The prospective randomized study SAMMPRIS (Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis) showed that aggressive medical management was superior to stenting, both because the risk…
Stenting (see Plate 9-17) has been investigated as an alternative therapy for patients with carotid artery disease. Two multicenter studies, the International Carotid Stenting Study (ICSS) and the North American…
The presence of pacemaker devices and renal failure limit the imaging studies performed in patients with ICA disease. MRIs cannot be performed in patients with pacemakers, and renal failure is…
DIAGNOSIS The diagnosis of anterior circulation ischemia is often made by noninvasive methods, including ultrasound techniques, computed tomography, and magnetic resonance imaging techniques (see Plates 9-14 and 9-15). Digital subtraction…
Neurologic findings vary by the location of the occlusion and the adequacy of collateral circulation. A large MCA territory stroke is usually seen in patients with MCA mainstem occlusion without…
Atherosclerosis causes stenosis or occlusion of extracranial and intracranial arteries and is directly responsible for a significant percentage of cerebral ischemic events. Atheroma formation involves the progressive deposition of circulating…
Giant cell arteritis is a common form of systemic vasculopathy affecting patients older than 50 years. Although it typically involves the temporal, maxillary, and ophthalmic arteries, it can rarely affect…
In addition to treating the acute stroke, attention must be directed toward prevention of future strokes. Identifying and modifying potential risk factors is essential. Pharmacologic treatment using antihypertensives, statins, and…
CT is readily available in most hospitals and reliably demonstrates the presence or absence of intracerebral hemorrhage. Immediately after the onset of bleeding, intracerebral hematomas (ICHs) are seen on CT…
Timing and Evolution In intracerebral hemorrhage patients, symptoms and signs gradually develop over minutes or hours. Improvements and fluctuations do not occur during this time. In aneurysmal subarachnoid hemorrhage, symptoms…
