Central nervous system
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha in Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
Cerebral angiography may be performed using CT, MRI or direct catheter angiography. Cerebral angiography demonstrates the cerebral blood vessels by opacifying them with a suitable contrast agent. Intra-arterial angiography is normally carried out following selective placement of an angiographic catheter in either a carotid or vertebral artery, following catheterisation of a femoral artery using the Seldinger method. A contrast injector may be employed that enables a bolus of contrast to be injected in a controlled and repeatable fashion. However, hand injection is commonly used, as sufficient pressure can be applied to overcome the patient’s blood pressure and it may be quicker than repeatedly connecting the injector pump. Close co-operation with the radiologist is necessary to obtain optimal timing between injection and the first exposure. The acquisition of one or more mask images allows for image optimisation in the case of movement artefact.
Stroke
Henry J. Woodford in Essential Geriatrics, 2022
Mechanical clot retrieval is a form of endovascular therapy that can directly remove blockages from cerebral arteries to restore blood flow. It can be used in acute ischaemic stroke caused by proximal intracranial vessel occlusion in the anterior circulation when there is significant persisting disability (i.e. NIHSS score six or more). The procedure usually follows intravenous thrombolysis, unless there is a contraindication. In addition to an initial standard CT scan, a CT or MR angiogram study is required to demonstrate the vessel occlusion. Conventional cerebral angiography is then performed, either under sedation or possibly general anaesthesia, usually via the femoral artery and under X-ray guidance. A clot retrieval device, attached to a guidewire, is used to re-establish blood flow. Most commonly, a metallic mesh stent is expanded within the clot to trap it and allow extraction. It should be performed as soon as possible after symptom onset and usually within six hours.15 Occasionally, it is administered between six and 24 hours of symptom onset (including ‘wake up' strokes) if potentially salvageable brain tissue has been detected by imaging techniques such as CT perfusion or DWI-MRI sequences.
Carotid and cerebral angiography
Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead in Cardiovascular Catheterization and Intervention, 2017
Traditionally, cerebral angiography has been performed by neuroradiologists, but the application of percutaneous inter-vention for chronic brachiocephalic occlusive diseases and acute stroke has resulted in the increasing involvement of interventional cardiologists. Accordingly, cardiologists are expected to have an understanding of diseases that impact circulation to the brain, including diseases of the aortic arch, carotid artery, subclavian and vertebral artery, and intra-cranial diseases. This chapter discusses the purpose, specific goals, technique, and complications of catheter-based cerebral angiography. Subclavian artery (SCA) intervention, extracranial carotid and vertebral intervention, and intracranial and stroke intervention are covered in separate chapters.
Thrombosis of the draining vein causes intracranial haemorrhage in the natural history of brain arteriovenous malformation: case report
Published in British Journal of Neurosurgery, 2019
Raita Fukaya, Katsuhiro Mizutani, Masahito Fukuchi, Koji Fujii
A 52-year-old man was transported to the emergency department of our hospital following a witnessed convulsion of the right upper extremity and a loss of consciousness. Initial non-contrast computed tomography (CT) revealed a small, high-density lesion in the left parietal lobe (Figure 1(A,B)). The lesion was found to be a cross-section of the intraluminal thrombus of the vein. Follow-up CT and magnetic resonance imaging (MRI), conducted 15 h after the initial CT, showed the presence of a small AVM with subcortical and intraventricular haemorrhage located from the left parietal lobe to the lateral ventricle (Figure 1(C)). Subsequently, cerebral angiography demonstrated a small, left parietal AVM (Figure 1(E–G)). The AVM nidus was supplied by a parietal branch of the left middle cerebral artery, and the venous phase showed a single draining vein, primarily through to the superior sagittal sinus. No pedicle aneurysm was found in the feeding arteries, and no thrombus was observed in the draining vein. The high-density lesion on the initial CT of the left parietal lobe was retrospectively identified as an intraluminal thrombus in the single draining vein of the AVM. A T2-weighted MRI image showed a flow void near the haematoma, indicating that the thrombus was already lysed (Figure 1(D)).
Dural venous sinus stenting in patients with idiopathic intracranial hypertension: report of outcomes from a single-center prospective database and literature review
Published in Expert Review of Ophthalmology, 2022
Matthew J Kole, Juan Carlos Martinez-Gutierrez, Francisio Sanchez, Rosa Tang, Peng Roc Chen
In our multidisciplinary group, patients are followed up in neurovascular clinic at two weeks, six weeks, and six months post-procedure. A CT venogram is obtained at the six-week appointment to verify stent patency. Patients are also referred back to their neuro-ophthalmologist for a full evaluation at 4 to 6 weeks and 6 months as above. As shown in Table 3, improvement in papilledema, visual acuity, RNFL thickness and visual fields are expected by six-week follow-up. Any arrest in progressive improvement, or worsening of any of these ophthalmological parameters should prompt immediate referral back to the treating neuro-endovascular specialist for further evaluation. In our practice, antiplatelet medications are stopped one week prior to performing repeat cerebral angiography at six months post-procedure, as well as a repeat LP. If signs and symptoms of IIH are improved, opening pressure is reduced from initial evaluation, and no further evidence of cerebral venous sinus stenosis is noted, then patients are seen yearly after this time. A low dose aspirin (81 mg) is continued as long as it can be tolerated by the patient.
Glioblastoma multiforme presenting as cryptogenic intracerebral hemorrhage
Published in Baylor University Medical Center Proceedings, 2018
Jose M. Soto, Kristopher A. Lyon, Ethan A. Benardete
In the emergency department, the patient had mild weakness in her left upper and lower extremity but otherwise a normal neurologic examination. She denied recent head trauma or anticoagulant use. CT angiography of the brain did not demonstrate an underlying vascular lesion. Magnetic resonance imaging (MRI) of the brain with and without gadolinium contrast, likewise, did not reveal an underlying mass (Figure 2). The patient underwent catheter-based cerebral angiography, which did not show an underlying vascular abnormality. She improved neurologically while in the hospital and was discharged home on levetiracetam for seizure prophylaxis.
Related Knowledge Centers
- Aneurysm
- Angiography
- Arteriovenous Malformation
- Common Carotid Artery
- Computed Tomography Angiography
- Femoral Artery
- Radiography
- Catheter
- Thorotrast
- Contrast Agent