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1.
Stroke ; 55(4): 1025-1031, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38527154

RESUMO

BACKGROUND: To differentiate between pseudo occlusion (PO) and true occlusion (TO) of internal carotid artery (ICA) is important in thrombectomy treatment planning for patients with acute ischemic stroke. Although delayed contrast filling has been differentiated carotid PO from TO, its application has been limited by the implementations of multiphasic computed tomography angiography. In this study, we hypothesized that carotid ring sign, which is readily acquired from single-phasic CTA, can sufficiently differentiate carotid TO from PO. METHODS: One thousand four hundred and twenty patients with anterior circulation stroke receiving endovascular therapy were consecutively recruited through a hospital- and web-based registry. Two hundred patients with nonvisualization of the proximal ICA were included in the analysis after a retrospective screening. Diagnosis of PO or TO of the cervical segment of ICA was made based on digital subtraction angiography. Diagnostic performances of carotid ring sign on arterial-phasic CTA and delayed contrast filling on multiphasic computed tomography angiography were evaluated and compared. RESULTS: One-hundred twelve patients had ICA PO and 88 had TO. Carotid ring sign was more common in patients with TO (70.5% versus 6.3%; P<0.001), whereas delayed contrast filling was more common in PO (94.9% versus 7.7%; P<0.001). The sensitivity and specificity of carotid ring sign in diagnosing carotid TO were 0.70 and 0.94, respectively, whereas sensitivity and specificity of delayed contrast filling was 0.95 and 0.92 in judging carotid PO. CONCLUSIONS: Carotid ring sign is a potent imaging marker in diagnosing ICA TO. Carotid ring sign could be complementary to delayed contrast filling sign in differentiating TO from PO, in particular in centers with only single-phasic CTA.


Assuntos
Doenças das Artérias Carótidas , Estenose das Carótidas , AVC Isquêmico , Acidente Vascular Cerebral , Humanos , Angiografia por Tomografia Computadorizada/métodos , Estudos Retrospectivos , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Acidente Vascular Cerebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Angiografia Digital/métodos
2.
No Shinkei Geka ; 52(2): 380-388, 2024 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-38514128

RESUMO

Surgical extirpation of brain arteriovenous malformations(AVMs)requires precise pre-surgical simulation. Utilizing image software, widely used with picture archiving and communication systems(PACS), surgeons can generate simulation images that precisely illustrate the proper feeders, passing arteries, and drainers. The crucial steps for creating informative simulation images include: (1)the free rotation of reconstructed 3D digital subtraction angiography(DSA)images; (2)removal of irrelevant arteries(the most important procedure); and(3)construction of stereo imagery of the "core images." This article presents a detailed description of these procedures.


Assuntos
Malformações Arteriovenosas Intracranianas , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/cirurgia , Imageamento Tridimensional/métodos , Angiografia Digital/métodos , Artérias , Encéfalo/diagnóstico por imagem
4.
Sci Rep ; 14(1): 6154, 2024 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-38486099

RESUMO

Intra-arterial nimodipine administration is a widely used rescue therapy for cerebral vasospasm. Although it is known that its effect sets in with delay, there is little evidence in current literature. Our aim was to prove that the maximal vasodilatory effect is underestimated in direct angiographic controls. We reviewed all cases of intra-arterial nimodipine treatment for subarachnoid hemorrhage-related cerebral vasospasm between January 2021 and December 2022. Inclusion criteria were availability of digital subtraction angiography runs before and after nimodipine administration and a delayed run for the most affected vessel at the end of the procedure to decide on further escalation of therapy. We evaluated nimodipine dose, timing of administration and vessel diameters. Delayed runs were performed in 32 cases (19 patients) with a mean delay of 37.6 (± 16.6) min after nimodipine administration and a mean total nimodipine dose of 4.7 (± 1.2) mg. Vessel dilation was more pronounced in delayed vs. immediate controls, with greater changes in spastic vessel segments (n = 31: 113.5 (± 78.5%) vs. 32.2% (± 27.9%), p < 0.0001) vs. non-spastic vessel segments (n = 32: 23.1% (± 13.5%) vs. 13.3% (± 10.7%), p < 0.0001). In conclusion intra-arterially administered nimodipine seems to exert a delayed vasodilatory effect, which should be considered before escalation of therapy.


Assuntos
Hemorragia Subaracnóidea , Vasoespasmo Intracraniano , Humanos , Nimodipina/farmacologia , Vasodilatadores/uso terapêutico , Vasoespasmo Intracraniano/diagnóstico por imagem , Vasoespasmo Intracraniano/tratamento farmacológico , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/tratamento farmacológico , Angiografia Digital
5.
Neurosurg Focus ; 56(3): E12, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38427991

RESUMO

OBJECTIVE: This study aimed to assess the efficacy and safety of stereotactic radiosurgery (SRS) in treating transverse-sigmoid sinus dural arteriovenous fistulas (TSS DAVFs), and to investigate post-SRS sinus patency, focusing on the risk factors associated with treated sinus occlusion. METHODS: Data from 34 patients treated with SRS between January 2006 and April 2023 were analyzed. Detailed angioarchitecture was confirmed using digital subtraction angiography before SRS. Angiography of the ipsilateral internal carotid artery and vertebral artery was performed to evaluate whether the involved side of the TSS was used for normal venous drainage. TSS stenosis was defined as sinus diameter < 50% of the normal proximal diameter. DAVF shunt obliteration, TSS occlusion, neurological status, and adverse events were also evaluated. RESULTS: Of the 34 patients, 21 had Borden type I and 14 had Borden type II DAVFs. The median age at SRS was 64 years (interquartile range 54-71 years), and the follow-up period was 31 months (interquartile range 15-94 months). Complete shunt obliteration was achieved in 24 (70.6%) patients. The cumulative 2-, 3-, and 5-year shunt obliteration rates were 49.6%, 71.2%, and 86.0%, respectively. Borden type I had higher obliteration rates (60.5%, 83.1%, and 94.4%, respectively) than Borden type II (41.7%, 51.4%, and 75.7%, respectively; p = 0.034). TSS occlusion occurred in 5 patients (14.7%). The cumulative 1-, 5-, and 10-year TSS occlusion rates were 2.9%, 8.3%, and 23.6%, respectively, across the entire cohort. All occlusions occurred exclusively in the sinuses that were not used for normal venous drainage. Cox proportional analyses revealed that TSS stenosis and the sinus not being used for normal venous drainage were significantly associated with a greater risk of TSS occlusion after SRS (HR 9.44, 95% CI 1.01-77.13; p = 0.049). CONCLUSIONS: SRS is effective and safe for TSS DAVF and results in favorable shunt obliteration, symptom improvement, and low complication rates. TSS occlusion after SRS is asymptomatic and is limited to sinuses that are not used for normal venous drainage.


Assuntos
Malformações Vasculares do Sistema Nervoso Central , Embolização Terapêutica , Radiocirurgia , Seios Transversos , Humanos , Pessoa de Meia-Idade , Idoso , Constrição Patológica , Seios Transversos/diagnóstico por imagem , Seios Transversos/cirurgia , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Angiografia Digital , Resultado do Tratamento
6.
Neurosurg Focus ; 56(3): E10, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38428010

RESUMO

OBJECTIVE: Spinal dural arteriovenous fistulas (SDAVFs) often go undiagnosed, leading to irreversible spinal cord dysfunction. Although digital subtraction angiography (DSA) is the gold standard for diagnosing SDAVF, DSA is invasive and operator dependent, with associated risks. MR angiography (MRA) is a promising alternative. This study aimed to evaluate the performance of MRA as an equal alternative to DSA in investigating, diagnosing, and localizing SDAVF. METHODS: Prospectively collected data from a single neurosurgeon at a large tertiary academic center were searched for SDAVFs. Eligibility criteria included any patient with a surgically proven SDAVF in whom preoperative DSA, MRA, or both had been obtained. The eligible patients formed a consecutive series, in which they were divided into DSA and MRA groups. DSA and MRA were the index tests that were compared to the surgical SDAVF outcome, which was the reference standard. Accurate diagnosis was considered to have occurred when the imaging report matched the operative diagnosis to the correct spinal level. Comparisons used a two-sample t-test for continuous variables and Fisher-Freeman-Halton's exact test for categorical variables, with p < 0.05 specifying significance. Univariate, bivariate, and multivariate analyses were conducted to investigate group associations with DSA and MRA accuracy. Positive predictive value, sensitivity, and accuracy were calculated. RESULTS: A total of 27 patients with a mean age of 63 years underwent surgery for SDAVF. There were 19 male (70.4%) and 8 female (29.6%) patients, and the mean duration of symptoms at the time of surgery was 14 months (range 2-48 months). Seventeen patients (63%) presented with bowel or bladder incontinence. Bivariate analysis of the DSA and MRA groups further revealed no significant relationships between the characteristics and accuracy of SDAVF diagnosis. MRA was found to be more sensitive and accurate (100% and 73.3%) than DSA (85.7% and 69.2%), with a subanalysis of the patients with both preoperative MRA and DSA showing that MRA had a greater positive predictive value (78.6 vs 72.7), sensitivity (100 vs 72.7), and accuracy (78.6 vs 57.1) than DSA. CONCLUSIONS: In surgically proven cases of SDAVFs, the authors determined that MRA was more accurate than DSA for SDAVF diagnosis and localization to the corresponding vertebral level. Incomplete catheterization at each vertebral level may result in the failure of DSA to detect SDAVF.


Assuntos
Malformações Vasculares do Sistema Nervoso Central , Angiografia por Ressonância Magnética , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Angiografia por Ressonância Magnética/métodos , Angiografia Digital/métodos , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Medula Espinal/diagnóstico por imagem , Medula Espinal/cirurgia , Valor Preditivo dos Testes
7.
AJNR Am J Neuroradiol ; 45(3): 351-357, 2024 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-38360787

RESUMO

BACKGROUND AND PURPOSE: Accurate pretreatment diagnosis and assessment of spinal vascular malformations using spinal CTA are crucial for patient prognosis, but the postprocessing reconstruction may not be able to fully depict the lesions due to the complexity inherent in spinal anatomy. Our purpose was to explore the application value of the spinal subtraction and bone background fusion CTA (SSBBF-CTA) technique in precisely depicting and localizing spinal vascular malformation lesions. MATERIALS AND METHODS: In this retrospective study, patients (between November 2017 and November 2022) with symptoms similar to those of spinal vascular malformations were divided into diseased (group A) and nondiseased (group B) groups. All patients underwent spinal CTA using Siemens dual-source CT. Multiplanar reconstruction; routine bone subtraction, and SSBBF-CTA images were obtained using the snygo.via and ADW4.6 postprocessing reconstruction workstations. Multiple observers researched the following 3 aspects: 1) preliminary screening capability using original images with multiplanar reconstruction CTA, 2) the accuracy and stability of the SSBBF-CTA postprocessing technique, and 3) diagnostic evaluation of spinal vascular malformations using the 3 types of postprocessing images. Diagnostic performance was analyzed using receiver operating characteristic analysis, while reader or image differences were analyzed using the Wilcoxon signed-rank test or the Kruskal-Wallis rank sum test. RESULTS: Forty-nine patients (groups A and B: 22 and 27 patients; mean ages, 44.0 [SD, 14.3] years and 44.6 [SD,15.2] years; 13 and 16 men) were evaluated. Junior physicians showed lower diagnostic accuracy and sensitivity using multiplanar reconstruction CTA (85.7% and 77.3%) than senior physicians (93.9% and 90.9%, 98% and 95.5%). Short-term trained juniors achieved SSBBF-CTA image accuracy similar to that of experienced physicians (P > .05). In terms of the visualization and localization of spinal vascular malformation lesions (nidus/fistula, feeding artery, and drainage vein), both multiplanar reconstruction and SSBBF-CTA outperformed routine bone subtraction CTA (P = .000). Compared with multiplanar reconstruction, SSBBF-CTA allowed less experienced physicians to achieve superior diagnostic capabilities (comparable with those of experienced radiologists) more rapidly (P < .05). CONCLUSIONS: The SSBBF-CTA technique exhibited excellent reproducibility and enabled accurate pretreatment diagnosis and assessment of spinal vascular malformations with high diagnostic efficiency, particularly for junior radiologists.


Assuntos
Doenças Vasculares , Malformações Vasculares , Masculino , Humanos , Adulto , Angiografia Digital/métodos , Estudos Retrospectivos , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X/métodos , Sensibilidade e Especificidade
8.
Br J Radiol ; 97(1154): 386-391, 2024 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-38302092

RESUMO

OBJECTIVE: To explore the feasibility of using marking and fusion image-guided technique with cone-beam CT (CBCT) in cases of kidney ruptured haemorrhage without extravascular leakage in digital subtraction angiography (DSA) images. METHODS: This is a retrospective case-control study that included 43 patients who underwent transcatheter arterial embolization for kidney ruptured haemorrhage and difficult haemostasis. The patients were divided into two groups: the CBCT group (cases without extravascular leakage observed in angiography) and the control group (cases with clearly identifiable target vessels in angiography). The baseline characteristics and clinical outcomes were collected and analysed. RESULTS: The results showed no statistically significant differences in the duration of the procedure and intraoperative blood transfusion between the control and CBCT groups (P > .05). The study clarified that the CBCT group had a significantly higher rate of improvement of gross haematuria compared to the control group (P < .05). The CBCT group showed a greater increase in haemoglobin and a lesser increase in creatinine. The clinical success rates were 87.5% in the control group and 90.9% in the CBCT group (P > .05). CONCLUSIONS: The marking and fusion image-guided technique is useful in cases of kidney ruptured haemorrhage without extravascular leakage of contrast agent. The technique is safe, feasible, and effective, and we believe it is superior to purely DSA-guidance. ADVANCES IN KNOWLEDGE: The use of the marking and fusion image-guided technique is recommended to overcome the challenge of undetectable target vessels during interventional procedures. This technique is considered as non-inferior to purely DSA-guided interventional procedures where the target vessels are clearly identifiable.


Assuntos
Hemorragia , Rim , Humanos , Projetos Piloto , Estudos Retrospectivos , Estudos de Casos e Controles , Angiografia Digital/métodos , Hemorragia/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico/métodos
9.
Br J Radiol ; 97(1156): 838-843, 2024 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-38379411

RESUMO

OBJECTIVES: To evaluate the clinical value of using a split-bolus contrast injection protocol in improving image quality consistency and diagnostic accuracy in lower extremity CT angiography (CTA). METHODS: Fifty (mean age, 66 ± 12 years) and 39 (mean age, 66 ± 11 years) patients underwent CTA in the lower extremity arteries using split-bolus and fixed-bolus injection schemes, respectively. The objective and subjective image quality of the 2 groups were compared and the diagnostic efficacy for the degree of vessel stenosis was compared using digital subtraction angiography as the gold standard. A P < .05 was considered statistically significant. RESULTS: In comparison with the fixed-bolus scheme, the split-bolus scheme greatly improved the consistency of image quality of the low extremities by significantly increasing the arterial enhancement (337.87 ± 64.67HU vs. 254.74 ± 71.58HU, P < .001), signal-to-noise ratio (22.58 ± 11.64 vs. 7.14 ± 1.98, P < .001), and contrast-to-noise ratio (37.21 ± 10.46 vs. 31.10 ± 15.40, P = .041) in the infrapopliteal segment. The subjective image quality was better (P < .001) and the diagnostic accuracy was higher in the split-bolus group than in the fixed-bolus group (96.00% vs. 91.67%, P < .05, for diagnosing >50% stenosis, and 97.00% vs. 89.10%, P < .05, for diagnosing occlusion) for the infrapopliteal segment arteries. CONCLUSIONS: Compared with the fixed-bolus injection scheme, the split-bolus injection scheme improves the image quality consistency and diagnostic accuracy especially for the infrapopliteal segment arteries in lower extremity CTA. ADVANCES IN KNOWLEDGE: (1) The split-bolus injection scheme of CTA of the lower extremity arteries improves the overall image quality, uniformity of contrast enhancement. (2) Compared with the fixed-bolus injection scheme, the split-bolus injection scheme especially improves the infrapopliteal segment arteries image quality and diagnostic efficacy.


Assuntos
Artérias , Angiografia por Tomografia Computadorizada , Humanos , Pessoa de Meia-Idade , Idoso , Angiografia por Tomografia Computadorizada/métodos , Constrição Patológica , Angiografia Digital/métodos , Artérias/diagnóstico por imagem , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/irrigação sanguínea , Meios de Contraste
10.
Comput Biol Med ; 171: 107987, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38350395

RESUMO

OBJECTIVE: Alignment between preoperative images (high-resolution magnetic resonance imaging, magnetic resonance angiography) and intraoperative medical images (digital subtraction angiography) is currently required in neurointerventional surgery. Treating a lesion is usually guided by a 2D DSA silhouette image. DSA silhouette images increase procedure time and radiation exposure time due to the lack of anatomical information, but information from MRA images can be utilized to compensate for this in order to improve procedure efficiency. In this paper, we abstract this into the problem of relative pose and correspondence between a 3D point and its 2D projection. Multimodal images have a large amount of noise and anomalies that are difficult to resolve using conventional methods. According to our research, there are fewer multimodal fusion methods to perform the full procedure. APPROACH: Therefore, the paper introduces a registration pipeline for multimodal images with fused dual views is presented. Deep learning methods are introduced to accomplish feature extraction of multimodal images to automate the process. Besides, the paper proposes a registration method based on the Factor of Maximum Bounds (FMB). The key insights are to relax the constraints on the lower bound, enhance the constraints on the upper bounds, and mine more local consensus information in the point set using a second perspective to generate accurate pose estimation. MAIN RESULTS: Compared to existing 2D/3D point set registration methods, this method utilizes a different problem formulation, searches the rotation and translation space more efficiently, and improves registration speed. SIGNIFICANCE: Experiments with synthesized and real data show that the proposed method was achieved in accuracy, robustness, and time efficiency.


Assuntos
Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Angiografia por Ressonância Magnética/métodos , Imageamento por Ressonância Magnética/métodos , Angiografia Digital/métodos , Imageamento Tridimensional/métodos , Algoritmos
11.
J Stroke Cerebrovasc Dis ; 33(5): 107644, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38387761

RESUMO

BACKGROUND: The rapid progress in imaging techniques has led to an upsurge in the incidence of optic nerve arteriovenous malformations (AVMs) diagnoses. Nevertheless, a comprehensive integration addressing their diagnostic and therapeutic attributes remains elusive. CASE DESCRIPTION AND THE LITERATURE REVIEW: In this report, we present a case of optic nerve AVM in a patient who initially presented with progressive visual deterioration in the right eye. An orbital magnetic resonance imaging (MRI) scan revealed an abnormal signal intensity within the optic nerve region of the affected eye, and Computed Tomography Angiography (CTA) demonstrated the presence of a vascular malformation involving the optic nerve in the right eye. The diagnosis of optic nerve AVMs relies on Digital Subtraction Angiography (DSA). Given the challenging nature of surgical intervention, the patient opted for conservative management. Upon subsequent evaluation, no significant changes were observed in the patient's right visual acuity and visual field. Furthermore, a comprehensive literature review was conducted. CONCLUSIONS: In summary, the principal clinical presentations associated with optic nerve AVMs include a deterioration in both visual acuity and visual field. Angiography serves as the preferred diagnostic modality to confirm optic nerve AVMs. Microsurgical intervention or interventional embolization techniques may offer effective management approaches to address this complex condition.


Assuntos
Embolização Terapêutica , Malformações Arteriovenosas Intracranianas , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/terapia , Imageamento por Ressonância Magnética , Nervo Óptico/diagnóstico por imagem , Acuidade Visual , Campos Visuais , Angiografia Digital , Embolização Terapêutica/métodos
12.
Eur Radiol Exp ; 8(1): 25, 2024 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-38361025

RESUMO

BACKGROUND: Digital subtraction angiography (DSA) yields high cumulative radiation dosages (RD) delivered to patients. We present a temporal interpolation of low frame rate angiograms as a method to reduce cumulative RDs. METHODS: Patients undergoing interventional evaluation and treatment of cerebrovascular vasospasm following subarachnoid hemorrhage were retrospectively identified. DSAs containing pre- and post-intervention runs capturing the full arterial, capillary, and venous phases with at least 16 frames each were selected. Frame rate reduction (FRR) of the original DSAs was performed to 50%, 66%, and 75% of the original frame rate. Missing frames were regenerated by sampling a gamma variate model (GVM) fit to the contrast response curves to the reduced data. A formal reader study was performed to assess the diagnostic accuracy of the "synthetic" studies (sDSA) compared to the original DSA. RESULTS: Thirty-eight studies met inclusion criteria (average RD 1,361.9 mGy). Seven were excluded for differing views, magnifications, or motion. GVMs fit to 50%, 66%, and 75% FRR studies demonstrated average voxel errors of 2.0 ± 2.5% (mean ± standard deviation), 6.5 ± 1.5%, and 27 ± 2%, respectively for anteroposterior projections, 2.0 ± 2.2%, 15.0 ± 3.1%, and 14.8 ± 13.0% for lateral projections, respectively. Reconstructions took 0.51 s/study. Reader studies demonstrated an average rating of 12.8 (95% CI 12.3-13.3) for 75% FRR, 12.7 (12.2-13.2) for 66% FRR and 12.0 (11.5-12.5) for 50% FRR using Subjective Image Grading Scale. Kendall's coefficient of concordance resulted in W = 0.506. CONCLUSION: FRR by 75% combined with GVM reconstruction does not compromise diagnostic quality for the assessment of cerebral vasculature. RELEVANCE STATEMENT: Using this novel algorithm, it is possible to reduce the frame rate of DSA by as much as 75%, with a proportional reduction in radiation exposure, without degrading imaging quality. KEY POINTS: • DSA delivers some of the highest doses of radiation to patients. • Frame rate reduction (FRR) was combined with bolus tracking to interpolate intermediate frames. • This technique provided a 75% FRR with preservation of diagnostic utility as graded by a formal reader study for cerebral angiography performed for the evaluation of cerebral vasospasm. • This approach can be applied to other types of angiography studies.


Assuntos
Exposição à Radiação , Humanos , Angiografia Digital/métodos , Estudos Retrospectivos , Angiografia Cerebral/métodos , Doses de Radiação
13.
J Med Case Rep ; 18(1): 109, 2024 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-38383477

RESUMO

BACKGROUND: While noninvasive imaging is typically used during the initial assessment of carotid artery disease, digital subtraction angiography remains the gold standard for evaluating carotid stent thrombosis and stenosis (Krawisz in Cardiol Clin 39:539-549, 2021). This case highlights the importance of digital subtraction angiography for assessing carotid artery stent patency in place of non-invasive imaging. CASE PRESENTATION: We present a 61-year-old African American male patient with a history of right cervical internal carotid artery dissection that was treated with carotid artery stenting and endovascular thrombectomy, who developed recurrent right hemispheric infarcts related to delayed carotid stent thrombosis. Digital subtraction angiography found multiple filling defects consistent with extensive in-stent thrombosis not clearly observed with magnetic resonance angiography. Etiology was likely secondary to chronic antiplatelet noncompliance. Therefore, the patient was treated medically with a heparin drip, and dual antiplatelet therapy (dAPT) was restarted. At 1-month follow-up the patient did not report new motor or sensory deficits. CONCLUSION: In the setting of delayed carotid stent thrombosis secondary to antiplatelet noncompliance, digital subtraction angiography may play an essential diagnostic role for early identification and determination of the most appropriate treatment.


Assuntos
Estenose das Carótidas , Trombose , Humanos , Masculino , Pessoa de Meia-Idade , Stents/efeitos adversos , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/cirurgia , Angiografia Cerebral , Trombose/diagnóstico por imagem , Trombose/etiologia , Artéria Carótida Interna/diagnóstico por imagem , Angiografia Digital
14.
J Stroke Cerebrovasc Dis ; 33(3): 107575, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38232582

RESUMO

AIM: This study aimed to evaluate the feasibility of transcranial color-coded sonography (TCCS) and contrast-enhanced ultrasound (CEUS) in assessing middle cerebral artery (MCA) stem stenosis or occlusion compared to digital subtraction angiography (DSA). METHODS: A total of 48 cases including 96 MCAs suspected stem stenosis or obstruction in the MCA were assessed by TCCS, CE-TCCS, and DSA. The diameters of the most severe stenosis (Ds), proximal normal artery (Dn), and diameter stenosis rate of MCA were measured using both the color doppler flow imaging (CDFI) modality of TCCS or CEUS and the CEUS imaging modality. The intraclass correlation coefficients (ICCs) and 95 % confidence intervals (CI) were evaluated, and a weighted Kappa value was used to evaluate the intra-observer agreement, inter-observer agreement, agreement between CDFI modality and DSA stenosis or occlusion, and agreement between CEUS imaging modality and DSA stenosis or occlusion. RESULTS: The ICC results indicated excellent repeatability and reproducibility (all ICCs > 0.75; weighted Kappa values >0.81). Compared with DSA, the weighted Kappa values and 95 % CIs of stenosis (the first measurement was taken by two observers) of CDFI modality and CEUS imaging modality were 0.175 (0.041, 0.308) and 0.779 (0.570, 0.988) for observers A and 0.181 (0.046, 0.316) and 0.779 (0.570, 0.988) for observers B respectively. CONCLUSION: This study indicates that inter- and intra-observer agreements were good for the direct method of measuring percentages of MCA stenosis by TCCS and CEUS. CEUS imaging modality is a new and reliable imaging modality approach to evaluate the MCAs stenosis and occlusion.


Assuntos
Transtornos Cerebrovasculares , Artéria Cerebral Média , Humanos , Artéria Cerebral Média/diagnóstico por imagem , Constrição Patológica , Angiografia Digital/métodos , Reprodutibilidade dos Testes , Estudos de Viabilidade , Ultrassonografia Doppler Transcraniana/métodos , Sensibilidade e Especificidade
15.
AJNR Am J Neuroradiol ; 45(2): 155-162, 2024 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-38238091

RESUMO

BACKGROUND AND PURPOSE: Collateral circulation plays an important role in steno-occlusive internal carotid artery disease (ICAD) to reduce the risk of stroke. We aimed to investigate the utility of planning-free random vessel-encoded arterial spin-labeling (rVE-ASL) in assessing collateral flows in patients with ICAD. MATERIALS AND METHODS: Forty patients with ICAD were prospectively recruited. The presence and extent of collateral flow were assessed and compared between rVE-ASL and DSA by using Contingency (C) and Cramer V (V) coefficients. The differences in flow territory alterations stratified by stenosis ratio and symptoms, respectively, were compared between symptomatic (n = 19) and asymptomatic (n = 21) patients by using the Fisher exact test. RESULTS: Good agreement was observed between rVE-ASL and DSA in assessing collateral flow (C = 0.762, V = 0.833, both P < .001). Patients with ICA stenosis of ≥90% were more likely to have flow alterations (P < .001). Symptomatic patients showed a higher prevalence of flow alterations in the territory of the MCA on the same side of ICAD (63.2%), compared with asymptomatic patients (23.8%, P = .012), while the flow alterations in the territory of anterior cerebral artery did not differ (P = .442). The collateral flow to MCA territory was developed primarily from the contralateral internal carotid artery (70.6%) and vertebrobasilar artery to a lesser extent (47.1%). CONCLUSIONS: rVE-ASL provides comparable information with DSA on the assessment of collateral flow. The flow alterations in the MCA territory may be attributed to symptomatic ICAD.


Assuntos
Doenças das Artérias Carótidas , Estenose das Carótidas , Humanos , Estenose das Carótidas/diagnóstico por imagem , Constrição Patológica , Marcadores de Spin , Angiografia Digital , Artéria Carótida Interna/diagnóstico por imagem , Circulação Colateral , Circulação Cerebrovascular , Angiografia por Ressonância Magnética
16.
BMC Neurol ; 24(1): 38, 2024 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-38262944

RESUMO

BACKGROUND: Contrast-induced encephalopathy (CIE) is a rare complication during or after angiography, usually transient and reversible. CIE diagnosis is challenging due to the absence of no formal diagnostic criteria. CIE can mimic stroke symptoms, including visual disturbances, seizures, confusion, coma, and focal neurological deficits. This case reports neurological deficit reversal in a CIE patient due to the embolization of an intracranial aneurysm, the second angiographic procedure in six days. CASE PRESENTATION: A 77-year-old woman was admitted to the hospital for headaches. The cerebral computed tomography (CT) scan indicated a subarachnoid hemorrhage. The first digital subtraction angiography (DSA) identified an aneurysm of 4 mm ∗ 3 mm in size in the M1 segment of the right middle cerebral artery (MCA). Then, embolization surgery was performed for the cerebral aneurysm, which was successful. However, the patient had post-operative headaches, slurred speech, epilepsy, limb weakness, and delirium post-procedure. The non-contrast cerebral CT indicated widespread edema in the right cerebral hemisphere. The patient was diagnosed with CIE and treated with symptomatic supportive therapy. Eventually, the patient's neurological deficits and cerebral edema improved significantly. CONCLUSIONS: The current case emphasized the importance of early diagnosis and symptomatic treatment of CIE. Thus, CIE should be the first consideration during the differential diagnosis of a patient having acute neurological impairment after repeated DSA.


Assuntos
Aneurisma Intracraniano , Acidente Vascular Cerebral , Hemorragia Subaracnóidea , Feminino , Humanos , Idoso , Angiografia Digital , Cefaleia
17.
Neurology ; 102(3): e208118, 2024 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-38175990

RESUMO

A 17-year-old boy with typical neurodevelopment presented with 3 months of lower-limb weakness without a history of trauma. Physical examination, plain radiography and a T2-weighted MRI revealed a port-wine stain over the lumbar region, significant scoliosis below the cervical segment, and a multifocal flow void sign (steal phenomenon) from epidural space to dorso-lumbar spine, respectively (Figure 1). CT angiography identified an enhancing dorsal vascular mass with involvement of the spinal canal including destruction of the vertebral body determined to be extensive arteriovenous shunts on digital subtraction angiography (DSA) (Figure 2).


Assuntos
Escoliose , Canal Medular , Masculino , Humanos , Adolescente , Radiografia , Vértebras Lombares , Espaço Epidural , Imageamento por Ressonância Magnética , Angiografia Digital
18.
Clin Radiol ; 79(3): e393-e400, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38182477

RESUMO

AIM: To compare the performance of two non-contrast magnetic resonance angiography (MRA) sequences, silent MRA and time of flight (TOF) MRA, in the evaluation of intracranial dural arteriovenous fistula (DAVF). MATERIALS AND METHODS: Forty consecutive patients with DAVF were enrolled and evaluated prospectively using silent MRA, TOF MRA, and digital subtraction angiography (DSA). The location, Cognard classification, arterial feeders, and venous drainage were evaluated. The therapeutic strategy and possible route were predicted on both silent and TOF MRA and these were compared with DSA during subsequent endovascular treatment. RESULTS: Sensitivity and accuracy of silent and TOF MRA for localisation (96.4% versus 96% and 96% versus 95%, respectively) and classification (96% versus 94% and 96% versus 93.5%, respectively) were high. Silent MRA showed higher sensitivity than TOF MRA for arterial feeders and draining veins (87% versus 79% and 81.6% versus 67%). This improved to a sensitivity of 96.4% and 89% when prominent feeders were considered. The sensitivity and accuracy were 92.6% and 85.8% for immediate draining veins. Both silent and TOF MRA were accurate for therapeutic planning (96% versus 85%), although silent MRA was more accurate. CONCLUSION: Silent MRA can more reliably evaluate the various angioarchtectural components of DAVF compared to TOF MRA.


Assuntos
Malformações Vasculares do Sistema Nervoso Central , Angiografia por Ressonância Magnética , Humanos , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Angiografia Digital , Veias , Espectroscopia de Ressonância Magnética
19.
Stroke ; 55(2): 311-323, 2024 02.
Artigo em Inglês | MEDLINE | ID: mdl-38252756

RESUMO

Intracranial atherosclerotic disease (ICAD) is one of the most common causes of stroke worldwide. Among people with stroke, those of East Asia descent and non-White populations in the United States have a higher burden of ICAD-related stroke compared with Whites of European descent. Disparities in the prevalence of asymptomatic ICAD are less marked than with symptomatic ICAD. In addition to stroke, ICAD increases the risk of dementia and cognitive decline, magnifying ICAD societal burden. The risk of stroke recurrence among patients with ICAD-related stroke is the highest among those with confirmed stroke and stenosis ≥70%. In fact, the 1-year recurrent stroke rate of >20% among those with stenosis >70% is one of the highest rates among common causes of stroke. The mechanisms by which ICAD causes stroke include plaque rupture with in situ thrombosis and occlusion or artery-to-artery embolization, hemodynamic injury, and branch occlusive disease. The risk of stroke recurrence varies by the presumed underlying mechanism of stroke, but whether techniques such as quantitative magnetic resonance angiography, computed tomographic angiography, magnetic resonance perfusion, or transcranial Doppler can help with risk stratification beyond the degree of stenosis is less clear. The diagnosis of ICAD is heavily reliant on lumen-based studies, such as computed tomographic angiography, magnetic resonance angiography, or digital subtraction angiography, but newer technologies, such as high-resolution vessel wall magnetic resonance imaging, can help distinguish ICAD from stenosing arteriopathies.


Assuntos
Acidente Vascular Cerebral , Humanos , Constrição Patológica , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia , Tomografia Computadorizada por Raios X , Infarto Cerebral , Angiografia Digital
20.
Neurosurg Rev ; 47(1): 32, 2024 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-38182923

RESUMO

The purpose of this study was to investigate the application and efficacy analysis of in situ interposition bypass in complex intracranial aneurysms. This study retrospectively analyzed the clinical data of 21 patients with complex intracranial aneurysms treated with in situ interposition bypass grafting in the Department of Neurosurgery at Tianjin Huanhu Hospital from June 2015 to December 2022. The aneurysms were located in the middle cerebral artery in 16 cases, the anterior cerebral artery in 3 cases, the posterior cerebral artery in 1 case, and the posterior inferior cerebellar artery in 1 case. The interposition graft vessels were taken from the radial artery in 15 cases, the superficial temporal artery in 5 cases, and the occipital artery in 1 case. All patients underwent end-to-end anastomosis with in situ interposition bypass after aneurysm resection, including 13 cases of "I-shaped" type, 5 cases of "V-shaped" type, and 3 cases of "Y-shaped" type. Postoperative digital subtraction angiography (DSA) or computed tomography angiography (CTA) reviews were performed for all the patients, and modified Rankin Scale (mRS) score was used to assess patient prognosis. Three patients developed postoperative basal ganglia infarction and two of them recovered well. One case developed transient incomplete aphasia and one case developed mild hemiparesis, which recovered well after 3 months. The remaining 16 patients did not develop new neurological deficits. Postoperative DSA or CTA showed that the anastomosis of the bypass graft and the graft vessels were patent, and all aneurysms were completely eliminated. Regular postoperative follow-up ranged from 3 to 89 months, and no aneurysm recurred. The percentage of patients with mRS ≤ 2 at the final follow-up was 90.5%. Based on the experience of surgical treatment in our center, in situ interposition bypass technique is a safe and effective option for the treatment of some complex intracranial aneurysms.


Assuntos
Aneurisma Intracraniano , Humanos , Aneurisma Intracraniano/cirurgia , Estudos Retrospectivos , Procedimentos Neurocirúrgicos , Angiografia Digital , Artéria Cerebral Média
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