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2. Mechanical recanalization for acute bilateral cerebral artery occlusion - literature overview with a caseMiran Jeromel, Zoran Miloševič, Janja Pretnar-Oblak, 2020, pregledni znanstveni članek Povzetek: Background. Acute bilateral internal carotid artery (ICA) and/or middle cerebral artery (MCA) occlusion is extremely rare and associated with poor clinical outcomes. There are only a few reports in the literature about mechanical thrombectomy being performed for acute bilateral occlusions. The treatment strategies and prognoses (clinical outcomes) are therefore unclear. Methods. A systematic review of the literature was performed through several electronic databases with the following search terms: acute bilateral stroke, mechanical recanalization and thrombectomy. Results. In the literature, we identified five reports of six patients with bilateral ICA and/or MCA occlusion treated with mechanical recanalization. Additionally, we report our experience with a subsequent contralateral large brain artery occlusion during intravenous thrombolytic therapy, where the outcome after mechanical thrombectomy was not dependent on the time from stroke onset but rather on the capacity of collateral circulation exclusively. Conclusions. Acute bilateral cerebral (ICA and/or MCA) occlusion leads to sudden severe neurological deficits (comas) with unpredicted prognoses, even when mechanical recanalization is available. As the collateral capacity seems to be more important than the absolute time to flow restoration in determining the outcomes, simultaneous thrombectomy by itself probably does not lead to improved functional outcomes.
Ključne besede: acute bilateral stroke, mechanical recanalization, thrombectomy
Objavljeno v DiRROS: 12.07.2024; Ogledov: 398; Prenosov: 162
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4. Cerebral hyperperfusion syndrome after carotid angioplastyZoran Miloševič, Bojana Žvan, Marjan Zaletel, Miloš Šurlan, 2002, objavljeni znanstveni prispevek na konferenci Povzetek: Background. Cerebral hyperperfusion syndrome after carotid endarterectomy is an uncommon but well-de- fined entity. There are only few reports of "hyperperfusion injury" following carotid angioplasty. Case report. We report an unstable arterial hypertension and high grade carotid stenosis in a 58-year-old, right-handed woman. After a stroke in the territory of middle cerebral artery carotid angioplasty was per- formed in the patient. Among riskfactors, the long lasting arterial hypertension was the most pronounced. Immediately after the procedure, the patient was stable without any additionalneurologic deficit. The sec- ond day, the patient had an epileptic seizure and CT revealed a small haemorrhage in the left frontal lobe. Conclusions. The combination of a high grade carotid stenosis and unstable arterial pressure is probably an important prognostic factor in the pathogenesis of hyperperfusion syndrome.
Objavljeno v DiRROS: 31.01.2024; Ogledov: 684; Prenosov: 140
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5. Carotid angioplasty with cerebral protectionZoran Miloševič, Bojana Žvan, Marjan Zaletel, Miloš Šurlan, 2002, izvirni znanstveni članek Povzetek: Background. Carotid endarterectomy (CF.A) is widely used in the management of high-rade carotid stenosis: It is a surgical procedure requiring general anaesthesia and is suitable only for lesions located at or close to the carotid bifurcation. It may develop complications, such as stroke, death, cranial nerve palsies, wound haematoma and cardiac complications. The risk of complications is increased in patients with recurrent carotid artery stenosis following CEA, in subjects undergoing radiotherapy to the neck, and in patients with cardiopulmonary disease. The drawbacks of CEA have led physicians to search for alternative treatment options. Carotid angioplasty and stenting (CAS) is less invasive than CEA. The method is particularly suitable for the treatment of recurrent stenosis after previous CEA and distalinternal artery stenosis, which is inaccessible for CEA. CAS does not cause cranial nerve palsies. Moreover, it does not require general anaesthesiaand causes lower morbidity and mortality in patients with severe cardiopulmonary disease. The complications of CAS include stroke due to distalimmobilisation of a plaque or thrombus dislodged during the procedure, abrupt vessel occlusion due to thrombosis, dissection or vasospasm, and restenosis due to intmal hyperplasia. CAS is a relatively new procedure; therefore, it is essential to establish its efficacy and safety before it is introduced widely into clinical practice. Patients and methods. In Slovenia, we have also started with carotid angioplasty by the study: Slovenian Carotid Angioplasty Study (SCAS). We performed CAS in 17 patients (12 males and 5 females) aged from 69 to 82 years. All patients were symptomatic with stenosisgreater than 70 %. 10 patients suffered transient ischemic attacks, 4 patients minor strokes and 3 patients amaurosis fugax. (Abstract truncated at 2000 characters)
Objavljeno v DiRROS: 31.01.2024; Ogledov: 594; Prenosov: 112
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6. Computed tomographic angiography in intracranial vascular diseasesZoran Miloševič, 2000, pregledni znanstveni članek Povzetek: Background. The development of spiral computed tomography (CT) introduced a more precise imaging of the vessels also with computed tomographic angiography(CTA). Because it is a minimaly invasive method, it was widely accepted by radiologists and clinicians. In early 90ties CTA also accompanied conventional angiography and magnetic resonance angiography (MRA) in imaging of intracranial vascular diseases. CTA is used for the detection and evaluation of intracranial aneurysms, vascular malformations, stenoocclusive diseases of intracranial arteries and pathological changes of venous sinuses. Comparing to conventional angiography as the "gold standard", CTA has high specificity, sensibility and diagnostic accuracy concerning detections of intracranial aneurysms. Regarding vascular malformations, CTA is used for diagnostics and pre and postopeative evaluation of it. CTA can show good results in imaging of venous angiomas, and so invasive conventional angiography can be avoided in this pathology. Stenosis and occlusions of arteries can be diagnosed and evaluated in patients with cerebral vasospasm, patients with acute stroke, and patients with chronical arterial stenoses and occlusions. CTA is useful for the demonstration of occusive and stenosing changes of intracranial venous sinuses. Conclusion. With CTA it is possible togenerate threedimensional reconstructed images which give a more accurate determination of anatomical relations in intracranial vascular diseases. The main disadventage of CTA in comparison to intraarterial angiography is the lower spatial resolution of CTA, but is constantly imprving with the development of better scanners and workstations, so that there are great possibilities for further deveopement and wider use of CTA in the diagnosis ofintracranial vascaular diseases.
Objavljeno v DiRROS: 24.01.2024; Ogledov: 426; Prenosov: 111
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7. Acute subarachnoid haemorrhage : detection of aneurysms of intracranial arteries by computed tomographic angiographyZoran Miloševič, 1999, izvirni znanstveni članek Povzetek: Background. We wanted to determine the diagnostic accuracy, sensitivity and specificity of computed tomographic angiography (CTA) of intracranial vessels,and to establish the advantages and disadvantages of CTA compared to digital subtraction angiography (DSA) as the gold standard in patients with acute subarachnoid haemorrhage (SAH). Patients and methods. We prospectively studied 52 patients with acute SAH. Confirmation of the haemorrhage by a conventional computed tomography (CT) scan was immediately followed by intracranial CTA. DSA was performed after the CTA examination and so did not influence the interpretation of CTA images. The sensitivity, specificity and diagnostic accuracy of CTA were determined by comparing the results with the data from DSA and with the surgical findings. Cases where the CTA and DSA results did not match were analysed, and the advantages and disadvantages of intracranial CTA were determined. Results. The diagnostic accuracy of CTA was 95%, its sensitivity was 93%, and its specificity was 98%. False-negative results were obtained in three patients who harboured small aneurysms, two in the region of the cavernous sinus and one at the division of pericallosal and callosomarginal arteries. In one patient with a false-positive result, DSA showed an infundibular widening of the posterior communicating artery. In all seven patients who underwent operations on the basis of CTA results, the surgical findings confirmed the presence of aneurysms as well as the intracranial vessel anatomy demonstrated by CTA. Conclusions. Intracranial CTAis a fast and minimally invasive method with a high diagnostic accuracy, sensitivity and specificity, which has an important place in the detection andpreoperative evaluation of intracranial aneurysms in patients with acute SAH.
Objavljeno v DiRROS: 22.01.2024; Ogledov: 506; Prenosov: 157
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