scholarly journals The role of combined computed tomographic angiography and digital subtraction angiography in the management of cervico-facial vascular lesions

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Ahmed Mostafa Mohamed Kassem ◽  
Alaa Mohamed Fathy ◽  
Abdel Aziz Mohamed Alnekidy ◽  
Mohamed Ahmed Morsy ◽  
Mohamed Mahmoud El Shafei
Keyword(s):  
Success Rate ◽  
Digital Subtraction Angiography ◽  
Computed Tomographic Angiography ◽  
Vascular Lesions ◽  
Digital Subtraction ◽  
Technical Success ◽  
Technical Success Rate ◽  
Computed Tomographic ◽  
Tomographic Angiography

Abstract Background Cervicofacial vascular lesions are one of the most challenging diseases managed by intervention radiologists and specialized surgeons. These lesions were diagnosed to be vascular in origin by other imaging techniques such as Duplex and/or magnetic resonance imaging (MRI). All patients underwent computed tomographic angiography (CTA) to confirm the diagnosis as well as to decide the most effective choice of management based on multidisciplinary team (MDT). Then, Digital subtraction angiography (DSA) was done as it is offering an accurate vascular map for the vascular lesions which is inevitable for successful super-selective endovascular embolization which can be done at same sitting. Small cases of arteriovenous malformations (AVMs) were sufficiently managed by only embolization, whereas cases of adequately embolized large AVMs as well as juvenile nasopharyngeal angiofibroma (JNA) cases were followed by surgery with the advantage of less blood loss and decreasing operation time as well as complications. This prospective study was done to highlight the role of combined CTA and DSA in cervicofacial vascular lesion management. Results Twenty patients were included in our study: 16 patients were males, and 4 were females; 17 of them were under 40 years, and three were above 40 years. Preoperative embolization was done in 12 patients, which were all the cases of JNAs and large AVMs. Four patients were managed by only embolization as a definitive treatment. Complete technical success rate was about 94%, while only 6% (single case) of the partial technical success rate which was due to a very small accessory feeder that could not be catheterized even with repeated trials. Conclusions Combined CTA and DSA is the cornerstone for managing vascular lesions in the cervicofacial region, which necessitates a MDT to decide the most beneficial and least complicated way for management.

scholarly journals Contrast extravasation from basilar artery without aneurysm formation on digital subtraction angiography in computed tomography angiogram-negative subarachnoid hemorrhage: A case report

2021 ◽  
Vol 12 ◽  
pp. 498
Author(s):  
Hideki Nakajima ◽  
Takuro Tsuchiya ◽  
Shigetoshi Shimizu ◽  
Hidenori Suzuki
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Digital Subtraction Angiography ◽  
Basilar Artery ◽  
Neurological Status ◽  
Computed Tomographic Angiography ◽  
World Federation ◽  
Digital Subtraction ◽  
Contrast Extravasation ◽  
Computed Tomographic ◽  
Tomographic Angiography

Background: The causes of angiogram-negative subarachnoid hemorrhage (SAH) on initial angiography, which accounts for 10–30% of spontaneous SAH, are heterogeneous and still unclear. We report a case of nonaneurysmal SAH, in which initial computed tomographic angiography (CTA) showed no source of bleeding, but the subsequent digital subtraction angiography (DSA) revealed contrast extravasation from the basilar artery without aneurysms. Case Description: A 67-year-old woman with a medical history of hypertension presented as SAH of World Federation of Neurological Surgeons Grade II. CTA on admission did not show any cause of bleeding and DSA was subsequently performed to show contrast extravasation from a perforator of the middle third of the basilar artery without aneurysms during the subsequent DSA, resulting in profound deterioration SAH and neurological status. The patient was conservatively treated. Follow-up DSAs on days 2 and 16 showed no source of bleeding as well. Conclusion: Although the precise cause of bleeding in this case is uncertain, SAH might be caused by local dissection of the basilar artery perforator, and the bleeding site might heal spontaneously without forming of a pseudoaneurysm.

Comparison of Computed Tomographic Angiography with Digital Subtraction Angiography in the Diagnosis of Cerebral Aneurysms: A Meta-analysis

Neurosurgery ◽  
2003 ◽  
Vol 52 (3) ◽  
pp. 624-631 ◽  
Author(s):  
E. Thomas Chappell ◽  
Federico Castro Moure ◽  
Matthew C. Good
Keyword(s):  
Digital Subtraction Angiography ◽  
Standard Method ◽  
World Literature ◽  
Meta Analysis ◽  
Cerebral Aneurysms ◽  
Computed Tomographic Angiography ◽  
Digital Subtraction ◽  
Computed Tomographic ◽  
Number Of Patients ◽  
Tomographic Angiography

Abstract OBJECTIVE To compare a novel diagnostic radiological technique, computed tomographic angiography (CTA), with the standard method, namely digital subtraction angiography (DSA), in the diagnosis of cerebral aneurysms. METHODS A comprehensive search of the world literature on CTA was performed. Articles that reported on prospective comparisons of CTA and DSA in the evaluation of patients suspected of harboring cerebral aneurysms were selected for data extraction. Suitable statistical methods were applied to the extracted data for meta-analysis. RESULTS Twenty-one references met the criteria for use in the meta-analysis. Unweighted calculations based on data for 1251 patients resulted in a sensitivity of 0.933 (93.3%; range, 75.4–100%) and a specificity of 0.878 (87.8%; range, 0–100%). When the studies were weighted for the number of patients in each study, the sensitivity decreased slightly, to 0.927 (92.7%), and the specificity decreased more substantially, to 0.772 (77.2%). CONCLUSION On the basis of this meta-analysis, DSA remains the standard method. However, many who use CTA have reported it to be as good as or better than DSA in the diagnosis and treatment of cerebral aneurysms, as well as being of less risk and discomfort to their patients and easier and less expensive to perform.

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