Ensayo pictórico: control imagenológico de aneurismas tratados ¿qué examen elegir? / Pictorial essay: imaging control of treated aneurysms. which exam to choose?

Resumen: El tratamiento de aneurismas intracraneanos rotos y no rotos incluye opciones quirúrgicas (clips vasculares) y endovasculares. Existen varios dispositivos y técnicas de manejo endovascular (coils, stents, diversores de flujo), cuyo conocimiento permite elegir e interpretar adecuadamente las técnicas de imágenes para el seguimiento no invasivo. Mediante una revisión pictográfica del control de aneurismas intracraneanos tratados quirúrgicamente y vía endovascular, se muestran las diferencias en la capacidad de caracterización en el seguimiento con angio TC, angio RM sin contraste (con técnica de "tiempo de vuelo" o "TOF" por sus siglas en inglés), angio RM con gadolinio endovenoso (C+) y angiografía por sustracción digital (ASD). Adicionalmente se entregan recomendaciones para el seguimiento de aneurismas según modalidad y dispositivo de tratamiento.

Abstract: Treatment of intracranial ruptured and unruptured aneurysms can be performed with surgical (vascular clips) or endovascular procedures (coils, stents, flw diverters). There are several devices and techniques for endovascular treatment. Knowledge of this techniques allows physicians to choose and interpret accurately imaging modalities for non-invasive follow-up. Through a pictorial essay of imaging follow-up of treated intracranial aneurysms we show the differences in characterization with computed tomography angiography, magnetic resonance angiography without contrast (time of flght or "TOF" technique), contrast enhanced MR angiography (C+) and digital subtraction angiography (DSA). Additionally we recommend imaging modalities for each treatment device.

Artificial Luminal Narrowing on Contrast-Enhanced Magnetic Resonance Angiograms on an Occasion of Stent-Assisted Coiling of Intracranial Aneurysm: In Vitro Comparison Using Two Different Stents with Variable Imaging Parameters

OBJECTIVE: Intracranial stenting for stent-assisted coiling of aneurysms requires adequate follow-up imaging. The aim of this in vitro study was to compare in-stent artificial luminal narrowing on contrast-enhanced MR angiograms (CE-MRA) when applying Neuroform(R) and Enterprise(R) stents for stent-assisted coiling. MATERIALS AND METHODS: Two intracranial nitinol stents (Enterprise(R) and Neuroform(R)) were placed in silicon tubes and then imaged at 3 T and 1.5 T by the use of a T1-weighted three-dimensional spoiled gradient-echo sequence with minimal TR and TE. CE-MRAs were obtained by using different imaging planes, voxel sizes, and bandwidths, and with or without parallel imaging. Artificial lumen narrowing (ALN) was calculated and the results were compared. RESULTS: Lower magnetic field strength, axial plane perpendicular to axis of stent, and wider bandwidth resulted in a lower ALN on CE-MRA for both stents. Larger voxel size resulted in lower ALN for Neuroform(R) stent. The parallel imaging acceleration factor did not affect ALN. The mean ALN was lower for Neuroform(R), but it was not significant by a paired t test. CONCLUSION: CE-MRA of the stented lumen of vascular phantom was partially impaired with ALN. Consequently, image plane orientation, magnetic field strength, bandwidth, and voxel size should be adjusted appropriately to reduce ALN.

Nursing of patients with ischemic cerebrovascular disease treated by intracranial stent / 中国实用护理杂志

Objective To evaluate the nursing methods of patients with ischemic cerebrovascular disease treated by intracranial stent. Methods 90 patients with ischemic cerebrovascular disease in our hospital during March 2006 to March 2010 were selected, their clinical nursing measures were summarized. Results All patients passed the treatment process, mean hospital stay was ( 19.8 ± 4.0)days. Conclusions Elaborate nursing to patients with ischemic cerebrovascular disease treated by intracranial stent can effectively reduce the average length of hospital stay.

Sum of the Curve Indices for Estimating the Vascular Tortuousness of the Internal Carotid Artery / 신경중재치료의학

PURPOSE: Most technical difficulties in intracranial stenting are derived from the vascular resistance caused by the severe tortuousness of intracranial arteries. The purpose of this study was to develop a practical method for measuring vascular tortuousness so that it would be possible to predict technical difficulties requiring further technical support. MATERIALS AND METHODS: We developed a best-fit circle metrics which made measurement of vascular tortuousness feasible, which was called "curve index (CI)". We compared the curve index in 56 consecutive patients who underwent M1 stenting for symptomatic severe stenosis. The difference in the CI between the successful and the aborted groups was statistically compared by using the Mann-Whitney U test. ROC curve analysis was performed to evaluate the diagnostic performance of the best-fit circle metrics. RESULTS: There was no statistically significant difference between the successful and the aborted cases in the CIs of each curve segment. However, the sum of all CIs of the aborted group was significantly larger (3.49) than that of the successful group (2.53) (p=0.013). On ROC curve analysis, the area under the curve was 0.806. When we took the cut-off value to be 3, the sensitivity was 75% and the specificity 85%. CONCLUSION: We developed a practical method for measuring the CI of vessel curves in order to estimate the tortuousness of the internal carotid artery. A CI less than 3, therefore, indicates a favorable vascular curvature for the intracranial stenting procedure. A vessel having a higher curve index was more likely to be aborted.

Staged Y-shaped Stent Assisted Coil Embolization in a Wide-Neck Basilar Tip Aneurysm: Case Report / 신경중재치료의학

A 67-year-old male presented with a subarachnoid hemorrhage and was found to have a basilar artery (BA) tip aneurysm, which was incorporated to both posterior cerebral arteries (PCAs). First, he was treated with the single stent, which was deployed from P1 segment of the right PCA to BA, and coil embolization was done. Follow-up angiogram at 18 months revealed coil compaction of the aneurysm. Therefore, we accomplished the Y-configured dual stent assisted coil embolization. Follow-up angiogram at 30 months revealed no recanalization of aneurysm and patent blood flow of both PCAs. In conclusion, staged Y-shaped stents assisted coil embolization is an alternative treatment option in a wide-neck basilar tip aneurysm decreasing the extent of coil compaction of aneurysm and preserving an incorporated vessel.

Stent-Assisted Angioplasty for Symptomatic Middle Cerebral Artery Stenosis: Short-term Arteriographic and Clinical Outcome

OBJECTIVE: Stent-assisted angioplasty is an effective treatment modality in the coronary and peripheral arterial disease, however, its efficacy for intracranial atherosclerotic disease has not been verified. We assess the treatment outcome of stent-assisted angioplasty for symptomatic middle cerebral artery (MCA) stenosis. METHODS: We performed stent-assisted angioplasty in 12 patients with symptomatic high-grade stenosis(>60%) on the proximal portion of the MCA, who had either recurrent transient ischemic attacks (TIAs) resistant to medical therapy or perfusion problems. Patient records were analyzed for angiographic characteristic, degree of stenosis, preprocedural regimen of antiplatelet and/or anticoagulation agents, used devices, procedure-related complications, and clinical and radiographic outcomes. RESULTS: Stent-assisted angioplasty was successfully performed in 8 patients without any serious complications. Two patients had arterial rupture. One of two patients was rescued by an additional stenting and balloon tamponade, and the other patient was dead. Another complications among the 2 patients included thrombotic occlusion and distal thrombosis. Residual stenosis was less than 50% in diameter in all the patients. During follow-up period (mean, 11 months), stroke attacks including TIAs did not recur in 9 of 11 patients who had experienced intractable TIAs or strokes. All of 8 patients who underwent follow-up cerebral angiography had no restenosis. CONCLUSION: Stent-assisted angioplasty for refractory and symptomatic MCA stenosis is a relatively safe and effective procedure. It can be used to prevent recurrent TIAs or strokes in selected patients.