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Bahram Mokri - One of the best experts on this subject based on the ideXlab platform.
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incidence and outcome of cervical artery Dissection a population based study
Neurology, 2006Co-Authors: Robert Jr D Brown, Jayawant Mandrekar, Bahram MokriAbstract:Background: Incidence rates for internal carotid artery Dissection (ICAD) have been reported to be 2.6 to 2.9 per 100,000, but reliable epidemiologic data for vertebral artery Dissection (VAD) are not available. Objective: To determine the incidence rate of cervical artery Dissection (CAD) in a defined population. Methods: With IRB approval, we used the medical record linkage system of the Rochester Epidemiology Project to identify all patients diagnosed with spontaneous ICAD and VAD for the period of 1987–2003 in Olmsted County, MN. Results: Of 48 patients with CAD, there were 32 patients with ICAD and 18 patients with VAD. In Olmsted County, the average annual incidence rate for ICAD was 1.72 per 100,000 population (95% CI, 1.13 to 2.32) and for VAD 0.97 per 100,000 population (95% CI, 0.52 to 1.4). The average annual incidence rate for CAD was 2.6 per 100,000 population (95% CI, 1.86 to 3.33). The most frequently encountered symptoms in CAD were head or neck pain (80%), cerebral ischemia (TIA or infarct) (56%), and Horner syndrome (25%). Good outcome (defined as modified Rankin score of 0 to 2) was seen in 92% of patients. No recurrence of Dissection was observed during a mean 7.8 years of follow-up. Conclusions: Internal carotid artery Dissection was detected approximately twice as frequently as vertebral artery Dissection in the overall study, but in the latter half of the study period, vertebral artery and internal carotid artery Dissection incidence rates were equivalent. The majority of cervical artery Dissection patients in the community have excellent outcome, and contrary to many tertiary referral series, re-Dissection is rare.
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Aortic Dissection Decades Following Internal Carotid Artery Dissection Report of Two Cases
Angiology, 1997Co-Authors: Wouter I. Schievink, Bahram MokriAbstract:Recurrent Dissections involving carotid, vertebral, or renal arteries have been described in patients with spontaneous cervical artery Dissections, with a maximal interval between Dissections of fourteen years. The authors describe 2 patients in whom aortic Dissections developed twenty-five and forty years, respectively, following carotid artery Dissections. These 2 patients constituted 8% of the total number of patients from Rochester, Minnesota, who were diagnosed with aortic Dissection between 1987 and 1992. The first patient, a forty-five-year-old woman, presented in 1948 with right neck pain and headache, associated with several episodes of transient numbness of the right face and numbness and clumsiness of the left upper and lower extremities. Examination showed right miosis. Angiography showed a stenosis of the extracranial right internal carotid artery beginning several centimeters from the bifurcation. She died at age eighty-five from an aortic Dissection. The second patient, a thirty-eight-year-old man, noted left orbital and frontotemporal headaches and drooping of the left eyelid in 1962. Examination showed left oculosympathetic palsy. Angiography showed stenosis and an aneurysm in the midportion of the extracranial left internal carotid artery. He died at age sixty-three from an aortic Dissection. These cases suggest that following a carotid artery Dissection the risk of a recurrent arterial Dissection may remain elevated for a prolonged period of time and the recurrent Dissection may involve the aorta.
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Spontaneous Dissections of Cervicocephalic Arteries
Primer on Cerebrovascular Diseases, 1997Co-Authors: Bahram MokriAbstract:This chapter describes spontaneous Dissections of cervicocephalic arteries. Of the cervicocephalic arteries, the artery that is most commonly involved by Dissection is the extracranial segment of the internal carotid artery (ICA). The vertebral artery (VA) is the second most commonly involved vessel. Extracranial VA Dissections may extend intracranially, or the Dissection may involve only the intracranial segment of the artery, very rarely extending to the basilar artery. Dissections of the ICA are more common in redundant arteries, and hypertension is more common than general population in patients with spontaneous ICA and VA Dissections. Basilar artery Dissection may occur as an extension of Dissection from a vertebral artery, or the Dissection may involve only the basilar artery. Clinical manifestations are focal ischemic symptoms in the distribution of posterior circulation, frequently associated with or preceded by occipital headaches or neck pain or both. Spontaneous Dissections of middle cerebral arteries, posterior cerebral arteries, and anterior cerebral arteries may rarely occur. Dissections of anterior, middle, or posterior cerebral arteries on angiography may appear as elongated stenoses with or without aneurysmal dilations.
Christian J M Vrints - One of the best experts on this subject based on the ideXlab platform.
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spontaneous coronary artery Dissection
Heart, 2010Co-Authors: Christian J M VrintsAbstract:Spontaneous coronary artery Dissection (SCAD) is a rare cause of acute coronary syndrome or sudden cardiac death. Initial reports on this condition were scarce as they were based on postmortem examination of fatal cases. Currently, the clinical recognition of SCAD has increased as coronary angiography is utilised frequently in the clinical evaluation of patients with acute coronary syndromes. Moreover, intracoronary imaging techniques such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), which provide detailed morphological information on coronary lesions and on the location of Dissection planes between the different layers of the arterial wall, have enabled a more detailed clinical assessment of SCAD. Furthermore, non-invasive coronary angiography by multidetector computed tomography (MDCT) has been used for longitudinal follow-up evaluation of patients with SCAD. The clinical presentation of SCAD depends on the extent and the flow limiting severity of the coronary Dissection, and ranges from asymptomatic to unstable angina, acute myocardial infarction, and ventricular arrhythmias to sudden cardiac death. As several diseases and conditions have been associated with SCAD it therefore probably constitutes a heterogeneous entity. The use of coronary stents represented a breakthrough in the management of iatrogenic coronary Dissections occurring during percutaneous interventions. However, in SCAD their application should be balanced against the expected outcome after a spontaneous natural course of this condition, because coronary stenting may end up in a ‘full metallic jacket’ covering of a long segment of the coronary artery. Current insights into the aetiology, pathogenesis, diagnostic imaging and therapeutic management of SCAD are reviewed. Coronary artery Dissection can be primary or secondary. Primary Dissections occur spontaneously whereas secondary Dissections occur as an extension from aortic root Dissection or following an insult as a consequence of coronary angiography, coronary intervention, cardiac surgery or chest trauma. Dissection of the coronary artery results in separation of the …
Rossella Fattori - One of the best experts on this subject based on the ideXlab platform.
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interdisciplinary expert consensus document on management of type b aortic Dissection
Journal of the American College of Cardiology, 2013Co-Authors: Rossella Fattori, Christoph A Nienaber, Arturo Evangelista, Paola De Rango, Martin Czerny, H Rousseau, Marc A A M SchepensAbstract:An expert multidisciplinary panel in the treatment of type B aortic Dissection reviewed available literature to develop treatment algorithms using a consensus method. Data from 63 studies published from 2006 to 2012 were retrieved for a total of 1,548 patients treated medically, 1,706 patients who underwent open surgery, and 3,457 patients who underwent thoracic endovascular repair (TEVAR). For acute (first 2 weeks) type B aortic Dissection, the pooled early mortality rate was 6.4% with medical treatment and increased to 10.2% with TEVAR and 17.5% with open surgery, mostly for complicated cases. Limited data for treatment of subacute (2 to 6 weeks after onset) type B aortic Dissection showed an early mortality rate of 2.8% with TEVAR. In chronic (after 6 weeks) type B aortic Dissection, 5-year survival of 60% to 80% was expected with medical therapy because complications were likely. If interventional treatment was applied, the pooled early mortality rate was 6.6% with TEVAR and 8.0% with open surgery. Medical treatment of uncomplicated acute, subacute, and chronic type B aortic Dissection is managed with close image monitoring. Hemodynamic instability, organ malperfusion, increasing periaortic hematoma, and hemorrhagic pleural effusion on imaging identify patients with complicated acute type B aortic Dissection requiring urgent aortic repair. Recurrence of symptoms, aortic aneurysmal dilation (>55 mm), or a yearly increase of >4 mm after the acute phase are predictors of adverse outcome and need for delayed aortic repair (“complicated chronic aortic Dissections”). The expert panel is aware that this consensus document provides proposal for strategies based on nonrobust evidence for management of type B aortic Dissection, and that literature results were largely heterogeneous and should be interpreted cautiously.
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aortic diameter 5 5 cm is not a good predictor of type a aortic Dissection observations from the international registry of acute aortic Dissection irad
Circulation, 2007Co-Authors: Linda Pape, Arturo Evangelista, Rossella Fattori, Santi Trimarchi, Thomas T Tsai, Eric M Isselbacher, Jae Kuen Oh, Patrick T Ogara, Gabriel Meinhardt, Eduardo BossoneAbstract:Background— Studies of aortic aneurysm patients have shown that the risk of rupture increases with aortic size. However, few studies of acute aortic Dissection patients and aortic size exist. We used data from our registry of acute aortic Dissection patients to better understand the relationship between aortic diameter and type A Dissection. Methods and Results— We examined 591 type A Dissection patients enrolled in the International Registry of Acute Aortic Dissection between 1996 and 2005 (mean age, 60.8 years). Maximum aortic diameters averaged 5.3 cm; 349 (59%) patients had aortic diameters <5.5 cm and 229 (40%) patients had aortic diameters <5.0 cm. Independent predictors of Dissection at smaller diameters (<5.5 cm) included a history of hypertension (odds ratio, 2.17; 95% confidence interval, 1.03 to 4.57; P=0.04), radiating pain (odds ratio, 2.08; 95% confidence interval, 1.08 to 4.0; P=0.03), and increasing age (odds ratio, 1.03; 95% confidence interval, 1.00 to 1.05; P=0.03). Marfan syndrome pati...
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nonsurgical reconstruction of thoracic aortic Dissection by stent graft placement
The New England Journal of Medicine, 1999Co-Authors: Christoph A Nienaber, Rossella Fattori, Gunnar K Lund, Christoph Dieckmann, Walter Wolf, Yskert Von Kodolitsch, V Nicolas, A PierangeliAbstract:Background The treatment of thoracic aortic Dissection is guided by prognostic and anatomical information. Proximal Dissection requires surgery, but the appropriate treatment of distal thoracic aortic Dissection has not been determined, because surgery has failed to improve the prognosis. Methods We prospectively evaluated the safety and efficacy of elective transluminal endovascular stent–graft insertion in 12 consecutive patients with descending (type B) aortic Dissection and compared the results with surgery in 12 matched controls. In all 24 patients, aortic Dissection was diagnosed by magnetic resonance angiography. In each group, the Dissection involved the aortic arch in 3 patients and the descending thoracic aorta in all 12 patients. With the patient under general anesthesia, either surgical resection was undertaken or a custom-designed endovascular stent–graft was placed by unilateral arteriotomy. Results Stent–graft placement resulted in no morbidity or mortality, whereas surgery for type B disse...
Gunther Deuschl - One of the best experts on this subject based on the ideXlab platform.
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internal carotid artery Dissection and stroke after scuba diving a case report and review of the literature
Journal of Neurology, 2009Co-Authors: T Bartsch, Milena Palaschewski, Barbara Thilo, Andreas Koch, Robert Stingele, Jens Volkmann, Gunther DeuschlAbstract:Serious neurological complications after diving have increased in the last years because of its increased popularity [1, 2, 5, 7]. Dangerous neurological complications such as ischemic stroke reflecting an acute central nervous system pathology are frequently associated with a dysbaric air embolism or decompression sickness (Caisson’s disease), but may also include rarer causes [8]. Due to unspecific clinical presentation, the differential diagnosis of diving-related neurological symptoms may be difficult. A Dissection of cervical arteries in young to middle-aged scuba divers has rarely been described. We describe a patient with internal carotid artery Dissection after scuba diving, who presented at the emergency department with subacute embolic strokes. In addition, we also summarize the published reports to date of cervical artery Dissections associated with scuba diving.
A Pierangeli - One of the best experts on this subject based on the ideXlab platform.
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nonsurgical reconstruction of thoracic aortic Dissection by stent graft placement
The New England Journal of Medicine, 1999Co-Authors: Christoph A Nienaber, Rossella Fattori, Gunnar K Lund, Christoph Dieckmann, Walter Wolf, Yskert Von Kodolitsch, V Nicolas, A PierangeliAbstract:Background The treatment of thoracic aortic Dissection is guided by prognostic and anatomical information. Proximal Dissection requires surgery, but the appropriate treatment of distal thoracic aortic Dissection has not been determined, because surgery has failed to improve the prognosis. Methods We prospectively evaluated the safety and efficacy of elective transluminal endovascular stent–graft insertion in 12 consecutive patients with descending (type B) aortic Dissection and compared the results with surgery in 12 matched controls. In all 24 patients, aortic Dissection was diagnosed by magnetic resonance angiography. In each group, the Dissection involved the aortic arch in 3 patients and the descending thoracic aorta in all 12 patients. With the patient under general anesthesia, either surgical resection was undertaken or a custom-designed endovascular stent–graft was placed by unilateral arteriotomy. Results Stent–graft placement resulted in no morbidity or mortality, whereas surgery for type B disse...
