- Carotid-Carotid Artery Crossover Bypass with a Synthetic Vascular Graft for Symptomatic Type 1A Common Carotid Artery Occlusion. [Journal Article]
- WNWorld Neurosurg 2017 Dec 18
- CONCLUSIONS: Carotid-carotid artery crossover bypass with a synthetic vascular graft is a safe and effective therapeutic approach for patients with symptomatic type 1A CCAO. However, studies with larger series are needed to enable more precise conclusions.
- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- The term amaurosis fugax is often used interchangeably to describe transient visual loss (TVL). However, it is employed widely in medicine to refer to any cause of transient monocular visual loss. He...
The term amaurosis fugax is often used interchangeably to describe transient visual loss (TVL). However, it is employed widely in medicine to refer to any cause of transient monocular visual loss. Here, we will refer to amaurosis fugax only in the context of transient monocular visual loss associated with vascular thromboembolic events arising from the internal carotid arterial system.
- Antiphosphospholipid syndrome presenting with amaurosis fugax and cotton wool spots. [Journal Article]
- AJAm J Ophthalmol Case Rep 2017; 7:143-145
- CONCLUSIONS: Antiphospholipid syndrome can be considered in the differential diagnosis of patients presenting with AF, assymetric CWS, and/or rapid progression of symptoms.
- Subfoveal choroidal thickness and volume in severe internal carotid artery stenosis patients. [Journal Article]
- IJInt J Ophthalmol 2017; 10(12):1870-1876
- CONCLUSIONS: The choroidal thickness in severe ICA stenosis eyes is lower than in fellow eyes. The choroidal thinning may occur before the retinal changes in patients with ocular ischemic syndrome. Evaluations of choroidal thickness may be useful to choose the optimal therapeutic schedule for ICA patients.
- Crevice sign as an indicator of plaque laceration associated with postoperative severe thromboembolism after carotid artery stenting: a case report. [Journal Article]
- NJNagoya J Med Sci 2017; 79(4):559-564
- Carotid artery stenting (CAS) is increasingly utilized in patients with carotid artery stenosis. Various intraprocedural and postprocedural complications have been reported in the literature. We pres...
Carotid artery stenting (CAS) is increasingly utilized in patients with carotid artery stenosis. Various intraprocedural and postprocedural complications have been reported in the literature. We present a case of symptomatic major thromboembolism after CAS. The intraprocedural angiogram showed extraordinary slow filling of the contrast medium into the plaque, which we named as "crevice sign." An 83-year-old man presented repeat right amaurosis fugax for 6 months. The radiological examinations revealed 85% stenosis of the origin of the right internal carotid artery. The patient underwent right CAS. The procedure was performed without any problems; however, the angiogram showed slow filling of contrast medium into the carotid plaque through the stent (crevice sign). Sixty minutes later in the ward, the patient presented sudden onset of left hemiparesis and aphasia. Emergency catheter angiography did not show in-stent thrombus, major artery occlusion, or the crevice sign. Magnetic resonance imaging on the next day revealed wide acute infarction of the right cerebral hemisphere. Physicians should be aware of the intraprocedural crevice sign so that a subsequent catastrophic ischemic event can be prevented.
- Successful retinal blood flow augmentation after extracranial-intracranial bypass. [Journal Article]
- ANActa Neurochir (Wien) 2018; 160(2):301-304
- A 61-year-old woman visited us with recent onset right-side weakness. Magnetic resonance imaging showed ischemic changes at the left internal border zone due to occlusive disease affecting the left p...
A 61-year-old woman visited us with recent onset right-side weakness. Magnetic resonance imaging showed ischemic changes at the left internal border zone due to occlusive disease affecting the left proximal internal carotid artery. Prompt oral dual antiplatelet therapy and intravenous fluid were administered with subsequent induced hypertension and without reperfusion therapy. Although the hemiparesis was improved, she complained of a new-onset transient left-side monocular visual loss. Fluorescein angiography confirmed delayed perfusion in the left eye. We performed extracranial-intracranial bypass for flow augmentation. After bypass, the amaurosis fugax resolved. Follow-up retinal fluorescein angiography also showed improved retinal perfusion.
- Contrast-enhanced transoral carotid ultrasonography for the diagnosis and follow-up of extracranial internal carotid artery dissection: A case report. [Case Reports]
- JCJ Clin Ultrasound 2017 Oct 09
- A 56-year-old woman was admitted to our hospital because of amaurosis fugax. The carotid angiogram showed irregularly stenotic lesions of the left and right internal carotid arteries (ICAs), suggesti...
A 56-year-old woman was admitted to our hospital because of amaurosis fugax. The carotid angiogram showed irregularly stenotic lesions of the left and right internal carotid arteries (ICAs), suggestive of dissection. Follow-up evaluation was performed by transoral carotid ultrasonography (TOCU) with contrast enhancement (CE), which yielded better vessel lumen and intramural hematoma visualization than color Doppler imaging. CE-TOCU is useful for evaluating ICA dissections that extends to the high cervical portion.
- [Intracranial Pressure Evaluation by Ophthalmologist]. [Journal Article]
- CSCesk Slov Oftalmol 2017; 73(2):57-60
- CONCLUSIONS: D-ODM is a useful screening method in the evaluation of IKT for hydrocephalus, brain tumors, cerebral hemorrhage after brain trauma and also in ocular diseases: Glaucoma, Ocular hypertension, orbitopathy (endocrine orbitopathy), ischemic / non-ischemic occlusion of blood vessels of the eye, indirect detection ICT carotid artery-cavernous fistula, amaurosis fugax, optic neuropathy. D-ODM is suitable for immediate evaluation of IKT, but is not suitable for continuous monitoring. As it can be repeated, it is useful for a patient suspected of having an increased ICT.Key words: central retinal artery, central retinal vein, colour Doppler ultrasonography, digital ophthalmodynamometry, intracranial pressure, pressure of cerebrospinal fluid, transcranial Doppler ultrasonography, intraocular pressure, venous pulsation pressure, venous outflow pressure, retinal venous pressure.
- Lights Out: An Unusual Case of Amaurosis Fugax. [Journal Article]
- AJAm J Med 2018; 131(2):e39-e42
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- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- Symptoms of extracranial carotid disease are most often caused by embolization. Arterial emboli account for approximately one-quarter of strokes in Europe and North America, and 80% of these originat...
Symptoms of extracranial carotid disease are most often caused by embolization. Arterial emboli account for approximately one-quarter of strokes in Europe and North America, and 80% of these originate from atherosclerotic lesions in a surgically accessible artery in the neck. The most common lesion is at the bifurcation of the carotid artery. Transcranial Doppler studies have shown that emboli are seen in approximately 20% of patients with moderate (> 50% stenosis) lesions at the carotid bifurcation and even higher rates with more than 70% stenoses. The incidence and frequency of emboli are increased in recently symptomatic patients. The neurologic dysfunction associated with microemboli may appear as sudden or transient, neurologic symptoms that may include unilateral motor and sensory loss, aphasia (difficulty finding words), or dysarthria (difficulty speaking due to motor dysfunction). These are termed Transient Ischemic Attack (TIA). Most TIAs are brief (minutes). By convention, 24 hours is the arbitrary limit of a TIA. If the symptoms persist, it is a stroke, or cerebrovascular accident (CVA). An embolus to the ophthalmic artery, the first branch of the internal carotid artery, produces a temporary monocular loss of vision called amaurosis fugax or permanent blindness. Lesions of atherosclerosis in the internal carotid artery occur along the wall of the carotid bulb opposite to the external carotid artery origin. The enlargement of the bulb just distal to this major branch point creates an area of low wall shear stress, flow separation, and loss of unidirectional flow. Presumably, this allows greater interaction of atherogenic particles and the vessel walls at this site and accounts for the localized plaque at the carotid bifurcation. The accessibility of this localized atheroma allows effective removal of the plaque and a dramatic reduction in stroke risk. Without treatment, 26% of patient with TIAs and more than 70% with carotid artery stenosis will develop permanent neurological impairment (CVA) from continued embolization at two years. The risk of CVA can be reduced to 9% with plaque removal and is usually lower for a patient presenting with amaurosis fugax.