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1.
Introduction Long-term follow-up after coil embolization of intracranial aneurysms is mandatory to monitor coil compacting and aneurysm
recurrence. Most centers perform one digital subtraction angiography (DSA) on follow-up continuing with time-of-flight magnetic
resonance angiography (TOF–MRA). This study explores the diagnostic value of TOF–MRA at 1.5 T versus 3 T compared to DSA.
Materials and methods In 18 patients with 20 aneurysms treated with coil embolization, TOF–MRA at 1.5 and 3 T were performed the day before follow-up
DSA, the latter serving as reference. Optimized diagnostic protocols were applied (1.5 T: 0.78 × 0.55 × 0.8 mm, voxel size;
acquisition time (TA), 6.37 min; 3 T: 0.56 × 0.45 × 0.65 mm, voxel size; TA, 3.12 min). Three independent neuroradiologists
experienced in neuroendovascular therapy rated the occlusion rate (“complete occlusion” vs. “residual neck” vs. “residual
aneurysm”) and compared the two methods subjectively. Weighted κ statistics were calculated to assess the level of interobserver agreement.
Results Compared to DSA, TOF–MRA was more sensitive in detecting neck remnants, with a slight advantage at 3 T. Regarding artifact
load, there are advantages at 1.5 T. Ratings of the occlusion rate correlated highly between all observers (r > 0.85, p < 0.001, respectively). Interobserver agreement was high in all cases (к
w ≈ 0.8, respectively).
Conclusion TOF–MRA is a reliable tool for follow-up imaging of cerebral aneurysms after endovascular treatment. Our study shows no advantage
of TOF–MRA at 3 T over 1.5 T, when comparable measurement protocols are applied. TOF–MRA at 1.5 T therefore provides appropriate
information regarding a therapeutic decision. 相似文献
2.
Tobias Struffert Martin Köhrmann Tobias Engelhorn Tim Nowe Gregor Richter Peter D. Schellinger Stefan Schwab Arnd Doerfler 《European radiology》2009,19(9):2286-2293
The Penumbra Stroke System (PSS) was cleared for use in patients with ischemic stroke by the FDA in January 2008. We describe
our experience of using this new system in acute large vessel occlusive disease following thrombolysis. Fifteen consecutive
patients (mean age 60 years) suffering from acute ischemic stroke were treated with the PSS after intravenous or intra-arterial
standard treatment with tissue plasminogen activator (n = 14) or ReoPro (n = 1). All patients presented with TIMI 3 before use of the PSS. Carotid stenting (n = 3) and intracranial balloon angioplasty or stenting (n = 2) were performed if indicated. Neurological evaluation was performed using the NIHSS score and the mRS score. Initial
median NIHSS score in 12 patients with occlusions in the anterior circulation was 15; three patients with basilar artery occlusion
presented with coma. Median symptom to procedure start time was 151 min. In the anterior circulation, 9 of the 12 target vessels
were recanalised successfully (TIMI 2 and 3). The rate of patients with independent clinical outcome (mRS ≤ 2) was 42%. One
patient died 5 days after unsuccessful treatment, one after 28 days and one after 85 days owing to heart attack. Basilar artery
occlusions could be recanalised in all cases to TIMI 3. The clinical result after 90 days was mRS 4 in two cases and mRS 5
in one case. Symptomatic haemorrhage did not occur. The PSS can safely be used for recanalisation in patients with acute ischemic
stroke due to large vessel occlusion, who have already received thrombolysis treatment. The recanalisation rate was 80%. Symptomatic
haemorrhage did not occur. Randomized trials may demonstrate that endovascular mechanical thrombectomy improves patient outcome. 相似文献
3.
Perfusion CT in acute stroke: prediction of vessel recanalization and clinical outcome in intravenous thrombolytic therapy 总被引:2,自引:0,他引:2
Kloska SP Dittrich R Fischer T Nabavi DG Fischbach R Seidensticker P Osada N Ringelstein EB Heindel W 《European radiology》2007,17(10):2491-2498
This study evaluated perfusion computed tomography (PCT) for the prediction of vessel recanalization and clinical outcome
in patients undergoing intravenous thrombolysis. Thirty-nine patients with acute ischemic stroke of the middle cerebral artery
territory underwent intravenous thrombolysis within 3 h of symptom onset. They all had non-enhanced CT (NECT), PCT, and CT
angiography (CTA) before treatment. The Alberta Stroke Program Early Computed Tomography (ASPECT) score was applied to NECT
and PCT maps to assess the extent of ischemia. CTA was assessed for the site of vessel occlusion. The National Institute of
Health Stroke Scale (NIHSS) score was used for initial clinical assessment. Three-month clinical outcome was assessed using
the modified Rankin scale. Vessel recanalization was determined by follow-up ultrasound. Of the PCT maps, a cerebral blood
volume (CBV) ASPECT score of >6 versus ≤6 was the best predictor for clinical outcome (odds ratio, 31.43; 95% confidence interval,
3.41–289.58; P < 0.002), and was superior to NIHSS, NECT and CTA. No significant differences in ASPECT scores were found for the prediction
of vessel recanalization. ASPECT score applied to PCT maps in acute stroke patients predicts the clinical outcome of intravenous
thrombolysis and is superior to both early NECT and clinical parameters.
S.P. Kloska and R. Dittrich contributed equally to this work. 相似文献
4.
Ramgren B Siemund R Cronqvist M Undrén P Nilsson OG Holtås S Larsson EM 《Neuroradiology》2008,50(11):947-954
Introduction The purpose of this prospective study was to compare 3T and 1.5T magnetic resonance angiography (MRA) with digital subtraction
angiography (DSA) for the follow-up of endovascular treated intracranial aneurysms to assess the grade of occlusion.
Materials and methods Thirty-seven patients with 41 aneurysms who had undergone endovascular treatment with detachable coils were included. MRA
was performed on the same day using an eight-channel sensitivity encoding head-coil with 3D axial inflow technique. At 3T,
a contrast-enhanced transverse 3D fast gradient echo acquisition was also performed. Most patients underwent DSA the following
day. MRA scans and DSA were classified first independently by two neuroradiologists and an interventional neuroradiologist.
Secondly, a consensus was done. Source images, maximum intensity projection, multiplanar reconstruction and volume rendering
reconstructions were used for MRA evaluations. A modification of the Raymond classification, previously used for DSA evaluation
of recanalization, was used.
Results Statistical comparison of the consensus showed that 3T MRA with 3D axial inflow technique had better agreement with DSA (κ = 0.43) than 1.5T MRA(κ = 0.21) and contrast-enhanced MRA (CE-MRA) at 3T (κ = 0.17). The susceptibility artefacts from the coil mesh were significally smaller at 3T (p = 0.002–0.007) than at 1.5T.
Conclusion 3T MRA, using a sensitivity encoding head-coil, showed better agreement with DSA than 1.5T and CE-MRA at 3T for evaluation
of aneurysms treated with endovascular coiling. 相似文献
5.
Introduction This study aimed to evaluate the safety and efficiency of the endovascular treatment of transverse–sigmoid sinus dural arteriovenous
fistulas (TS_dAVF).
Methods A total of 150 consecutive patients and 348 procedures were evaluated.
Results Pulsatile tinnitus (81%), headache (15%), and intracranial hemorrhage (10%) were the most frequent manifestations of the TS_dAVFs.
More than half of the affected sinuses were partially or completely thrombosed. Access-wise treatment was performed transarterial
(n = 33), transvenous (n = 21), or a combination thereof (n = 96). A mean of 2.4 procedures per patient was required. Immediate postprocedural occlusion rate after transarterial embolization
was 30% only. Transvenous treatment alone resulted in an early occlusion rate of 81%, with delayed complete obliteration of
half of the remaining fistulas. After combined transarterial/transvenous treatment, the angiographic cure rate was 54%. At
follow-up, 88% of patients with residual shunt after the treatment showed complete occlusion. The cumulative complication
rate was 9% (n = 13), with minor adverse events in ten patients (7%) and major complications in three patients (2%).
Conclusion Transvenous coil occlusion of the sinus segment with the adjacent dAVF site, eventually combined with transarterial occlusion
of supplying arteries, is a very effective and well-tolerated treatment method. In selected patients, variations of these
methods (e.g., sinus stenting, compartmental sinus occlusion) can be useful.
D. Kühne: retired. 相似文献
6.
Jian-Ren Liu Björn-Moritz Plötz Axel Rohr Robert Stingele Olav Jansen Karsten Alfke 《Neuroradiology》2009,51(5):299-304
Introduction Cardiac right-to-left shunt (RLS), mainly due to patent foramen ovale (PFO), is a risk factor for paradoxical embolism and
stroke. Results of studies about brain lesions in diffusion-weighted imaging (DWI) in PFO patients were controversial. DWI
only detects acute ischemic lesions. We assessed the hypothesis that, in T2-weighted magnetic resonance imaging (T2WI) of
stroke patients, RLS is associated with a typical distribution of small white matter lesions.
Materials and methods In this retrospective case–control study, T2WI images of 162 stroke patients were evaluated. From stroke patients admitted
between 1999 and 2003, 81 stroke patients with RLS were identified with contrast-enhanced transcranial Doppler (bubble test).
Controls were 81 age-matched stroke patients without RLS (negative bubble test). In T2WI images, small lesions (<2 cm) were
categorized depending on their location in subcortical white matter, peritrigonal white matter, deep and paraventricular white
matter, and basal ganglia. Additionally, larger territorial infarcts were rated.
Results In T2WI frontal or predominantly frontal-located subcortical small white matter, lesions are significantly associated with
RLS (p < 0.0001, chi-square test). Forty-three patients with RLS (53%) and only 19 control patients (23%) showed this frontal dominance.
Odds ratio is 3.7 (95% confidence interval = 1.9–7.1) for having a RLS when T2WI shows this lesion pattern in a stroke patient.
No patient of the RLS group and 6% of the control group had parietal dominance. Distribution of small lesions in other locations
like basal ganglia or deep white matter showed no significant difference for the groups.
Conclusion A distribution of mainly frontal subcortical small white matter lesions in T2WI is significantly associated with RLS in stroke
patients. 相似文献
7.
The aim of our study was to compare multidetector row computed tomography (CT) angiography (MDCTA) with digital subtraction
angiography (DSA) in the detection and characterization of intracranial aneurysms. Between September 2005 and May 2007, 55
consecutive patients with suspected intracranial aneurysms underwent conventional DSA and MDCTA. Thirty-two women and 23 men
were enrolled in the study. The mean patient age was 54 (range = 26–79 years). All MDCTA and DSA images were independently
evaluated on a workstation by two radiologists, who had 8 and 6 years of experience in CT vascular imaging and angiography.
Using DSA as the gold standard, the sensitivity and specificity of CT angiography was calculated for each reader with 95%
confidence intervals. The sensitivity was also calculated for aneurysms smaller than 3 mm with 95% confidence intervals. The
agreement between the readers for detecting aneurysms was calculated using kappa statistics. A kappa statistic greater than
0.75 was considered an excellent agreement beyond chance, a kappa statistic of 0.4–0.75, fair to good agreement, and a kappa
statistic less than 0.4, poor agreement. At DSA, 64 aneurysms were present in 50 patients involved in the study; seven patients
had two aneurysms each, and four patients had three aneurysms each. In five patients, no aneurysm was detected by using MDCTA
and DSA, and evaluations were considered as true negative by MDCTA. These five patients also had negative findings at repeat
DSA. For readers 1 and 2, the sensitivity of MDCT in detecting aneursyms were 96.9% (95% CI = 89.3–99.1%; 62 of 64) and 98.4
% (95% CI = 91.7–99.7%; 63 of 64), respectively. The spescificity was100% (95% CI = 99.7–100%; 1,256 of 1,256) for both readers.
The kappa value indicating interobserver agreement was in the category of excellent (kappa = 0.99 (95% CI = 0.97–1). Regarding
the aneurysms smaller than 3 mm, for readers 1 and 2, the sensitivities were 84.6% (95% CI = 57.8–95.7%; 11 of 13) and 92.3%
(95% CI = 66.7–98.6; 12 of 13), respectively. MDCTA is accurate in the detection and characterization of intracranial aneurysms
and can be used as a reliable alternative imaging technique to DSA. A strategy of using CT angiography as the primary method,
with DSA reserved for any cases of uncertainty, appears safe and reliable. 相似文献
8.
Knaapen P de Mulder M van der Zant FM Peels HO Twisk JW van Rossum AC Cornel JH Umans VA 《European journal of nuclear medicine and molecular imaging》2009,36(2):237-243
Background Primary percutaneous coronary intervention (PCI) performed in large community hospitals without cardiac surgery back-up facilities
(off-site) reduces door-to-balloon time compared with emergency transferal to tertiary interventional centers (on-site). The
present study was performed to explore whether off-site PCI for acute myocardial infarction results in reduced infarct size.
Methods and results One hundred twenty-eight patients with acute ST-segment elevation myocardial infarction were randomly assigned to undergo
primary PCI at the off-site center (n = 68) or to transferal to an on-site center (n = 60). Three days after PCI, 99mTc-sestamibi SPECT was performed to estimate infarct size. Off-site PCI significantly reduced door-to-balloon time compared
with on-site PCI (94 ± 54 versus 125 ± 59 min, respectively, p < 0.01), although symptoms-to-treatment time was only insignificantly reduced (257 ± 211 versus 286 ± 146 min, respectively,
p = 0.39). Infarct size was comparable between treatment centers (16 ± 15 versus 14 ± 12%, respectively p = 0.35). Multivariate analysis revealed that TIMI 0/1 flow grade at initial coronary angiography (OR 3.125, 95% CI 1.17–8.33,
p = 0.023), anterior wall localization of the myocardial infarction (OR 3.44, 95% CI 1.38–8.55, p < 0.01), and development of pathological Q-waves (OR 5.07, 95% CI 2.10–12.25, p < 0.01) were independent predictors of an infarct size > 12%.
Conclusions Off-site PCI reduces door-to-balloon time compared with transferal to a remote on-site interventional center but does not
reduce infarct size. Instead, pre-PCI TIMI 0/1 flow, anterior wall infarct localization, and development of Q-waves are more
important predictors of infarct size. 相似文献
9.
Alexandre A. Cochet Luc Lorgis Alain Lalande Marianne Zeller Jean-Claude Beer Paul M. Walker Claude Touzery Jean-Eric Wolf François Brunotte Yves Cottin 《European radiology》2009,19(9):2117-2126
The aim of this study was to compare the prognostic significance of microvascular obstruction (MO) and persistent microvascular
obstruction (PMO) as assessed by cardiac magnetic resonance (CMR) in patients with acute myocardial infarction (AMI). CMR
was performed in 184 patients within the week following successfully reperfused first AMI. First-pass images were performed
to evaluate extent of MO and late gadolinium-enhanced images to assess PMO and infarct size (IS). Major adverse cardiac events
(MACE) were collected at 1-year follow-up. MO and PMO were found in 127 (69%) and 87 (47%) patients, respectively. By using
univariate logistic regression analysis, high Global Registry of Acute Coronary Events (GRACE) risk score (odds ratio [OR]
95% confidence interval [CI]: 3.6 [1.8–7.4], p < 0.001), IS greater than 10% (OR [95% CI]: 2.7 [1.1–6.9], p = 0.036), left ventricular ejection fraction less than 40% (OR [95% CI]: 2.4 [1.1–5.2], p = 0.027), presence of MO (OR [95% CI]: 3.1 [1.3–7.3], p = 0.004) and presence of PMO (OR [95% CI]:10 [4.1–23.9], p < 0.001) were shown to be significantly associated with the outcome. By using multivariate analysis, presence of MO (OR [95%
CI]: 2.5 [1.0–6.2], p = 0.045) or of PMO (OR [95% CI]: 8.7 [3.6–21.1], p < 0.001), associated with GRACE score, were predictors of MACE. Presence of microvascular obstruction and persistent microvascular
obstruction is very common in AMI patients even after successful reperfusion and is associated with a dramatically higher
risk of subsequent cardiovascular events, beyond established prognostic markers. Moreover, our data suggest that the prognostic
impact of PMO might be superior to MO. 相似文献
10.
Xin Lou Weijian Jiang Lin Ma Ning Ma Youquan Cai Dehui Huang Edward Hochung Wong 《Neuroradiology》2009,51(9):557-561
Introduction Not uncommonly, differentiating multiple sclerosis (MS) from ischemic cerebral vascular disease is difficult based on conventional
magnetic resonance imaging (MRI). We aim to determine whether preferential occult injury in the normal-appearing corpus callosum
(NACC) is more severe in patients with MS than symptomatic carotid occlusion by comparing fractional anisotropy (FA) from
diffusion tensor imaging (DTI).
Methods Eighteen patients (eight men, ten women; mean age, 38.6 years) with MS and 32 patients (24 men, eight women; mean age, 64.0 years)
with symptomatic unilateral internal carotid occlusion were included. DTI (1.5 T) were performed at corpus callosum which
were normal-appearing on fluid-attenuated inversion recovery MRI. Mean FA was obtained from the genu, anterior body, posterior
body, and splenium of NACC. Independent-sample t test statistical analysis was performed.
Results The FA values in various regions of NACC were lower in the MS patients than symptomatic carotid occlusion patients, which
was statistically different at the anterior body (0.67 ± 0.12 vs 0.74 ± 0.06, P = 0.009), but not at genu, posterior body, and splenium (0.63 ± 0.09 vs 0.67 ± 0.07, P = 0.13; 0.68 ± 0.09 vs 0.73 ± 0.05, P = 0.07; 0.72 ± 0.09 vs 0.76 ± 0.05, P = 0.13).
Conclusion MS patients have lower FA in the anterior body of NACC compared to patients with symptomatic carotid occlusion. It suggests
that DTI has potential ability to differentiate these two conditions due to the more severe preferential occult injury at
the anterior body of NACC in MS. 相似文献
11.
Laurent Thines Ronit Agid Amir R. Dehdashti Leodante da Costa M. Christopher Wallace Karel G. Terbrugge Michael Tymianski 《Neuroradiology》2009,51(8):505-515
Introduction Extracranial–intracranial (EC/IC) bypass is a useful procedure for the treatment of cerebral vascular insufficiency or complex
aneurysms. We explored the role of multidetector computed tomography angiography (MDCTA), instead of digital subtraction angiography
(DSA), for the postoperative assessment of EC/IC bypass patency.
Methods We retrospectively analyzed a consecutive series of 21 MDCTAs from 17 patients that underwent 25 direct or indirect EC/IC
bypass procedures between April 2003 and November 2007. Conventional DSA was available for comparison in 13 cases. MDCTA used
a 64-slice MDCT scanner (Aquilion 64, Toshiba). The proximal and distal patencies were analyzed independently on MDCTA and
DSA by a neuroradiologist and a neurosurgeon. The bypass was considered patent when the entire donor vessel was opacified
without discontinuity from proximal to distal ends and was visibly in contact with the recipient vessel.
Results MDCTA depicted the patency status in every patient. Bypasses were patent in 22 cases, stenosed in one, and occluded in two.
DSA always confirmed the results of the MDCTA (sensitivity = 100%, 95% CI = 0.655–1.0; specificity 100%, 95% CI = 0.05–1.0).
Conclusions MDCTA is a non-invasive and accurate exam to assess the postoperative EC/IC bypass patency and is a promising technique in
routine follow-up. 相似文献
12.
Stent-protected angioplasty of carotid artery stenosis may be an alternative to surgical endarterectomy. Results published
so far are indecisive, with evidence both in favour of and against this procedure. After the recent publication of two large
European multicentre trials (SPACE and EVA-3S) almost 3,000 patients have been included in randomized studies. For this report,
we therefore conducted a systematic review of randomized studies that compared endovascular treatment with surgery for carotid
stenosis. We evaluated seven trials including 2,973 patients. In our meta-analysis endovascular treatment seemed to carry
a slightly higher risk for stroke or death within 30 days after the procedure as compared with surgery (8.2% vs. 6.2%; p = 0.04; OR 1.35), whereas the rates of disabling stroke or death within 30 days did not differ significantly (p = 0.47; n.s.). On the other hand, surgery carried a significantly higher risk for cranial nerve palsy (4.7% vs. 0.2%; p < 0.0001; OR 0.17) and myocardial infarction (2.3% vs. 0.9%; p = 0.03; OR 0.37). Long-term effects of both methods still need to be evaluated. Two other large multicentre trials (ICSS
and CREST) are ongoing. Results of these studies will increase the database to about 7,000 randomized patients. Future meta-analyses
should then allow definitive treatment recommendations.
The publication of first results from the SPACE study [1] has fuelled a controversial debate as to whether endovascular treatment of severe carotid artery stenosis constitutes an
alternative to surgical endarterectomy—the gold-standard method so far. This article first reviews all randomized trials comparing
endovascular treatment of carotid artery stenosis with surgery. In a meta-analysis the safety and efficacy of both methods
are compared. Some questions arising from SPACE are then discussed separately. 相似文献
13.
Introduction Despite the high grade of standardisation of study protocols, there is still room for variability among the centres in specific
treatment aspects. We evaluated the treatment risk in stent-protected angioplasty of the carotid versus endarterectomy (SPACE)
associated with the specific patient enrolment rates of the centres.
Materials and methods The analysed endpoints were ipsilateral stroke or death [primary outcome event (pOE)] and any stroke or death [secondary outcome
event (sOE)] until 30 days after treatment. A binary logistic regression analysis with random effects was performed separately
for each treatment arm. The centres were secondarily categorised in three classes: I) ≥25 patients enrolled, II) ten to 24
patients and III) <10 patients and a hierarchic log linear model was fitted to test the three-way interaction of treatment,
number of patients per class and outcome.
Results The random effects logistic regression analysis in the carotid artery stenting (CAS) arm proved a significant increase in
pOE with decreasing number of patients enrolled (−0.0190 ± 0.0085, p = 0.025, deviance 35.7 with 32 df), whereas no such effect was found in the carotid endartectomy (CEA) arm (−0.010 ± 0.008, p = 0.24, deviance 39.78 with 32 df). In the log linear model, there was a significant interaction between treatment, number of patients per centre and sOE (p = 0.023). The odds ratios for sOE in the enrolment classes (CAS vs. CEA) were 0.98 (95% CI 0.50–1.94, p = 0.95) for class I, 1.13 (95% CI 0.47–2.77, p = 0.77) for class II and 11.56 (95% CI 1.40–253.45, p = 0.01) for class III centres.
Conclusion Despite rigorous standardisation and quality requirements for operator qualification, there seemed to be a decrease in complication
rate with increasing patient enrolment numbers in the CAS arm while this signal could not be detected in the CEA arm of SPACE. 相似文献
14.
Urbach H Dorenbeck U von Falkenhausen M Wilhelm K Willinek W Schaller C Flacke S 《Neuroradiology》2008,50(5):383-389
Introduction Since digital subtraction angiography (DSA) carries a low risk of morbidity, and is associated with patient discomfort and
higher cost, our objective was to determine whether high-resolution 3-D time-of-flight MR angiography (TOF-MRA) at 3 T may
replace DSA in the follow-up of patients after coiling of an intracranial aneurysm.
Methods This prospective study included 50 consecutive patients with a ruptured and subsequently coiled intracranial aneurysm. All
patients were followed up at a mean of 14 months after coiling with DSA and high-resolution 3-D TOF-MRA at 3 T generating
0.02 mm3 isotropic voxels. One examiner used DSA and TOF-MR angiograms to assess the need for and risk of retreatment; these data
were used to calculate intermodality agreement. Another two examiners independently assessed aneurysm occlusion by DSA and
TOF-MRA according to the Raymond scale; these data were used to calculate interobserver agreement.
Results Discrepancies between DSA and TOF-MRA were found in three patients (intermodality agreement κ = 0.86). While DSA indicated
complete aneurysm occlusion, TOF-MRA showed small neck remnants in the three patients. Coils on all DSA projections obscured
these three neck remnants. Interobserver agreement was higher for DSA (κ = 0.82) than for TOF-MRA (κ = 0.68), which was in
part due to the complexity of the information provided by TOF source images and reconstructions.
Conclusion 3-D TOF-MRA at 3 T is not only an adjunctive tool but is ready to replace DSA in the follow-up of patients with previously
coiled intracranial aneurysms. Additional DSA may only be performed in complex and not clearly laid out aneurysms. 相似文献
15.
Is digital substraction angiography still needed for the follow-up of intracranial aneurysms treated by embolisation with detachable coils? 总被引:8,自引:0,他引:8
Boris Lubicz Carine Neugroschl Laurent Collignon Olivier François Danielle Balériaux 《Neuroradiology》2008,50(10):841-848
Introduction Follow-up of intracranial aneurysms treated by embolisation with detachable coils is mandatory to detect a possible recanalisation.
The aim of this study was to compare contrast-enhanced magnetic resonance angiography (CE-MRA) with digital substraction angiography
(DSA) used to detect aneurysm recanalisation to determine if DSA is still needed during follow-up.
Materials and methods From May 2006 to May 2007, 55 patients with 67 aneurysms were treated by endosaccular coiling with (n = 9) or without (n = 58) an adjunctive stent. Follow-up imaging protocol included MRA at 6 and 12 months and a DSA at 12 months or earlier if
a major recanalisation was identified on the 6-month MRA. Two neuroradiologists independently reviewed MRA images (readers
1 and 2) and two other reviewed DSA images.
Results Follow-up DSA showed stability of the aneurysm occlusion in 52 cases, recanalisation in 14 cases, and further thrombosis in
one. On CE-MRA, both readers identified all recanalisations but one (sensitivity of 93%) as they missed a major recanalisation
in a 2-mm ruptured aneurysm. There were two false-positive evaluations by reader 1 and three for reader 2. Mean specificity
of CE-MRA to detect aneurysm recanalisation was 95.5%.
Conclusion CE-MRA is accurate to detect aneurysm recanalisation after embolisation with detachable coils. CE-MRA may be proposed as first-intention
imaging technique for their follow-up. However, its sensitivity and specificity remain inferior to that of DSA and major recurrences
may be missed in very small aneurysms. Therefore, a single DSA remains mandatory during the imaging follow-up. 相似文献
16.
Sims JR Rordorf G Smith EE Koroshetz WJ Lev MH Buonanno F Schwamm LH 《AJNR. American journal of neuroradiology》2005,26(2):246-251
BACKGROUND AND PURPOSE: The relationship between location of occlusion and clinical outcome is poorly understood in patients receiving intravenous tissue-type plasminogen activator (IV tPA). We postulated that acute stroke patients receiving IV tPA with patent vasculature or occult arterial occlusion by CT angiography (CTA) would have better outcomes and decreased hemorrhagic risk. METHODS: We identified 47 patients from our prospective stroke database who underwent CTA before treatment with IV tPA. Site of occlusion was categorized as M1 segment of the middle cerebral artery, M2 segment, multiple (either carotid, basilar, or both middle and anterior cerebral arteries), or absent (no occlusion proximal to M3). The effect of site of occlusion on National Institutes of Health Stroke Scale (NIHSS), early improvement (> or = 4-point improvement in NIHSS at 24 hours after treatment), intracranial hemorrhages, and modified Rankin scale (mRS) at 7 days was tested in a multivariate analysis. RESULTS: The location of occlusion correlated with initial NIHSS for multiple, M1, M2 and absent occlusions (median NIHSS scores were 18, 18, 15, 10, respectively) (P < .02, rank sum). Following adjustment for initial NIHSS, age, and time to treatment, the absence of occlusion remained associated with early improvement (OR 5.0, 95% CI 1.1-23.3; P = .04) and independence at day 7 (mRS < or = 2) (OR 6.8, 95% CI 1.3-34.6; P = .02). Overall prevalence of symptomatic hemorrhages was 6.4%. Patients without occlusion had no hemorrhages (0% versus 23.3%; P < .04). CONCLUSION: Among patients treated with tPA, those with patent vasculature or occult distal occlusion on CTA before treatment have lower NIHSS, better chances of early improvement and early independence with fewer hemorrhages. 相似文献
17.
Akiko Hosomi Yoshinari Nagakane Kei Yamada Nagato Kuriyama Toshiki Mizuno Tsunehiko Nishimura Masanori Nakagawa 《Neuroradiology》2009,51(9):549-555
Introduction It is often clinically difficult to assess the severity of aphasia in the earliest stage of cerebral infarction. A method
enabling objective assessment of verbal function is needed for this purpose. We examined whether diffusion tensor (DT) tractography
is of clinical value in assessing aphasia.
Methods Thirteen right-handed patients with left middle cerebral artery infarcts who were scanned within 2 days after stroke onset
were enrolled in this study. Magnetic resonance data of ten control subjects were also examined by DT tractography. Based
on the severity of aphasia at discharge, patients were divided into two groups: six patients in the aphasic group and seven
in the nonaphasic group. Fractional anisotropy (FA) and number of arcuate fasciculus fibers were evaluated. Asymmetry index
was calculated for both FA and number of fibers.
Results FA values for the arcuate fasciculus fibers did not differ between hemispheres in either the patient groups or the controls.
Number of arcuate fasciculus fibers exhibited a significant leftward asymmetry in the controls and the nonaphasic group but
not in the aphasic group. Asymmetry index of number of fibers was significantly lower (rightward) in the aphasic group than
in the nonaphasic (P = 0.015) and control (P = 0.005) groups. Loss of leftward asymmetry in number of AF fibers predicted aphasia at discharge with a sensitivity of 0.83
and specificity of 0.86.
Conclusions Asymmetry of arcuate fasciculus fibers by DT tractography may deserve to be assessed in acute infarction for predicting the
fate of vascular aphasia. 相似文献
18.
Robert A. Taylor Farhan Siddiq Muhammad Zeeshan Memon Adnan I. Qureshi Gabriela Vazquez Minako Hayakawa John C. Chaloupka 《Neuroradiology》2009,51(8):531-539
Introduction The study’s purpose is to report the technical and clinical outcomes of a patient cohort that underwent vertebral artery ostium
stent placement for atherosclerotic stenosis.
Methods We retrospectively analyzed a prospectively collected database of neurointerventional procedures performed at a single center
from 1999 to 2005. Outcome measures included recurrent transient neurological deficits (TNDs), stroke, and death. Kaplan–Meier
analysis was used to estimate stroke- and/or death-free survival at 12 months. Cox proportional hazard was used to identify
risk factors for recurrent vertebrobasilar ischemic events.
Results Seventy-two patients with 77 treated vertebral ostial lesions were included. The 30-day stroke and/or death rate was 5.2%
(n = 4), although no event was directly related to the vertebral ostium stent placement. Three procedure-related strokes were
secondary to attempted stent placement at other sites (one carotid artery and two basilar arteries), and the one death was
secondary to the presenting stroke severity. The mean clinical follow-up time available for 66 patients was 9 months. There
were 14 TNDs (21%), two strokes (3%), and two deaths (3%) recorded in the follow-up. Recurrent vertebrobasilar ischemic events
occurred in nine patients (seven TNDs and two strokes). No recurrent stroke and/or deaths were related to the treated vertebral
ostium. Stroke- and/or death-free survival rate (including periprocedural stroke and/or death) was 89 ± 5% at 12 months. No
vascular risk factor was significantly associated with recurrent vertebrobasilar ischemic events.
Conclusions Vertebral artery ostium stent placement can be safely and effectively performed with a low rate of recurrent stroke in the
territory of the treated vessel. Patients who also underwent attempted treatment of a tandem intracranial stenosis appeared
to be at highest risk for periprocedure stroke. 相似文献
19.
Objectives Knowledge of bone age in achondroplasia is required for the prediction of adult height, timings of limb lengthening, and epiphysiodesis
procedures. The purpose of this investigation was to determine the differences in skeletal age in achondroplasia and a control
population with the Tanner–Whitehouse 3 method using the RUS score and to determine the right age for the interventional procedure
for limb lengthening procedure or deformity correction in these patients.
Materials and methods Left hand radiographs of 34 patients (age range, 5–18 years) with achondroplasia were evaluated for skeletal age using the
RUS scoring system, which were compared with the left hand radiographs of 41 patients (age range, 5–18 years) without achondroplasia
measuring skeletal age. The difference in chronological age and RUS bone age were evaluated statistically according to gender
and age group.
Results In the achondroplasia group, chronological age were 10.5 ± 4.3 years for males and 10.1 ± 3.6 years for females and RUS bone
age were 9.2 ± 4.0 years for males and 8.9 ± 3.4 years for females, which showed statistically significantly difference (males
p = 0.0003 and females p < 0.0001), while in the control group, chronological age were 11.1 ± 2.9 years for males and 10.7 ± 3.4 years for females
and RUS bone age were 11.2 ± 3.4 years for males and 10.7 ± 3.3 years for females, which did not show statistically significantly
difference (males p = 0.54 and females p = 0.76). Our finding suggested a delay of 1.4 years for males and 1.2 years for females in the maturation of bone in achondroplasia
patients. Difference between chronological age and RUS bone age was 0.9 ± 1.1 for <10 years and 1.6 ± 0.9 for >10 years in
the study group, while 0.1 ± 1.1 for <10 years and −0.2 ± 0.6 for >10 years in the control group, which also showed >statistically
significant difference (<10 years p = 0.04 and >10 years p < 0.0001). These differences indicate that there was a delay in the maturation of bones by 1 year in the group <10 years
and 1.8 years in the group >10 years in achondroplasia patients compared to nonachondroplasia patients.
Conclusion We recommend the use of the Tanner–Whitehouse 3 method especially the radius, ulna, short bone score to measure the skeletal
age and to wait for a longer time before interventional procedures in achondroplasia patients.
Each author certifies that he has no commercial associations (e.g., consultancies, stock ownership, equity interests, patent/licensing
arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. 相似文献
20.
Christos D. Karkos Dimitrios G. Karamanos Konstantinos O. Papazoglou Filippos P. Demiropoulos Dimitrios N. Papadimitriou Thomas S. Gerassimidis 《Cardiovascular and interventional radiology》2010,33(1):34-40
We aimed to present our experience with carotid angioplasty and stenting (CAS) and to document how the technique evolved over
the last decade (1997–2007). A retrospective study of 333 patients (259 men; median age, 69 years) who underwent 336 CAS procedures.
Of these, 118 (35%) patients were symptomatic and 164 (49%) lesions involved the left carotid bifurcation. The first 163 patients
received a balloon-expandable stent, whereas the remaining 173 received a self-expandable one. Cerebral protection devices
were used in the last 84 (25%) procedures. Access was via the femoral artery in all but six cases, in which direct puncture
of the common carotid was necessary. The left common carotid originated from the innominate artery in 18 cases (5%). Conversion
to open endarterectomy was necessary in two patients due to inability to remove the filter. Perioperative neurological events
included stroke in 6 patients (1.8%), transient ischemic attack in 15 (4.5%), and hyperperfusion syndrome in 10 (3.0%). Three
patients died during the first 30 days. As a result, the mortality and the combined stroke/death rate were 0.9 and 2.4%, respectively,
with no differences between symptomatic and asymptomatic patients. Bradycardia was noted in 48 patients (14%), and hypotension
in 45 (13%). Univariate analysis identified hypertension (P = 0.03), hyperlipidemia (P = 0.02), and current or ex-smoking (P = 0.02) as significant risk factors for death/stroke. On multivariate analysis using logistic regression, only hyperlipidemia
[odds ratio (OR), 53.90; 95% confidence interval (CI), 4.19–693.47; P = 0.002] and current or ex-smoking (OR, 63.84; 95% CI,: 4.80–848.68; P = 0.001) remained statistically significant. In conclusion, CAS can be performed safely and effectively, with acceptable
mortality, stroke/death, and cardiovascular complication rates. Although technological advances (stent design, cerebral protection
devices), perioperative pharmacological management, and increasing experience are all clinically significant factors influencing
the short-term results, none appeared to be statistically significant in this patient sample. 相似文献