RESUMO
BACKGROUND: Treatment outside office hours has been associated with increased workflow times for intravenous thrombolysis (IVT) in acute ischemic stroke (AIS). Limited data suggest that this "off-hours effect" also exists for endovascular treatment (EVT). We investigated this phenomenon in a well-organized acute stroke care region in the Netherlands. METHODS: Retrospective, observational cohort study of consecutive patients with AIS who received reperfusion therapy in the Greater Amsterdam Area, consisting of 14 primary stroke centers and 1 comprehensive stroke center (IVT: 2009-2015, EVT: 2014-2017). Office hours were defined as presentation during weekdays between 8 AM and 5 PM, excluding National Festive days. Primary outcome was door-to-treatment time (door-to-needle [DNT] for IVT, door-to-groin [DGT] for EVT). For DGT, we used the door time of the first hospital. Other outcomes were in-hospital mortality, modified Rankin Scale (mRS) score at 90 days and symptomatic intracranial hemorrhage (sICH). We performed multivariable linear and logistic regression analyses and used multiple imputation to account for missing values. RESULTS: In total, 59% (2450/4161) and 61% (239/395) of patients treated with IVT and EVT, respectively, presented outside office hours. Median DNT was minimally longer outside office hours (32 vs. 30 min, p = 0.024, adjusted difference 2.5 min, 95% CI 0.7-4.2). Presentation outside office hours was not associated with a longer DGT (median 130 min for both groups, adjusted difference 7.0 min, 95% CI - 4.2 to 18.1). Clinical outcome and sICH rate also did not differ. CONCLUSION: Presentation outside office hours did not lead to clinically relevant treatment delays for reperfusion therapy in patients with AIS.
Assuntos
Isquemia Encefálica , Procedimentos Endovasculares , AVC Isquêmico , Acidente Vascular Cerebral , Isquemia Encefálica/complicações , Isquemia Encefálica/tratamento farmacológico , Humanos , Países Baixos , Reperfusão , Estudos Retrospectivos , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND AND PURPOSE: The Woven EndoBridge is an intrasaccular device for the treatment of intracranial aneurysms. The first generation consisted of a high-profile double-layer braid. This review aims to evaluate the outcomes of the new generation low-profile Woven EndoBridge single layer device for intracranial aneurysm treatment. METHODS: A systematic review was conducted with Medline, Embase, and Web of Science Conference Proceedings databases. The search strategy provided 589 articles, 15 articles were included. RESULTS: Fifteen articles were identified reporting the use of Woven EndoBridge single-layer devices in 963 aneurysms, mostly wide-necked bifurcation aneurysms. Procedural aneurysm rupture was reported in 8 of 963 patients (0.83%; 95%CI 0.39-1.66%) and thromboembolic events in 54 of 963 patients (5.61%, 95CI 4.31-7.26%). Cumulative morbidity was 2.85% (27/949, 95%CI 1.95-4.12%) and mortality 0.93% (9/963, 95%CI 0.46-1.80%). The overall rate of adequate aneurysm occlusion at last follow-up was 83.3% (613/736; 95%CI 80.4-85.8%). Retreatment was reported in 38 aneurysms in eight studies with 450 aneurysms with follow-up (38/450; 8.4%, 95CI 6.2-11.4%). In 12 studies comprising 644 aneurysms with follow-up, rebleeds occurred in three patients in three studies with mean follow-up between 3.3 and 14.4 months (0.47%, 95%CI 0.09-1.43%). CONCLUSION: Woven EndoBridge single-layer is a promising new low-profile device especially for wide-neck bifurcation aneurysms, both ruptured and unruptured. No antiplatelet medication is needed which is a great advantage, especially in ruptured aneurysms. Efficacy and safety compare favorably with (stent-assisted) coiling. However, no direct comparison with other treatments is available as yet.
Assuntos
Prótese Vascular , Procedimentos Endovasculares/instrumentação , Aneurisma Intracraniano/cirurgia , Aneurisma Roto/cirurgia , Humanos , Desenho de PróteseRESUMO
BACKGROUND AND PURPOSE: Aneurysmal subarachnoid hemorrhage is an important cause of mortality and morbidity. Modern hospital demographics are scarce. We evaluated the diagnosis and treatment of patients with SAH in a neurosurgical referral center. MATERIALS AND METHODS: Between March 2013 and April 2015, two hundred eighty-four patients with SAH diagnosed on CT or lumbar puncture were admitted. All patients underwent 64- to 128-detector row CT angiography. Additional imaging was with 3D rotational angiography of all vessels. In patients with aneurysms, characteristics and mode of treatment were recorded. RESULTS: In 197 of 220 patients with an aneurysmal bleeding pattern, we found a cause of the bleeding: One hundred ninety-five patients had a ruptured aneurysm (98%); 1 patient, a micro-AVM; and 1 patient, reversible vasoconstriction syndrome. Of 195 ruptured aneurysms, 6 were dissecting aneurysms and 3 were AVM-associated flow aneurysms. In 23 of 204 patients (11%) with an aneurysmal bleeding pattern and 3D rotational angiography performed, no cause was found. In 8 of 9 patients (89%) with lumbar puncture positive for SAH but CT negative for it, no cause was found. Of 180 patients with a ruptured aneurysm eligible for treatment, 147 (82%) were treated endovascularly and 30 aneurysms (17%) were clipped. Of 204 patients with an aneurysmal bleeding pattern and 3D rotational angiography, 72 (35%) had multiple aneurysms. These 72 patients had, altogether, 117 additional aneurysms, of which 24 (21%) were treated by either coiling or clipping. CONCLUSIONS: This study provides robust data on hospital demographics of SAH in a neurosurgical referral center, based on CTA and 3D rotational angiography of all vessels.
Assuntos
Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/patologia , Hemorragia Subaracnóidea/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Cerebral , Angiografia por Tomografia Computadorizada/efeitos adversos , Feminino , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , NeuroimagemRESUMO
Diagnosis of biotinidase deficiency is rare and usually made in infancy, through newborn screening or after presenting symptoms. We present the case of 19-year old male with progressive optic atrophy and in a second phase spinal cord syndrome unresponsive to immunosuppressive therapies. After diagnosis of profound biotinidase deficiency, oral biotin substitution was started with partial visual improvement and normalization of gait. This case highlights the possibility of late-onset biotinidase deficiency and its treatable character.
Assuntos
Deficiência de Biotinidase/diagnóstico por imagem , Deficiência de Biotinidase/tratamento farmacológico , Atrofia Óptica/diagnóstico por imagem , Atrofia Óptica/tratamento farmacológico , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/tratamento farmacológico , Biotina/administração & dosagem , Deficiência de Biotinidase/genética , Humanos , Masculino , Atrofia Óptica/genética , Doenças da Medula Espinal/genética , Adulto JovemRESUMO
BACKGROUND AND PURPOSE: Hemodynamics are thought to play a role in intracranial aneurysm growth and rupture. Computational fluid dynamics is frequently performed to assess intra-aneurysmal hemodynamics, using generalized flow waveforms of healthy volunteers as inflow boundary conditions. The purpose of this study was to assess differences in inflow conditions for different aneurysmal parent artery locations and variations of circle of Willis configurations. MATERIALS AND METHODS: In a series of 96 patients with 103 aneurysms, velocity measurements were acquired using 2D phase-contrast MR imaging perpendicular to the aneurysmal parent arteries in the circle of Willis. Circle of Willis configurations were inspected for variations using multiple overlapping thin-slab-acquisition MRAs. Flow rates, velocity magnitudes, and pulsatility indices were calculated for each parent artery location in subgroups of complete and incomplete circle of Willis configurations. RESULTS: Flow rates, velocity magnitudes, and pulsatility indices were significantly different among aneurysmal parent arteries. Incomplete circle of Willis configurations were observed in 24% of the cases. Significantly lower basilar artery flow rates were observed in configurations with hypoplastic P1 segments. Significantly higher A1 flow rates were observed in configurations with a hypoplastic contralateral A1 segment. CONCLUSIONS: Inflow conditions vary substantially between aneurysmal parent arteries and circle of Willis configurations. We have created a collection of parent artery-specific inflow conditions tailored to the patient-specific circle of Willis configuration that can be used in future computational fluid dynamics studies analyzing intra-aneurysmal hemodynamics.
Assuntos
Circulação Cerebrovascular/fisiologia , Círculo Arterial do Cérebro/fisiopatologia , Hemodinâmica/fisiologia , Aneurisma Intracraniano/fisiopatologia , Adulto , Idoso , Círculo Arterial do Cérebro/patologia , Feminino , Humanos , Hidrodinâmica , Aneurisma Intracraniano/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND AND PURPOSE: Collateral flow is associated with clinical outcome after acute ischemic stroke and may serve as a parameter for patient selection for intra-arterial therapy. In clinical trials, DSA and CTA are 2 imaging modalities commonly used to assess collateral flow. We aimed to determine the agreement between collateral flow assessment on CTA and DSA and their respective associations with clinical outcome. MATERIALS AND METHODS: Patients randomized in MR CLEAN with middle cerebral artery occlusion and both baseline CTA images and complete DSA runs were included. Collateral flow on CTA and DSA was graded 0 (absent) to 3 (good). Quadratic weighted κ statistics determined agreement between both methods. The association of both modalities with mRS at 90 days was assessed. Also, association between the dichotomized collateral score and mRS 0-2 (functional independence) was ascertained. RESULTS: Of 45 patients with evaluable imaging data, collateral flow was graded on CTA as 0, 1, 2, 3 for 3, 10, 20, and 12 patients, respectively, and on DSA for 12, 17, 10, and 6 patients, respectively. The κ-value was 0.24 (95% CI, 0.16-0.32). The overall proportion of agreement was 24% (95% CI, 0.12-0.38). The adjusted odds ratio for favorable outcome on mRS was 2.27 and 1.29 for CTA and DSA, respectively. The relationship between the dichotomized collateral score and mRS 0-2 was significant for CTA (P = .01), but not for DSA (P = .77). CONCLUSIONS: Commonly applied collateral flow assessment on CTA and DSA showed large differences, indicating that these techniques are not interchangeable. CTA was significantly associated with mRS at 90 days, whereas DSA was not.
RESUMO
BACKGROUND AND PURPOSE: At our institution, patients with large or giant ICA aneurysms are preferably treated with endovascular ICA balloon occlusion. Alternative treatment or conservative treatment is offered only for patients who cannot tolerate permanent ICA occlusion. In this observational study, we report the clinical and imaging results of ICA occlusion for aneurysms in a large single-center patient cohort. MATERIALS AND METHODS: Between January 1995 and January 2015, occlusion of the ICA was considered in 146 patients with large or giant ICA aneurysms. Ninety-six patients (66%) passed the angiographic test occlusion, and, in 88 of these 96 patients (92%), the ICA was permanently occluded. In 11 of 88 patients with angiographic tolerance, ICA occlusion was performed with the patient under general anesthesia without clinical testing. RESULTS: There was 1 hypoperfusion infarction after hypovolemic shock from a large retroperitoneal hematoma (complication rate 1.1% [95% CI, 1%-6.8%]). The mean imaging and clinical follow-up was 35 months (median 18 months; range, 3-180 months). On the latest MR imaging, 87 of 88 aneurysms (99%) were completely occluded and 61 of 80 aneurysms (76%) were decreased in size or completely obliterated. Of 62 patients who presented with cranial nerve dysfunction by mass effect of the aneurysm, 30 (48%) were cured, 25 (40%) improved, 6 (10%) were unchanged, and 1 patient (2%) was hemiplegic after a complication. CONCLUSIONS: ICA occlusion for large and giant aneurysms after angiographic test occlusion was safe and effective. Two-thirds of eligible patients passed the angiographic test. Most aneurysms shrunk, and most cranial nerve dysfunctions were cured or improved.
Assuntos
Oclusão com Balão/métodos , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/terapia , Artéria Carótida Interna/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Oclusão com Balão/instrumentação , Angiografia Cerebral , Estudos de Coortes , Terapia Combinada , Embolização Terapêutica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/terapia , Adulto JovemRESUMO
BACKGROUND AND PURPOSE: The use of stents in the setting of SAH is controversial because of concerns about the efficacy and risk of dual antiplatelet therapy. We compare complications of stent-assisted coil embolization in patients with acutely ruptured aneurysms with complications in patients with unruptured aneurysms. MATERIALS AND METHODS: Between February 2007 and March 2015, 45 acutely ruptured aneurysms and 47 unruptured aneurysms were treated with stent-assisted coiling. Patients with ruptured aneurysms were not pretreated with antiplatelet medication but received intravenous aspirin during the procedure. Thromboembolic events and early rebleeds were recorded. RESULTS: In ruptured aneurysms, 9 of 45 patients had thromboembolic complications. Four patients remained asymptomatic, 4 developed infarctions, and 1 patient died. The permanent complication rate in ruptured aneurysms was 11% (95% CI, 4%-24%). Five of 45 patients (11%; 95% CI, 4%-24%) had an early rebleed from the treated aneurysm after 3-45 days, and in 4, this rebleed was fatal. In 46 patients with 47 unruptured aneurysms, thromboembolic complications occurred in 2. One patient remained asymptomatic; the other had a thalamus infarction. The complication rate in unruptured aneurysms was 2.2% (1 of 46; 95% CI, 0.01%-12%). No first-time hemorrhages occurred in 46 patients with 47 aneurysms during 6 months of follow-up. CONCLUSIONS: The complication rate of stent-assisted coiling with early adverse events in ruptured aneurysms was 10 times higher than that in unruptured aneurysms. Early rebleed accounted for most mortality. In ruptured aneurysms, stent-assisted coil embolization is associated with increased morbidity and mortality and should only be considered when less risky options have been excluded.
Assuntos
Aneurisma Roto/terapia , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Aneurisma Intracraniano/terapia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Prótese Vascular , Embolização Terapêutica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Stents/efeitos adversos , Tromboembolia/epidemiologia , Tromboembolia/etiologiaRESUMO
Animal models reproducing the characteristics of human epilepsy are essential for the elucidation of the pathophysiological mechanisms. In epilepsy research there is ongoing debate on whether the epileptogenic process is a continuous process rather than a step function. The aim of this study was to assess progression of epileptogenesis over the long term and to evaluate possible correlations between SE duration and severity with the disease progression in the kainic acid model. Rats received repeated KA injections (5mg/kg) until a self-sustained SE was elicited. Continuous depth EEG recording started before KA injection and continued for 30 weeks. Mean seizure rate progression could be expressed as a sigmoid function and increased from 1 ± 0.2 seizures per day during the second week after SE to 24.4 ± 6.4 seizures per day during week 30. Seizure rate progressed to a plateau phase 122 ± 9 days after SE. However, the individual seizure rate during this plateau phase varied between 14.5 seizures and 48.6 seizures per day. A circadian rhythm in seizure occurrence was observed in all rats. Histological characterization of damage to the dentate gyrus in the KA treated rats confirmed the presence of astrogliosis and aberrant mossy fiber sprouting in the dentate gyrus. This long-term EEG monitoring study confirms that epileptogenesis is a continuous process rather than a step function.
Assuntos
Ondas Encefálicas/efeitos dos fármacos , Eletroencefalografia , Epilepsia do Lobo Temporal/induzido quimicamente , Agonistas de Aminoácidos Excitatórios/toxicidade , Ácido Caínico/toxicidade , Análise de Variância , Animais , Encéfalo/efeitos dos fármacos , Encéfalo/fisiopatologia , Ritmo Circadiano/efeitos dos fármacos , Modelos Animais de Doenças , Masculino , Monitorização Fisiológica , Ratos , Ratos Sprague-DawleyRESUMO
INTRODUCTION: CT angiography (CTA) is increasingly used as primary diagnostic tool to replace digital subtraction angiography (DSA) in patients with subarachnoid hemorrhage (SAH). However, 3D rotational angiography (3DRA) has substituted DSA as a reference standard. In this prospective observational study, we compare CTA with 3DRA of all cerebral vessels in a large cohort of patients with SAH. METHODS: Of 179 consecutive patients with SAH admitted between March 2013 and July 2014, 139 underwent 64- to 256-detector row CTA followed by complete cerebral 3DRA within 24 h. In 86 patients (62 %), 3DRA was performed under general anesthesia. Two observers from outside hospitals reviewed CTA data. RESULTS: In 118 of 139 patients (85 %), 3DRA diagnosed the cause of hemorrhage: 113 ruptured aneurysms, three arterial dissections, one micro-arteriovenous malformation (AVM), and one reversible vasoconstriction syndrome. On CTA, both observers missed all five non-aneurysmal causes of SAH. Sensitivity of CTA in depicting ruptured aneurysms was 0.88-0.91, and accuracy was 0.88-0.92. Of 113 ruptured aneurysms, 28 were ≤3 mm (25 %) and of 95 additional aneurysms, 71 were ≤3 mm (75 %). Sensitivity of depicting aneurysms ≤3 mm was 0.28-0.43. Of 95 additional aneurysms, the two raters missed 65 (68 %) and 58 (61 %). Sensitivity in detection was lower in aneurysms of the internal carotid artery than in other locations. CONCLUSION: CTA had some limitations as primary diagnostic tool in patients with SAH. All non-aneurysmal causes for SAH and one in ten ruptured aneurysms were missed. Performance of CTA was poor in aneurysms ≤3 mm. The majority of additional aneurysms were not depicted on CTA.
Assuntos
Angiografia Cerebral/métodos , Imageamento Tridimensional/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Intensificação de Imagem Radiográfica/métodos , Reprodutibilidade dos Testes , Rotação , Sensibilidade e EspecificidadeRESUMO
BACKGROUND AND PURPOSE: A new curative embolization technique with Onyx for selected small and medium-sized superficially located brain AVMs was developed, which consists of obliteration of the nidus, including incremental occlusion of the draining veins. We report our first clinical results. MATERIALS AND METHODS: Between June 2008 and July 2011, 24 patients (7 women, 17 men; mean age, 41 years; range, 6-74 years) with AVMs were selected for curative embolization with Onyx. Presentation was hemorrhage in 14 and seizures in 10 patients. AVM location was frontal in 11, occipital in 6, parietal in 4, and temporal in 3. AVM size was a mean of 2.2 cm (median, 2; range, 1-3 cm). RESULTS: Complete angiographic obliteration of the AVM with Onyx in a single session was achieved in all 24 patients. There were no hemorrhagic or ischemic complications (0%; 95% CI, 0%-16.3%), and no new deficits induced by the treatment. Of 14 patients with ruptured AVMs, 1 patient who presented with a large frontal hematoma died shortly after surgical evacuation of the hematoma following complete embolization of a micro-AVM. Follow-up angiography at 3 months in 23 patients demonstrated a small AVM remnant in 1 that was treated with gamma knife radiosurgery. The other 22 AVMs remained completely occluded. CONCLUSIONS: In selected patients with small and medium-sized superficial brain AVMs, as defined in our study, injection of Onyx by using a curative embolization technique in a single session seems to provide a safe and effective alternative to radiosurgery or surgery.
Assuntos
Dimetil Sulfóxido/uso terapêutico , Embolização Terapêutica/métodos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/terapia , Polivinil/uso terapêutico , Adolescente , Idoso , Criança , Feminino , Hemostáticos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Radiografia , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND AND PURPOSE: MR angiography (MRA) is increasingly used as a noninvasive imaging technique for the follow-up of coiled intracranial aneurysms. However, the need for contrast enhancement has not yet been elucidated. We compared 3D time-of-flight MRA (TOF-MRA) and contrast-enhanced MRA (CE-MRA) at 3T with catheter angiography. MATERIALS AND METHODS: Sixty-seven patients with 72 aneurysms underwent TOF-MRA, CE-MRA, and catheter-angiography 6 months after coiling. Occlusion status on MRA was classified as adequate (complete and neck remnant) or incomplete by 2 independent observers. For TOF-MRA and CE-MRA, interobserver agreement, intermodality agreement, and correlation with angiography were assessed by kappa statistics. RESULTS: Catheter-angiography revealed incomplete occlusion in 12 (17%) of the 69 aneurysms; 3 aneurysms were excluded due to MR imaging artifacts. Interobserver agreement was good for CE-MRA (kappa = 0.77; 95% confidence interval [CI], 0.55-0.98) and very good for TOF-MRA (kappa = 0.89; 95% CI, 0.75-1.00). Correlation of TOF-MRA and CE-MRA with angiography was good. The sensitivity of TOF-MRA and CE-MRA was 75% (95% CI, 43%-95%); the specificity of TOF-MRA was 98% (95% CI, 91%-100%) and of CE-MRA, 97% (95% CI, 88%-100%). All 5 incompletely occluded aneurysms, which were additionally treated, were correctly identified with both MRA techniques. Areas under the receiver operating characteristic curve for TOF-MRA and CE-MRA were 0.90 (95% CI, 0.79-1.00) and 0.91 (95% CI, 0.79-1.00). Intermodality agreement between TOF-MRA and CE-MRA was very good (kappa = 0.83; 95% CI, 0.65-1.00), with full agreement in 66 (96%) of the 69 aneurysms. CONCLUSIONS: In this study, TOF-MRA and CE-MRA at 3T were equivalent in evaluating the occlusion status of intracranial aneurysms after coiling. Because TOF-MRA does not involve contrast administration, this method is preferred over CE-MRA.
Assuntos
Embolização Terapêutica/instrumentação , Gadolínio DTPA , Aumento da Imagem/métodos , Aneurisma Intracraniano/patologia , Aneurisma Intracraniano/terapia , Angiografia por Ressonância Magnética/métodos , Meios de Contraste , Embolização Terapêutica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Resultado do TratamentoRESUMO
BACKGROUND AND PURPOSE: Fenestrations of intracranial arteries are variants resulting from incomplete fusion of primitive vessels. An association with aneurysms is suggested in many studies. On conventional angiography, fenestrations are rarely visible. 3D rotational angiography (3DRA) provides improved visualization of cerebral vessels from any desired angle. We used 3DRA to assess the frequency and location of fenestrations of intracranial arteries and a possible relationship with aneurysms. MATERIALS AND METHODS: In 208 patients with suspected intracranial aneurysms, 3DRA of 1, 2, or 3 cerebral vessels (in 143, 16, and 49 patients) was reviewed for the presence and location of fenestrations and aneurysms. When fenestrations were present in combination with aneurysms, we noted the relationship of the locations. RESULTS: In 59 of 208 patients, 61 fenestrations were detected (28%). Fenestrations were more frequent in the anterior than in the posterior circulation (23% versus 7%), and the most common location was the anterior communicating artery (AcomA) (43 of 61, 70%). The frequency of fenestrations in 185 patients with aneurysms was not different from the frequency in 23 patients without aneurysms. Of 220 aneurysms present in 208 patients, 10 aneurysms (4.5%) were located on a fenestration. Of 61 fenestrations, 51 (84%) were not associated with an aneurysm. CONCLUSIONS: With 3DRA, fenestrations were found in 28% of patients. In our study, fenestrations occurred more often in the anterior than in the posterior circulation, and the most common location was the AcomA. A definite relationship between fenestrations and aneurysms cannot be concluded from our data.
Assuntos
Algoritmos , Angiografia Cerebral/métodos , Artérias Cerebrais/anormalidades , Artérias Cerebrais/diagnóstico por imagem , Imageamento Tridimensional/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intensificação de Imagem Radiográfica/métodos , Reprodutibilidade dos Testes , Rotação , Sensibilidade e Especificidade , Adulto JovemRESUMO
BACKGROUND AND PURPOSE: Patients with intracranial aneurysms are at risk for future development of new aneurysms and growth of additional untreated aneurysms. Because in previous long-term studies duration of follow-up varied widely, the time interval after which screening could be effective remains largely unknown. The purpose of this study was to assess the incidence of de novo aneurysm formation and the growth of additional untreated aneurysms in patients with coiled aneurysms followed up with MR angiography (MRA) after a fixed period of 5 years. MATERIALS AND METHODS: In 65 patients with coiled intracranial aneurysms, high-resolution 3T MRA was performed 5.1 +/- 0.2 years after coiling. MRA follow-up imaging was compared with MRA or CT angiography at the time of coiling. Additional aneurysms detected at MRA follow-up were classified as unchanged, grown, de novo, or incomparable with previous imaging. RESULTS: In 13 of 65 patients (20%), 24 additional aneurysms were found. Four aneurysms were incomparable with previous imaging and 2 of these were clipped. Of the remaining 20 additional aneurysms, 1 was de novo, 1 had grown slightly, and 18 were unchanged. The incidence of de novo aneurysm formation after 5 years was 1.54% (95% confidence interval, 0.01-9.0%). For additional aneurysms known at the time of initial coiling and for the 1 de novo aneurysm, no treatment was indicated. CONCLUSIONS: MRA screening 5 years after coiling for detection of de novo aneurysms and growth of additional untreated aneurysms has a low yield in terms of finding aneurysms that need to be treated.
Assuntos
Embolização Terapêutica/métodos , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/terapia , Angiografia por Ressonância Magnética , Adulto , Idoso , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Incidência , Aneurisma Intracraniano/epidemiologia , Masculino , Pessoa de Meia-Idade , Recidiva , Resultado do TratamentoRESUMO
BACKGROUND AND PURPOSE: The long-term fate of coiled intracranial aneurysms is largely unknown, and prolonged imaging follow-up has been advocated. The yield of follow-up imaging in coiled aneurysms adequately occluded at 6 months is unknown. In such patients, we performed time-of-flight MR angiography (MRA) to assess the incidence and therapeutic consequences of reopening 5-11 years after coiling. MATERIALS AND METHODS: Between 1995 and 2002, 661 aneurysms in 607 patients were coiled in 3 participating centers. Six-month follow-up angiograms were obtained in 497 (75%) aneurysms, of which 316 (64%) in 297 patients were adequately occluded. Of 297 patients, 84 were excluded for various reasons and 73 could not be traced. Of 140 eligible patients, 104 (74%) with 111 aneurysms were studied with 3T MR imaging and high-resolution MRA at a mean of 6.0 years after coiling (median, 5.6 years; range, 5.0-10.6 years). RESULTS: The proportion of aneurysms with reopening was 3.6% (4/111; 95% confidence interval [CI], 1.1%-9.2%). One reopened aneurysm, which initially contained intraluminal thrombus, was additionally coiled (0.9%; 95% CI, 0.0%-5.4%). CONCLUSION: In intracranial aneurysms with adequate occlusion at 6 months after coiling, the proportion of reopening needing retreatment after >5 years is low. The number of reopened aneurysms with therapeutic consequences was too small to assess risk factors, but probably the presence of intraluminal thrombus is one such risk factor. Most patients with coiled intracranial aneurysms that are adequately occluded at 6 months might not need prolonged imaging follow-up.
Assuntos
Aneurisma Roto/terapia , Embolização Terapêutica , Aneurisma Intracraniano/terapia , Angiografia por Ressonância Magnética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Roto/diagnóstico , Estudos de Coortes , Feminino , Seguimentos , Humanos , Aneurisma Intracraniano/diagnóstico , Masculino , Pessoa de Meia-Idade , Recidiva , RetratamentoRESUMO
BACKGROUND AND PURPOSE: During surgery of symptomatic aneurysms, additional small angiographic occult aneurysms are commonly found. With 3D rotational angiography (3DRA) small aneurysms are more easily depicted than with digital subtraction angiography (DSA). In this study we compare 3DRA with DSA in the depiction of small additional aneurysms. MATERIALS AND METHODS: Three hundred fifty 3D datasets of 1 vascular tree of 350 patients with at least 1 intracranial aneurysm on the dataset were re-evaluated for the presence of additional aneurysms by 2 observers in consensus. Two other observers, blinded to the 3D images, re-evaluated DSA images of the same 350 vascular trees for these additional aneurysms. Results were compared. RESULTS: In 350 3D datasets, 350 target aneurysms and 94 additional aneurysms were detected. The mean size of 94 additional aneurysms was 3.54 mm (median, 3; range, 0.5-17 mm). The proportion of aneurysms Assuntos
Angiografia Digital/métodos
, Angiografia Cerebral/métodos
, Imageamento Tridimensional/métodos
, Aneurisma Intracraniano/diagnóstico por imagem
, Intensificação de Imagem Radiográfica/métodos
, Feminino
, Humanos
, Masculino
, Reprodutibilidade dos Testes
, Rotação
, Sensibilidade e Especificidade
RESUMO
BACKGROUND AND PURPOSE: Our aim was to determine the diagnostic accuracy of multisection CT angiography combined with matched mask bone elimination (CTA-MMBE) for detection of intracranial aneurysms compared with digital subtraction angiography (DSA) and 3D rotational angiography (3DRA). MATERIALS AND METHODS: Between January 2004 and February 2006, 108 patients who presented with clinically suspected subarachnoid hemorrhage underwent both CTA-MMBE and DSA for diagnosis of an intracranial aneurysm. Two neuroradiologists, independently, evaluated 27 predefined vessel locations in the CTA-MMBE images for the presence of an aneurysm. After consensus, diagnostic accuracy of CTA was calculated per predefined location and per patient. Interobserver agreement was calculated with kappa statistics. RESULTS: In 88 patients (81%), 117 aneurysms (82 ruptured, 35 unruptured) were present on DSA. CTA-MMBE detected all ruptured aneurysms except 1. Overall specificity, sensitivity, positive predictive value, and negative predictive value of CTA-MMBE were 0.99, 0.90, 0.98, and 0.95 per patient and 0.91, 1.00, 0.97, and 0.99 per location, respectively. Sensitivity was 0.99 for aneurysms >/=3 mm and 0.38 for aneurysms <3 mm. Interobserver agreement for aneurysm detection was excellent (kappa value of 0.92 per location and 0.80 per patient). CONCLUSION: CTA-MMBE is accurate in detecting intracranial aneurysms in any projection without overprojecting bone. CTA-MMBE has limited sensitivity in detecting very small aneurysms. Our data suggest that DSA and 3DRA can be limited to the vessel harboring the ruptured aneurysm before endovascular treatment, after detection of a ruptured aneurysm with CTA.
Assuntos
Angiografia Digital/métodos , Angiografia Cerebral/métodos , Imageamento Tridimensional/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Crânio/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intensificação de Imagem Radiográfica/métodos , Reprodutibilidade dos Testes , Rotação , Sensibilidade e Especificidade , Técnica de SubtraçãoRESUMO
OBJECTIVE: In patients with non-traumatic subarachnoid hemorrhage (SAH) and no evidence for a cerebral aneurysm on angiography, a frequent cause of the hemorrhage is perimesencephalic hemorrhage or other cerebral vascular pathology. In some patients no cause is found. The exact incidence of a spinal vascular malformation (SVM) as the origin for the SAH is not known. We assessed the occurrence of SVM in angiogram-negative, non-perimesencephalic subarachnoid hemorrhage (NPSAH). METHODS: 47 patients (from a consecutive cohort of 632) were identified with an angiogramnegative, non-perimesencephalic subarachnoid hemorrhage and 42 of these were analyzed by performing MR-imaging of the complete spinal neuraxis with additional spinal angiography on indication. RESULTS: In four patients a spinal vascular malformation was identified as the cause of the SAH, indicating an incidence of 9 % of SVM in NPSAH, and an incidence of 1 % of SVM in all patients with SAH. INTERPRETATION: Systematic analysis of angiogram-negative, non-perimesencephalic subarachnoid hemorrhage by MR imaging of the complete spinal neuraxis yields a higher incidence of SVM than previously documented. We recommend MR imaging of the complete spinal neuraxis in patients with a non-perimesencephalic subarachnoid hemorrhage in whom no cause for the hemorrhage has been found.
Assuntos
Medula Espinal/anormalidades , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/etiologia , Malformações Vasculares/complicações , Malformações Vasculares/diagnóstico , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Mesencéfalo/irrigação sanguínea , Mesencéfalo/patologia , Estudos Prospectivos , Estudos Retrospectivos , Medula Espinal/irrigação sanguínea , Medula Espinal/patologia , Adulto JovemRESUMO
BACKGROUND AND PURPOSE: The purpose of this study was to assess the incidence of de novo aneurysm formation, the incidence of subarachnoid hemorrhage (SAH), and the growth of existing untreated aneurysms in 52 patients after therapeutic carotid artery balloon occlusion for carotid aneurysms. PATIENTS AND METHODS: Between January 1996 and August 2004, 52 patients were treated with carotid artery balloon occlusion for carotid aneurysms. In June 2005, all patients, their next of kin, or family physicians were contacted and questioned concerning episodes of headache or hospital admissions that could be attributed to SAH. In addition, MR imaging and MR angiography (MRA) at 3T were performed in 26 of 44 surviving patients after a mean follow-up period of 50.2 months (median, 43.5 months; range, 14-107 months). MR imaging and MRA studies were compared with the digital subtraction angiograms at the time of carotid artery occlusion. RESULTS: During clinical follow-up of 52 patients at a mean of 50.3 months (median, 42.5 months; range, 0-107 months), no episodes of SAH were reported (0%; 97.5% confidence interval [CI], 0-8.2%). In the 26 patients with follow-up MR imaging, no de novo aneurysms were detected (0%; 97.5 CI, 0-13.2%). Five existing untreated small aneurysms in 5 patients had not enlarged after a mean follow-up of 40 months. CONCLUSION: In this study, therapeutic carotid artery occlusion was not associated with development of new aneurysms or enlargement of existing untreated aneurysms with time.
Assuntos
Oclusão com Balão , Doenças das Artérias Carótidas/epidemiologia , Doenças das Artérias Carótidas/terapia , Angiografia Cerebral , Hemorragia Subaracnóidea/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma/diagnóstico por imagem , Aneurisma/epidemiologia , Aneurisma/terapia , Angiografia Digital , Doenças das Artérias Carótidas/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Hemorragia Subaracnóidea/epidemiologia , Fatores de Tempo , Resultado do TratamentoRESUMO
A 17-year-old woman, attending a ballet school, presented with left shoulder pain due to synovial osteochondromatosis.