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24 Stroke Rehabilitation
291
3. Stroke patients with a larger Ashworth
number would likely be in what
Brunnstrom stage of their rehabilitation?
A. Flaccid stage
B. Early synergic exor/extensor motor
function stage
C. Spastic synergy dominant stage
D. Isolated motor control and smooth
coordinated joint motion
Answer: C
4. Shoulder-hand syndrome, a form of
complex regional pain syndrome, is a
painful condition that is challenging to
treat and impairs recovery. The best way
to treat this condition is through:
A. Early comprehensive aggressive
prevention program initiated in the
rst 24h of admission
B. Cutaneous desensitization of the
extremity
C. Elevation of the limb
D. Prophylactic use of gabapentin
within the rst 24h of the rst sign
of paralysis
Answer: A
5. After surgery, you are attempting to provide important discharge instructions to
your patient. Which of the following
patients may be alert and attentive but
would have the most difculty understanding your instructions?
A. A patient with aprosodia
B. A patient with a lesion in the frontal
operculum of the right cerebrum
C. A patient with damage to the rst
temporal gyrus
D. A person with right hemiplegia
Answer: C
6. Spasticity can adversely affect patients
causing skin breakdown, abnormal posture during gait, and wheelchair seating or result in soft tissue contractures.
It also can be benecial in providing
enough tone in a paralytic limb to facilitate ambulation. When selecting the
appropriate medication to treat spasticity in a stroke patient, which of the following considerations is least relevant
to the decision?
A. Level of sedation
B. Dose-dependent muscle weakness
C. Liver toxicity
D. Myonecrosis
Answer: D
7. Emotional lability is common in poststroke patients. Many medications used
to treat agitation negatively impact neurologic recovery. Which of the following classes of medications are relatively
contraindicated in stroke patients?
A. Serotonin reuptake inhibitors
B. Benzodiazepines
C. Tricyclic antidepressants
D. Anticonvulsants
Answer: B
References
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4. Singh S, Hamdy S. Dysphagia in stroke patients.
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5. Feinberg MJ, Knebl J, Tully J.Prandial aspiration and
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6. Panther K. The free water protocol. Swallowing
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7. Barer DH. The natural history and functional consequences of dysphagia after hemispheric stroke. J
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14. Velstra IM, Ballert CS, Cieza A.A systematic literature review of outcome measures for upper extremity
function using the international classication of functioning, disability, and health as reference. PM & R.
2011;3(9):846–60.
15. Malhotra S, Pandyan AD, Rosewilliam S, Roffe C,
Hermens H. Spasticity and contractures at the wrist
after stroke: time course of development and their
association with functional recovery of the upper
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16. Chollet F, Acket B, Raposo N, Albucher JF, Loubinoux
I, Pariente J. Use of antidepressant medications to
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17. Karaiskos D, Tzavellas E, Spengos K, Vassilopoulou
S, Paparrigopoulos T. Duloxetine versus citalopram
and sertraline in the treatment of poststroke depression, anxiety, and fatigue. J Neuropsychiatry Clin
Neurosci. 2012;24(3):349–53.
18. Bhogal SK, Teasell R, Foley N, Speechley
M. Heterocyclics and selective serotonin reuptake
inhibitors in the treatment and prevention of poststroke
depression. J Am Geriatr Soc. 2005;53(6):1051–7.
19. Hall KM, Cohen ME, Wright J, Call M, Werner
P. Characteristics of the functional independence
measure in traumatic spinal cord injury. Arch Phys
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20. Keith RA, Wilson DB, Gutierrez P.Acute and subacute rehabilitation for stroke: a comparison. Arch
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21. Kramer AM, Steiner JF, Schlenker RE, Eilertsen TB,
Hrincevich CA, Tropea DA, etal. Outcomes and costs
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22. Brandstater ME. Stroke rehabilitation. In: DeLisa
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23. Feigenson JS, McDowell FH, Meese P, McCarthy
ML, Greenberg SD.Factors inuencing outcome and
length of stay in a stroke rehabilitation unit. Part 1.
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651–6.
24. Wade DT, Wood VA, Hewer RL. Recovery after
stroke—the rst 3 months. J Neurol Neurosurg
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25. Wade DT, Hewer RL.Functional abilities after stroke:
measurement, natural history and prognosis. J Neurol
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26. Chan ML. Description of a return-to-work occupational therapy programme for stroke rehabilitation in
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Index
A
Aberrant left subclavian artery, 1
Accessory spinal nerve, 4
Acute ischemic stroke, 282
Acute/subacute stroke period, key management issues in,
282–286
Adaptive intimal thickening (AIT), 24, 25
Adenosine, 12, 16, 17, 128
Advanced Trauma Life Support (ATLS) protocol, 267
Aggressive medical management (AMM), 131
Amaurosis fugax, 46, 71, 136
American Heart Association, 287
Anastomosis, 153, 154, 168, 169
Aneurysm
arteriovenous, 63
carotid arteries, 47, 235
carotid and vertebral arteriography, 119
ECCAs and ECVAs, 29
extracerebral carotid artery, 39
fusiform, 30
mycotic, 30
pseudoaneurysm, 100, 101, 259
18-G Angiocatheter, 163
Angiography, evolution of, 114
Ansa cervicalis, 5, 137
Anterior scalene muscle, 203, 204
Anticoagulation, 47, 245, 246
Antiplatelet therapy, 127, 128, 245, 246
Antithrombotic therapy, 245, 246
Apraxia, 285
Aorta, arch of, 1
Aortic arch branches
occlusive lesions
axillo-axillary bypass, 207, 208
carotid subclavian bypass/transposition
operations, 203–206
carotid-carotid artery bypass, 206, 207
CTA and MRA, 199
diagnostic studies, 198, 200
duplex ultrasound, 199
endovascular therapy, 200–202
extra-thoracic arterial reconstructions, 202, 203
indications, 200
transthoracic supra-aortic trunk reconstruction,
Aorto-innominate bypass, 212
Arterial occlusive disease, 197, 200
Arterial partial pressure of carbon dioxide (PaCO
Arterial partial pressure of oxygen (PaO
Arterial pressure, 10, 11
Arteriography, 76
Arteriotomy, 139, 154
Arteriovenous aneurysms, 63
Arteriovenous stulas (AVFs), 105
Arteriovenous malformations (AVMs), 105
Artery-to-artery embolization, 26, 29, 39
Ashworth number, 284, 291
Aspirin, 127, 128
Aspirin and Carotid Endarterectomy (ACE) trial, 128
Asymptomatic Carotid Surgery Trial (ACST), 130
Asymptomatic Carotid Surgery Trial-2 (ACST-2), 182
Asymptomatic Carotid Trial-1 (ACT-1), 181, 182
Atherosclerosis, 24–27, 39, 91, 151, 165, 197, 215, 227,
Atorvastatin, 129, 132
Atraumatic clamps, 205
Autologous vein/supercial femoral artery, 170
Autonomic nervous system, 14, 16
Autoregulation, 12, 13, 16
Axillo-axillary bypass, 207, 208
B
Balloon angioplasty, 202
Balloon test occlusion, 120, 121
Balloon-expandable stents, 202
Baroreceptors, 258
Baroreex failure, 258
BCA, see Brachiocephalic artery
Beaver® blade, 163
208–210
carotid (see Carotid arteriography)
catheter-based arteriography, 262
cervico-cerebral arteriography, 118
right vertebral arteriography, 124
vertebral (see Vertebral arteriography)
264
failure, 259
), 14
2
), 13
2
© The Editor(s) (if applicable) and The Author(s) 2018
S. S. Hans (ed.), Extracranial Carotid and Vertebral Artery Disease,
https://doi.org/10.1007/978-3-319-91533-3
293
294
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Index
Berenstein catheter, 188
Bilateral carotid endarterectomy, 164
Bilateral high cervical internal carotid artery dissection,
102
Bilateral upper extremity segmental pressure, 198
Bilateral vertebral artery ow, 74
Blood pressure medications, 130, 131
Blood-brain barrier, 9
Blunt cerebrovascular injuries (BCVI), 267, 275
CAD, 247
management, 272, 273
modied Denver criteria, 272
screening and diagnosis, 271, 272
B-mode imaging, 67, 68, 74, 80
Bovine aortic arch, 6
Brachiocephalic artery (BCA), 2, 197, 199, 200
Bradycardia, 141
Brain circulation, 10
Broca’s aphasia, 285
BSA bypass, 210, 211
C
Capillary density, 10
Cardiac arrhythmias, 142
Cardiopulmonary disease, 209
Carotid arteriography
advanced angiographic techniques, 118
aneurysms, 119
balloon test occlusion, 120, 121
cone-beam CT angiography, 122
contraindications, 115, 116
CT scanning, 114
Doppler ultrasound, 114
extracranial vascular stenosis, 118
indications, 115
intravascular ultrasound, 123
limitations, 122
maneuvers and dynamic imaging, 118
modern neuroangiography imaging systems, 121
MRI, 114, 115
procedural risks, 118
techniques
angiography imaging systems, 116
catheters and wires, choice of, 116, 117
pre-procedural evaluation, 116
vascular access phase, 116
vascular malformations, 119, 120
vascular neoplasms, 120
stenosis
antiplatelet therapy, 127, 128
blood pressure medications and carotid disease,
130, 131
carotid disease, statins for, 129, 130
clinical trials, 132
multimodal therapy, 131
Carotid and Vertebral Artery Transluminal Angioplasty
Study (CAVATAS), 176–177, 184
Carotid scanning, indications of, 70, 71
Carotid aneurysm, 75, 261, 262, 264
Carotid angiography, 50, 118, 122
Carotid angioplasty, 45, 54, 55, 91, 194
Carotid arteries, 90, 151
aneurysm, 47, 235
angle of insonation, 80
bifurcation, 164
nerves in neck to, 4
accessory spinal nerve, 4
ansa cervicalis, 5
external laryngeal nerve, 4
glossopharyngeal nerve, 4
hypoglossal nerve, 5
ramus mandibularis, 4
reconstruction, 51
stenosis, surgical technique, 156
Carotid arteriography, 125
Carotid artery reconstruction, 51
Carotid artery restenosis, incidence of, 165
Carotid artery stenting (CAS), 55, 57, 135, 171, 194
ACST-2, 182
ACT-1, 181, 182
CAVATAS, 176, 177
clinical trials, 171
complications and salvage techniques, 191
contraindications, 192, 193
CREST, 180, 181
CREST trial, 183
EVA-3S clinical trial, 177, 178
ICSS, 180
indications, 187
outcomes, 176
post-procedural care, 192
procedure planning, 187
SAPPHIRE trial, 178, 179, 183
SPACE trial, 179, 180
TCAR, 190, 191
transfemoral procedural details, 188–190
Carotid artery stenting vs. endarterectomy, 172–175
Carotid artery surgery, 45
carotid angioplasty, 54, 55
carotid artery disease, history, 45
carotid endarterectomy, modern techniques, 51–54
evolution, 47–49, 51
landmark studies in, 55–57
transcervical carotid stenting, 55
Carotid atherosclerosis, 130, 169
Carotid basilar systems, 7
Carotid bifurcation, 2, 54, 68
Carotid body tumors (CBTs), 37–40, 75, 108, 253
clinical presentation, 254
complications
Baroreex failure, 258
stroke, pseudoaneurysm and mortality, 259
CTA, 255
diagnosis and preoperative planning, 254, 255
duplex ultrasound, 254
exposure, surgical incisions for, 257
hypertensive crisis, 259
operative technique, 256, 257
avoiding nerve injury, 257, 258
high exposure, 257
reconstruction, 258
Index
295
pathogenesis, 253
preoperative embolization, 255
presentation, 259
Shamblin classication, 256
Carotid disease, 46, 47
blood pressure medications and, 130
management, 57
Carotid dissection, see Cervical artery dissection
Carotid duplex ultrasound, 72, 73, 75, 76, 80
Carotid endarterectomy (CEA), 4, 27, 50, 53, 58, 76,
128, 135, 149
ACST-2, 182
ACT-1, 181, 182
anesthesia, 136
vs. carotid artery stenting, 57
CAVATAS, 176, 177
clinical trials, 171
complications
cranial nerve palsy, 141
hematoma of neck, 141
hemodynamic instability, 141
patch graft infection, 142, 144
postoperative myocardial infarction and cardiac
arrhythmias, 142
postoperative stroke, 141, 142
CREST trial, 180, 181, 183
EVA-3S clinical trial, 177, 178
for high plaque, 147
anesthesia, 150
complications, 150
digastric muscle, posterior belly of, 147
gain distal exposure, 147
intraoperative carotid stenting, 149
ICSS, 180
indications, 136
indwelling shunt, insertion of, 139, 140
vs. medical management, 56
modern techniques, 51–54
outcomes, 176
pathophysiology, 135, 136
positioning and incision, 137
postoperative care, 141
retrojugular approach for, 149
SAPPHIRE trial, 178, 179, 183
shunt
placement, 138, 139
types of, 139
SPACE trial, 179, 180
Carotid interposition grafting (CIG)
complications, 169
diagnostic studies, 167, 168
distal anastomosis, 169
for failed carotid stenting, 168
indications, 167
proximal anastomosis, 168
shunt placement, 169
without shunt, 168
Carotid intima-media thickness (CIMT), 76
Carotid kinks, 236
clinical presentation, 232
CTA and MRA, 232
denition, 230, 231
duplex ultrasound, 232
medical management, 233
pathology and classication, 231
prevalence and risk factors, 231
surgical management, 233
Carotid revascularization, carotid stenosis after, 94, 95
Carotid Revascularization Endarterectomy versus
Stenting Trial (CREST), 180, 181, 184
Carotid Revascularization Endarterectomy versus
Stenting Trial-2 (CREST-2), 132
Carotid shunt, 52, 58
Carotid stenosis, 54, 151
after carotid revascularization, 94, 95
carotid plaque characterization, 93, 94
CTA, 91
degree of, 92, 93
measurement of, 94
MRA, 91
Carotid stenting, 55, 57, 58, 94, 149, 168, 171, 176
Carotid stump pressure, 138, 162
Carotid subclavian bypass/transposition operations,
203–206
Carotid-carotid artery bypass, 206, 207
Catheter angiography, 109, 114, 122, 123, 244
Catheter-based arteriography, 262
Catheters, 116, 117, 188
Berenstein catheter, 188
double curve, 117
reverse curve, 117
simple curve, 117
Cerebral angiography, 113
Cerebral autoregulation, 12, 13
Cerebral blood ow, 10, 14
Cerebral metabolism, 11, 12
Cerebral vascular function, 12
Cerebral vasculature, 9, 13, 15
Cerebral venous pressure, 11
Cerebral venules, 11
Cerebrovascular angiography, 67
Cerebrovascular circulation, 225
Cerebrovascular disease, noninvasive testing of, 67
Cerebrovascular imaging, 85
CE-MRA, 88
CTA, 89, 90
ow voids, 85, 86
FMD, 103, 104, 227, 229
hemangiomas, 106, 107
JNAs, 109
MRA, 86
MRI, 85
neck, vascular neoplasms in, 106
paragangliomas, 107, 109
PC-MRI, 88
TOF MRA, 86, 87
vascular malformations, 104–106
Cerebrovascular lesions
Ehlers-Danlos syndrome, 235, 236
GCA, 234, 235
Marfan’s syndrome, 235
Takayasu’s arteritis, 234
296
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Index
Cerebrovascular resistance component, 11
Cerebrovascular system
arterial pressure component, 10, 11
cerebral autoregulation, 12, 13
cerebral blood ow, regulation of, 10
cerebral metabolism and functional activity, 11, 12
cerebrovascular resistance component, 11
chemical regulation, 13
neural regulation, 14
PaCO
, 13
2
PaO
, 14
2
parasympathetic regulation, 15
sympathetic regulation, 15
venous pressure/intracranial pressure component, 11
Cervical (V1) segment, 22
Cervical artery dissection (CAD)
BCVI, 247
catheter angiography, 244
clinical presentation, 243
CTA, 244
diagnosis, 243
endovascular/open surgical treatment, 246, 247
follow-up, 247
incidence and epidemiology, 241
initial treatment, 248
MRA, 243, 244
outcome, 247
pathogenesis, 242, 243
predisposing factors
extrinsic risk factors, 241, 242
family history, 242
intrinsic risk factors, 242
presenting signs and symptoms, 243
recurrences, 248
symptom, 248
treatment, 245
anticoagulation and antiplatelet therapy, 245, 246
antiplatelet therapy, 246
antithrombotic therapy, duration of, 246
thrombolytic therapy, 246
transcranial duplex and microembolic detection,
246
ultrasound, 244
Cervico-cerebral arteriography, 118
Cervico-dorsal ganglion, 5
Check-Flo
®
valve, 189
Chemical regulation, 13
Chemodectomas, 107, 253
Chief cells, 38, 39
Cholinergic nerves, 13–15
Chylous leak, 223
Circle of Willis, 90, 91
Clamp brosis, 160
Clamp trauma, 160
Clonidine, 259
Coil embolization, 263
COL3A1 gene, 242
Common aortic arch anomalies, 1
Common carotid arteries (CCA), 1, 2, 21, 152
Composite cardiovascular events, 176
Computed tomography (CT), 100, 101, 114
Computed tomography angiography (CTA), 89, 90, 96,
100, 101, 199
carotid stenosis, 91
CAD, 244
CAS, 187
CBT, 255
extracranial carotid artery aneurysms, 262, 264
FMD, 228
post-processing, 89
Concomitant arterial and aerodigestive injuries, 271
Cone-beam CT angiography, 122
Connective-tissue disease, 227
Contractures, 281, 282, 284
Contralateral vertebral arteriography, 123
Contrast injection, 117, 118
Contrast-enhanced MR angiography (CE-MRA), 88
Cranial (V4) segment, 22
Cranial nerve injuries, 155, 165, 177, 179, 256–258
Cranial nerve palsy, 141
Cyclooxygenase (COX), 128
Cystic medial degeneration (CMD), 29
D
Decubitus ulcers, 283
Deep vein thrombosis (DVT), 282
Denver grading scale, 272
Depression, 282, 286
Dietary manipulation, 223
Digastric muscle, 147, 275
Digital subtraction angiography (DSA), 116
carotid kinks, 232
FMD, 228
Digital subtraction catheter-directed
angiography, 200
Distal intraluminal balloon occlusion, 170
Distal vertebral artery, 63, 64, 218–219
Doppler ultrasonography, 94, 114
Double curve catheter, 117
Double ushing technique, 117
Drug-eluting stents, 222
Dual antiplatelet therapy (DAPT), 128
Duplex ultrasound, 73, 151, 161, 199
carotid kinks, 232
CBT, 254
FMD, 228
surveillance, 159
vertebral artery reconstruction, 216
Dynamic angiography, 118
Dysphagia, 280, 281
E
Eastern Association for the Surgery
of Trauma (EAST), 247
Ehlers-Danlos syndrome, 235, 236, 264
Elastic artery, 23
Electroencephalographic (EEG) monitoring, 152
Embolic debris, 192
Embryological carotid-basilar connections, 4
Emotional lability, 286, 291
Index
297
Endarterectomy, 26, 49, 54
Endarterectomy Versus Angioplasty with Symptomatic
Severe Carotid Stenosis (EVA-3S) clinical
trial, 177, 178
Endoluminal techniques, 223
Endovascular techniques, 200–202
ENROUTE
®
system, 190
Eversion carotid endarterectomy (ECEA)
complications, 155, 156
indications, 151, 153
postoperative care, 155
techniques, 151, 152, 154
External beam radiotherapy, 98–99
External carotid artery (ECA), 2, 3, 137
External laryngeal nerve, 4–5
Extracerebral carotid artery (ECA), 39
Extracranial atherosclerosis, 135
Extracranial carotid arteries (ECCAs), 21, 22
aneurysms, 29, 30, 234, 261
cause, 264
clinical diagnosis and imaging studies, 262
clinical presentation, 261
CTA, 262, 264
endovascular treatment, 263
management, 265
postoperative complication, 265
surgical treatment, 262, 263
treatment, 264
atherosclerotic disease, 24–27
carotid body tumor, 37, 39
dissection, 27–29
FMD, 30–32
stenosis, 172–175
vasculitis, 32
GCA, 32, 33, 35, 36
TA, 36, 37
Extracranial cerebrovascular trauma
BCVI
management, 272, 273
screening and diagnosis, 271, 272
epidemiology, 267
PCVI
concomitant arterial and aerodigestive
injuries, 271
endovascular approaches, 269
ICA thrombosis, 270
location, general conduct and order of operations,
268
screening and diagnosis, 267, 268
zone 1 neck injuries, 269
zone 2 neck injuries, 269, 270
zone 3 Injuries, 271
penetrating vertebral artery injuries, management of,
271
Extracranial pathways, 90, 91
Extracranial vascular stenosis, 118
Extracranial vasculature, 90
Extracranial vertebral arteries (ECVAs), 21–23, 64
aneurysms, 29, 30, 264
atherosclerotic disease, 24–27
carotid body tumor, 37, 39
dissection, 27–29
FMD, 30–32
vasculitis, 32
GCA, 32, 33, 35, 36
TA, 36, 37
Extracranial vertebral-basilar duplex, 68
Extra-thoracic arterial reconstructions, 202–203
Extravascular hematoma, 30
F
Facial nerve, marginal mandibular branch, 4
Failed carotid stenting, 168
Fatty streak (FS), 24
Fibroatheroma, 24, 25, 27
Fibrocalcic plaques, 26
Fibromuscular dysplasia (FMD), 39, 75,
103, 104, 109
clinical presentation, 227
CTA, 228
denition, 225
differential diagnosis
atherosclerosis, 227
connective-tissue disease, 227
vasculitis, 227
DSA, 228
duplex ultrasound, 228
ECCAs and ECVAs, 30
etiology, 225, 226
gender distribution and, 236
imaging modalities for work-up, 228
internal carotid, 226
investigations, 227, 228
majority, 236
medical management, 229
MRA, 228
pathologic classication, 226
pathology and classication, 226, 227
prevalence, 225
progression, 230
surgical management, 229, 230
Flow artifact, 88
Flow voids, 85–86, 105, 122
Flow-related artifact, 87
Free Water Protocol, 280, 290
5Fr system, 116–117
Functional Independence Measure (FIM), 288, 289
Fusiform aneurysm, 30, 244
G
Giant cell, 35, 37
Giant cell arteritis (GCA), 32–34, 36, 40, 234, 235
Glenohumeral subluxation, 284
Glomus caroticum tumors, see Carotid body tumors
Glomus jugulare, 107, 108
Glomus tumors, 107
Glossopharyngeal nerve injury, 4, 7, 150, 262, 275
Gore-Tex®, 163
Greater saphenous vein graft, 169
Guidewires, 117, 118, 168
298
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Index
H
Head and neck cancer invading carotid artery, 167
Heart and great vessels, 2
Hemangiomas, 106, 107
Hematoma of neck, 141
Hemodynamic instability, 141
Heparin, 50, 140, 152, 154, 201, 245, 262–263
High-resolution duplex ultrasound system, 71
High-resolution ultrasound, 74
Horner syndrome, 243
Hyperemia test, 69, 74
Hyperlipidemia, 132, 231, 285
Hyperperfusion syndrome, 142
Hyperplastic restenosis, 160
Hypertension, 15, 16, 37, 51, 76, 128, 131, 231, 258
Hypoechoic plaques, 74, 136
Hypoglossal artery (HA), 3
Hypoglossal nerve, 5, 141, 145
Hypoplastic vertebral artery, 69
Hypotension, 12, 141, 191, 192
I
Iatrogenic clamp injury, 160
ICAM1 gene, 242
Indirect laryngoscopy, 161
Indwelling shunt, insertion of, 139, 140
Infarct, acute, 95, 103
Innominate artery, 202, 210
In-stent restenosis (ISR), 96, 160
Internal carotid artery (ICA), 1–3, 21, 28, 49, 77, 234
anatomic variations, 4
distal exposure of, 148
thrombosis, 270
Internal carotid stenosis, 73
Internal elastic lamina (IEL), 23
Internal jugular vein, 3, 203
International Carotid Stenting Study (ICSS), 180, 184
Intersocietal Accreditation Commission-accredited
vascular laboratory (ICAVL), 161
Intimal broplasia, 31, 32, 226
Intimal injury, 29
Intimal xanthoma, 24
Intracranial pathways, 91
Intraluminal thrombus, 29, 95, 235
Intramural hematoma, 86, 103, 109, 242–245
Intraoperative carotid stenting, 149
Intraplaque hemorrhage, 25, 26, 93, 160
Intravascular ultrasound, 123
Invasive catheter angiography, 118, 124
Ischemia, 22, 25, 139, 141, 215
Ischemic strokes, 272
J
Jackson-Pratt drain, 163
Javid clamp, 139, 140
JB1, 188
Joint contractures, 283
Juvenile nasopharyngeal angiobromas (JNAs), 109
K
Kaplan-Meier curve, 248
L
Language disorders, 285
Left common carotid artery (LCCA), 1, 6, 200, 203, 205,
207
coiling, 230
Left hemispheric middle cerebral artery strokes, 286
Left internal mammary artery (LIMA), 200
Left subclavian artery, 1, 6
Left vertebral artery, 7
dissection, 103
Lemole-Strong clamp, 209
Levator scapula muscle, 219
Luminal thrombi, 35, 37
Lymphatic injuries, 206
Lymphatic malformations, 105
Lymphatic vascular malformation, 107
M
Magnetic resonance angiography (MRA), 86, 102, 199
CAD, 243, 244
carotid kinks, 232
carotid stenosis, 91
CAS, 187
FMD, 228
vertebral artery reconstruction, 216
Magnetic resonance imaging (MRI), 85, 102, 115
Marfan’s syndrome, 235
Maximum image intensity (MIP) imaging, 216
Medial broplasia, 32, 39, 226
Medial hyperplasia, 32
Metastasis, 40
Microembolic signal (MES), 246
Middle cerebral artery (MCA), 78
completing lling of, 144
occlusion, 144
stenosis, 79
Motor paralysis, 283
MTHFR gene, 242
Multimodal therapy, 131
Muscular artery, 23
Mycotic aneurysms, 30, 262
Myointimal cells, 25
Myointimal hyperplasia (MIH), 98, 160
N
Near-occlusion of carotid, 93
Neck, vascular neoplasms in, 106
Neck injuries
zone 1, 269
zone 2, 269, 270
zone 3, 271
Neointimal hyperplasia, 94, 222
Nerve bers, 2
Nerve injury, 206, 220
Index
299
Neural regulation, 14
Neuroangiography, 117, 121, 124
Neurodevelopmental (Bobath) techniques, 288
Neuroendovascular Solitaire™ device, 144
Nitric oxide, 12, 16
Non-disabling stroke, 176, 177
Noninvasive vascular lab testing
carotid and vertebral scanning,
indications of, 70, 71
carotid artery and vertebral artery duplex, 67–70
carotid duplex scanning, limitations of, 75, 76
carotid endarterectomy, 76
contraindications and limitations, 71
equipment and supplies, 71
examination protocol, 72
incidental ndings, 74
interpretation and diagnostic criteria, 72, 73
plaque characterization, 74
TCD, 76, 77, 80
unusual ndings, 75
US Preventive Services Task Force, 76
vertebral artery ow, 74
Norepinephrine, 15
North American Symptomatic Carotid
Endarterectomy Trial (NASCET), 92
O
Occult subclavian stenosis, 71
Octreotide, 221, 223
Omohyoid muscle, 203
Oxidized low-density lipoprotein (LDL), 25
Posterior inferior cerebellar artery (PICA), 78
Postoperative myocardial infarction, 142
Postoperative stroke, 141, 142
Poststroke rehabilitation care, 279–282
Potassium, 12, 16
Power motion mode (PMD), 79
PRAFOs, 284
Pruitt-Inahara
®
shunt, 139
Pseudoaneurysm, 100, 101, 119,
144, 259, 261, 273
R
Radiation therapy, 39
Radiation-induced carotid stenosis, 99–101
Ramus mandibularis, 4
Recurrent carotid stenosis, 159
contraindications, 161
indications, 160, 161
pathogenesis, 159, 160
postoperative complications, 164
postoperative management, 164
preoperative evaluation, 161
procedure, 162, 163
Redo endarterectomy, 165
Re-endarterectomy, 164, 165
Restenosis, 94, 95, 97, 98, 160, 176, 180
Retrograde ow, 190
Reverse curve catheter, 117
Right carotid artery, 229
Right vertebral arteriography, 124
Rotational angiography, 118, 121
Ruptured atherosclerotic plaque, 95
P
Paraganglioma, 37–39, 107–109
Parasympathetic regulation, 15
Patch graft infection, 142, 144
Patch grafting, 150
Penetrating cerebrovascular injuries (PCVI)
concomitant arterial and aerodigestive
injuries, 271
ICA thrombosis, 270
location, general conduct and order of operations,
268
neck injuries
zone 1, 269
zone 2, 269, 270
zone 3, 271
screening and diagnosis, 267, 268
Penetrating neck injuries, 268
Penetrating vertebral artery injuries
endovascular therapy, 271
management of, 271
Percutaneous vascular access, 124
Perfusion pressure, 10
Pharmacotherapy, 272
Phase-contrast MR imaging (PC-MRI), 88
Polytetrauoroethylene (PTFE) graft, 163, 263
Posterior circulation ischemia, 215, 223
S
S-aortic trunks, 2
Succinate dehydrogenase subunit B (SDHB), 39
Succinate dehydrogenase subunit D (SDHD), 39
Selective serotonin reuptake inhibitors
(SSRIs), 286
Shamblin classication, 255, 256
Shoulder-hand syndrome, 291
Signal saturation, 87
Simple curve catheter, 117
Soft tissue malformations, 120
Spatulated end-to-end anastomosis, 264
Speech disorders, 285
Spontaneous dissection, 242
Spring-coil guidewire, 117
Stair-step artifact, 87, 109
Statins, for carotid disease, 129, 130
Steno-occlusive disease, 118
Stenting and Angioplasty with Protection in Patients at
High Risk for Endarterectomy (SAPPHIRE)
trial, 178, 179
Stent-Protected Angioplasty Versus Carotid
Endarterectomy (SPACE) trial, 179, 180
Sternocleidomastoid muscle (SCM), 152, 203
Stroke, 135, 144, 151, 155, 176, 220, 259, 279, 285
300
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Index
Stroke rehabilitation
acute setting, poststroke rehabilitation care in,
279–282
acute/subacute stroke period, key management issues
in, 282–286
Brunnstrom recovery stages, 283
functional outcome, 279
inpatient rehabilitation, 287
outpatient therapy, 287
poststroke patient, therapeutic modalities in, 288
prognosis and functional outcome after, 288, 290
right hemispheric hemorrhagic stroke, 290
speech and language disorders, 285
stroke patient, post-acute care of, 287
typical strokes, neurologic and behavioral
characteristics, 286, 287
Stylohyoid muscle, 150, 257
Styloid process, 4, 150, 162
Subarachnoid hemorrhage, 29, 227, 246
Subclavian artery, 69, 203, 204, 206
Subclavian steal syndrome, 69, 70, 80, 97–99
Suboccipital (V3) segment, 22
Subsequent pulmonary embolism, 282
Succinate dehydrogenase (SDH) enzyme, 39
Sundt™ shunt, 139, 163
Supercial femoral artery (SFA), 162, 167
Supra-aortic neuroangiography, 116, 117
Supra-aortic trunk vessel, 212
Sustentacular cells, 39
Sympathetic regulation, 15
Sympathetically mediated vasoconstriction, 17
Systemic heparinization, 162
T
T1 shortening, 86
Takayasu’s arteritis (TA), 36, 37, 234–236
Tapered PTFE graft, 167
Temporal artery, 35
biopsy, 34, 40
Thrombolytic therapy, 246
Thrombus, 26, 29, 49, 194
Thyroid cartilage, 1, 2
Ticagrelor, 127, 128, 132
Time-of-ight (TOF) MRA, 86, 109
Time-of-ight MR angiography (TOF MRA), 86, 87
Trans-carotid artery revascularization (TCAR), 55, 190,
191, 195
Transcervical carotid stenting, 55
Transcranial Doppler sonography (TCD), 76, 77, 79, 80,
246
Transducers, 71–72
Transfemoral carotid artery stenting, contraindications,
195
Transient ischemic attack (TIA), 119, 135, 155
Transthoracic supra-aortic trunk reconstruction, 208–210
Tricyclic antidepressants (TCAs), 286
Triphasic Doppler waveforms, 198
True aneurysms, 30, 31
Tunica adventitia, 22
Tunica intima, 22, 23
Tunica media, 22
Tuohy-Borst connector, 189
U
Ulcerated atherosclerotic plaque, 92
Urinary incontinence, 283
V
Vagus nerve, 1, 4, 203, 221
Vascular access phase, 116, 221
Vascular cell adhesion molecule-1 (VCAM-1), 25
Vascular clamp, 139, 141, 168, 201, 219
Vascular malformations, 104–106, 119, 120
Vascular neoplasms
carotid and vertebral arteriography, 120
neck, 106
Vasculitis, 32
FMD, 227
GCA, 32–36
TA, 36, 37
Vein bypass, 63, 64, 218
Venous pressure/intracranial pressure component, 11
Venous vascular malformation, 106
Vertebral (V2) segment, 22
Vertebral arteriography, 113
advanced angiographic techniques, 118
aneurysms, 119
balloon test occlusion, 120, 121
cone-beam CT angiography, 122
contraindications, 115, 116
CT scanning, 114
Doppler ultrasound, 114
extracranial vascular stenosis, 118
indications, 115
intravascular ultrasound, 123
limitations, 122
maneuvers and dynamic imaging, 118
modern neuroangiography imaging systems, 121
MRI, 114, 115
procedural risks, 118
techniques
angiography imaging systems, 116
catheters and wires, choice of, 116, 117
pre-procedural evaluation, 116
vascular access phase, 116
vascular malformations, 119, 120
vascular neoplasms, 120
Vertebral artery (VAs), 5, 22, 90
anatomic variations, 5, 6
aneurysm, 63, 64
angioplasty, 63
bypass, 64
duplex, 67–70
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