RESUMO
OBJECTIVE: Carotid artery stenting (CAS) under flow reversal with dual protection using a proximal balloon and distal filter has been an established procedure for internal carotid artery (ICA) stenosis. This study investigates the effect of external carotid artery (ECA) occlusion on outcomes of CAS and ICA flow under flow reversal. METHODS: We reviewed 231 cases of CAS under flow reversal with ECA occlusion and 32 without. In the last 14 of 32 cases, the flow in the ICA under flow reversal was analyzed by ultrasound. The collateral index, which was defined as the total value of the maximum diameters of the ipsilateral anterior cerebral artery at the A1 segment and the anterior communicating artery, as well as those of the ipsilateral posterior cerebral artery at the P1 segment and the ipsilateral posterior communicating artery, and the maximum diameter of the ipsilateral ECA were correlated with the flow direction in the ICA. RESULTS: There was no significant difference in the outcome of CAS between the groups with or without ECA occlusion. Among the 14 cases without ECA occlusion, antegrade flow in the ICA was observed in 6 cases (42.9â¯%). The group with the antegrade flow in the ICA exhibited a significantly lower collateral index (5.08±0.33 vs 6.71±0.28, p=0.01) and a significantly larger ECA diameter (4.66±0.51â¯mm vs 3.21±1.24â¯mm, p=0.01) than the group with the stagnant or retrograde flow in the ICA. CONCLUSIONS: The outcomes of CAS under flow reversal were acceptable even without ECA occlusion. The ECA occlusion may not be necessary for CAS under dual protection; however, distal filter protection should be used even under flow reversal.
Assuntos
Artéria Carótida Interna , Estenose das Carótidas , Stents , Humanos , Idoso , Masculino , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Feminino , Estenose das Carótidas/cirurgia , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/fisiopatologia , Pessoa de Meia-Idade , Resultado do Tratamento , Idoso de 80 Anos ou mais , Artéria Carótida Externa/diagnóstico por imagem , Circulação Cerebrovascular/fisiologia , Estudos RetrospectivosRESUMO
The incidence of subarachnoid hemorrhages (SAHs) in Japan has recently decreased. However, trends in the annual rates of unruptured cerebral aneurysms (UCAs) are unclear because calculations based on follow-up periods are limited to patients with ruptured cerebral aneurysms. We aimed to clarify current trends in the estimated annual rupture rates of UCAs in Japan and to identify the most relevant contributing factors. We analyzed data from the Japanese Ministry of Health, Labour and Welfare and records of the Japan Neurosurgical Society. The estimated annual rupture rates of UCAs between 2003 and 2018 were calculated according to age-adjusted mortality rates of SAH and number of treated ruptured cerebral aneurysms (RCAs). We estimated trends in annual rupture rates using sensitivity analysis and assessed associations between estimated annual rupture rates and the prevalences of hypertension and current smoking. The estimated annual rupture rate of UCAs significantly decreased from 1.44 to 0.87% and from 0.92 to 0.76%, respectively, in terms of age-adjusted mortality rates of SAH and number of treated RCAs (p < 0.001). The range of changes in estimated annual rupture rates of UCAs was - 1.13%â0.83%, representing a declining UCA trend of 88%. The estimated annual rupture rates of UCAs declined by 0.02-0.10% and 0.01-0.05% with every percent decrease in hypertension and current smoking prevalence, respectively. The estimated annual rupture rate of UCAs has recently decreased in Japan, possibly due to a decrease in the prevalence of hypertension rather than smoking.
Assuntos
Aneurisma Roto , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Humanos , Aneurisma Intracraniano/epidemiologia , Aneurisma Roto/epidemiologia , Japão/epidemiologia , Feminino , Masculino , Hemorragia Subaracnóidea/epidemiologia , Pessoa de Meia-Idade , Idoso , Hipertensão/epidemiologia , Adulto , Incidência , Fatores de Risco , PrevalênciaRESUMO
We aimed to develop a new artificial intelligence software that can automatically extract and measure the volume of white matter hyperintensities (WMHs) in head magnetic resonance imaging (MRI) using only thick-slice fluid-attenuated inversion recovery (FLAIR) sequences from multiple centers. We enrolled 1092 participants in Japan, comprising the thick-slice Private Dataset. Based on 207 randomly selected participants, neuroradiologists annotated WMHs using predefined guidelines. The annotated images of participants were divided into training (n = 138) and test (n = 69) datasets. The WMH segmentation model comprised a U-Net ensemble and was trained using the Private Dataset. Two other models were trained for validation using either both thin- and thick-slice MRI datasets or the thin-slice dataset alone. The voxel-wise Dice similarity coefficient (DSC) was used as the evaluation metric. The model trained using only thick-slice MRI showed a DSC of 0.820 for the test dataset, which is comparable to the accuracy of human readers. The model trained with the additional thin-slice dataset showed only a slightly improved DSC of 0.822. This automatic WMH segmentation model comprising a U-Net ensemble trained on a thick-slice FLAIR MRI dataset is a promising new method. Despite some limitations, this model may be applicable in clinical practice.
Assuntos
Inteligência Artificial , Imageamento por Ressonância Magnética , Substância Branca , Humanos , Imageamento por Ressonância Magnética/métodos , Substância Branca/diagnóstico por imagem , Masculino , Feminino , Idoso , Processamento de Imagem Assistida por Computador/métodos , Pessoa de Meia-Idade , Idoso de 80 Anos ou maisRESUMO
Background: Among pediatric cases of moyamoya disease (MMD), cerebral ischemic symptoms often progress and worsen rapidly in infants under one year of age; therefore, it is important to treat them as early as possible. However, direct bypass surgery is often technically difficult for infants due to their small blood vessels. Here, we describe our technique to resolve the technical challenges encountered during superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass surgery in infants aged <1 year with MMD, focusing on specific procedures. Case Description: We performed bilateral STA-MCA and indirect bypass in a 1-year-old girl with MMD and cerebral infarction. Before treatment, a peripherally inserted central venous catheter (PICC) was placed to avoid ischemic attacks associated with crying, dehydration, and malnutrition. All examinations and procedures that would be stressful to the patient, such as blood examinations, were performed using PICC or under sedation. The STA-MCA diameters were 0.8 and 1.2 mm, respectively. After suturing the planned anastomosis with one stitch using an 11-0 monofilament nylon thread, the thread was lifted upward, and the arterial wall was incised. Anastomosis was performed using an 11-0 monofilament nylon thread with 2-4 stitches on each side. The operation was completed without patency problems. Postoperative blood flow improved, and the patient had a good treatment course. Conclusion: Direct bypass for MMD patients aged <1 year is technically challenging; however, the vessels can be connected if the procedure is carefully performed with consideration of the characteristics of the infant's vessels.
RESUMO
Endovascular procedures have become the standard treatment for acute stroke caused by large vessel occlusion. Various strategies are available, including stent retrieval, aspiration catheter placement, and combined techniques. However, the first-pass effect can be maximized using the technique most familiar to each surgeon and institution. Therefore, it is necessary to understand the characteristics of each device and develop case-specific treatment strategies.
Assuntos
Isquemia Encefálica , Procedimentos Endovasculares , Acidente Vascular Cerebral , Humanos , Isquemia Encefálica/cirurgia , Resultado do Tratamento , Acidente Vascular Cerebral/cirurgia , Acidente Vascular Cerebral/etiologia , Trombectomia/efeitos adversos , Trombectomia/métodos , Stents/efeitos adversos , Estudos RetrospectivosRESUMO
Currently, stricter indications for carotid artery stenosis are required owing to improvements in multifaceted medical treatment, including the intensive management of risk factors for atherosclerosis and lifestyle changes. High-risk factors for carotid artery stenting, such as vulnerable plaques, severe calcification, pseudo-occlusion, and difficult access, should be evaluated before endovascular intervention. Therefore, we need to understand the characteristics of each device to achieve maximum risk reduction for carotid artery stenting.
Assuntos
Estenose das Carótidas , Humanos , Estenose das Carótidas/etiologia , Stents/efeitos adversos , Artéria Carótida Interna , Resultado do TratamentoRESUMO
BACKGROUND: Endovascular treatment of ruptured intracranial aneurysms (rIAs) accompanied by intracerebral hematoma (ICH) can be challenging because the ICH can be enlarged due to intraoperative anticoagulation during the endovascular procedure. This retrospective study aimed to compare the outcomes of aneurysmal subarachnoid hemorrhage with and without ICH treated by endovascular procedures. METHODS: We reviewed 62 patients who underwent endovascular treatment of rIAs between January 2015 and April 2023. The patients were divided into 2 groups: those with ICH (group H; n = 13) and those without ICH (group N; n = 49). The patient demographics, aneurysm characteristics, World Federation of Neurosurgical Societies (WFNS) grade, complications (e.g., symptomatic vasospasm, hydrocephalus), and outcomes were assessed stratified by the presence of ICH. In group H, age, sex, complications, WFNS grade, and hematoma volume were also analyzed in relation to the outcomes at discharge. RESULTS: None of these patients required removal of ICH after endovascular treatment of the rIA. We found no significant differences in patient characteristics, aneurysm morphologies, WFNS grade, or overall outcomes between the 2 groups. In contrast, only a poor WFNS grade was significantly associated with poor outcomes (modified Rankin scale score ≥3) in group H (P = 0.04), and the ICH volume was not significantly different between those with good (6.2 ± 5.8 mL) and poor (14.6 ± 10.4 mL) outcomes in group H (P = 0.20). CONCLUSIONS: Endovascular treatment without hematoma evacuation did not adversely affect the outcomes of rIAs with ICH when the clinical condition and aneurysm morphology permitted. Surgical invasion might be avoidable with this less-invasive strategy without worsening the outcomes.
Assuntos
Aneurisma Roto , Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Hemorragia Cerebral/cirurgia , Hemorragia Subaracnóidea/complicações , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Hematoma/cirurgia , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/efeitos adversosRESUMO
Diagnostic image analysis for unruptured cerebral aneurysms using artificial intelligence has a very high sensitivity. However, further improvement is needed because of a relatively high number of false positives. This study aimed to confirm the clinical utility of tuning an artificial intelligence algorithm for cerebral aneurysm diagnosis. We extracted 10,000 magnetic resonance imaging scans of participants who underwent brain screening using the "Brain Dock" system. The sensitivity and false positives/case for aneurysm detection were compared before and after tuning the algorithm. The initial diagnosis included only cases for which feedback to the algorithm was provided. In the primary analysis, the sensitivity of aneurysm diagnosis decreased from 96.5 to 90% and the false positives/case improved from 2.06 to 0.99 after tuning the algorithm (P < 0.001). In the secondary analysis, the sensitivity of aneurysm diagnosis decreased from 98.8 to 94.6% and the false positives/case improved from 1.99 to 1.03 after tuning the algorithm (P < 0.001). The false positives/case reduced without a significant decrease in sensitivity. Using large clinical datasets, we demonstrated that by tuning the algorithm, we could significantly reduce false positives with a minimal decline in sensitivity.
Assuntos
Aneurisma Intracraniano , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Inteligência Artificial , Angiografia por Ressonância Magnética/métodos , Algoritmos , Imageamento por Ressonância MagnéticaRESUMO
OBJECTIVE: Direct bypass surgery by superficial temporal artery (STA) - middle cerebral artery anastomosis is an established procedure for moyamoya disease (MMD). However, some patients may develop cerebral infarction (CI) due to the watershed shift phenomenon after the surgery. This study sought to investigate the correlation between the postoperative changes of STA flow as well as cerebral blood flow (CBF) and the incidence of CI after direct bypass surgery for MMD. METHODS: We conducted a retrospective study of 62 hemispheres in 50 subjects who underwent direct bypass surgery for MMD. All subjects underwent pre- and post-operative MR imaging, ultrasound evaluation of STA, and single-photon emission computed tomography. The presence of CI was correlated with preoperative CBF, the delta difference of each value of the STA between before and after the surgery, and the postoperative increase ratio of CBF. RESULTS: All bypass procedures were patent, and CI was observed in 4 cases (6.4%). There was no significant association between the incidence of CI and both pre- and post-operative CBF. However, there was a significant difference in delta pulsatility index (PI) of the STA between cases with or without CI (-0.38±0.22 and -0.87±0.63, respectively, p=0.03). Whereas, other factors did not show any significant differences between those with or without CI. CONCLUSIONS: A relatively high postoperative PI of the STA was significantly associated with the incidence of CI after direct bypass surgery for MMD. A larger study is needed to confirm these findings.
RESUMO
Objective: We report a case of dolichoectatic vertebrobasilar aneurysms treated with multiple low-profile visualized intraluminal support (LVIS) stents followed by flow redirection endoluminal device (FRED) flow diverter to prevent the growth of the thrombosed aneurysm. Case Presentation: A 71-year-old man developed diplopia due to oculomotor nerve palsy after 11 years of follow-up for an enlarging thrombosed dolichoectatic vertebrobasilar artery aneurysm. He initially had a fusiform thrombosed aneurysm from the right vertebral artery to the basilar artery. This lesion was tortuous and strongly compressed the pons. A total of 11 LVISs were deployed from the right posterior cerebral artery to the right vertebral artery. Six months after surgery, there was no enlargement of the thrombosed aneurysm on MRI and the contrast leakage out of the stent was markedly reduced in DSA compared to immediately after surgery. One year and seven months after surgery, contrast leakage out of the stent was increased in DSA. The FRED was placed within the overlapped LVISs, and contrast leakage was somewhat reduced. After 2 years and 7 months from the initial treatment, the contrast leakage was still observed. However, there was no enlargement of the aneurysm and no complications related to treatments were observed. Conclusion: Treatment with multiple LVIS stents followed by FRED flow diverter treatment for dolichoectatic vertebrobasilar aneurysms (DVAs) may be one of the treatment options for controlling the growth of thrombotic aneurysms without complications, but the long-term prognosis of this case is unclear, and careful follow-up is mandatory.
RESUMO
BACKGROUND: Aneurysm wall enhancement (AWE) is a potential surrogate biomarker for aneurysm instability. Previous studies have assessed AWE using 2D multiplanar methods, most of which were conducted qualitatively. OBJECTIVE: To use a new quantitative tool to analyze a large cohort of saccular aneurysms with 3D-AWE maps METHODS: Saccular aneurysms were imaged prospectively with 3T high resolution MRI. 3D-AWE maps of symptomatic (defined as ruptured or presentation with sentinel headache/cranial nerve neuropathy) and asymptomatic aneurysms were created by extending orthogonal probes from the aneurysm lumen into the wall. Three metrics were used to characterize enhancement: 3D circumferential AWE (3D-CAWE), aneurysm-specific contrast uptake (SAWE), and focal AWE (FAWE). Aneurysms with a circumferential AWE higher than the corpus callosum (3D-CAWE ≥1) were classified as 3D-CAWE+. Symptomatic presentation was analyzed with univariate and multivariate logistic models. Aneurysm size, size ratio, aspect ratio, irregular morphology, and PHASES and ELAPSS scores were compared with the new AWE metrics. Bleb and microhemorrhage analyses were also performed. RESULTS: Ninety-three aneurysms were analyzed. 3D-CAWE, SAWE, and FAWE were associated with symptomatic status (OR=1.34, 1.25, and 1.08, respectively). A multivariate model including aneurysm size, 3D-CAWE+, age, female gender, and FAWE detected symptomatic status with 80% specificity and 90% sensitivity (area under the curve=0.914, =0.967). FAWE was also associated with irregular morphology and high-risk location (p=0.043 and p=0.001, respectively). In general, blebs enhanced 56% more than the aneurysm body. Areas of microhemorrhage co-localized with areas of increased SAWE (p=0.047). CONCLUSIONS: 3D-AWE mapping provides a new set of metrics that could potentially improve the identification of symptomatic aneurysms.
Assuntos
Aneurisma Roto , Aneurisma Intracraniano , Humanos , Feminino , Fatores de Risco , Aneurisma Intracraniano/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , CefaleiaRESUMO
Evaluation of motor function ischemic stroke rat models includes qualitative assessments such as the modified neurological severity score (mNSS). However, mNSS cannot evaluate the function of forelimbs and hindlimbs separately. We quantitatively assessed motor function in a middle cerebral artery occlusion (MCAO) rat model of ischemic stroke. We recorded transcranial stimulation motor evoked potentials (tcMEPs) from MCAO rats and measured the changes in onset latency and amplitude at the forelimbs and hindlimbs up to 28 days after stroke. All MCAO subjects showed hemiparesis. The amplitudes of tcMEPs in both fore- and hindlimbs were inversely correlated with mNSS scores, but the amplitudes in the forelimbs improved later than those in the hindlimbs. The onset latency of tcMEPs in the forelimbs and hindlimbs remained almost unchanged during the follow-up period. Our results showed the differences in tcMEPs amplitude recovery times between the forelimbs and hindlimbs after MCAO, which emphasizes the importance of separately evaluating forelimbs and hindlimbs in post-ischemic stroke models. This minimally invasive and longitudinal quantitative method could be useful for further research on diseases and neurogenesis.
Assuntos
AVC Isquêmico , Acidente Vascular Cerebral , Ratos , Animais , Potencial Evocado Motor , Membro Anterior , Membro PosteriorRESUMO
OBJECTIVES: To investigate temporal changes in imaging findings of conservatively treated acute unruptured vertebral basilar artery dissection (VBAD) and its contributing factors. METHODS: Fifty-three patients who underwent conservative treatment for 64 cases of acute VBAD diagnosed between January 2006 and March 2019 with follow-up of at least 12 months after onset were retrospectively investigated. Statistical analyses of age, sex, medical history, pattern of onset, lesion site, imaging findings and changes over time, regular medication, and outcomes were performed. RESULTS: Changes in the vascular morphology of the lesion site during the follow-up period were observed in only 23 (43 %) patients (median time until change: 19 days). Univariate analysis of factors contributing to morphological changes at the dissection site showed that changes were significantly more likely in younger patients (p = 0.011). Patients taking antiplatelet drugs had a significantly greater rate of deterioration at the dissection site (p = 0.028) than others. On multivariate analysis, age was an independent factor contributing to changes at the dissection site, and taking antiplatelet drugs, particularly clopidogrel, was an independent factor contributing to deterioration. No patient developed intracranial hemorrhage, cerebral infarction, or worsening of neurological symptoms during follow-up. CONCLUSIONS: Morphological changes at the dissection site are more likely in younger patients with acute unruptured VBAD and those taking antiplatelet drugs. However, chances of intracranial hemorrhage, cerebral infarction, or worsening of neurological symptoms during conservative therapy are low; therefore, acute unruptured VBAD may be considered a benign condition.
Assuntos
Aneurisma Intracraniano , Dissecação da Artéria Vertebral , Humanos , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/patologia , Estudos Retrospectivos , Inibidores da Agregação Plaquetária/uso terapêutico , Clopidogrel , Dissecação da Artéria Vertebral/diagnóstico por imagem , Hemorragias Intracranianas , Infarto Cerebral , Artéria Vertebral/patologia , Aneurisma Intracraniano/terapiaRESUMO
Background: Aneurysm wall enhancement has been identified as a potential biomarker for aneurysm instability. Enhancement has been determined by different approaches on 2D multiplanar views. This study describes a new method to quantify enhancement through 3D heatmaps and histograms. Methods: A custom algorithm was developed using orthogonal probes extending from the aneurysm lumen into the wall to create 3D heatmaps and histograms of wall enhancement on 7T-MRI. Three quantitative metrics for general, specific, and focal wall enhancement were generated from the histograms. Results: Thirty-two aneurysms were analyzed and classified based on 3D heatmaps and histograms. Larger aneurysms were more enhancing (Spearman's r=0.472, p=0.006), and had more heterogeneous enhancement (Spearman's r=0.557, p<0.001) than smaller aneurysms. Patterns of enhancement differed between saccular, fusiform, and thrombosed aneurysms. Fusiform aneurysms were larger (p=0.015) and had more heterogenous enhancement compared to saccular aneurysms. Fusiform aneurysms had more areas of focal enhancement (p<0.001) and right skewed histograms (p=0.003). Conclusions: The 3D analysis of aneurysm wall enhancement provides topographic data of the entire aneurysm wall. New metrics developed based on this method showed that large and fusiform aneurysms have heterogenous enhancement.
RESUMO
A method of cerebral protection during endovascular treatment for innominate artery stenosis (IAS) has not been established. Herein, we report a case of symptomatic IAS in a 76-year-old woman. A balloon guide catheter (BGC) was inserted through the right brachial artery (BA) and guided distally to the stenosis. The BGC balloon was inflated, and stenting was performed with balloon protection of both the anterior and posterior cerebral circulation, without any complications. Stenting of the IAS with the BGC using the BA approach is useful, as it is a simple technique that can prevent distal embolization.
Assuntos
Artéria Braquial , Tronco Braquiocefálico , Feminino , Humanos , Idoso , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/cirurgia , Constrição Patológica , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/cirurgia , Stents , CatéteresRESUMO
OBJECTIVE: Inflammatory atherosclerotic remodeling of unruptured intracranial aneurysms (UIAs) wall, which could be detected as aneurysm wall enhancement (AWE) in MR vessel wall imaging (VWI), plays a pivotal role in pathophysiology of progression to rupture. On the other hand, abdominal aortic calcification reflects the extent of systemic atherosclerosis, which in turn predicts the risk of atherosclerotic cardiovascular as well as cerebrovascular diseases. This study sought to investigate whether the abdominal aortic calcification was associated with increased wall enhancement of UIAs in VWI. METHODS: This retrospective study reviewed subjects who underwent evaluation using 3T MR-VWI of UIAs and abdominal CT before endovascular treatments for UIAs between 2018 to 2020. Abdominal aortic calcification volume (ACV) was quantitatively measured from abdominal CT scans between renal arteries and bifurcation. The presence of AWE was correlated with patient profile, aneurysm morphology, and the ACV. RESULTS: A total of 42 patients with 50 UIAs were included. AWE was detected in 19 (38.0%) UIAs. Maximum diameter (9.2 ± 5.0 mm vs 5.3 ± 1.5 mm, P < 0.01) and the ACV (8.2 ± 6.0 mL vs 4.7 ± 4.6 mL, P = 0.038) were significantly higher in UIAs with AWE than those without AWE. CONCLUSIONS: The ACV was significantly associated with increased wall enhancement of UIAs. Systemic atherosclerosis might be a risk factor for the instability of UIAs. Future studies examining the effect of medications for systemic atherosclerosis on the extent of AWE in UIAs is warranted.
Assuntos
Aterosclerose , Aneurisma Intracraniano , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Angiografia Cerebral/métodos , Estudos Retrospectivos , Imageamento por Ressonância Magnética/métodosRESUMO
PURPOSE: Carotid artery stenting (CAS) is an alternative treatment strategy to carotid endarterectomy. However, post-intervention in-stent restenosis (ISR) remains a complication. The timing, frequency, and prognostic factors of ISR are unclear. The incidence and timing of post-CAS ISR were investigated, including plaque imaging to investigate the prognostic factors. METHODS: We retrospectively investigated 308 patients diagnosed with carotid stenosis who underwent CAS between April 2008 and April 2020. The patients also underwent carotid ultrasonography (US) at 1, 3, 6, and 12 months postinterventionally and every 6 months thereafter. Contributory factors in patients with ISR were also investigated. RESULTS: The percentage value of ISR was 4.9% (15/308). The median time from the procedure to ISR was 7 months. The ISR rate was higher for patients with a plaque/muscle ratio of ≤ 2.30 on T2-weighted imaging (T2WI) on black-blood magnetic resonance imaging (BB MRI) (p = 0.022). A plaque/muscle ratio of ≤ 2.30 on BB MRI T2WI was identified as an independent risk factor for ISR. A comparison of the incidence of ISR and the plaque/muscle ratio level on MRI T2WI was also significant (p < 0.001). In T2WI imaging of BB MRI, the cutoff value for detecting ISR from the Plaque/Muscle ratio was 1.310 [area under the curve (AUC) = 0.935, Sensitivity = 100%, specificity = 85.2%]. CONCLUSIONS: The incidence of post-CAS ISR was 4.9%, at a median time of 7 months after stenting. Plaque/muscle ratio on T2WI in pre-intervention MRI plaque imaging may be a useful predictor of post-intervention ISR.
Assuntos
Estenose das Carótidas , Placa Aterosclerótica , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/patologia , Artérias Carótidas/cirurgia , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/patologia , Estenose das Carótidas/cirurgia , Constrição Patológica , Humanos , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/patologia , Placa Aterosclerótica/cirurgia , Estudos Retrospectivos , Stents , Resultado do TratamentoRESUMO
Current MR-vessel wall imaging (VWI) of unruptured intracranial aneurysms (UIAs) permits the visualization of wall structures. Aneurysm wall enhancement (AWE) was associated with atherosclerotic remodeling of the aneurysm wall accompanied by infiltration of inflammatory cells, potentially contributing to rupture. This study sought to investigate whether the luminal concentrations of atherosclerotic proteins in the aneurysm sac were associated with increased wall enhancement of UIAs in VWI. Subjects undergoing endovascular treatment for UIAs were prospectively recruited. All subjects underwent evaluation using 3 T-MRI including pre/post contrast VWI of the UIAs. Blood samples were collected from the aneurysm sac and the parent artery during endovascular procedures. The presence of AWE was correlated with the delta difference in concentration between the aneurysm sac and the parent artery for each atherosclerotic protein. A total of consecutive 45 patients with 50 UIAs were enrolled. The delta differences of anti-oxidized low-density lipoprotein (LDL) antibody, small dense LDL, and lipoprotein(a) [Lp(a)] were significantly higher in UIAs with AWE compared with those without AWE (767.6 ± 1957.1 versus - 442.4 ± 1676.3 mIU/mL, p = 0.02, 114.8 ± 397.7 versus - 518.5 ± 1344.4 µg/mL, p = 0.04, and - 5.6 ± 11.3 versus - 28.7 ± 38.5 µg/mL, p = 0.01, respectively). In multivariate logistic regression analysis, the delta Lp(a) was significantly associated with AWE (p = 0.04). Increased concentrations of atherogenic proteins in the aneurysm sac were significantly associated with wall enhancement of UIAs. Future studies examining the effect of medications for atherosclerosis on the atherogenic proteins within the aneurysm sac and hence the wall enhancement are warranted.
Assuntos
Aterosclerose , Aneurisma Intracraniano , Aterosclerose/diagnóstico por imagem , Angiografia Cerebral/métodos , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodosRESUMO
OBJECTIVE: Post operative cognitive dysfunction (POCD) has been widely observed after major surgery, particularly in elderly patients with general anesthesia (GA). However, a specific unanswered question is whether different approaches to anesthetic managements are associated with different cognitive outcomes after endovascular treatments for unruptured intracranial aneurysms (UIAs). The purpose of this study is to assess the correlation of POCD with GA versus monitored anesthesia care (MAC). METHODS: We performed a pragmatic, prospective study to assess the association between different anesthetic approaches and POCD. We compared the pre- and post-procedural Montreal Cognitive Assessment (MoCA) scores in patients with normal cognition who underwent treatments of UIAs with various endovascular methods, using either GA or MAC. RESULTS: A total of 23 patients with UIAs were enrolled in the study. Seven (30.4%) and sixteen (69.6%) UIAs were treated without perioperative complications under GA or MAC, respectively. There was a significant decline in the post-procedural MoCA score under GA (mean difference = 1.14; 95% confidence interval = [0.42-1.87], P < 0.01). By contrast, there was no significant difference of MoCA score between pre- and post-procedure under MAC (mean difference = 0.19; 95% confidence interval = [-0.29-0.67], P = 0.59). CONCLUSIONS: Treating UIAs using MAC was associated with a decrease in POCD as compared to GA in patients undergoing endovascular treatments for UIAs with normal cognition. Larger randomized studies are needed to confirm these findings.
Assuntos
Aneurisma Intracraniano , Complicações Cognitivas Pós-Operatórias , Idoso , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Projetos Piloto , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Prospectivos , Resultado do TratamentoRESUMO
Aneurysm wall enhancement (AWE) after the administration of contrast gadolinium is a potential biomarker of unstable intracranial aneurysms. While most studies determine AWE subjectively, this study comprehensively quantified AWE in 3D imaging using a semi-automated method. Thirty patients with 33 unruptured intracranial aneurysms prospectively underwent high-resolution imaging with 7T-MRI. The signal intensity (SI) of the aneurysm wall was mapped and normalized to the pituitary stalk (PS) and corpus callosum (CC). The CC proved to be a more reliable normalizing structure in detecting contrast enhancement (p < 0.0001). 3D-heatmaps and histogram analysis of AWE were used to generate the following metrics: specific aneurysm wall enhancement (SAWE), general aneurysm wall enhancement (GAWE) and focal aneurysm wall enhancement (FAWE). GAWE was more accurate in detecting known morphological determinants of aneurysm instability such as size ≥ 7 mm (p = 0.049), size ratio (p = 0.01) and aspect ratio (p = 0.002). SAWE and FAWE were aneurysm specific metrics used to characterize enhancement patterns within the aneurysm wall and the distribution of enhancement along the aneurysm. Blebs were easily identified on 3D-heatmaps and were more enhancing than aneurysm sacs (p = 0.0017). 3D-AWE mapping may be a powerful objective tool in characterizing different biological processes of the aneurysm wall.