Carotid cavernous fistulas are abnormal communications between the carotid artery or its branches and the cavernous sinus. It can be traumatic or spontaneous. The widely accepted treatment is by detachable balloons. Advancements in the field of endovascular medicine made available other options for the treatment of this condition. Covered stents are widely available and offer preservation of the parent artery while occluding the fistula.

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Lower incidence of vascular events following small artery ischemic stroke Small artery infarction, which is particularly prevalent among Asians (1), carries a lower risk of recurrent stroke at one-month compared with other stroke subtypes, but long-term findings are inconsistent (2,3). Data on subsequent myocardial infarction risk after small artery stroke are limited. We compared the incidence of vascular events following ischemic stroke due to small artery disease vs. other etiologies among prospectively recruited Asian patients admitted to the Singapore General Hospital from 2005 to 2007. Telephone follow᎑up at a median of 30 months (IQR 24-34) masked to clinical information was obtained for 89% of the cohort. Among the 731 patients with known stroke etiology, 49% had small artery infarction, 38% had large artery infarction, 12% had cardioembolic, and 1% had other etiology. Figure 1 shows the cumulative incidence of subsequent vascular events. Using Cox regression adjusted for age, gender, hypertension, diabetes, hyperlipidemia, smoking, and atrial fibrillation, small artery infarction was associated with a lower incidence of recurrent stroke [hazard ratio (HR) 0•62; P = 0•047], myocardial infarction (HR 0•45; P = 0•031), vascular death (HR 0•18; P = 0•002), and composite vascular events (HR 0•59, P = 0•007) compared with nonsmall artery stroke. The lower risk of subsequent vascular events following small artery infarction may be explained by a differing underlying pathology from large artery and

Please cite this article as: I. Petrov, et al., A case of successful interventional treatment in acute basilar artery occlusion, Cor et Vasa 58 (2016) e287-e291 as published in the online version of Cor et Vasa available at SOUHRNPopisujeme případ úspěšné rekanalizace a příznivý klinický výsledek u pacienta s akutním uzávěrem bazilární tepny (basilar artery occlusion, BAO) a intervenční léčby (interventional treatment, IT). Sedmašedesátiletý muž byl přijat v komatózním stavu, s kvadruplegií a decerebrační rigiditou. Při příjmu byly zjištěny hodnoty skóre 11 na stupnici GLCS (Glasgow-Liege Coma Scale), 24 na stupnici National Institutes of Health Stroke Scale (NIHSS) a 5 na modifi kované Rankinově škále (modifi ed Rankin Scale, mRS). Před IT byl pořízen nekontrastní CT sken. Pro podezření na BAO bylo okamžitě provedeno angiografi cké vyšetření mozku, které prokázalo BAO mediálního a distálního segmentu. Léčba se prováděla intraarteriální katetrizací včetně balonkové angioplastiky a trombolýzy s aplikací 20 mg přípravku Actilyse (do 4 hodin od nástupu symptomů). Následné angiografi cké vyšetření potvrdilo optimální výsledek výkonu, po němž bylo na JIP pacientovi infuzně podáno během dalších tří hodin 10 mg přípravku Actilyse. Vzhledem ke zlepšení neurologického stavu byla o 12 hodin později provedena extubace. První den došlo k obnově vědomí a dokázal mluvit; další neurologický defi cit nebyl zjištěn. Kontrolní CT neprokázalo nové známky ischemické cévní mozkové příhody. CT angiografi e prokázala úplnou rekanalizaci distálního segmentu bazilární tepny a středně významnou reziduální stenózu v mediálním segmentu. Sedmý den po výkonu byl pacient propuštěn z nemocnice s hodnotami skóre NIHSS 7, GLCS 20 a mRS 3. Podle našeho názoru byla v našem případě léčba úspěšná díky rychle stanovené klinické diagnóze, rychlé dostupnosti katetrizačního sálu a časně provedené mechanicko-farmakologické rekanalizaci. ABSTRACTWe describe a case of successful recanalisation and favorite clinical outcome of a patient with acute basilar artery occlusion (BAO) and interventional treatment (IT). A 67-year old patient presented in a comatose state, with quadriplegia, and decerebrate posturing. His initial Glasgow-Liege Coma Scale (GLCS) score was 11, Institutes of Health Stroke Scale (NIHSS) 24, and modifi ed Rankin Scale (mRS) 5. Non-contrast CT was performed before IT. Due to suspicion of BAO, an immediate cerebral angiography was performed. It demonstrated BAO in the middle and distal segment. Intra-arterial catheter based treatment was performed including balloon angioplasty and thrombolysis with 20 mg Actilyse (within four hours of symptoms onset). An optimal angiographic result was achieved. After the procedure the patient was treated in ICU with another 10 mg Actilyse infused over the next 3 hours. Because of neurological condition improving, the patient was extubated 12 hours later. On the fi rst day, he regained consciousness, being able to speak, without new neurologic defi cit. Control CT did not demonstrate new signs of ischemic s...

Background Several randomized trials have indicated a benefit from endovascular therapy in acute ischemic stroke (AIS) patients. In some centers, interventional cardiologists with previous large carotid stenting experience can play significant role for this treatment. Objectives We present retrospective analysis of prospectively collected data of endovascular treatment of stroke (EVTS) performed by interventional cardiologists in collaboration with neurologists in 46 patients in single center. Methods Between 2014 and 2017 46 consecutive AIS patients underwent EVT, men 69.7% (7 with posterior circulation stroke and 5 with wake-up stroke), with mean age 64.6±13 years and average National Institutes of Health Stroke Scale (NIHSS) score of 12.2±5 at presentation. During the same period of time 20 patients, 16 men, at mean age 69.4±12, and NIHSS score 11.8±7 received IVT. In the EVT group two methods were applied: Method 1, Supraselective intra-arterial thrombolysis (IAT) alone or IAT plus balloon angioplasty (PBA); Method 2, Aspiration with Penumbra aspiration system (PAS) or Combination of PAS plus low dose IAT. Results The mean symptoms onset-to-treatment (needle) time (ONT) in the EVT group was 221.7±121.5 minutes, and 185.5±34.9 in the IVT group (p=0.19T). Conscious sedation and local anesthesia was used in 84.7% of the patients (40), general anesthesia in 15.2%; preprocedural MRI was performed in 58.7% and CT in 71.7% of the patients. In the EVT group successful reperfusion (TICI 2b-3 flow) was achieved in 35 (76.1%) patients: in 73.9% with Method 1 and in 86.7% with Method 2 (p=0.44). Poor or no recanalization (TICI 0–1-2a) was observed in 26.1%. Twenty six of 46 patients (56.5%) treated with endovascular methods and respectively 9 (45%) with IVT demonstrated favorable clinical outcome of mRS score 0–2 at 90 days (p=0.91). The overall 3-month mortality was 15.2%, 13% after EVT and 20% after IVT (p=0.48). Conclusions Our initial experience with EVT of AIS performed by trained cardiologists with carotid experience is encouraging, with a relatively moderate to high rate of successful angiographic recanalization and good clinical results. Funding Acknowledgement Type of funding source: None