Search

We retrospectively reviewed the mortality rate of the patients with subarachnoid hemorrhage (SAH) who received initial treatment in Kurashiki Central Hospital, for the 10-year period from 1999 through 2008. The overall mortality was 18.1% (120/662). The average fatality rate in such cases has shown a decreasing trend, from 24.2% in 1999-2002 to 15.9% in 2005-2008 (p=0.016). Transition in initial diagnostic modality from the time-consuming digital subtraction angiography to the less-invasive computed tomographic angiography, appropriate indication for the operation, and improvement in postoperative management might affect this decline in fatality cases.

The optimal therapeutic approach for chronic carotid occlusion with contralateral carotid stenosis (ICO-ICS) remains uncertain. The aim of this study was to elucidate the safety and efficacy of initial vascular reconstruction for ICS in patients with ICO-ICS.Eleven patients with ICO-ICS who demonstrated severe cerebral hypoperfusion in the hemisphere ipsilateral to ICO were treated in our institution between February 2003 and November 2007. Revascularization for ICS after measuring cerebral blood flow (CBF) by single photon emission computed tomography (SPECT) was performed either by carotid endarterectomy or carotid stenting. External carotid artery-internal carotid artery (EC-IC) bypass for ICO was also performed when SPECT after revascularization for ICS still demonstrated marked hypoperfusion.In 6 patients with collateral flow via the anterior communicating artery and/or who had high-grade ICS (70%), sufficient improvement of CBF solely by revascularization for ICS was confirmed. With regard to perioperative complications, 2 patients suffered bradycardia and hypotension and another 2 showed asymptomatic cerebral infarction on diffusion-weighted magnetic resonance imaging.Overall results for revascularization of ICS prior to that for ICO in patients with ICO-ICS were acceptable. CBF of bilateral hemispheres was sufficiently improved in more than half of the patients solely by revascularization for ICS. This strategy might be both efficient and effective for ICO-ICS.

The evaluation of plaque characteritics as well as the degree of luminal narrowing is important in the management of carotid stenosis. Several reports have shown that intraplaque hemorrhage (IPH), which plays a pivotal role in plaque vulnerability, emits high signal intensity on T1-weighted images of high-resolution black-blood (BB) MRIs. When an MRI is used to screen for vulnerable plaque, a short scanning duration and a simple MRI protocol are required. This study assessed the utility of screening BB-MRI to detect IPH. Ninety-three consecutive cases with atherosclerotic carotid stenosis scheduled for carotid endarterectomy (CEA) or carotid artery stenting between January 2005 and December 2007 were included. High-resolution BB-MRI scans were obtained with 2D double-inversion recovery fast spin-echo sequences with cardiac gating. Screening BB-MRIs were performed with 3D gradient-echo sequences suppressing blood flow signals by radiofrequency wave spatial saturation over the scanning field of 3D time-of-flight MRA. The relative overall plaque signal intensities with reference to the sternocleidomastoid muscle were calculated, and the correlation of intensities on T1-weighted images between high-resolution BB-MRI and screening BB-MRI was investigated. We excluded 50 cases because of restenosis following CEA, use of a pacemaker, a long interval (10 days) between high-resolution and screening BB-MRI examinations, or poor-quality images. Among the 43 cases included, the relative overall plaque signal intensity of high-resolution BB-MRI and screening BB-MRI were closely correlated (r = 0.568, p0.001). Screening BB-MRI can be an alternative to high-resolution BB-MRI in the assessment of IPH and may be a useful tool for detection of vulnerable plaque.

Management of atherosclerotic carotid arteries requires both plaque characterization and determination of the degree of stenosis, especially when carotid stenting (CAS) is being considered for severe carotid stenosis. Recent studies have demonstrated that high-resolution MRI can identify plaque components, such as the lipid-rich necrotic core, intraplaque hemorrhage, fibrous tissue, and the calcification present in human carotid atherosclerosis. The purpose of this study was to assess the feasibility of black blood MRI (BB-MRI) for accurately identifying the plaque components in vivo. Twenty-six consecutive patients scheduled for carotid endarterectomy (CEA) underwent a BB-MRI examination within 2 weeks before the surgical procedure using a 1.5-T Philips scanner with a protocol that generated 2 contrast weightings (T1 and T2). The MR images were acquired using cardiac gating to minimize motion artifact and fat suppression to reduce MR signals from subcutaneous fatty tissue. The plaque evaluations obtained by BB-MRI were compared with the intra-operative video recordings, the excised specimens, and the histological sections. With BB-MRI, the combination of the signal intensities in the T1- and T2-weighted images for each component (lipid deposits, intra-plaque hemorrhage, fibrous plaque, and calcification) showed findings that corresponded with the excised specimens. Complex morphological features could also be assessed by BB-MRI. BB-MRI is a useful method for noninvasively imaging and characterizing atherosclerotic carotid arteries. This MRI technique can provide valuable information that can be used to decide whether to perform a CEA or a CAS in patients with severe carotid stenosis. Furthermore, BB-MRI appears to be a useful tool for the investigation of the pathogenesis and natural history of carotid atherosclerosis.