Evaluation of relation among aneurysmal neck, parent artery, and daughter arteries in middle cerebral artery aneurysms, by three-dimensional digital subtraction angiography

2005 ◽  
Vol 28 (3) ◽  
pp. 196-200 ◽  
Author(s):  
Takashi Sadatomo ◽  
Kiyoshi Yuki ◽  
Keisuke Migita ◽  
Eiji Taniguchi ◽  
Yasunori Kodama ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Digital Subtraction Angiography ◽  
Cerebral Artery ◽  
Three Dimensional ◽  
Parent Artery ◽  
Digital Subtraction ◽  
Aneurysmal Neck ◽  
Middle Cerebral Artery Aneurysms

MORPHOLOGICAL DIFFERENCES BETWEEN RUPTURED AND UNRUPTURED CASES IN MIDDLE CEREBRAL ARTERY ANEURYSMS

Neurosurgery ◽  
2008 ◽  
Vol 62 (3) ◽  
pp. 602-609 ◽  
Author(s):  
Takashi Sadatomo ◽  
Kiyoshi Yuki ◽  
Keisuke Migita ◽  
Eiji Taniguchi ◽  
Yasunori Kodama ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Three Dimensional ◽  
Artery Aneurysm ◽  
Parent Artery ◽  
Unruptured Aneurysms ◽  
Type D ◽  
Type C ◽  
Morphological Differences ◽  
Middle Cerebral Artery Aneurysms

Abstract OBJECTIVE To elucidate the morphological differences between ruptured and unruptured aneurysms, three-dimensional digital subtraction angiography was performed in 44 cases (20 unruptured, 24 ruptured) of middle cerebral artery aneurysm. METHODS When the neck was located on the extension of the midline of the parent artery, it was defined as Type C; when it was not, it was defined as Type D. Aspect ratio (AP ratio; dome/neck ratio) and daughter artery ratio (DA ratio; diameter of the larger daughter artery/diameter of the smaller daughter artery) were calculated, and these ratios were compared for ruptured and unruptured cases. RESULTS Nineteen cases were Type C and 25 cases were Type D. χ2 test revealed that there were significantly more ruptured cases among Type C (14 out of 19) compared with Type D (10 out of 25) (P < 0.05). AP ratios were 2.24 ± 0.75 for ruptured cases and 1.56 ± 0.58 for unruptured cases. DA ratios were 1.53 ± 0.54 in ruptured cases and 2.14 ± 0.80 for unruptured cases. Both showed significant differences (P < 0.01). In cases with an AP ratio of 1.8 or greater and a DA ratio less than 1.7, 13 out of 15 (87%) were ruptured cases. On the contrary, in cases with an AP ratio less than 1.8 and a DA ratio of 1.7 or greater, 12 out of 13 (92%) were unruptured cases. CONCLUSION Type C and equality of the diameters of two daughter arteries, together with high AP ratios, seem to be morphological factors that associate with aneurysmal rupture.

scholarly journals Preoperative simulation of a middle cerebral artery aneurysm clipping using a rotational three-dimensional digital subtraction angiography

2021 ◽  
Vol 12 ◽  
pp. 70
Author(s):  
Yuiko Kimura ◽  
Toshihiro Mashiko ◽  
Eiju Watanabe ◽  
Kensuke Kawai
Keyword(s):  
Middle Cerebral Artery ◽  
Digital Subtraction Angiography ◽  
Cerebral Artery ◽  
Three Dimensional ◽  
Artery Aneurysm ◽  
Digital Subtraction ◽  
Preoperative Simulation ◽  
The Difference ◽  
Operative Findings ◽  
Cerebral Artery Aneurysm

Background: In recent years, young neurosurgeons have had few opportunities to gain experience with clipping surgeries. The first author was sometimes surprised that she could not predict the anatomical relationships between the aneurysm and vessels during actual surgery. This study investigated the differences between the expected and actual operative findings during clipping surgery for aneurysms of the middle cerebral artery. Methods: Medical records for 15 patients who underwent rotational three-dimensional (3D) digital subtraction angiography (3D-DSA) before the clipping surgery were analyzed after the surgery. The anatomical relationships between the aneurysm and parent arteries were defined by the intraoperative findings just before clipping. The viewing direction to obtain this definitive perspective (virtual viewing direction) was measured. The angle between this viewing direction and the coordinate axis was denoted as the “virtual angle for clipping (VAC).” Results: The VAC between the X-axis and viewing direction on the XY-plane (VAC-XY) ranged from –43° to +73° (mean, +27°), and the angle between the XY-plane and viewing direction (VAC-Z) ranged from +25° to –34° (mean, 5.5°). The difference between the VAC-XY and mean angle was significantly larger in cases with hidden branches behind the aneurysm. In these cases, the virtual viewing direction visualized the neck of the aneurysm. There is no correlation between M1 length and VAC-XY or VAC-Z discrepancy. Conclusion: 3D-DSA or 3D computed tomography angiography images visualizing the neck of the aneurysm should be obtained in combination with images obtained from the standard oblique angle.

scholarly journals Discrepancy between two-dimensional and three-dimensional digital subtraction angiography for the planning of endovascular coiling of small cerebral aneurysms <5 mm

2020 ◽  
Vol 26 (6) ◽  
pp. 733-740
Author(s):  
Te-Chang Wu ◽  
Yu-Kun Tsui ◽  
Tai-Yuan Chen ◽  
Ching-Chung Ko ◽  
Chien-Jen Lin ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Three Dimensional ◽  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Parent Artery ◽  
Two Dimensional ◽  
Digital Subtraction ◽  
Rotational Angiography ◽  
Treatment Choices ◽  
The Impact

Background To investigate the discrepancy between two-dimensional digital subtraction angiography and three-dimensional rotational angiography for small (<5 mm) cerebral aneurysms and the impact on decision making among neuro-interventional experts as evaluated by online questionnaire. Materials and methods Eight small (<5 mm) ruptured aneurysms were visually identified in 16 image sets in either two-dimensional or three-dimensional format for placement in a questionnaire for 11 invited neuro-interventionalists. For each set, two questions were posed: Question 1: “Which of the following is the preferred treatment choice: simple coiling, balloon remodeling or stent assisted coiling?”; Question 2: “Is it achievable to secure the aneurysm with pure simple coiling?” The discrepancies of angio-architecture parameters and treatment choices between two-dimensional-digital subtraction angiography and three-dimensional rotational angiography were evaluated. Results In all eight cases, the neck images via three-dimensional rotational angiography were larger than two-dimensional-digital subtraction angiography with a mean difference of 0.95 mm. All eight cases analyzed with three-dimensional rotational angiography, but only one case with two-dimensional-digital subtraction angiography were classified as wide-neck aneurysms with dome-to-neck ratio < 1.5. The treatment choices based on the two-dimensional or three-dimensional information were different in 56 of 88 (63.6%) paired answers. Simple coiling was the preferred choice in 66 (75%) and 26 (29.6%) answers based on two-dimensional and three-dimensional information, respectively. Three types of angio-architecture with a narrow gap between the aneurysm sidewall and parent artery were proposed as an explanation for neck overestimation with three-dimensional rotational angiography. Conclusions Aneurysm neck overestimation with three-dimensional rotational angiography predisposed neuro-interventionalists to more complex treatment techniques. Additional two-dimensional information is crucial for endovascular treatment planning for small cerebral aneurysms.

scholarly journals Stent-assisted coil embolization on down-the-barrel view with spring-shaped microcatheter in patient with M1 ultrawide necked circumferential aneurysm

2018 ◽  
pp. bcr-2017-013597
Author(s):  
Hyo Sung Kwak ◽  
Jung Soo Park ◽  
Eun Jeong Koh
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Middle Cerebral Artery ◽  
Digital Subtraction Angiography ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Digital Subtraction ◽  
Safe Technique ◽  
Delayed Complications

Herein, we describe a technique for stent-assisted coil embolization with a spring-shaped microcatheter in a patient with an M1 ultrawide-necked circumferential aneurysm in the middle cerebral artery (MCA). A 49-year-old man was referred for treatment of an incidentally detected M1 large-circumference aneurysm on magnetic resonance angiography. Subsequent digital subtraction angiography revealed an 18.2×16.5 mm ultrawide-necked circumferential aneurysm on the distal M1 portion of the left MCA, and we planned stent-assisted coil embolization using a spring-shaped microcatheter. After we deployed the stent, we performed coil embolization under the down-the-barrel view by pulling out the microcatheter little by little. Using this technique, we could fill the coil mass evenly into the aneurysmal sac around the stent. And there were no immediate or delayed complications after the procedure. Stent-assisted coiling using a spring-shaped microcatheter is a useful and safe technique for treating ultrawide-necked circumferential aneurysm or fusiform aneurysms.

Abstract WP137: Validation of a New Diagnostic Scoring System of Transcranial Doppler for Middle Cerebral Artery Stenosis

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Qing Hao ◽  
Steven R Levine ◽  
Clotilde Balucani ◽  
Edward Feldmann
Keyword(s):  
Middle Cerebral Artery ◽  
Digital Subtraction Angiography ◽  
Cerebral Artery ◽  
Transcranial Doppler ◽  
Scoring System ◽  
Hard Copy ◽  
Digital Subtraction ◽  
Ratio Score ◽  
Predictive Values ◽  
New Scoring

Introduction: Large vessel intracranial stenosis (LVIS) is the most common stroke subtype worldwide and is associated with high risk of stroke recurrence. Current transcranial Doppler (TCD) diagnostic criteria for LVIS mainly rely on velocity measurement with unsatisfactory accuracy. Hypothesis: A new scoring system that integrated several features of the cerebral blood flow velocity from TCD is able to offer more reliable identification of significant (≥ 50%) LVIS. Methods: Using the TCD-Digital Subtraction Angiography (DSA) database from a previous NIH-funded trial - Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA), the hard copy TCDs from SONIA trial were reviewed blinded to the results of DSA. A summed score was calculated for each middle cerebral artery (MCA) based on the four parameters: mean velocity (MV) (score 0: MV<80 cm/s, 1: MV=80-99 cm/s, 2: MV=100-119 cm/s, 3: MV≥120 cm/s); stenotic/pre-stenoic ratio (score 0: ratio<2, 1: ratio≥2); stenotic/contralateral MCA ratio (score 0: ratio<1.50, 1: ratio=1.50-1.99, 2: ratio ≥ 2.00); spectrum pattern (score 0: normal spectrum, 1: any pattern of turbulence). DSA results (presence of ≥ 50% stenosis) from SONIA were used as the gold standard. To define the optimal score that predict significant stenosis on DSA, predictive values (positive predictive value [PPV] and negative predictive values [NPV], and overall accuracy) with 95% CI were calculated. Results: 110 MCAs with both TCD and DSA were available in 72 patients (50.7 % of total patients with TCD). The mean score was 1.8 (SEM 0.21), the optimal cutoff score with balanced PPV and NPV for identifying ≥50% stenosis was >4 with the PPV 76% (53-92), NPV = 84% (75-91) and overall accuracy 83% (76-90).The PPV of the new scoring system (76%) was higher than velocity-only criteria in SONIA (i.e. previously validated cutpoints from SONIA of MV=80 cm/s [32%] or 100 cm/s [37%]), while NPV remained similar between the two methods (84% for new scoring vs 86% or 85%). Conclusions: The new TCD scoring system suggested higher diagnostic accuracy compared to the velocity-only method in diagnosis of ≥50% MCA stenosis using digital subtraction angiography as the confirmative method. Further validation is required.

Usefulness of Preoperative Three-Dimensional Computed Tomographic Angiography With Two-Dimensional Computed Tomographic Imaging for Rupture Point Detection of Middle Cerebral Artery Aneurysms

2008 ◽  
Vol 62 (suppl_1) ◽  
pp. ONS126-ONS133 ◽  
Author(s):  
Kojiro Wada ◽  
Hirohiko Arimoto ◽  
Hidenori Ohkawa ◽  
Toshiki Shirotani ◽  
Yohsitaro Matsushita ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Ct Angiography ◽  
Cerebral Artery ◽  
Three Dimensional ◽  
Ct Image ◽  
Two Dimensional ◽  
Computed Tomographic ◽  
Transsylvian Approach ◽  
Risk Of Rupture ◽  
Middle Cerebral Artery Aneurysms

Abstract Objective: We report the technique of three-dimensional computed tomographic (CT) angiography with a two-dimensional CT image aiding in the early operation of ruptured middle cerebral artery aneurysms. This combined image allows the prediction of the rupture point in the aneurysm and may reduce the risk of rupture during early clipping surgery. Methods: The findings for 14 patients with 14 middle cerebral artery ruptured aneurysms who underwent subsequent early clipping were analyzed. The average aneurysm size was 8.5 mm, and there were two large and one giant aneurysms. CT examinations were performed by means of a multidetector CT scanner (Aquilion M16; Toshiba Medical Systems, Tokyo, Japan) and reconstructed with a workstation (ZIO M900 QUADRA; Amin Co., Ltd., Tokyo, Japan). We constructed an operating view through three-dimensional CT angiography for a lateral transsylvian approach with a two-dimensional CT image (nonshaded volume-rendering image), which was perpendicular to the direction of the surgical approach. Using this combined image, we predicted the rupture point of the aneurysm and successfully performed clipping surgery through a lateral transsylvian approach. Rupture points were confirmed at the time of surgery. Rupture points of 13 out of 14 aneurysms appeared as we expected, but one differed; all aneurysms were successfully clipped. Thirteen of the 14 patients could be clipped without rupture at surgery, but the remaining patient experienced rupture just after craniotomy. Conclusion: The combination of three-dimensional CT angiography and two-dimensional CT images may help improve the surgical outcome by indicating aneurysmal rupture points, leading to the prevention of rupture.

scholarly journals Republished: Stent-assisted coil embolization on down-the-barrel view with spring-shaped microcatheter in patient with M1 ultrawide necked circumferential aneurysm

2018 ◽  
Vol 10 (6) ◽  
pp. e13-e13
Author(s):  
Hyo Sung Kwak ◽  
Jung Soo Park ◽  
Eun Jeong Koh
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Middle Cerebral Artery ◽  
Digital Subtraction Angiography ◽  
Cerebral Artery ◽  
Coil Embolization ◽  
Digital Subtraction ◽  
Safe Technique ◽  
Delayed Complications

Herein, we describe a technique for stent-assisted coil embolization with a spring-shaped microcatheter in a patient with an M1 ultrawide-necked circumferential aneurysm in the middle cerebral artery (MCA). A 49-year-old man was referred for treatment of an incidentally detected M1 large-circumference aneurysm on magnetic resonance angiography. Subsequent digital subtraction angiography revealed an 18.2×16.5 mm ultrawide-necked circumferential aneurysm on the distal M1 portion of the left MCA, and we planned stent-assisted coil embolization using a spring-shaped microcatheter. After we deployed the stent, we performed coil embolization under the down-the-barrel view by pulling out the microcatheter little by little. Using this technique, we could fill the coil mass evenly into the aneurysmal sac around the stent. And there were no immediate or delayed complications after the procedure. Stent-assisted coiling using a spring-shaped microcatheter is a useful and safe technique for treating ultrawide-necked circumferential aneurysm or fusiform aneurysms.

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