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Shah KA, White TG, Teron I, Turpin J, Dehdashti AR, Temes RE, Black K, Woo HH. Quantitative magnetic resonance angiography as an alternative imaging technique in the assessment of cerebral vasospasm after subarachnoid hemorrhage. Interv Neuroradiol 2024; 30:271-279. [PMID: 36357992 PMCID: PMC11095350 DOI: 10.1177/15910199221138167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/25/2022] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION The major mechanism of morbidity of delayed cerebral ischemia after subarachnoid hemorrhage (SAH) is considered to be severe vasospasm. Quantitative MRA (QMRA) provides direct measurements of vessel-specific volumetric blood flow and may permit a clinically relevant assessment of the risk of ischemia secondary to cerebral vasospasm. PURPOSE To evaluate the utility of QMRA as an alternative imaging technique for the assessment of cerebral vasospasm after SAH. METHODS QMRA volumetric flow rates of the anterior cerebral artery (ACA), middle cerebral artery (MCA), and posterior cerebral artery (PCA) were compared with vessel diameters on catheter-based angiography. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of QMRA for detecting cerebral vasospasm was determined by receiver-operating characteristic curves. Spearman correlation coefficients were calculated for QMRA flow versus angiographic vessel diameter. RESULTS Sixty-six vessels (10 patients) were evaluated with QMRA and catheter-based angiography. The median percent QMRA flow of all vessels with angiographic vasospasm (55.0%, IQR 34.3-71.6%) was significantly lower than the median percent QMRA flow of vessels without vasospasm (91.4%, IQR 81.4-100.4%) (p < 0.001). Angiographic vasospasm reduced QMRA-assessed flow by 23 ± 5 (p = 0.018), 95 ± 12 (p = 0.042), and 16 ± 4 mL/min (p = 0.153) in the ACA, MCA, and PCA, respectively, compared to vessels without angiographic vasospasm. The sensitivity, specificity, PPV, and NPV of QMRA for the discrimination of cerebral vasospasm was 84%, 72%, 84%, and 72%, respectively, for angiographic vasospasm >25% and 91%, 60%, 87%, and 69%, respectively, for angiographic vasospasm >50%. The Spearman correlation indicated a significant association between QMRA flows and vessel diameters (rs = 0.71, p < 0.001). CONCLUSION Reduction in QMRA flow correlates with angiographic vessel narrowing and may be useful as a non-invasive imaging modality for the detection of cerebral vasospasm after SAH.
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Affiliation(s)
- Kevin A Shah
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Timothy G White
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Ina Teron
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Justin Turpin
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Amir R Dehdashti
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Richard E Temes
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Karen Black
- Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Henry H Woo
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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McGuire LS, Kumar P, Ryoo JS, Alaraj A. Selective endovascular treatment of cervical arterial dissection using quantitative magnetic resonance angiography. Interv Neuroradiol 2024; 30:64-71. [PMID: 35656756 PMCID: PMC10956450 DOI: 10.1177/15910199221106040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The role of endovascular treatment in cervical artery dissection (CAD) is equivocal. This study compared cerebral blood flow in CAD between medically and endovascularly treated patients using quantitative magnetic resonance angiography (QMRA). METHODS Retrospective chart review was completed for patients with CAD. Inclusion criteria were adults (>18 years) with diagnosis of dissection of the internal carotid artery or vertebral artery who received QMRA. The cases were reviewed for clinical presentation, diagnosis, management, and imaging, and in particular, patients who underwent endovascular treatment were evaluated. RESULTS Forty-one patients were included, 46.3% female and mean age 46.0+/- 11.9 years. 21 patients (51.2%) had contralateral (ICA) dissections while 19 (46.3%) had vertebral artery (VA) dissections, and 1 had both involved. Five patients underwent stenting, angioplasty, or both. Baseline characteristics between patients who underwent medical versus endovascular treatment were similar, although patients undergoing stenting/angioplasty were more likely to have diabetes (p = 0.015) and prior anticoagulation use (p = 0.007). All endovascular patients demonstrated ischemia on MRI versus 53.1% of those undergoing medical management (p = 0.047). Comparing ipsilateral vessel flow over time in these two patient groups showed those who underwent stenting or angioplasty had lower baseline flows, albeit non-significant (p = 0.629). Patients who underwent endovascular treatment had lower distal flow compared to the medical management group. CONCLUSION This study represents the first to assess vessel flow using QMRA in patients who underwent endovascular treatment of CAD. In combination with progressive symptoms, QMRA may serve as a useful adjunct in the selection of patients for endovascular intervention in arterial dissections.
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Affiliation(s)
- Laura Stone McGuire
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Prateek Kumar
- Department of Neurology, University of Illinois at Chicago, Chicago, IL, USA
| | - James S. Ryoo
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
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Chen LH, Spagnolo-Allende A, Yang D, Qiao Y, Gutierrez J. Epidemiology, Pathophysiology, and Imaging of Atherosclerotic Intracranial Disease. Stroke 2024; 55:311-323. [PMID: 38252756 PMCID: PMC10827355 DOI: 10.1161/strokeaha.123.043630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
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.
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Affiliation(s)
- Li Hui Chen
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Antonio Spagnolo-Allende
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Dixon Yang
- Department of Neurology, Rush University, Chicago, IL, USA
| | - Ye Qiao
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Jose Gutierrez
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Charles JH, Desai S, Jean Paul A, Hassan A. Multimodal imaging approach for the diagnosis of intracranial atherosclerotic disease (ICAD): Basic principles, current and future perspectives. Interv Neuroradiol 2024; 30:105-119. [PMID: 36262087 PMCID: PMC10956456 DOI: 10.1177/15910199221133170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 09/29/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To review the different imaging modalities utilized in the diagnosis of Intracranial Atherosclerotic Disease (ICAD) including their latest development and relevance in management of ICAD. METHODS A review of the literature was conducted through a search in google scholar, PubMed/Medline, EMBASE, Scopus, clinical trials.gov and the Cochrane Library. Search terms included, "imaging modalities in ICAD," "ICAD diagnostic," "Neuroimaging of ICAD," "Evaluation of ICAD". A summary and comparison of each modality's basic principles, advantages and disadvantages were included. RESULTS A total of 144 articles were identified and reviewed. The most common imaging used in ICAD diagnoses were DSA, CTA, MRA and TCD. They all had proven accuracy, their own benefits, and limitations. Newer modalities such as VWI, IVUS, OCT, PWI and CFD provide more detailed information regarding the vessel walls, plaque characteristics, and flow dynamics, which play a tremendous role in treatment guidance. In certain clinical scenarios, using more than one modality has been shown to be helpful in ICAD identification. The rapidly evolving software related to imaging studies, such as virtual histology, are very promising for the diagnostic and management of ICAD. CONCLUSIONS ICAD is a common cause of recurrent ischemic stroke. Its management can be both medical and/or procedural. Many different imaging modalities are used in its diagnosis. In certain clinical scenario, a combination of two more modalities can be critical in the management of ICAD. We expect that continuous development of imaging technique will lead to individualized and less invasive management with adequate outcome.
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Affiliation(s)
| | - Sohum Desai
- Department of Endovascular Surgical Neuroradiology, Valley Baptist Medical Center, Harlingen, Texas, USA
| | - Axler Jean Paul
- School of Medicine, State University of Haiti, Port Au Prince, Haiti
| | - Ameer Hassan
- Department of Endovascular Surgical Neuroradiology, Valley Baptist Medical Center, Harlingen, Texas, USA
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Kim SJ, Schneider DJ, Feldmann E, Liebeskind DS. Intracranial atherosclerosis: Review of imaging features and advances in diagnostics. Int J Stroke 2022; 17:599-607. [PMID: 34983259 DOI: 10.1177/17474930211066427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intracranial atherosclerotic disease is one of the leading causes of ischemic strokes and poses a moderate risk of recurrence. Diagnosis is currently limited to stenosis on luminal imaging, which likely underestimates the true prevalence of the disease. Detection of non-stenosing intracranial atherosclerosis is important in order to optimize secondary stroke prevention strategies. This review collates findings from the early seminal trials and the latest studies in advanced radiological techniques that characterize symptomatic intracranial atherosclerotic disease across various imaging modalities. While computed tomography angiography (CTA) and magnetic resonance angiography (MRA) comprise diagnostic mainstays in identifying stenotic changes secondary to atherosclerosis, emerging techniques such as high-resolution MRA, quantitative MRA, and computational fluid dynamics may reveal a myriad of other underlying pathophysiological mechanisms.
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Affiliation(s)
- Song J Kim
- Vascular Neurology and Neurocritical Care, Sutter Health Comprehensive Stroke Care Center, San Francisco, CA, USA
| | - David J Schneider
- Cardiovascular Research Institute of Vermont, The University of Vermont, Colchester, VT, USA
| | - Edward Feldmann
- Neurosciences and Rehabilitation, Baystate Health, Springfield, MA, USA
| | - David S Liebeskind
- Neurovascular Imaging Research Core and UCLA Stroke Center, Los Angeles, CA, USA
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Ryu B, White TG, Shah KA, Turpin J, Link T, Dehdashti AR, Katz JM, Black K, Woo HH. Utility of quantitative magnetic resonance angiography and non-invasive optimal vessel analysis for identification of complications and long-term hemodynamic changes in post-pipeline embolization patients. Interv Neuroradiol 2021; 28:396-403. [PMID: 34346801 PMCID: PMC9326859 DOI: 10.1177/15910199211034668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Quantitative magnetic resonance angiography and non-invasive optimal vessel analysis serve as powerful tools to collect and analyze hemodynamic data from pipeline embolization patients. At our institution, patients receive post-embolization quantitative magnetic resonance angiography within 24 h of treatment and within 6 months for follow-up to evaluate pipeline patency. Here, we aim to elucidate the long-term hemodynamic changes following pipeline embolization device placement and report two cases in which in-stent stenosis was detected. METHODS Medical records of patients who underwent pipeline embolization device placement for an internal carotid artery aneurysm between 2017 and 2019 were reviewed. Patients who received post-procedure NOVA and follow-up NOVA were included in the study (n = 32). Location and size of aneurysm, number of pipeline embolization device deployed, and complications were collected along with the non-invasive optimal vessel analysis report (flow volume rate (ml/min), mean, systolic, and diastolic flow velocities (cm/s), and vessel diameter (mm)). Internal carotid artery vessel flow rate was measured proximal to the pipeline embolization device. Derivations of hemodynamic parameters (pulsatility index, Lindegaard ratio, and wall shear stress) were calculated. RESULTS The middle cerebral artery mean and diastolic flow velocities were significantly lower on the follow-up NOVA compared to the post-procedure NOVA. Moreover, follow-up NOVA demonstrated lower middle cerebral artery wall shear stress on the side with flow diversion compared to the post-procedure NOVA. In-stent stenosis, requiring intervention, was detected in two patients on follow-up NOVA. One patient had a successful balloon angioplasty of the stented internal carotid artery that resolved her stenosis. However, the second patient developed progressive stenosis and expired despite intervention. CONCLUSION Long-term hemodynamic adaptations post-pipeline embolization device demonstrate decreased wall shear stress and decreased mean and diastolic flow velocities in the distal middle cerebral artery, which suggest decreasing velocity of blood flow with endothelialization of the device. Furthermore, follow-up NOVA is a useful tool for detecting potential flow-related complications such as in-stent stenosis.
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Affiliation(s)
- Brendan Ryu
- Department of Neurosurgery, 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Timothy G White
- Department of Neurosurgery, 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Kevin A Shah
- Department of Neurosurgery, 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Justin Turpin
- Department of Neurosurgery, 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Thomas Link
- Department of Neurosurgery, 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Amir R Dehdashti
- Department of Neurosurgery, 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Jeffrey M Katz
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Manhasset, NY, USA
| | - Karen Black
- Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, Manhasset, NY, USA
| | - Henry H Woo
- Department of Neurosurgery, 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
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Ballout A, Schneider JR, Katz J. Quantitative Magnetic Resonance Angiography Fails to Screen In-Stent Restenosis but Predicts Good Long-Term Outcome. Cureus 2021; 13:e15395. [PMID: 34249545 PMCID: PMC8253166 DOI: 10.7759/cureus.15395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 11/20/2022] Open
Abstract
Wingspan stent in the setting of symptomatic intracranial atherosclerotic disease (ICAD) has shown to be associated with in-stent restenosis (ISR). Conventional angiography is typically used to detect ISR, but quantitative magnetic resonance angiography (QMRA), a non-invasive measure of blood hemodynamics, has also been used to screen for ISR. This report highlights a case where QMRA failed to screen for ISR in a patient who received a Wingspan stent for symptomatic intracranial vertebral artery stenosis but predicted good long-term outcome. The patient remained asymptomatic and had robust vertebrobasilar flow at long-term follow-up despite developing ISR.
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Affiliation(s)
- Ahmad Ballout
- Neurology, North Shore University Hospital/Hofstra Northwell School of Medicine, Manhasset, USA
| | - Julia R Schneider
- Neurology, North Shore University Hospital/Hofstra Northwell School of Medicine, Manhasset, USA
| | - Jeffrey Katz
- Neurology, North Shore University Hospital/Hofstra Northwell School of Medicine, Manhasset, USA
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Fiedler J, Reiser M, Košťál P, Kubále J, Ostrý S, Hrbáč T, Kešnerová P, Fadrná T, Langová K, Herzig R, Školoudík D. Blood Flow Volume Measurement in Cervical and Intracranial Arteries using Quantitative Magnetic Resonance Angiography and Duplex Sonography (Bocaccia) - A Prospective Observational Study. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:65-74. [PMID: 32340045 DOI: 10.1055/a-1113-7343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Cerebral blood flow volume is an important factor for the accurate diagnosis of neurovascular diseases and treatment indication. This study aims to assess correlations of blood flow volume measurements in cervical and intracranial arteries between duplex sonography and quantitative magnetic resonance angiography (qMRA). MATERIALS AND METHODS Consecutive patients with suspicion of cerebral vascular pathology underwent qMRA and duplex sonography of cervical and intracranial arteries with measurement of blood flow volume in bilateral common (CCA), internal (ICA) and external carotid arteries, vertebral and basilar arteries, middle, anterior, posterior cerebral and posterior communicating arteries using 2 different ultrasound machines. Ten patients underwent all examinations twice. Correlations between blood flow volume measurements were evaluated using Spearman's correlation coefficient and inter-class correlation coefficient (ICC). RESULTS In total, 21 subjects (15 males, mean age: 56.3 ± 6.2 years) were included in the study. Duplex sonography inter-investigator correlation was excellent (ICC = 0.972, p < 0.0001) as well as intra-investigator correlations of both qMRA and duplex sonography (ICC ˃ 0.990, p < 0.0001). Mostly high correlations were recorded between qMRA and duplex sonography in particular cervical arteries but only low to moderate correlations were obtained for intracranial arteries. The mean differences between blood flow volume measurements were 10.9 ± 8.1 % in the CCA and its branches when using qMRA and 15.0 ± 11.9 % when using duplex sonography, 13.5 ± 11.8 %/35.4 ± 34.2 % in the ICA siphon and its branches when using qMRA/duplex sonography, and 24.1 ± 19.7 %/44.9 ± 44.0 % in both vertebral arteries and the basilar artery when using qMRA/duplex sonography. CONCLUSION Duplex sonography as well as qMRA allow for highly reproducible measurement of blood flow volume in cervical and intracranial arteries in routine clinical practice.
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Affiliation(s)
- Jiří Fiedler
- Department of Neurosurgery, Comprehensive Stroke Center, University Hospital Plzeň, Czech Republic
| | - Martin Reiser
- Department of Neurology, Comprehensive Stroke Center, Hospital České Budějovice, Czech Republic
| | - Petr Košťál
- Department of Neurosurgery, Comprehensive Stroke Center, University Hospital Plzeň, Czech Republic
| | - Jiří Kubále
- Department of Radiology, Comprehensive Stroke Center, Hospital České Budějovice, Czech Republic
| | - Svatopluk Ostrý
- Department of Neurology, Comprehensive Stroke Center, Hospital České Budějovice, Czech Republic
| | - Tomáš Hrbáč
- Department of Neurosurgery, Comprehensive Stroke Center, University Hospital Ostrava, Czech Republic
| | - Petra Kešnerová
- Department of Neurology, 2nd Medical Faculty, Charles-University, Praha, Czech Republic
| | - Táňa Fadrná
- Center for Research and Science, Faculty of Health Sciences, Palacký-University Olomouc, Czech Republic
| | - Kateřina Langová
- Department of Biophysics, Faculty of Medicine and Dentistry, Institute of Molecular and Translational Medicine, Palacký-University Olomouc, Czech Republic
| | - Roman Herzig
- Department of Neurology, Comprehensive Stroke Center, Charles-University Faculty of Medicine in Hradec Kralove, Czech Republic
| | - David Školoudík
- Center for Research and Science, Faculty of Health Sciences, Palacký-University Olomouc, Czech Republic
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Whooley JL, David BC, Woo HH, Hoh BL, Raftery KB, Hussain Siddiqui A, Westerveld M, Amin-Hanjani S, Ghogawala Z. Carotid Revascularization and Its Effect on Cognitive Function: A Prospective Nonrandomized Multicenter Clinical Study. J Stroke Cerebrovasc Dis 2020; 29:104702. [PMID: 32107155 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104702] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/23/2019] [Accepted: 01/25/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is conflicting data on the effect of carotid revascularization on cognitive function. OBJECTIVE To examine cerebral blood flow and cognitive function after carotid revascularization. METHODS Patients with unilateral, asymptomatic hemodynamically significant carotid artery stenosis (80% by computed tomography angiography or magnetic resonance angiography) were eligible. Cerebral blood flow was measured preoperatively and 1 month postoperatively using quantitative phase contrast magnetic resonance angiography. Preoperative flow impairment was defined as ipsilateral flow at least 20% less than contralateral flow (ie, an ipsilateral and/or contralateral flow ratio ≤0.8). Significant improvement in blood flow was defined as at least a 0.15 increase in flow ratio from pre- to postoperative. A control group was managed medically. Four cognitive domains were assessed at baseline, 1 month, and 6-12 months postoperatively. RESULTS Seventy-five patients were enrolled at 6 sites; 53 carotid endarterectomy, 11 carotid artery stenting, and 11 medical management only controls. Preoperative Trails B scores were similar between groups. Revascularization was associated with significant improvement in executive function (Trials B) while no improvement was observed in controls (P = .007). Of patients with improvement in middle cerebral artery (MCA) flow, 90% had improved Trails B scores compared to 46.5% of patients without MCA flow improvement (P = .01). Greater absolute improvement in mean Trails B scores was observed in patients with MCA flow improvement compared to those without (48 seconds versus 24.7 seconds, P = .001). CONCLUSIONS In a cohort of patient with asymptomatic carotid stenosis, improvement in MCA flow following carotid revascularization is associated with improvement in executive functioning.
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Affiliation(s)
- Jenna L Whooley
- Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Brandon C David
- Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Henry H Woo
- Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset NY and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, New York
| | - Brian L Hoh
- Lillian S. Wells Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida
| | - Kevin B Raftery
- Department of Vascular Surgery, Lahey Hospital and Medical Center, Burlington MA and Tufts University School of Medicine, Boston, Massachusetts
| | - Adnan Hussain Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | | | - Sepideh Amin-Hanjani
- Department of Neurosurgery, University of Illinois College of Medicine, Chicago, Illinois
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Kim SJ, Kim YJ, Ko JH. Long Term Outcome of In-Stent Stenosis after Stent Assisted Coil Embolization for Cerebral Aneurysm. J Korean Neurosurg Soc 2019; 62:536-544. [PMID: 31484229 PMCID: PMC6732354 DOI: 10.3340/jkns.2019.0087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/03/2019] [Indexed: 11/27/2022] Open
Abstract
Objective The objective of this study was to evaluatelong-term radiologic prognosis and characteristics of in-stent stenosis (ISS) after stent assisted coiling (SAC) for cerebral aneurysm and analyze its risk factors.
Methods Radiological records of 362 cases of SAC during 10 years were retrospectively reviewed. Patients were included in this study if they had follow-up angiogram using catheter selected angiography at least twice. All subjected were followed up from 12 months to over 30 months. Of 120 patients, 123 aneurysms were enrolled. Patient data including age, sex, aneurysm size, neck size, procedural complication, kinds of stent, ISS associated symptom, ruptured state, location of ISS, degree of ISS, radiologic prognosis of ISS, follow-up period of time, and medical comorbidities such as hypertension, diabetes mellitus (DM), dyslipidemia, and smoking were collected.Statistical comparisons of group clinical characteristics were conducted for the total population.
Results Among 123 casesof aneurysm, 22 cases (17.9%) of ISS were revealed on follow-up angiography. Multiple stenting was performed in three cases and intra-procedural rupture occurred in two cases. Most cases were asymptomatic and symptomatic stenosis was identified in only one case. Sixteen cases were ruptured aneurysm. Mild stenosis was observed in 11 cases. Moderate stenosis was found in eight cases and severe stenosis was identified in three cases. Mean timing of identification of ISS was 8.90 months. The most common type was proximal type. Most cases were improved or not changed on follow-up angiography. Only one case was aggravated from mild stenosis to occlusion of parent artery. Mean follow-up period was 44.3 months. We compared risk factors and characteristic between ISS group and non-ISS group using univariate analysis. Multiple stenting was performed for three cases (13.6%) of the ISS group and four cases (4.0%) of the non-ISS group, showing no statistical difference between the two groups (p=0.108). Additionally, the proportion of patients who had more than two risk factors among four medical risk factors (hypertension, DM, dyslipidemia, and smoking) was higher in the ISS group than that in the non-ISS group, the difference between the two was not statistically significant either (31.8% vs. 12.9%, p=0.05).
Conclusion Clinical course and long-term prognosis of ISS might be benign. Most cases of ISS could be improved or not aggravated. Control of medical co-morbidity might be important. To the best of our knowledge, our study had more cases with longer follow-up period of time than other reports.
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Affiliation(s)
- Sung Jin Kim
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea
| | - Young-Joon Kim
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea
| | - Jung Ho Ko
- Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Korea
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Goto T, Shimamura K, Kuratani T, Kin K, Shijo T, Kudo T, Watanabe Y, Masada K, Sakaniwa R, Tanaka H, Sawa Y. Quantitative evaluation of blood flow in each cerebral branch associated with zone 1-2 thoracic endovascular aortic repair. Eur J Cardiothorac Surg 2019; 55:1079-1085. [PMID: 30689779 DOI: 10.1093/ejcts/ezy450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/24/2018] [Accepted: 11/27/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Optimal methods to quantitatively evaluate the blood flow in each cerebral artery after zone 1-2 thoracic endovascular aortic repair (TEVAR) remain unknown. Our objective was to evaluate the differences between preoperative and postoperative cerebral artery blood flows after zone 1-2 debranching TEVAR (dTEVAR). METHODS Between January 2016 and August 2018, a prospective analysis of the blood flow in both the internal carotid artery and the vertebral artery in 16 patients before and after zone 1-2 dTEVAR was conducted. Zone 1 dTEVAR with right axillary artery-left common carotid artery-left axillary artery (RAxA-LCCA-LAxA) bypass was performed on 7 patients. Zone 2 dTEVAR was performed on 9 patients: 4 underwent RAxA-LAxA bypass and 5 underwent LCCA-LAxA bypass. Quantitative magnetic resonance angiography was performed before and after zone 1-2 dTEVAR. RESULTS Total intracranial blood flow was preserved postoperatively [The median (interquartile range) preoperatively vs postoperatively: 621 (549-686) vs 638 (539-703) ml/min, not significant]. The anterior [469 (400-504) vs 475 (404-510) ml/min, not significant] and posterior cerebral blood flows [157 (121-199) vs 163 (123-210) ml/min, not significant] were also maintained postoperatively. In the 3 debranching procedures, the postoperative anterior and posterior cerebral blood flows were maintained at rates similar to preoperative rates, with the proportion of anterior and posterior cerebral circulations reaching almost 75% and 25%, respectively. No significant differences between preoperative and postoperative distributions of internal carotid artery blood flows were observed. Regarding vertebral artery blood flows, the distribution of blood flow through the left vertebral artery was significantly lower postoperatively than preoperatively; however, the postoperative right vertebral artery blood flow distribution significantly increased compared with the preoperative flow. CONCLUSIONS In zone 1-2 dTEVAR, total intracranial blood flow was preserved postoperatively, and the postoperative anterior and posterior cerebral circulations were maintained at rates similar to their preoperative rates.
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Affiliation(s)
- Takasumi Goto
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuo Shimamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Toru Kuratani
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Keiwa Kin
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takayuki Shijo
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomoaki Kudo
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshiki Watanabe
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kenta Masada
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryoto Sakaniwa
- Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hisashi Tanaka
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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12
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Intracranial atherosclerotic disease. Neurobiol Dis 2018; 124:118-132. [PMID: 30439443 DOI: 10.1016/j.nbd.2018.11.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/25/2018] [Accepted: 11/09/2018] [Indexed: 12/16/2022] Open
Abstract
Intracranial atherosclerosis (ICAS) is a progressive pathological process that causes progressive stenosis and cerebral hypoperfusion and is a major cause of stroke occurrence and recurrence around the world. Multiple factors contribute to the development of ICAS. Angiography imaging techniques can improve the diagnosis of and the selection of appropriate treatment regimens for ICAS. Neither aggressive medication nor endovascular interventions can eradicate stroke recurrence in patients with ICAS. Non-pharmacological therapies such as remote ischemic conditioning and hypothermia are emerging. Comprehensive therapy with medication in combination with endovascular intervention and/or non-pharmacological treatment may be a potential strategy for ICAS treatment in the future. We summarized the epidemiology, pathophysiological mechanisms, risk factors, biomarkers, imaging and management of ICAS.
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Bouillot P, Brina O, Delattre BMA, Ouared R, Pellaton A, Yilmaz H, Machi P, Lovblad KO, Farhat M, Pereira VM, Vargas MI. Neurovascular stent artifacts in 3D-TOF and 3D-PCMRI: Influence of stent design on flow measurement. Magn Reson Med 2018; 81:560-572. [DOI: 10.1002/mrm.27352] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 03/22/2018] [Accepted: 04/19/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Pierre Bouillot
- Departement of Neuroradiology; Geneva University Hospitals; Geneva Switzerland
- Laboratory for Hydraulic Machines (LMH); École Polytechnique Fédérale de Lausanne (EPFL); Lausanne Switzerland
| | - Olivier Brina
- Departement of Neuroradiology; Geneva University Hospitals; Geneva Switzerland
- Division of Neuroradiology, Department of Medical Imaging; Toronto Western Hospital, University Health Network; Toronto Ontario Canada
| | | | - Rafik Ouared
- Departement of Neuroradiology; Geneva University Hospitals; Geneva Switzerland
| | - Alain Pellaton
- Departement of Neuroradiology; Geneva University Hospitals; Geneva Switzerland
| | - Hasan Yilmaz
- Departement of Neuroradiology; Geneva University Hospitals; Geneva Switzerland
| | - Paolo Machi
- Departement of Neuroradiology; Geneva University Hospitals; Geneva Switzerland
| | - Karl-Olof Lovblad
- Departement of Neuroradiology; Geneva University Hospitals; Geneva Switzerland
| | - Mohamed Farhat
- Laboratory for Hydraulic Machines (LMH); École Polytechnique Fédérale de Lausanne (EPFL); Lausanne Switzerland
| | - Vitor Mendes Pereira
- Departement of Neuroradiology; Geneva University Hospitals; Geneva Switzerland
- Division of Neuroradiology, Department of Medical Imaging; Toronto Western Hospital, University Health Network; Toronto Ontario Canada
- Division of Neurosurgery, Department of Surgery; Toronto Western Hospital, University Health Network; Toronto Ontario Canada
| | - Maria Isabel Vargas
- Departement of Neuroradiology; Geneva University Hospitals; Geneva Switzerland
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14
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Andereggen L, Amin-Hanjani S, El-Koussy M, Verma RK, Yuki K, Schoeni D, Hsieh K, Gralla J, Schroth G, Beck J, Raabe A, Arnold M, Reinert M, Andres RH. Quantitative magnetic resonance angiography as a potential predictor for cerebral hyperperfusion syndrome: a preliminary study. J Neurosurg 2018; 128:1006-1014. [DOI: 10.3171/2016.11.jns161033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVECerebral hyperperfusion syndrome (CHS) is a rare but devastating complication of carotid endarterectomy (CEA). This study sought to determine whether quantitative hemodynamic assessment using MR angiography can stratify CHS risk.METHODSIn this prospective trial, patients with internal carotid artery (ICA) stenosis were randomly selected for pre- and postoperative quantitative phase-contrast MR angiography (QMRA). Assessment was standardized according to a protocol and included Doppler/duplex sonography, MRI, and/or CT angiography and QMRA of the intra- and extracranial supplying arteries of the brain. Clinical and radiological data were analyzed to identify CHS risk factors.RESULTSTwenty-five of 153 patients who underwent CEA for ICA stenosis were randomly selected for pre- and postoperative QMRA. QMRA data showed a 2.2-fold postoperative increase in blood flow in the operated ICA (p < 0.001) and a 1.3-fold increase in the ipsilateral middle cerebral artery (MCA) (p = 0.01). Four patients had clinically manifested CHS. The mean flow increases in the patients with CHS were significantly higher than in the patients without CHS, both in the ICA and MCA (p < 0.001). Female sex and a low preoperative diastolic blood pressure were the clearest clinical risk factors for CHS, whereas the flow differences and absolute postoperative flow values in the ipsilateral ICA and MCA were identified as potential radiological predictors for CHS.CONCLUSIONSCerebral blood flow in the ipsilateral ICA and MCA as assessed by QMRA significantly increased after CEA. Higher mean flow differences in ICA and MCA were associated with the development of CHS. QMRA might have the potential to become a noninvasive, operator-independent screening tool for identifying patients at risk for CHS.
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Affiliation(s)
- Lukas Andereggen
- Departments of 1Neurosurgery,
- 4Department of Neurosurgery and F.M. Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Kenya Yuki
- 4Department of Neurosurgery and F.M. Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | - Marcel Arnold
- 3Neurology, University Hospital of Bern, Inselspital, Bern, Switzerland
| | - Michael Reinert
- Departments of 1Neurosurgery,
- 6Department of Neurosurgery, Neurocenter Lugano, Lugano, Switzerland
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15
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Brunozzi D, Shakur SF, Ismail R, Linninger A, Hsu CY, Charbel FT, Alaraj A. Correlation Between Contrast Time-Density Time on Digital Subtraction Angiography and Flow: An in Vitro Study. World Neurosurg 2017; 110:e315-e320. [PMID: 29133005 DOI: 10.1016/j.wneu.2017.10.178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/30/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE Digital subtraction angiography (DSA) provides an excellent anatomic characterization of cerebral vasculature, but hemodynamic assessment is often qualitative and subjective. Various clinical algorithms have been produced to semiquantify flow from the data obtained from DSA, but few have tested them against reliable flow values. METHODS An arched flow model was created and injected with contrast material. Seventeen injections were acquired in anterior-posterior and lateral DSA projections, and 4 injections were acquired in oblique projection. Image intensity change over the angiogram cycle of each DSA run was analyzed through a custom MATLAB code. Time-density plots obtained were divided into 3 components (time-density times, TDTs): TDT10%-100% (time needed for contrast material to change image intensity from 10% to 100%), TDT100%-10% (time needed for contrast material to change image intensity from 100% to 10%), and TDT25%-25% (time needed for contrast material to change from 25% image intensity to 25%). Time-density index (TDI) was defined as model cross-sectional area to TDT ratio, and it was measured against different flow rates. RESULTS TDI10%-100%, TDI100%-10%, and TDI25%-25% all correlated significantly with flow (P < 0.001). TDI10%-100%, TDI100%-10%, and TDI25%-25% showed, respectively, a correlation coefficient of 0.91, 0.91, and 0.97 in the anterior-posterior DSA projections (P < 0.001). In the lateral DSA projection, TDI100%-10% showed a weaker correlation (r = 0.57; P = 0.03). Also in the oblique DSA projection, TDIs correlated significantly with flow. CONCLUSIONS TDI on DSA correlates significantly with flow. Although in vitro studies might overlook conditions that occur in patients, this method appears to correlate with the flow and could offer a semiquantitative method to evaluate the cerebral blood flow.
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Affiliation(s)
- Denise Brunozzi
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sophia F Shakur
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Rahim Ismail
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Andreas Linninger
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Chih-Yang Hsu
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
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Measuring Cerebral Blood Flow in Moyamoya Angiopathy by Quantitative Magnetic Resonance Angiography Noninvasive Optimal Vessel Analysis. Neurosurgery 2017; 81:921-927. [DOI: 10.1093/neuros/nyw122] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/08/2016] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Moyamoya disease causes progressive occlusion of the supraclinoidal internal carotid artery, and middle, anterior, and less frequently the posterior cerebral arteries, carrying the risk of stroke. Blood flow is often partially reconstituted by compensatory moyamoya collaterals and sometimes the posterior circulation. Cerebral revascularization can further augment blood flow. These changes to blood flow within the cerebral vessels, however, are not well characterized.
OBJECTIVE
To evaluate blood flow changes resulting from the disease process and revascularization surgery using quantitative magnetic resonance angiography with noninvasive optimal vessel analysis (NOVA).
METHODS
We retrospectively analyzed 190 preoperative and postoperative imaging scans in 66 moyamoya patients after revascularization surgery. Images were analyzed for blood flow using NOVA and compared with preoperative angiographic staging and postoperative blood flow. Blood flow rates within superficial temporal artery grafts were compared based on angiographic evidence of patency.
RESULTS
Diseased vessels had lower blood flow, correlating with angiographic staging. Flow in posterior cererbal and basilar arteries increased with disease severity, particularly when both the anterior and middle cerebral arteries were occluded. Basilar artery flow and ipsilateral internal carotid artery flow decreased after surgery. Flow rates were different between angiographically robust and poor direct bypass grafts, as well as between robust and patent grafts.
CONCLUSION
Preoperative changes in cerebral vessel flow as measured by NOVA correlated with angiographic disease progression. NOVA demonstrated that preoperative augmentation of the posterior circulation decreased after surgery. This report is the first to quantify the shift in collateral supply from the posterior circulation to the bypass graft.
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17
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Pu Y, Lan L, Leng X, Wong LKS, Liu L. Intracranial atherosclerosis: From anatomy to pathophysiology. Int J Stroke 2017; 12:236-245. [PMID: 28067615 DOI: 10.1177/1747493016685716] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Intracranial atherosclerotic stenosis is an important etiology subtype of ischemic stroke. Stenosis severity was thought to be the main reference index for clinical treatment and research. However, stenosis could not reflect the ischemia risk completely, instead the hemodynamic state across the lesion, the extent of collateral circulation, and perfusion impairment downstream the stenosis are more important. Aims We write this review aimed to summarize novel angiographic methods applied in the evaluation of functional severity of ICAS, and commented on their limitations and prospects in future research. Summary of review The main methods to estimate cerebral blood flow including fractional flow assessed by signal intensity ratio, computational fluid dynamics analysis or pressure wire, quantitative magnetic resonance angiography. Fractional flow as a series cerebral hemodynamic parameters may reflect the status of collateral circulation and cerebral blood flow. But the accuracy of the methods was not validated. The method to calculate fractional flow reserve in cardiovascular disease cannot duplicate in cerebrovascular disease. Fractional flow measurement by floating a pressure guidewire across the intracranial stenosis was technically feasible and safe. In the future researches, a non-invasive method should be established to identify high-risk intracranial lesions and may help in decision-making. Conclusions The relationship between stenosis and cerebral blood flow was individualized. Cerebral hemodynamic criteria should be used to screen patients to endovascular treatment, which will optimize the diagnosis and treatment strategies for patients with symptomatic intracranial artery stenosis.
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Affiliation(s)
- Yuehua Pu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linfang Lan
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xinyi Leng
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lawrence KS Wong
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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18
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Wu C, Schnell S, Vakil P, Honarmand AR, Ansari SA, Carr J, Markl M, Prabhakaran S. In Vivo Assessment of the Impact of Regional Intracranial Atherosclerotic Lesions on Brain Arterial 3D Hemodynamics. AJNR Am J Neuroradiol 2017; 38:515-522. [PMID: 28057635 DOI: 10.3174/ajnr.a5051] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/26/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial atherosclerosis induces hemodynamic disturbance, which is not well-characterized, particularly in cerebral flow redistribution. We aimed to characterize the impact of regional stenotic lesions on intracranial hemodynamics by using 4D flow MR imaging. MATERIALS AND METHODS 4D flow MR imaging was performed in 22 symptomatic patients (mean age, 68.4 ± 14.2 years) with intracranial stenosis (ICA, n = 7; MCA, n = 9; basilar artery, n = 6) and 10 age-appropriate healthy volunteers (mean age, 60.7 ± 8.1 years). 3D blood flow patterns were visualized by using time-integrated pathlines. Blood flow and peak velocity asymmetry indices were compared between patients and healthy volunteers in 4 prespecified arteries: ICAs, MCAs, and anterior/posterior cerebral arteries. RESULTS 3D blood flow pathlines demonstrated flow redistribution across cerebral arteries in patients with unilateral intracranial stenosis. For patients with ICA stenosis compared with healthy volunteers, significantly lower flow and peak velocities were identified in the ipsilateral ICA (P = .001 and P = .001) and MCA (P < .001 and P = .001), but higher flow, in the ipsilateral PCA (P < .001). For patients with MCA stenosis, significantly lower flow and peak velocities were observed in the ipsilateral ICA (P = .009 and P = .045) and MCA (P < .001 and P = .005), but significantly higher flow was found in the ipsilateral posterior cerebral artery (P = .014) and anterior cerebral artery (P = .006). The asymmetry indices were not significantly different between patients with basilar artery stenosis and the healthy volunteers. CONCLUSIONS Regional intracranial atherosclerotic lesions not only alter distal arterial flow but also significantly affect ipsilateral collateral arterial hemodynamics.
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Affiliation(s)
- C Wu
- From the Department of Biomedical Engineering (C.W., M.M.), McCormick School of Engineering, Northwestern University, Chicago, Illinois .,Departments of Radiology (C.W., S.S., P.V., A.R.H., S.A.A., J.C., M.M.).,Philips Healthcare (C.W.), Gainesville, Florida
| | - S Schnell
- Departments of Radiology (C.W., S.S., P.V., A.R.H., S.A.A., J.C., M.M.)
| | - P Vakil
- Departments of Radiology (C.W., S.S., P.V., A.R.H., S.A.A., J.C., M.M.)
| | - A R Honarmand
- Departments of Radiology (C.W., S.S., P.V., A.R.H., S.A.A., J.C., M.M.)
| | - S A Ansari
- Departments of Radiology (C.W., S.S., P.V., A.R.H., S.A.A., J.C., M.M.).,Neurological Surgery (S.A.A.)
| | - J Carr
- Departments of Radiology (C.W., S.S., P.V., A.R.H., S.A.A., J.C., M.M.)
| | - M Markl
- From the Department of Biomedical Engineering (C.W., M.M.), McCormick School of Engineering, Northwestern University, Chicago, Illinois.,Departments of Radiology (C.W., S.S., P.V., A.R.H., S.A.A., J.C., M.M.)
| | - S Prabhakaran
- Neurology (S.P.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Ott S, Struffert T, Saake M, Gölitz P, Adamek E, Doerfler A. Influence of different reconstruction parameters in the visualization of intracranial stents using C-arm flat panel CT angiography: experience in an animal model. Acta Radiol 2016; 57:233-40. [PMID: 25711233 DOI: 10.1177/0284185115571988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 01/18/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND C-arm flat panel computed tomography angiography (CA-CTA) is a relatively new imaging modality. Consequently, knowledge about postprocessing parameters and their influence on image quality is still limited, especially for the visualization of implanted microstents. PURPOSE To optimize reconstruction parameters by evaluating the influence of these different parameters for CA-CTA visualization of microstents in an animal model. MATERIAL AND METHODS Eleven microstents were implanted within the left common carotid artery of 11 New Zealand white rabbits. Both CA-CTA, using intra-venous delivery of contrast material, and conventional digital subtraction angiography (DSA) was performed. CA-CTA datasets were reconstructed using three different image characteristics (normal, sharp, smooth). Two experienced neuroradiologists evaluated the image quality and performed measurements of inner and outer stent diameters as well as measurements of the lumen area. RESULTS Stent deployment was performed successfully in all animals. Inter-observer correlation coefficient for all measurements was high (r = 0.87-0.92). Lumen area and inner stent diameter were significantly smaller in image characteristic "smooth" (P < 0.01) than in "sharp" and "normal". Outer stent diameter was larger in "smooth" than in "sharp" and "normal" (P < 0.01). Stent strut size was significantly wider using image characteristic "smooth". "Sharp" and "normal" compared best to DSA, with "sharp" providing the closest match to DSA measurements, with the trade-off of significantly more noise than in the "normal" reconstructions. CONCLUSION The use of different image characteristics in the postprocessing of CA-CTA datasets has an influence on the visualization of implanted stents. Image characteristic "sharp" and "normal" compared best to DSA.
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Affiliation(s)
- Sabine Ott
- Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Tobias Struffert
- Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Marc Saake
- Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Philipp Gölitz
- Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Edyta Adamek
- Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Arnd Doerfler
- Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany
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20
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Eker OF, Boudjeltia KZ, Jerez RAC, Le Bars E, Sanchez M, Bonafé A, Costalat V, Courbebaisse G. MR derived volumetric flow rate waveforms of internal carotid artery in patients treated for unruptured intracranial aneurysms by flow diversion technique. J Cereb Blood Flow Metab 2015; 35:2070-9. [PMID: 26264871 PMCID: PMC4671130 DOI: 10.1038/jcbfm.2015.176] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 05/27/2015] [Accepted: 06/22/2015] [Indexed: 11/09/2022]
Abstract
Little is known about the hemodynamic disturbances induced by the cerebral aneurysms in the parent artery and the effect of flow diverter stents (FDS) on these latter. A better understanding of the aneurysm-parent vessel complex relationship may aid our understanding of this disease and to optimize its treatment. The ability of volumetric flow rate (VFR) waveform to reflect the arterial compliance modifications is well known. By analyzing the VFR waveform and the pulsatility in the parent vessel, this study aimed to test the hypotheses that (1) intracranial aneurysms might disrupt the blood flow of the parent vessel and (2) the treatment by FDS might have measurable corrective effect on these changes. Ten patients followed for unruptured intracranial aneurysms treated by FDS and ten healthy volunteers as control group were included in this study. Two-dimensional quantitative phase-contrast magnetic resonance imaging (MRI) was performed on each patient on the ICA artery upstream and downstream to the aneurysm, and on each volunteer at similar locations. The aneurysms altered significantly the parent vessel pulsatility and this effect was correlated to their volume. The aneurysms treatment by FDS allowed for the restoration of a normally modulated flow and pulsatility correction in the parent vessel.
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Affiliation(s)
- Omer F Eker
- Department of Interventional Neuroradiology, Gui de Chauliac Hospital, CHRU de Montpellier, Montpellier, France.,CREATIS Laboratory-INSA Lyon, Villeurbanne, France.,Laboratory of Experimental Medicine (ULB 222 Unit), CHU Charleroi, Hôpital Vésale, Montigny-le-Tilleul, Belgium
| | - Karim Zouaoui Boudjeltia
- Laboratory of Experimental Medicine (ULB 222 Unit), CHU Charleroi, Hôpital Vésale, Montigny-le-Tilleul, Belgium
| | | | - Emmanuelle Le Bars
- Department of Interventional Neuroradiology, Gui de Chauliac Hospital, CHRU de Montpellier, Montpellier, France
| | - Mathieu Sanchez
- Department of Interventional Neuroradiology, Gui de Chauliac Hospital, CHRU de Montpellier, Montpellier, France
| | - Alain Bonafé
- Department of Interventional Neuroradiology, Gui de Chauliac Hospital, CHRU de Montpellier, Montpellier, France
| | - Vincent Costalat
- Department of Interventional Neuroradiology, Gui de Chauliac Hospital, CHRU de Montpellier, Montpellier, France
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Lopes DK, Johnson AK, Kellogg RG, Heiferman DM, Keigher KM. Long-term radiographic results of stent-assisted embolization of cerebral aneurysms. Neurosurgery 2014; 74:286-91. [PMID: 24335816 DOI: 10.1227/neu.0000000000000263] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage is a disabling disease. Endovascular coiling provides minimally invasive, effective, and safe treatment of both ruptured and unruptured intracranial aneurysms. Intracranial stents have improved the endovascular treatment of complex aneurysms, but the long-term durability of this treatment modality needs clarification. OBJECTIVE To elucidate the long-term success of intracranial stent use in the treatment of aneurysms. METHODS Four hundred ten patients were treated with stent-assisted endovascular management of 464 aneurysms. Treatment of 363 small aneurysms, 88 large aneurysms, and 13 giant aneurysms was analyzed with respect to both long-term anatomic results with digital subtraction angiography and magnetic resonance angiography over the follow-up period. RESULTS The 6-month angiographic results of 387 aneurysm treatments revealed complete aneurysm occlusion in 282 (72.9%), residual aneurysm neck in 50 (12.9%), and residual aneurysm filling in 55 (14.2%). Long-term radiographic follow-up, performed in 262 patients (mean, 3.63 years), showed significant recurrence of only 3 aneurysms after 6-month follow-up imaging. Forty-eight aneurysms (11.9%) were considered radiographic failures during the follow-up period. CONCLUSION The aneurysm recurrence rate after stent-assisted embolization in this series was similar to published data using only coil embolization for the period between treatment and the initial follow-up imaging. For aneurysms that do not initially recur, the presented data suggest improved durability in the subsequent long-term follow-up period. ABBREVIATIONS DSA, digital subtraction angiographyMRA, magnetic resonance angiography.
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22
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Current Utility of Diagnostic Catheter Cerebral Angiography. J Stroke Cerebrovasc Dis 2014; 23:e145-50. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 09/13/2013] [Indexed: 11/21/2022] Open
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23
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Evaluation of Noninvasive Follow-up Methods for the Detection of Intracranial In-Stent Restenosis. Invest Radiol 2013; 48:98-103. [DOI: 10.1097/rli.0b013e318276db43] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Chavent A, Kazemi A, Voguet C, Osseby GV, Palova E, Ricolfi F. Endovascular treatment of symptomatic intracranial atheromatous stenosis: a single center study of 21 consecutive cases. J Neuroradiol 2012; 39:332-41. [PMID: 23174303 DOI: 10.1016/j.neurad.2012.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 02/04/2012] [Accepted: 02/17/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This retrospective single-center study evaluated the technical success as well as the periprocedural and long-term complications of angioplasty with stenting of symptomatic intracranial atheromatous stenosis. PATIENTS AND METHODS From January 2005 to December 2010, 21 patients were treated by angioplasty with stent implantation for symptomatic atheromatous intracranial stenosis greater or equal to 50% at least 7 days after a stroke. RESULTS The median population age was 65 years (range: 41-88 years), and 76% (16/21) of the candidates had a history of transient ischemic attack (TIA) or stroke before the event qualifying them for an endovascular procedure. In addition, 86% (18/21) were taking antithrombotic medication at the time of the qualifying event. Technical success was obtained in all cases. The periprocedural stroke or death rate was 9.5% (2/21), and there was no other stroke or death after 30 days during the mean follow-up of 1.4 years. CONCLUSION Endovascular treatment of symptomatic intracranial atherothrombotic stenosis can lead to severe complications, particularly during the periprocedural period, but it also represents the only alternative treatment for patients who fail with medical therapy. Future studies need to focus on improvement of periprocedural complications. Essentially, this should include more rigorous selection of candidates as well as a better understanding of the pathophysiological mechanism(s) of the ischemic phenomenon related to stenosis.
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Affiliation(s)
- A Chavent
- Service de neuroradiologie, hôpital Bocage, CHU de Dijon, 2, boulevard Maréchal-De-Lattre-De-Tassigny, 21079 Dijon, France.
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25
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Bunck AC, Jüttner A, Kröger JR, Burg MC, Kugel H, Niederstadt T, Tiemann K, Schnackenburg B, Crelier GR, Heindel W, Maintz D. 4D phase contrast flow imaging for in-stent flow visualization and assessment of stent patency in peripheral vascular stents--a phantom study. Eur J Radiol 2012; 81:e929-37. [PMID: 22770579 DOI: 10.1016/j.ejrad.2012.05.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 04/26/2012] [Accepted: 05/04/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE 4D phase contrast flow imaging is increasingly used to study the hemodynamics in various vascular territories and pathologies. The aim of this study was to assess the feasibility and validity of MRI based 4D phase contrast flow imaging for the evaluation of in-stent blood flow in 17 commonly used peripheral stents. MATERIALS AND METHODS 17 different peripheral stents were implanted into a MR compatible flow phantom. In-stent visibility, maximal velocity and flow visualization were assessed and estimates of in-stent patency obtained from 4D phase contrast flow data sets were compared to a conventional 3D contrast-enhanced magnetic resonance angiography (CE-MRA) as well as 2D PC flow measurements. RESULTS In all but 3 of the tested stents time-resolved 3D particle traces could be visualized inside the stent lumen. Quality of 4D flow visualization and CE-MRA images depended on stent type and stent orientation relative to the magnetic field. Compared to the visible lumen area determined by 3D CE-MRA, estimates of lumen patency derived from 4D flow measurements were significantly higher and less dependent on stent type. A higher number of stents could be assessed for in-stent patency by 4D phase contrast flow imaging (n=14) than by 2D phase contrast flow imaging (n=10). CONCLUSIONS 4D phase contrast flow imaging in peripheral vascular stents is feasible and appears advantageous over conventional 3D contrast-enhanced MR angiography and 2D phase contrast flow imaging. It allows for in-stent flow visualization and flow quantification with varying quality depending on stent type.
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Affiliation(s)
- Alexander C Bunck
- Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany.
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Ellis JA, Anderson RCE, O'Hanlon J, Goodman RR, Feldstein NA, Ghatan S. Internal cranial expansion surgery for the treatment of refractory idiopathic intracranial hypertension. J Neurosurg Pediatr 2012; 10:14-20. [PMID: 22702327 DOI: 10.3171/2012.3.peds11228] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Idiopathic intracranial hypertension (IIH) may be refractory to available medical and surgical therapies. Patients with this condition may suffer from intractable headaches, experience visual deterioration, or have other symptoms related to elevated intracranial pressure. Internal cranial expansion (ICE) is a novel surgical procedure that the authors have developed for the treatment of patients with this condition. Here, they describe ICE and present their initial experience in using this surgical procedure for the treatment of patients with refractory IIH. METHODS The authors conducted a retrospective review of 10 consecutive patients who underwent ICE for the treatment of IIH during a 5-year period. Preoperative and postoperative clinical parameters including patient symptoms, presence of papilledema, and available ICP or CSF opening pressures were compared. Procedural details and complications were noted. Intracranial volume increases were calculated using available pre- and postoperative CT scans. RESULTS Follow-up for the 10 patients in this series ranged from 1 to 39.6 months (mean 15.5 months). Technically successful ICE was performed in all patients within the cohort. Surgical complications included a single postoperative seizure in one patient and a sagittal sinus tear with no clinical sequelae in another patient. At the time of last follow-up, 7 (70%) of 10 patients were either symptomatically improved or asymptomatic. Six (67%) of 9 patients with preoperative headaches had reduction or resolution of this symptom, and all patients (4 of 4) with preoperative papilledema had a reduction in or complete resolution of this sign. Postoperative ICP or CSF opening pressures were normal in all patients (4 of 4) tested. Postoperative intracranial volume expansion ranged between 3.8% and 12%. CONCLUSIONS Internal cranial expansion is a safe and effective surgery for the treatment of patients with refractory IIH. This surgery expands the intracranial volume and thus promotes ICP normalization, which may lead to the reduction or complete resolution of the signs and symptoms of IIH. Internal cranial expansion may be used as part of a multidisciplinary management approach in the treatment of refractory IIH.
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Affiliation(s)
- Jason A Ellis
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York 10022, USA
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Golshani B, Lazzaro MA, Raslau F, Darkhabani Z, Baruah D, Eastwood D, Fitzsimmons BF, Zaidat OO. Surveillance imaging after intracranial stent implantation: non-invasive imaging compared with digital subtraction angiography. J Neurointerv Surg 2012; 5:361-5. [DOI: 10.1136/neurintsurg-2012-010341] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Prabhakaran S, Romano JG. Current diagnosis and management of symptomatic intracranial atherosclerotic disease. Curr Opin Neurol 2012; 25:18-26. [PMID: 22143202 PMCID: PMC3286605 DOI: 10.1097/wco.0b013e32834ec16b] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Intracranial atherosclerotic disease (IAD) is likely the most common cause of stroke world-wide and is associated with a very high risk of recurrence. It results in cerebral ischemia due to a variety of mechanisms, including artery-to-artery embolism, hemodynamic failure, and occlusion of penetrating arteries. New imaging modalities focused on physiological consequences of IAD have become available and recent treatment trials have been completed. RECENT FINDINGS We review the traditional imaging modalities, emphasizing the advantages and limitations of each method, and discuss the novel physiological approaches that interrogate physiological process to indicate specific mechanisms of ischemia. These allow deeper understanding of the pathophysiological processes that underlie IAD-related ischemia. The key findings of recent therapeutic trials are reviewed, including the landmark randomized studies showing advantage of antiplatelet agents and risk factor modification, and a significant risk of complications with endovascular approaches. SUMMARY Current evidence argues for aggressive medical management and suggests caution with interventional treatments. We propose that mechanistic information will further refine the risk assessment of patients with IAD to offer targeted therapy.
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Affiliation(s)
- Shyam Prabhakaran
- Department of Neurological Sciences, Head, Cerebrovascular Disease & Neurocritical Care, Rush University Medical Center, 1725 W. Harrison St. Suite 1121, Chicago, IL 60612, Tel: 312-563-2518 Fax: 312-563-2206
| | - Jose G. Romano
- Cerebrovascular Division, University of Miami, Miller School of Medicine, 1120 NW 14 St. Suite 1357, Miami FL 33136, Tel: 305-243-2336, Fax: 305-243-7081
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Degnan AJ, Gallagher G, Teng Z, Lu J, Liu Q, Gillard JH. MR angiography and imaging for the evaluation of middle cerebral artery atherosclerotic disease. AJNR Am J Neuroradiol 2011; 33:1427-35. [PMID: 21940802 DOI: 10.3174/ajnr.a2697] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Intracranial atherosclerotic disease may constitute the most common cause of ischemic stroke worldwide; yet, in the developed world, imaging research has largely focused on extracranial atherosclerosis. Many studies in populations of Asian, African, and Hispanic descent demonstrate the preponderance of intracranial stenosis compared with carotid stenosis. This review examines the clinical presentations of MCA atherosclerosis and stenosis and the use of noninvasive MR imaging in the assessment of intracranial vasculature. MRA is a well-validated technique that offers great advantage over traditional angiography. Advances in high-resolution MR imaging of MCA stenosis have the potential to yield excellent visualization of plaque. Future developments in high-resolution MR imaging to depict intracranial atherosclerosis are explored in this review; these advances will guide endovascular therapy and the comparison of novel interventions.
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Affiliation(s)
- A J Degnan
- University Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Calderon-Arnulphi M, Amin-Hanjani S, Alaraj A, Zhao M, Du X, Ruland S, Zhou XJ, Thulborn KR, Charbel FT. In vivo evaluation of quantitative MR angiography in a canine carotid artery stenosis model. AJNR Am J Neuroradiol 2011; 32:1552-9. [PMID: 21835941 DOI: 10.3174/ajnr.a2546] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Large-vessel cerebral blood flow quantification has emerged as a potential predictor of stroke risk. QMRA uses phase-contrast techniques to noninvasively measure vessel flows. To evaluate the in vivo accuracy of QMRA for measuring the effects of progressive arterial stenosis, we compared this technique with invasive flow measurements from a sonographic transit-time flow probe in a canine model. MATERIALS AND METHODS A sonographic flow probe was implanted around the CCA of hound dogs (n = 4) under general anesthesia. Pulsatile blood flow and arterial pressure were continuously recorded during CCA flow measurements with QMRA. A vascular tourniquet was applied around the CCA to produce progressive stenosis and varying flow rates. Statistical comparisons were made by using the Pearson product moment correlation coefficient. RESULTS A total of 60 paired CCA flow measurements were compared. Mean blood flows ranged between 21 and 691 mL/min during QMRA acquisition as measured by the flow probe. The correlation coefficients between flow probe and QMRA measurements for mean, maximum, and minimum volume flow rates were 0.99 (P < .0001), 0.98 (P < .0001), and 0.96 (P < .0001), respectively. The overall proportional difference between the 2 techniques was 7.8 ± 1%. Measurements at higher flow rates and in the absence of arterial stenosis had the lowest PD. CONCLUSIONS Noninvasive CCA flow measurements by using QMRA are accurate compared with invasive flow-probe measurements in a canine arterial flow model with stenosis and may be useful for the evaluation of the hemodynamic effects of stenosis caused by cerebrovascular atherosclerosis.
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Hemodynamic effect of Neuroform stent on intimal hyperplasia and thrombus formation in a carotid aneurysm. Med Eng Phys 2011; 33:573-80. [DOI: 10.1016/j.medengphy.2010.12.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 12/06/2010] [Accepted: 12/14/2010] [Indexed: 11/15/2022]
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Struffert T, Ott S, Adamek E, Schwarz M, Engelhorn T, Kloska S, Deuerling-Zheng Y, Doerfler A. Flat-detector computed tomography in the assessment of intracranial stents: comparison with multi detector CT and conventional angiography in a new animal model. Eur Radiol 2011; 21:1779-87. [PMID: 21365196 DOI: 10.1007/s00330-011-2093-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 01/08/2011] [Indexed: 11/28/2022]
Affiliation(s)
- Tobias Struffert
- Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany.
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Brisman JL, Pile-Spellman J, Konstas AA. Clinical utility of quantitative magnetic resonance angiography in the assessment of the underlying pathophysiology in a variety of cerebrovascular disorders. Eur J Radiol 2011; 81:298-302. [PMID: 21316169 DOI: 10.1016/j.ejrad.2010.12.079] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Revised: 12/06/2010] [Accepted: 12/28/2010] [Indexed: 01/05/2023]
Abstract
BACKGROUND Quantitative MRA (qMRA) is a relatively new technique that uses traditional time-of-flight and phase-contrast MRI to visualize extracranial and intracranial vascular anatomy and measure volumetric blood flow. We aimed to assess the clinical utility of qMRA in assessing the hypothesized pathophysiology (HP) in a range of cerebrovascular diseases. Moreover, we postulated that evaluation of the arterial waveforms, can improve the evaluation of the hypothesized pathophysiology by qMRA. METHODS We reviewed studies from 10 patients who underwent qMRA examinations before and after their treatments. Two reviewers assessed the anatomy, volumetric flow rates and arterial waveforms for each vessel sampled and reached a consensus as to whether the above parameters supported the clinical diagnosis/hypothesized pathophysiology and the subsequent management. FINDINGS All 20 qMRA studies were technically adequate. qMRA supported the HP in all 10 patients as determined by abnormal volumetric flow values in the affected vessels before treatment and by the correction of these abnormal values in the patients whose treatment was successful. Each of our five patients with occlusive disease/vasoconstriction demonstrated evidence of dampening of the arterial waveforms distally to the narrowed artery (parvus-tardus phenomenon). The parvus-tardus effect disappeared after treatment. CONCLUSION qMRA is unique in combining time-of-flight MRA in a complementary manner with phase-contrast MRA to obtain volumetric flow values and potentially important physiologic information from arterial waveform analysis in patients with a range of cerebrovascular diseases during the course of a single MR examination.
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Serafin Z, Strześniewski P, Lasek W, Beuth W. Methods and time schedule for follow-up of intracranial aneurysms treated with endovascular embolization: a systematic review. Neurol Neurochir Pol 2011; 45:421-30. [DOI: 10.1016/s0028-3843(14)60309-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Amin-Hanjani S, Alaraj A, Calderon-Arnulphi M, Aletich VA, Thulborn KR, Charbel FT. Detection of intracranial in-stent restenosis using quantitative magnetic resonance angiography. Stroke 2010; 41:2534-8. [PMID: 20930155 DOI: 10.1161/strokeaha.110.594739] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE In-stent restenosis (ISR) after angioplasty/stenting for intracranial stenosis has been reported in up to 25% to 30% of patients. Detection and monitoring of ISR relies primarily on serial catheter angiography, because noninvasive imaging methods are typically hampered by stent-related artifact. We examined the value of serial vessel flow measurements using quantitative magnetic resonance angiography (QMRA) in detection of ISR. MATERIAL AND METHODS Records of patients undergoing stenting for intracranial symptomatic stenosis >50% between 2005 and 2009 were retrospectively reviewed. Angiographic images were graded by a blinded neurointerventionalist for stenosis pretreatment, immediately after treatment, and during follow-up. Flow in the affected vessel measured by QMRA was recorded; > 25% reduction in flow was considered indicative of an adverse change. Clinical data regarding neurological outcome were also collected. RESULTS Twenty-eight patients underwent stenting during the time interval studied. Of these, 12 patients (mean age, 55.5 years; 8 female) had contemporaneous angiography and QMRA and were analyzed. Median follow-up was 9 months. Six patients (50%) demonstrated angiographic restenosis 2 to 12 months after treatment; all had an analogous decrease in flow in the vessel of interest. Of 3 patients with more severe flow decrement (> 50%), 2 experienced stroke. None of the patients without angiographic ISR demonstrated a flow decrease on QMRA. CONCLUSIONS In this preliminary series, flow decrease on QMRA is highly predictive of angiographic ISR. Additionally, the degree of flow decrement correlates with symptomatic ISR. QMRA may provide a useful noninvasive tool for serial monitoring after intracranial stenting.
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Affiliation(s)
- Sepideh Amin-Hanjani
- Department of Neurosurgery, Neuropsychiatric Institute (MC 799), University of Illinois at Chicago, Chicago, IL 60612-5970, USA.
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Struffert T, Kloska S, Engelhorn T, Deuerling-Zheng Y, Ott S, Doelken M, Saake M, Köhrmann M, Doerfler A. Optimized intravenous Flat Detector CT for non-invasive visualization of intracranial stents: first results. Eur Radiol 2010; 21:411-8. [PMID: 20711730 DOI: 10.1007/s00330-010-1931-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2010] [Revised: 07/04/2010] [Accepted: 07/26/2010] [Indexed: 11/30/2022]
Affiliation(s)
- Tobias Struffert
- Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany.
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Psychogios MN, Schramm P, Buhk JH, Xyda A, Gröschel K, Jung K, Knauth M. Angiographic CT after intravenous contrast agent application: A noninvasive follow-up tool after intracranial angioplasty and stenting. AJNR Am J Neuroradiol 2010; 31:1886-91. [PMID: 20634309 DOI: 10.3174/ajnr.a2168] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE ICAS is one of the therapeutic options in symptomatic cerebral artery stenosis. iaDSA is the current criterion standard examination after ICAS for the detection of ISR. In this study, we evaluated ivACT as a potential noninvasive follow-up alternative. MATERIALS AND METHODS In 17 cases, ivACT and iaDSA were performed after ICAS. Both procedures were carried out on a flat-panel-detector-equipped angiography system. Postprocessing of ivACT acquisitions was performed on a dedicated workstation producing multiplanar reformations of the stent region and other intracranial arteries. Restenotic lesions were compared with iaDSA measurements. All studies were independently evaluated by 2 experienced neuroradiologists blinded to patients data. RESULTS In 5 cases, ISR was diagnosed on iaDSA images. All restenotic lesions were reliably detected (sensitivity, 100%; 95%CI, 48%-100%) and could be correctly quantified on ivACT images in comparison with iaDSA. The neuroradiologists correctly excluded ISR in 11 of 12 lesions after viewing the ivACT examinations (specificity, 92%; 95%CI, 62%-100%). Measurements of ISR on ivACT were highly correlated to iaDSA (Pearson r = 0.94, P < .01). CONCLUSIONS IvACT is a promising noninvasive follow-up examination after ICAS. With its high spatial resolution, it can reliably detect or exclude ISR. Contrary to iaDSA, there is no need for a recovery period after ivACT and the risk of neurologic complications is practically lowered to zero.
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Affiliation(s)
- M-N Psychogios
- Department of Neuroradiology, University Medicine Goettingen, Germany.
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Clifton A. Quantitative magnetic resonance angiography: a promising tool in the assessment of intracranial in-stent stenosis? Stroke 2009; 40:676. [PMID: 19164791 DOI: 10.1161/strokeaha.108.529297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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