Том 9, брой 2 - 2013/ Vol. 9, No. 2 - 2013

I. Petrov, L. Grozdinski, I. Tasheva, B. Zehirov
Department of Cardiology and Angiology, City Clinic – Sofia, Bulgaria

Objective: Occluded and nearly occluded internal carotid arteries have lower risk of subsequent stroke, because antegrade flow no longer exists. Still, cervical ICA occlusion is associated with an annual risk of 6 to 20% of ipsilateral recurrent stroke. Extracranial-to-intracranial (EC-IC) artery bypass failed to reduce the risk of ischemic stroke. Occlusion/ near occlusion of internal carotid arteries has long been definitive contraindication for endovascular treatment but several small series showed that endovascular recanalization and stenting of occluded and near occluded carotids is feasible. Data are still controversial. To analyze and present the results of percutaneous recanalization and stenting of total and subtotal carotid stenoses for a 10 years period.

I. Petrov, M. Klissurski, S. Sirakov, B. Zehirov, A. Mihaylov, D. Petkova, Ts. Pramatarova, T. Kmetski, G. Georgieva-Kozarova, L. Penev, L. Grozdinski
City Clinic Cardiology Center MPHAC – Sofia, Bulgaria

Objective: To report the clinical, radiological, and haemodynamic data of three patients with AIS who underwent IAT.

Material and Methods: Two men and one woman, mean age of 61.6, two with MCA occlusion and one with posterior AIS, were treated. Clinical outcome was assessed according to NIHSS and mRS on day 1, 30 and 90. Neuroimaging included non-contrast CT or MRI, diffusion and angio MRI. All patients underwent cerebral angiography and met criteria for endovascular TL. Transcranial duplex scanning was used for haemodynamic assessment of the occlusion and recanalization. Actiyse was infused supraselectively via microcatheter in a mean dose of 38.3 mg. TICI score was documented at the end of the procedure. Post-procedural I.V. 24 h heparin infusion was given to one patient with poor TICI result.

J. Shimizu 1, J. Kubota 1, T. Fukuda 2, A. Sasaki 3, T. Azuma 3, K. Sasaki 4, K. Shimizu 5, T. Oishi 6, S. Umemura 7, H. Furuhata 1
1 Medical Engineering Laboratory,
2 Division of Neuropathology, The Jikei University School of Medicine – Tokyo, Japan
3 Faculty of Engineering, The University of Tokyo – Tokyo, Japan
4 Department of Veterinary Medicine, Tokyo University of Agriculture and Technology – Tokyo, Japan
5 Department of Zoology, Faculty of Science, Okayama University of Science – Okayama, Japan
6 Department of Cellular and Molecular Biology, Primate Research Institute, Kyoto University – Inuyama, Japan
7 Graduate School of Biomedical Engineering, Tohoku University – Sendai, Japan

Objective: We are developing mid-frequency sonothrombolysis, however, hemorrhagic complication in TRUMBI trial is a fence at these frequency. We evaluated safety in primate with a developed 490 kHz continuous waveform (CW)-US probe and investigated 400 kHz burst waveform (BW)-US emission for rabbit.

M. De Lima Oliveira, R. Nogueira, K. Andrade Norremose, A. Maria Negrao Esteves, F. Iuji Yamamoto, E. Faria Evaristo, M. Jacobsen Teixeira, E. Bor-Seng-Shu
Department of Neurology, University Hospital, University of São Paulo – São Paulo, Brazil

Objective: It is supposed that Transcranial Doppler ultrasonography (TCD) during thrombolysis may help to expose thrombi to tissue plasminogen acPvator (t-PA). The aim of this study is to determine if TCD can safely enhance the thrombolyPc acPvity of t-PA.

Material and Methods: Patients with acute ischemic stroke which fufill current criteria to intravenous t-PA treatment were randomly assigned to receive continuous 2 MHz TCD (the target group) or placebo (the control group). In follow up analysis, outcomes are defined as good (as indicated by a score of 0 to 2 on the modified Rankin scale) or favorable (scores of 0 to 1 on modified Rankin Scale).

S. Yoshikazu, R. Suzuki, Y. Oda, D. Omata, K. Maruyama
Laboratory of Drug and Gene Delivery Faculty of Pharma-sciences – Tokyo, Japan

Objective: The combination thrombolysis therapy with recombinant tissue plasminogen activator (rt-PA), microbubbles and ultrasound, was reported higher recanalization ratio in ischemic cerebrovascular disease. Ultrasound and microbubbles vibrate the fibrin net and accelerate thrombolysis. Recently, we developed novel liposomal submicron bubbles (Bubble Liposome (BLs)) containing ultrasound imaging gas, perfluoropropane. In this study, we developed BLs with Arg-Gly-Asp (RGD) sequence-containing peptides, which bind to the activated platelet glycoprotein IIb/IIIa complexes. The aim of this study was to examine the enhancing effects in ultrasonic thrombus imaging using these targeted BLs in vitro and in vivo.

M. De Lima Oliveira, R. Shimidt Brock, M. Augusto Taricco, S. Brasil Lima, M. Jacobsen Teixeira, E. Bor-Seng-Shu
Department of Neurology, University Hospital, University of São Paulo – São Paulo, Brazil

Objective: Arnold Chiari type I malformation is narrowly defined when the tonsils of the cerebellum extend below the foramen magnum, leading to a variety of neurological symptoms. Optimal treatment for patients with Arnold Chiari type 1 is not yet well established, especially when associated with syringomyelia. Isu et al (1993) described surgical decompression technique without performing the dural opening. Mushim and Frimm (2000) concluded more reliable reduction in the syringomyelia when duraplasty technique was applied, however some of these patients developed cerebrospinal (CSF) leaks and meningitis. Currently there are no data to determine which patients with Arnold-Chiari I malformation would benefit from the removal of the bone structure alone without the need for duraplasty.

I. Todorov, T. Eftimov, I. Hadzhiangelov, V. Nakov, P. Simeonov, E. Stavrev, C. Ninov, K. Romanski, Al. Petkov
Department of Neurosurgery, Military Medical Academy – Sofia, Bulgaria

Objective: For more than two decades the neuronavigation was successfully used in the neurosurgery. Some shortcomings of the method have evoked the need of an appropriate intraoperative imaging to compensate for the registration and shifting bias and the intraoperative ultrasound is found to be a good option. To analyze the results of the usage of intraoperative ultrasound combined with neuronavigation in different fields of neurosurgery.

Material and Methods: Between the years 2008 and 2013, 240 surgeries under ultrasound/navigation guidance were performed in the Department of Neurosurgery of the MMA – Sofia. Patients were at an average age of 54±14.26 years, harboring oncologic (91.3%), vascular (6.7%), inflammatory (1.3%) and congenital (0.8%) diseases. Integrated ultrasound navigation system (Sonowand Invite) was used intraoperatively in different modes: ultrasound only – in 46cases; 3D ultrasound registration – in 72 cases; “classic” neuronavigation (based on preoperative images) – in 15cases; and ultrasound-based navigation – in the rest 107 (45%) cases.

T. Shiogai 1, M. Yamamoto 1, M. Koyama 1, K. Yoshikawa 2, M. Nakagawa 3
1 Department of Clinical Neuroscience, Kyoto Takeda Hospital – Kyoto,
2 Department of Stroke Medicine, Hoshigaoka Kouseinenkin Hospital – Osaka,
3 Department of Neurology, Kyoto Prefectural University of Medicine – Kyoto, Japan

Objective: In order to evaluate cerebrovascular reserve capacity in the brain tissue, acetazolamide (ACZ) cerebrovascular reactivity (CVR) has been measured in major cerebral arteries by transcranial Doppler sonography. This has shown some correlation with CVR in the brain tissue, as measured by neuroradiological modalities. We have evaluated ACZ CVR in the brain tissue by transcranial power modulation imaging (PMI) and correlated with transcranial color duplex sonography (TCDS) observed CVR in the major arteries.

Material and Methods: Time-averaged maximum velocity (Vmax) in the middle/posterior cerebral arteries (MCA/PCA) was measured by TCDS before/after ACZ. After a bolus intravenous Levovist®, transcranial PMI was evaluated via temporal windows in 11 patients without and 10 patients with a transducer holder (Sonopod). Peak intensity (PI) and time to PI (TPI) before/ after ACZ were measured and CVR calculated on the basis of time-intensity curves in five regions of interest; bilateral basal ganglia (BG) and thalamus (Th), and contra-lateral temporal lobe (TL). Correlations between Vmax and PI/TPI in the corresponding vascular territories were evaluated before/after ACZ and in CVR.

M. De Lima Oliveira 1, J. Luiz Pedroso 2, P. Braga Neto 3, M. Ferreira Machado 4, R. Nogueira 5, O. Graziani Povoas Barsottin 6, E. Bor-Seng-Shu 7
1 Department of Neurolgy, University Hospital of São Paulo,
2 Department of Neurology, Medical Faculty, Federal University of São Paulo,
3 Hospital Israelita Albert Einstein – São Paulo, Brazil

Objective: Several studies have demonstrated increased substantia nigra (SN) in Parkinson's disease (PD), and Machado Joseph disease (MJD). Pathological substrate of PD is characterized by dopaminergic nigrostriatal cell loss, also found in MJD. Also, SN hiperechogenicity might be associated with nigrostriatal disfunction in PD, when comparing dopamine transport binding with SN echogenicity. The present study aimed to correlate the SN echogenicity size and striatal dopamine transporter density in MJD patients.

A. Numao 1, K. Suzuki 1, H. Takekawa 2, M. Miyamoto 1, T. Miyamoto 3, M. Iwanami 3, E. Takada 4, K. Hirata 1
1 Department of Neurology, Dokkyo Medical University – Tochigi, Japan
2 Stroke Division, Department of Neurology, Dokkyo Medical University – Tochigi, Japan
3 Department of Neurology, Dokkyo Medical University Koshigaya Hospital – Saitama, Japan
4 Center of Medical Ultrasonics, Dokkyo Medical University – Tochigi, Japan

Objective: In Parkinson's disease (PD), transcranial sonography (TCS) has been used to evaluate substantia nigra (SN) hyperechogenicity as a diagnostic tool. To quantify SN hyperechogenicity in patients with PD and Parkinsonian syndrome (PS), we applied semi-quantified evaluation method.

C. Vidinova, L. Voinov
Clinic of Ophthalmology, Military Medical Academy – Sofia, Bulgaria

Objective: Papilloedema is a difficult dillema to solve due to the different possible causes. The objective of our study is to present a difficult case of unilateral papilloedema.

Material and Methods: We used complete ophtalmologic examination including Visual acuity, perimetry, fluorecein angiography, OCT, ultrasonography and MR in trying to solve a difficult case.

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