Feasibility and Utility of Transradial Cerebral Angiograpy: Experience during the Learning Period

OBJECTIVE: We wanted to present our experiences for performing transradial cerebral angiography during the learning period, and we also wanted to demonstrate this procedure's technical feasibility and utility in various clinical situations. MATERIALS AND METHODS: Thirty-two patients were enrolled in the study. All of them had unfavorable situations for performing transfemoral angiography, i.e., IV lines in the bilateral femoral vein, a phobia for groin puncture, decreased blood platelet counts, large hematoma or bruise, atherosclerosis in the bilateral femoral artery and the insistence of patients for choosing another procedure. After confirming the patency of the ulnar artery with a modified Allen's test and a pulse oximeter, the procedure was done using a 21-G micorpuncture set and 5-F Simon II catheters. After angiography, hemostasis was achieved with 1-2 minutes of manual compression and the subsequent application of a hospital-made wrist brace for two hours. The technical feasiblity and procedure-related immediate and delayed complications were evaluated. RESULTS: The procedure was successful in 30/32 patients (93.8%). Failure occurred in two patients; one patient had hypoplasia of the radial artery and one patient had vasospasm following multiple puncture trials for the radial artery. Transradial cerebral angiography was technically feasible without significant difficulties even though it was tried during the learning period. Pain in the forearm or arm developed in some patients during the procedures, but this was usually mild and transient. Procedure-related immediate complications included severe bruising in one patient and a small hematoma in one patient. Any clinically significant complication or delayed complication such as radial artery occlusion was not demonstrated in our series. CONCLUSION: Transradial cerebral angiography is a useful alternative for the patients who have unfavorable clinical situations or contraindications for performing transfemoral cerebral angiography. For the experienced neurointerventionalists, it seems that additional training for perfoming transradial cerebral angiography is not needed.

Infraoptic Anterior Cerebral Artery Arising from Contralateral Internal Carotid Artery: Case Report

We report an unusual case of an anomalous origin of the anterior cerebral artery from the contralateral internal carotid artery at the level of the origin of the ophthalmic artery, which was discovered incidentally by MRI and MR angiography.

Endovascular Treatment of 20 Acutely Ruptured Cerebral Aneurysms with Detachable Coils

PURPOSE: To evaluate the preliminary results of endovascular coil treatment of acutely ruptured aneurysms. MATERIALS AND METHODS: Between August 1995 and December 1997, 18 patients with 20 ruptured aneurysms weretreated. They were classified as Hunt and Hess grade I (n=3), grade II (n=1), grade III (n=3), grade IV (n=10) orgrade V (n=1). Endovascular treatment was performed at mean 5.2 (range, 1-18) days. The first aneurysm was treatedwith mechanical detachable spirals (MDS) and the others with Guglielmi detachable coils (GDC). Aneurysm size wascategorized as small (n=17) or large (n=3). Ten aneurysms were located in the anterior circulation, and ten in theposterior circulation. Using the Glasgow outcome scale (GOS), clinical outcome was evaluated 5 to 27 months aftertreatment in 11 patients. Three patients had already died. RESULTS: In 14 of the 18 patients (16 of 20 aneurysms: 80%), treatment was successful. Four aneurysms failed due to unsuccessful catheter placement (n=2), smallaneurysm (n=1) or occlusion of the parent vessel (n=1). Total occlusion was observed in 13 aneurysms; 95-99%, orsubtotal occlusion, in two, and less than 95%, or incomplete occlusion, in one. Technical complications includedpassing of wire (n=1) and unintentional parent artery occlusion (n=1). There was a 7.1%(1/14) morbidity rate, butno mortality related to the technique. Six patients with Hunt and Hess grade I-III had good clinical outcome (3with GOS 1, and 2 with GOS 2). Four of the nine patients who were grade IV-V showed clinical improvement (GOS 3);two patients were clinically unchanged (GOS 4), and three died from the severity of primary hemorrhage. CONCLUSION: Endovascular coil treatment is a reasonable alternative for patients who are not candidates forconventional surgical treatment or in whom such treatment has failed.

Comparison of CT Angiography and Conventional Angiography in Detection of Intracranial Aneursyms

PURPOSE: To evaluate the usefulness of CT angiography (CTA) for the detection and assessment of intracranial aneurysms, compared with the findings of conventional angiography (CA) and surgery. MATERIALS AND METHODS: Among 243 patients who underwent CTA because of suspected intracranial a-neurysm, 116 who underwent surgery were studied. The patients were divided into two groups. Group 1 consisted of 77 patients (94 aneurysms) who underwent both preoperative CTA and CA, while group 2 comprised 39 patients (47 aneurysms) who underwent preoperative CTA only. The detection rate, size, shape and direction of the neck and its relationship to the adjacent vessel of the intracranial aneurysm seen during CTA were retrospectively compared with those seen during CA and surgery. Two radiologists worked in a blinded fashion without access to clinical information. RESULTS: In group 1, the detection rate of aneurysms seen during CTA was 89 % (84 of 94 cases), and for CA was 95 % (89 of 94 cases). Among ten undetected aneurysms, four cases were less than 3mm in size and six were out of the scanning area. In group 2, the detection rate of aneurysms seen during CTA was 94 %(44 of 47cases). Among three undetected aneurysms, one case was less than 3mm in size and two were out of the scanning area. For delineation of an aneurysm (the direction and shape of the neck, for example), CTA was equal or superior to CA in 75 of 82cases(91 % ). CONCLUSION: CTA is a useful technique for the evaluation of intracranial aneurysms in the circle of Willis, but cannot depict all vessels in the brain. CTA performed in conjunction with CA is useful for the detection of intracranial aneurysms.

Angiographic Distribution of the Seve re Stenosis in Korean Patients with Atherosclerotic Cerebral Vascular Disease

PURPOSE: To determine the location and distribution, as seen on cerebral angiograms, of severe atherosclerotic stenosis of atherosclerotic or occlusion among Koreans and to thus be aware of the differences in distribution of these conditions between Koreans and other ethnic groups included in previously reported data. MATERIALS AND METHODS: We retrospectively reviewed the cerebral angiographic findings of 268 patients in whom angiography had revealed at least one instance of severe stenosis (ss) (<70 %) and who had more than one risk factor for atherosclerosis. The review was focused on the location of the stenosis and multiplicity of the lesion. Statistical analysis employed the chi-square test, and the data obtained was compared with that reported for other ethnic groups. RESULTS: A total of 389 SS sites were detected in 268 patients. Isolated severe stenosis (IS) was found in 56 patients (21%), and multiple stenoses (MS) in 212 patients (79%). Lesions were located in the intracranial portion in 52 % of cases, and in the extracranial portion in 48%(p<.05). They were found in the anterior circulation in 59% and in the posterior circulation in 41 %(p<.05). Thirty-seven of 56 IS (66 %) were located in the intracranial portion and 19 (34 %) in the extracranial portion (p<.05). One hundred and sixty-seven(50 %) of 333 lesions involving multiple stenoses were seen in the extracranial portion, while 166 (50%) were located in the intracranial vessels. The higher prevalence of intracranial stenosis in the IS group than in the MS group was statistically significant (p<.05). CONCLUSION: On the basis of previously reported data, Korean patients with severe atherosclerotic stenosis tend to have more frequent multiple and intracranial stenoses than do Caucasians. Intracranial stenosis was more frequent in the isolated stenosis group than in the multiple stenosis group.

Usefulness of 3 Dimensional CT Angiography in the Diagnosis of Intracranial Aneurysms: Comparative Study with Conventional Angiography

PURPOSE: To assess the diagnostic capability of three-dimensional CT angiography(3D-CTA) in the diagnosis of intracranial aneurysms, compared with conventional angiography. MATERIALS AND METHODS: Twenty-two patients with intracranial aneurysms were studied using 3D-CTA and conventional angiography. Three-dimensional images were obtained with a helical CT scanner using SSD(shaded surface display) technique. 3D-CTA findings were retrospectively compared with conventional angiography with respect to lesion detection and delineation of the aneurysms. RESULTS: Of the 25 aneurysms demonstrated by conventional angiography, 23(92.0%) were detected by 3D-CTA. Aneurysmal necks were clearly visualized in 17 of 25 aneurysms(68.0%) with conventional angiography, and 19 of 23(82.6%) with 3D-CTA. And 3D-CTA is also superior to conventional angiography in aneurysmal delineation. CONCLUSION: 3D-CTA is thought to be a potential imaging modality in the evaluation of intracranial aneurysm, especially in aneurysmal delineation.