arch angiograms had to be followed by selective carotid angiography. Conclusion: Arch aortography appears to have a lower neurological complication rate than selective carotid angiography. [Copyright &y& Elsevier]

A case of carotid body tumour (paraganglioma) which is both unusual and highly vascular, arising from the carotid body is reported. The patient was a 68-year-old female with a right submandibular swelling. The initial pathological diagnosis was obtained from the incisional biopsy. Carotid angiography revealed the feeding vessels arising only from the external carotid artery. The tumour was completely removed and no evidence of recurrence could be found 2-years postoperatively. [ABSTRACT FROM AUTHOR]

Background. Ultrasonographic discrimination of subtotal stenosis from occlusion of the internal carotid artery (ACI) is frequently extremely complicated. Three-dimensional ultrasonography (3D US) is more reliable than color duplex ultrasonography. However, due to possible errors in the evaluation of subtotal stenosis and occlusion, 3D US should be complemented either by three-dimensional CT angiography (3D CTA) or classic angiography. Correct evaluation is extremely important for operative treatment of subtotal stenosis.Methods. In 22 patients, 3D US revealed occlusion of the ACI and in 11 patients subtotal stenosis. In all cases, the ultrasonographic findings were compared with 3D CTA findings, in 8 cases also with those of conventional angiography.Results. In two patients, 3D US evaluated the blockage as an occlusion while 3D CTA as well as angiography showed it to be a subtotal stenosis. In one patient, lumen reduction was so marked that it was not revealed by 3D CTA but only by angiography. In another case, the filiform ACI stenosis was covered by a distinct acoustic shadow of calcinated plaque. When compared, the remaining findings showed no significant differences.Conclusions. It is our opinion that 3D US is a good screening diagnostic method for diagnosing subtotal stenosis and occlusion of the ACI. However, owing to possible errors, it should be combined with 3D CTA or classic angiography. A precise evaluation is very important as subtotal ACI stenosis requires early operative treatment while ACI occlusion only requires conservative treatment.

A case is reported of a traumatic middle meningeal arteriovenous fistula, which was formed on the contralateral side to the head injury without a skull fracture and was no longer demonstrable on the repeated angiogram after 35 days without any surgical intervention. Possible mechanisms of fistula formation and its spontaneous closure are discussed. [ABSTRACT FROM AUTHOR]

Visualization of the superior ophthalmic vein (SOV) on carotid angiography was investigated based on a prospective sample of 452 carotid angiograms performed during one year. The SOV with normal blood flow direction, from facial veins into the cavernous sinus (CS), was seen on 26% and with reversed flow direction in 7% of the angiograms. A hypothesis was suggested that the anotomical variations of the middle cerebral (MCV) and uncal veins (UV) affected the visualization. When both the MCV and UV drained into the CS, the SOV was seen in 11% of 179 angiograms. If the MCV and UV bypassed the CS, the SOV was seen on 51% of 118 angiograms. The difference is significant. Intubation of the patient increased the visualization of the SOV with normal flow direction but did not affect the visualization of the SOV with reversed flow. No SOV with normal blood flow direction was seen on selective internal carotid angiography. [ABSTRACT FROM AUTHOR]

To compensate for differences in anatomy and magnification, a hand-held programmable calculator remodels the profile of the lateral view of a skull to fit the outline of a reference skull. The statistical analysis of 85 normalized carotid angiograms yields a numbered map of supratentorial structures. It is then possible to obtain, within 20 min and without sophisticated equipment, an objective analysis of any new angiogram. [ABSTRACT FROM AUTHOR]

Two cases of the anterior inferior cerebellar arteries originating from the cavernous and precavernous segments of the internal carotid artery are reported. In one case the course of the anomalous artery was confirmed by autopsy. This anomalous artery is considered to be a variant of persistent primitive trigeminal artery. The clinical significance is discussed briefly. [ABSTRACT FROM AUTHOR]

The reports of rupture of an aneurysm during carotid angiography are very few but the actual incidence is doubtless higher than recorded. The case presented is documented with the demonstration of a large middle cerebral artery aneurysm with an intratemporal hematoma, and, in sequence, the rupture of the aneurysm during the height of the injection and the subsequent extensive leakage of the contrast medium. The factors which which can lead to rupture of an aneurysm during the angiographic procedure are discussed. [ABSTRACT FROM AUTHOR]

Of 65 patients with neurological disorders examined with rapid serial angiography of the carotid artery, 24 had normal cerebral arteries, 17 atherosclerosis, 11 arterial ectasia and 13 both kinds of vascular changes. These patients were examined for hemispherical rCBF determination on the same occasion, using the Xenon clearance method. Primarily, the patients were examined without general anaesthesia, and they did not have acute illness, trauma, or angiographic evidence of a focal intracranial lesion. In addition, other parameters such as arterial size, ventricular size, cerebral circulation time, age, and sex were determined. All these data were studied statistically in a series of multiple regression analyses with a computer. No significant differences in rCBF could be found between cases with ectasia, atherosclerosis and without any kind of vascular changes. However, the mean value of rCBF in patients with atherosclerosis and in patients with intracranial ectasia was below the normal mean value, although it did not differ significantly from this value. Nor was any influence on the rCBF found in patients with marked stenosis of the internal carotid artery and those with slight stenosis. [ABSTRACT FROM AUTHOR]

In a consecutive series of 312 surgical aneurysm cases more than 90% of the patients reached neurosurgical expertise within 48 hours from bleeding. Computed tomography permitted prediction of the assumed rupture site based on blood clot location in the majority (86%) of cases. This target vascular territory was usually investigated by selective angiography and in 9 out of 10 patients an aneurysm, ultimately shown to be the correct source of bleeding, was demonstrated. In 14% of the cases the source of bleeding could not be established thus calling for complete four vessel studies. It is concluded that limited angiographic studies are compatible with preserving a high surgical standard in cases unequivocally exhibiting a localizing clot pattern on the CT scan. Though suboptimal in a general sense, incomplete vascular studies, if four vessel angiography is not obtainable without delay or risk, should not delay earliest possible clipping of ruptured aneurysms to avoid the devastating effects of recurrent bleeds. [ABSTRACT FROM AUTHOR]

Histological anaplasia, found in up to 10% of meningiomas, is an important prognostic sign as it is associated with increased recurrence rate and volume growth rate. We studied in retrospect a series of 230 primary intracranial meningiomas to discover whether histological anaplasia can be reliably foreseen in CT scans and angiograms. 205 meningiomas were histologically benign, and 25 meningiomas were classified as malignant (atypical or anaplastic), with either incipient (20) or overt (5) signs of anaplasia. Often CT parameters tested, three were associated significantly more often with malignant meningiomas: nodular contour (58.3% vs 26.7%), cysts (20.0% vs 4.4%) and absence of calcifications (92% vs 65.3%); none of these parameters was an absolute sign of anaplasia. 'Mushrooming', previously regarded as a definite sign of malignancy, was seen in 9% of benign meningiomas and in 21% of malignant ones. In angiography, no apparent differences between benign and malignant meningiomas were seen. The conclusion is that it is not possible to distinguish malignant meningiomas from benign ones with CT or angiography. [ABSTRACT FROM AUTHOR]

In the last 9 years, infundibular dilatation (ID) has been sought in 260 aneurysm (An) cases and 398 carotid angiogram's (CAG) to reveal its incidence and morphology. Findings were as follows: [ABSTRACT FROM AUTHOR]

This is a study of the changes that have occurred in the field of severe head injury since the advent of CT scanning, comparing two homogeneous series of patients selected by clinical status (Glasgow Coma Scale ⩽ 8), namely a series of 1,000 cases admitted to our Department between 1973 and 1976, already published in this Journal, and one of 385 cases cared for between 1979 and 1980, when CT scanning had become generally available. The two series of patients compare very closely in many respects, particularly in the incidence of surgical cases. In the more recent series the overall outcome was better both in surgical and in non-surgical cases. Among patients in the CT scan series the incidence of brain contusion associated with haematoma was greater than that of pure subdural haematomas. In non-surgical patients the CT scan, unlike cerebral angiography, afforded better identification of traumatic lesions and the grouping of patients into homogeneous categories correlating with a given outcome. On admission, cerebral angiography and CT scanning were equally effective in detecting lesions of surgical import; later in the course of the illness, however, CT scanning proved far more effective in detecting changes, with fully 15% of the patients being referred for surgery in the light of repeat CT scan findings as opposed to only 4% undergoing surgery on the indications of repeat angiography. Also, in the new series the mean interval from injury to surgery was shorter, with 64% of patients being operated on within 6 hours of the injury. The incidence of lucid intervals dropped from 30% in the first series to 16% in the second, both among surgical and non-surgical patients. That the systematic repetition of CT scans was instrumental in preventing the worsening of clinical status is demonstrated by the fact that 54 patients treated surgically for expanding lesions were excluded from the second series because they could be treated before they reached a GCS score of 8 or less, whereas such cases were quite exceptional in the older series. The CT scan approach resulted in a material increase of surgical interventions. Overall, the comparison of these two series of cases selected only by the criterion of clinical severity fails to provide a complete expression of the impact of CT scanning on our daily dealing with severe head injuries. [ABSTRACT FROM AUTHOR]

This is a review of 1,000 consecutive cases of severe head injury admitted to our Neurosurgical Department between January 1973 and August 1976, before the advent of CT scanning. All patients were comatose following head injury (GCS⩽8) and were treated homogeneously by the same neurosurgical team by a protocol that included immediate resuscitation on arrival, diagnosis of intracranial lesions by angiography, early surgery when needed, mechanical ventilation, steroids, and mannitol. Extracranial lesions, even if preponderant, were treated by various specialists in the Neurosurgical Department, which for all practical purposes operated as an Emergency Department. Admission criteria were very broad with no preadmission selection. The overall mortality for this series was 45%. A little less than half the patients made good recoveries or remained moderately disabled (47%); 6% were severely disabled, and 2% survived in a persistent vegetative state. More than two-thirds of the patients were brought to our Neurosurgical Department after a short stay at a general hospital; 72% were admitted within 6 hours of injury; 71% were traffic accident victims; and 34% had significant associated extracranial injuries. Carotid angiography was performed in 78% of the patients and indicated the presence of an intracranial haematoma requiring surgery in 36% of the whole series. Mortality was significantly higher in operated than in unoperated patients (56% versus 39%); those treated surgically, however, were older, in worse clinical condition, and showed a higher incidence of acute subdural haematomas associated with brain contusion. Carotid angiography proved very effective in revealing the presence of an expansive lesion but failed to reflect the severity of brain damage, since the group with 'negative' angiograms showed a high mortality (52%). Patients with a lucid interval had a higher percentage of surgical lesions than those with immediate coma (58% versus 26%); but fully 42% of them did not require surgery, and 25% had negative angiograms. From the prognostic point of view the clinical data elicited after initial resuscitation were highly predictive of the outcome: some individual neurological signs, such as mydriasis, posturing and eye movements, were not inferior to the GCS score in that respect. Age also proved a strong predictor, since elderly patients are more likely to have severe subdural and parenchymal lesions and their clinical severity is accordingly greater. Our series amounts to a data bank of cases both contemporary to and in good agreement with that collected by Jennett and his associates in their 1977 multinational study; and it affords a useful reference in the assessment of epidemiological variations and alternative management in relation to outcome. [ABSTRACT FROM AUTHOR]

Computed tomography and angiographical findings of cavernous haemangiomas of the brain are reported on the basis of six cases of the authors, and a review of the literature. Computed tomography showed well demarcated, round densities with tiny calcifications, and mild contrast enhancement (0-25 HU), with no mass effect and with open sulci round the lesion. The angiographical findings were normal except in one patient with an early draining vein and in another with a late draining vein; consequently an injection of at least 10 to 15 ml of contrast medium, and a prolonged angiographical series are recommended. According to the literature, capillary blush may also be seen in angiography. If both CT and angiography are used the diagnosis is definitive, and a neoplasm can be excluded. In five of our patients the diagnosis was verified surgically and histologically, while the sixth patient was not operated on because the frontoparietal lesion was near the motor region. In most cases, surgical removal is easy and successful. [ABSTRACT FROM AUTHOR]

An 11-year-old girl was operated on for a frontal arteriovenous malformation in 1978; a postoperative carotid angiogram showed no filling of the AVM. The patient still had epilepsy. In 1981 a carotid angiogram showed no AVM. Some months later a new carotid angiography was done. In the first lateral series no AVM was seen but on the second injection with one more millilitre of contrast medium a large frontal AVM became apparent. The reasons for such variable filling are discussed. [ABSTRACT FROM AUTHOR]

The venous drainage dynamics of the cavernous sinus were studied by means of 50 carotid angiograms and 18 orbital phlebographies performed on 47 patients with various tumours of the sellar area. Normal blood flow direction in the superior ophthalmic vein (SOV) (from the facial veins into the cavernous sinus) was seen in supra- and small intrasellar tumours, but not in parasellar tumours. In bigger intrasellar tumours and in parasellar tumours the reversed blood flow direction visible in the SOV (from the cavernous sinus into the facial veins) indicated infiltration or compression of the cavernous sinus by tumour. The sign of reversed flow together with CT findings is useful in differential diagnosis and in planning surgical treatment for tumours of the sellar area. [ABSTRACT FROM AUTHOR]

A case is described of pituitary apoplexy and consequent blindness during carotid angiography. The possibility of haemorrhage from the fragile pathological vessels of the tumour due to an increase in pressure in the carotid system during angiography is discussed. [ABSTRACT FROM AUTHOR]

Retinal artery obstruction is an ocular emergency which usually carries a poor visual prognosis. Restoration of fruitful vision depends on the underlying cause and the immediate start of treatment. However, none of the known treatment modalities, have so far, assured positive results consistently. Retinal artery obstructions are forewarners of possible systemic emboli/infarcts. Thus, it is imperative for ophthalmologists to identify the disease and get a thorough systemic examination done, preferably by a cardiologist, so as to prevent serious systemic morbidity. It is to be noted that in our case report, in spite of having delayed presentations, both the patients were subjected to thorough cardiovascular examinations. In clinical practice, patients are not further investigated, once the chances of visual recovery are bleak. Our case report highlights the importance of subjecting these patients to complete cardiovascular work ups, even though a poor visual recovery is expected, which can lead to detection of various cerebrovascular infarcts. [ABSTRACT FROM AUTHOR]

Background: Carotid plaque is often an important factor in ischemic stroke after it changes from stable to vulnerable, and low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c) are associated with plaque vulnerability. We aimed to investigate whether the LDL-c/HDL-c ratio, an easily available and novel biomarker, is associated with vulnerable plaques and enhances the warning effect on vulnerability compared to LDL-c or HDL-c alone., Methods: We conducted a retrospective study of 187 patients with severe CAS admitted to the Department of Vascular Surgery at the Nanjing Drum Tower Hospital from January 2019 to July 2021. They were divided into a stable plaque group and a vulnerable plaque group according to carotid ultrasonography, carotid angiography (CTA), and plaque pathology. Baseline information was collected and compared between the two groups. Correlation analysis was used to determine the degree of correlation between clinical variables. Univariate and multifactor logistic regression analyses were used to examine independent risk factors for vulnerable plaque in patients with severe CAS. Receiver operating characteristic (ROC) curves were used to assess the capacity of LDL-c/HDL-c to predict the occurrence of vulnerable plaque., Results: The age of the vulnerable plaque group was 68.12 ± 8.90 years, with 85 males (89.91%); the age of the stable plaque group was 68.77 ± 8.43 years, with 70 males (89.74%). Multivariate logistic regression analysis showed that LDL-c/HDL-c, smoking and diabetes were independent risk factors for vulnerable plaque (all P <0.05). The risk of vulnerable plaque was 4.78-fold greater in the highest LDL-c/HDL-c quartile (≥ 2.63) than in the lowest quartile (≤ 1.31) (P-trend <0.001), and the area under the ROC curve for LDL-c/HDL-c (AUC=0.681, P <0.001) was higher than that for LDL-c and HDL-c., Conclusion: LDL-c/HDL-c, smoking and diabetes were independent risk factors for vulnerable plaque in patients with severe CAS, and LDL-c/HDL-c had a higher predictive value for the presence of vulnerable plaque compared with other lipid parameters., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Os autores relatam o caso de uma paciente com macroadenoma pituitário não hemorrágico produzindo oclusão reversível de artéria carótida interna. A obstrução da artéria carótida interna por tumor pituitário é rara, particularmente na ausência de apoplexia hipofisária. A correlação neurorradiológica torna-se de fundamental importância para demonstrar a oclusão completa ou trombose do vaso afetado. O completo restabelecimento pós-cirúrgico do fluxo sangüíneo da artéria carótida interna torna-se imperativo para a completa regressão sintomatológica.The case of woman with diagnosis on non-hemorragic pituitary macroadenoma producing reversible occlusion of the internal carotid artery is presented. The obstruction of the internal carotid artery by a pituitary tumor is rare, particularly in the absence of hypophyseal apoplexy. The neuroradiological correlation becomes fundamentally important to demonstrate the complete occlusion or thrombosis of the affected vessel. The complete restablishment of blood flow of the internal carotid artery after surgery becomes imperative for the complete symptomatological regression.