Current Imaging Approaches and Challenges in the Assessment of the Intracranial Vasculature

2019 ◽  
pp. 17-50
Author(s):  
Justin E. Vranic ◽  
Mahmud Mossa-Basha
Keyword(s):  
Intracranial Vasculature

Comparative study of intracranial access in thrombectomy using next generation 0.088 inch guide catheter technology

2021 ◽  
pp. neurintsurg-2021-017341
Author(s):  
Devin V Bageac ◽  
Blake S Gershon ◽  
Jan Vargas ◽  
Maxim Mokin ◽  
Zeguang Ren ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Control Group ◽  
Anterior Circulation ◽  
Guide Catheter ◽  
Catheter Failure ◽  
Catheter Technology ◽  
Intracranial Vasculature

BackgroundMost conventional 0.088 inch guide catheters cannot safely navigate intracranial vasculature. The objective of this study is to evaluate the safety of stroke thrombectomy using a novel 0.088 inch guide catheter designed for intracranial navigation.MethodsThis is a multicenter retrospective study, which included patients over 18 years old who underwent thrombectomy for anterior circulation large vessel occlusions. Technical outcomes for patients treated using the TracStar Large Distal Platform (TracStar LDP) or earlier generation TRX LDP were compared with a matched cohort of patients treated with other commonly used guide catheters. The primary outcome measure was device-related complications. Secondary outcome measures included guide catheter failure and time between groin puncture and clot engagement.ResultsEach study arm included 45 patients. The TracStar group was non-inferior to the control group with regard to device-related complications (6.8% vs 8.9%), and the average time to clot engagement was 8.89 min shorter (14.29 vs 23.18 min; p=0.0017). There were no statistically significant differences with regard to other technical outcomes, including time to recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2B). The TracStar was successfully advanced into the intracranial internal carotid artery in 33 cases (73.33%); in three cases (6.67%), it was swapped for an alternate catheter. Successful reperfusion (mTICI 2B-3) was achieved in 95.56% of cases. Ninety-day follow-up data were available for 86.67% of patients, among whom 46.15% had an modified Rankin Score of 0–2%, and 10.26% were deceased.ConclusionsTracstar LDP is safe for use during stroke thrombectomy and was associated with decreased time to clot engagement. Intracranial access was regularly achieved.

Abstract W P81: Intracranial Aneurysms and Their Relationship to Circle of Willis Variations: A Retrospective Analysis of Patients in a University Hospital

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Dhanya Anand ◽  
Steve M Cordina
Keyword(s):  
Intracranial Aneurysms ◽  
Vascular System ◽  
Cerebral Aneurysms ◽  
University Hospital ◽  
Superior Cerebellar Artery ◽  
P Value ◽  
Anterior Circulation ◽  
Arterial Variations ◽  
Cerebellar Artery ◽  
Intracranial Vasculature

Background: Cerebral aneurysms, their rupture and resultant neurological sequelae are a major cause of morbidity and mortality. Multiple studies have analyzed the etiology of cerebral aneurysms including hemodynamic and congenital factors. Since the arterial supply of the brain develops entirely from the third pharyngeal arch and the dorsal aorta, any insult to the developing vascular system increases the probability of development of variations, including aneurysms. Purpose: To identify the association of arterial variations with aneurysms. Methods: A total of 83 patients with 106 intracranial aneurysms diagnosed by cerebral angiography from January 2011 to July 2014 were analyzed for variations in the intracranial vasculature. The type and laterality of the vascular variants in relation to the aneurysms were also examined. Results: On evaluation of the aneurysms, 65 (61.3 %) had associated variations in the intracranial vasculature. Among these, 51 (78.5 %) had variations ipsilateral to the aneurysm. 90 (84.9%) were in the anterior circulation. 52 patients (62.7%) were female. Various vascular variations including hypoplasia of posterior communicating (P-Comm) artery (56.5 %), variant anterior cerebral (ACA) artery (17.39%), fetal type posterior cerebral (PCA) artery (21.7%), fenestration of vertebral artery (1.4%), superior cerebellar artery duplication (1.4%) and arteriovenous malformations were noted. Fetal type PCAs were significantly more common in patients with anterior communicating (A-comm) (p-value <0.0115) and P-Comm A aneurysms (p-value <0.0131). Also, variations of A1 segment of ACA were significantly more common in A-Comm aneurysms (p-value <0.0013). Conclusions: The distribution of aneurysms in the intracranial vasculature in our study is comparable to previous literature. Among the arterial variations we found that fetal type PCAs are significantly common among A-Comm and P-Comm aneurysms. Also, variations in the A1 segment of ACAs were commonly associated with A-Comm aneurysms. Although further conformation of these associations is required with a prospective randomized control trial, if established, screening for these variations could help in primary prevention and early treatment of these aneurysms.

scholarly journals Novel Application of an Intermediate Sized Bridging Catheter as an Adjunct to Aneurysm Coiling in Patients with Tortuous Vasculature

2009 ◽  
Vol 15 (4) ◽  
pp. 448-452 ◽  
Author(s):  
G.J. Velat ◽  
M.F. Lawson ◽  
B.L. Hoh ◽  
J Mocco
Keyword(s):  
Intracranial Aneurysms ◽  
Parent Artery ◽  
Ruptured Aneurysms ◽  
Guide Catheter ◽  
Vessel Dissection ◽  
Aneurysm Coiling ◽  
Intracranial Vasculature

Selective microcatheterization of intracranial aneurysms during coiling can be limited by tortuous vasculature. Stabilization of the microcatheter via distal placement of the guide catheter in the intracranial vasculature may cause vessel dissection or vasospasm. We describe the application of an intermediate sized bridging catheter in four patients with tortuous vasculature who underwent successful coiling of ruptured aneurysms. No complications occurred. The intermediate sized bridging catheter is a useful adjunct for navigation of tortuous parent artery vasculature.

scholarly journals A Case of Glucocorticoid Remediable Aldosteronism and Thoracoabdominal Aneurysms

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Anahita Shahrrava ◽  
Sunnan Moinuddin ◽  
Prajwal Boddu ◽  
Rohan Shah
Keyword(s):  
Salt Intake ◽  
Case Fatality ◽  
Aortic Aneurysms ◽  
High Rate ◽  
Thoracic Aortic Aneurysms ◽  
Familial Form ◽  
Early Use ◽  
Mineralocorticoid Antagonists ◽  
Aortic Dissections ◽  
Intracranial Vasculature

Glucocorticoid remediable aldosteronism (GRA) is rare familial form of primary aldosteronism characterized by a normalization of hypertension with the administration of glucocorticoids. We present a case of GRA and thoracoabdominal aneurysm complicated by multiple aortic dissections requiring complex surgical and endovascular repairs. Registry studies have shown a high rate of intracranial aneurysms in GRA patients with high case fatality rates. The association of thoracoabdominal aneurysms with GRA has not been described, thus far, in literature. Studies have shown that high tissue aldosterone levels concomitant with salt intake have a significant role in the pathogenesis of aneurysms and this may explain the formation of aneurysms in the intracranial vasculature and aorta. The association of GRA with thoracic aortic aneurysms needs to be further studied to develop screening recommendations for early identification and optimal treatment. Also, the early use of mineralocorticoid antagonists may have a significant preventive and attenuating effect in aneurysm formation, an association which needs to be confirmed in future studies.

Evolving Role of Digital Subtraction Angiography in Neurosurgical Practice

Neurosurgery ◽  
1982 ◽  
Vol 11 (3) ◽  
pp. 430-438 ◽  
Author(s):  
Thomas A. Duff ◽  
Patrick A. Turski ◽  
Joseph F. Sackett ◽  
Charles M. Strother ◽  
Andrew B. Crummy
Keyword(s):  
Digital Subtraction Angiography ◽  
Digital Processing ◽  
Initial Assessment ◽  
Digital Subtraction ◽  
Arteriovenous Fistulas ◽  
Pathological Conditions ◽  
Vascular Bypass ◽  
Intracranial Vasculature

Abstract Advances in digital subtraction angiography (DSA) have allowed the evaluation of a number of pathological conditions involving the extra-and intracranial vasculature. In addition to its role in diagnosis. DSA has been used for the postoperative assessment of endarterectomy, aneurysm clipping, and vascular bypass and for the follow-up of arteriovenous fistulas or malformations. This paper describes the theory and anticipated improvements in the digital processing of radiological information and presents our initial assessment of its clinical utility.

scholarly journals Quantitative Assessment of the Intracranial Vasculature of Infants and Adults Using iCafe (Intracranial Artery Feature Extraction)

2021 ◽  
Vol 12 ◽  
Author(s):  
Li Chen ◽  
Dennis W. W. Shaw ◽  
Stephen R. Dager ◽  
Neva M. Corrigan ◽  
Baocheng Chu ◽  
...  
Keyword(s):  
Brain Development ◽  
Age Groups ◽  
Vascular Diseases ◽  
Intracranial Artery ◽  
Adult Age ◽  
Tof Mra ◽  
Age Related ◽  
Healthy Infants ◽  
Development And Aging ◽  
Intracranial Vasculature

Comprehensive quantification of intracranial artery features may help to assess and understand regional variations of blood supply during early brain development and aging. We analyzed vasculature features of 27 healthy infants during natural sleep, 13 infants at 7-months (7.3 ± 1.0 month), and 14 infants at 12-months (11.7 ± 0.4 month), and 13 older healthy, awake adults (62.8 ± 8.7 years) to investigate age-related vascular differences as a preliminary study of vascular changes associated with brain development. 3D time-of-flight (TOF) magnetic resonance angiography (MRA) acquisitions were processed in iCafe, a technique to quantify arterial features (http://icafe.clatfd.cn), to characterize intracranial vasculature. Overall, adult subjects were found to have increased ACA length, tortuosity, and vasculature density compared to both 7-month-old and 12-month-old infants, as well as MCA length compared to 7-month-old infants. No brain laterality differences were observed for any vascular measures in either infant or adult age groups. Reduced skull and brain sharpness, indicative of increased head motion and brain/vascular pulsation, respectively, were observed in infants but not correlated with length, tortuosity, or vasculature density measures. Quantitative analysis of TOF MRA using iCafe may provide an objective approach for systematic study of infant brain vascular development and for clinical assessment of adult and pediatric brain vascular diseases.

scholarly journals Intracranial vasculature 3D printing: review of techniques and manufacturing processes to inform clinical practice

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Petrice M. Cogswell ◽  
Matthew A. Rischall ◽  
Amy E. Alexander ◽  
Hunter J. Dickens ◽  
Giuseppe Lanzino ◽  
...  
Keyword(s):  
Clinical Practice ◽  
3D Printing ◽  
Manufacturing Processes ◽  
Intracranial Vasculature

scholarly journals Recurrent Transient Ischemic Attacks in a Patient with POEMS Syndrome

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
A. Akyol ◽  
B. Nazliel ◽  
H. Z. Batur Caglayan ◽  
Y. Oner ◽  
G. Turkoz Sucak
Keyword(s):  
Monoclonal Gammopathy ◽  
Cerebral Arteries ◽  
Poems Syndrome ◽  
Prior History ◽  
Transient Ischemic Attacks ◽  
Skin Changes ◽  
Pathophysiologic Mechanism ◽  
Middle Cerebral Arteries ◽  
History Of ◽  
Intracranial Vasculature

A 47-year-old female with a prior history of POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome was admitted with transient ischemic attacks complicated by dysarthria and right-sided hemiparesis. A blood survey indicated thrombocytosis and hyperfibrinogenemia while imaging of intracranial vasculature showed occlusion of the bilateral middle cerebral arteries. POEMS syndrome, of which arterial thromboses have been mentioned as a manifestation, is rarely accompanied by transient ischemic attacks. The pathophysiologic mechanism is yet unclear and needs further investigation.

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