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Helg F, Colombo E, Inauen C, Höbner LM, Sebök M, Schubert T, Fierstra J, Spinello A, Wegener S, Luft AR, Kulcsar Z, Regli L, Esposito G. The Value of Non-Invasive Optimal Vessel Analysis Quantitative Magnetic Resonance Angiography for Studying Flow and Collateral Patterns in Patients with Bilateral Carotid Steno-Occlusive Disease. Brain Sci 2025; 15:211. [PMID: 40002542 PMCID: PMC11852749 DOI: 10.3390/brainsci15020211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Revised: 02/04/2025] [Accepted: 02/14/2025] [Indexed: 02/27/2025] Open
Abstract
Background/Objectives: Bilateral steno-occlusive disease of the internal carotid artery (ICA) carries an increased stroke risk with associated high morbidity and mortality. Management of these patients is often complex. In this study, we evaluate the value of non-invasive optimal vessel analysis quantitative magnetic resonance angiography (NOVA-qMRA) for studying flow and collateral patterns in patients with bilateral carotid steno-occlusive disease. Methods: Patients with bilateral ICA-stenosis ≥ 50% who received NOVA-qMRA were included in this study. The volume flow rates (VFRs) of the A2-segment of the anterior cerebral artery (A2-ACA), M1-segment of the middle cerebral artery (M1-MCA), and P2-segment of the posterior cerebral artery (P2-PCA) were analyzed. Demographic, clinical, and treatment data were collected. Results: Twenty-two patients (mean age ± SD: 68 ± 10 years) were included. Nineteen patients (86%) were symptomatic. Thirteen patients (59%) were revascularized; among them, M1-VFR was significantly lower (p-value = 0.01) on the side selected for revascularization (88 mL/min ± 53) compared to the contralateral one (130 mL/min ± 56). P2-VFR was significantly higher (p-value = 0.04) in the treated subgroup (108 mL/min ± 41) than in the non-treated one (83 mL/min ± 34). Conclusions: The present study supports the use of NOVA-qMRA to study flow and collateral patterns in patients with bilateral steno-occlusive carotid disease, especially M1- and P2-VFR. This information may be helpful for decision-making and to tailor revascularization treatment.
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Affiliation(s)
- Fiona Helg
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland; (F.H.); (E.C.); (L.M.H.); (M.S.); (J.F.); (A.S.); (L.R.)
| | - Elisa Colombo
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland; (F.H.); (E.C.); (L.M.H.); (M.S.); (J.F.); (A.S.); (L.R.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland; (S.W.); (A.R.L.)
| | - Corinne Inauen
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Lara Maria Höbner
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland; (F.H.); (E.C.); (L.M.H.); (M.S.); (J.F.); (A.S.); (L.R.)
| | - Martina Sebök
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland; (F.H.); (E.C.); (L.M.H.); (M.S.); (J.F.); (A.S.); (L.R.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland; (S.W.); (A.R.L.)
| | - Tilman Schubert
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland; (T.S.); (Z.K.)
| | - Jorn Fierstra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland; (F.H.); (E.C.); (L.M.H.); (M.S.); (J.F.); (A.S.); (L.R.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland; (S.W.); (A.R.L.)
| | - Antonio Spinello
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland; (F.H.); (E.C.); (L.M.H.); (M.S.); (J.F.); (A.S.); (L.R.)
| | - Susanne Wegener
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland; (S.W.); (A.R.L.)
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Andreas R. Luft
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland; (S.W.); (A.R.L.)
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland;
- Cereneo Center for Neurology and Rehabilitation, 6354 Vitznau, Switzerland
| | - Zsolt Kulcsar
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland; (T.S.); (Z.K.)
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland; (F.H.); (E.C.); (L.M.H.); (M.S.); (J.F.); (A.S.); (L.R.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland; (S.W.); (A.R.L.)
| | - Giuseppe Esposito
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, 8091 Zurich, Switzerland; (F.H.); (E.C.); (L.M.H.); (M.S.); (J.F.); (A.S.); (L.R.)
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland; (S.W.); (A.R.L.)
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Agarkov M, Kozlov K, Senkina E, Gornov S, Linkova N, Kechaeva E, Medvedev D, Krasichkov A, Dyatlova A, Polyakova V. Endovascular Recanalization and Carotid Stenting: The New Approach to Restore Cerebral Perfusion during Aortic Dissection. J Clin Med 2024; 13:2716. [PMID: 38731245 PMCID: PMC11084725 DOI: 10.3390/jcm13092716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/03/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024] Open
Abstract
A type A aortic dissection (TAAD) is a dangerous condition requiring emergency surgery. Due to the similarity of the symptoms of cerebral malperfusion in TAAD and the signs of ischemic stroke, a differential diagnosis of these diseases is not always available. Patients with TAAD after cerebral malperfusion can have a neurological deficit. Thrombolysis is performed in this case. It can worsen the patient's condition and increase the risk of mortality and disability. The aim of the study is to evaluate the new approach to restoring cerebral perfusion during aortic dissection. This approach includes endovascular recanalization and carotid stenting. METHODS Two clinical cases of TAAD complicated by cerebral malperfusion are described. The first patient is 73 years old and was admitted as planned to perform transcatheter aortic valve implantation (TAVI) for grade III aortic stenosis. The patient underwent transcatheter aortic valve implantation (TAVI) on the second day after admission. The second patient is 60 years old and was hospitalized by an ambulance with strong hypertension and ischemia. The surgical correction of aortic dissection was postponed until the neurological status assessment in both patients. RESULTS The surgery to correct the aorta dissection was deemed inappropriate. The carotid arteries have been reanalyzed, and cerebral perfusion has been restored in a short time in both patients. CONCLUSION Acute bilateral internal carotid occlusion is a potentially fatal TAAD outcome. Emergency endovascular recanalization and carotid stenting may be considered one of the few ways to restore cerebral perfusion.
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Affiliation(s)
- Maxim Agarkov
- Interventional Radiology Gusev Central District Hospital, 56, Moskovskaya Str., Gusev, 238051 Kaliningrad Oblast, Russia
| | - Kirill Kozlov
- Military Medical Academy of Ministry of Defense of the Russian Federation, 6, Akademica Lebedeva Str., 194044 St. Petersburg, Russia
- St. Petersburg Institute of Bioregulation and Gerontology, 3 Dynamo Ave., 197110 St. Petersburg, Russia
| | - Ekaterina Senkina
- Alexander’s Hospital, 4, Solidarnosti Ave., 193312 St. Petersburg, Russia
| | - Sergey Gornov
- The Federal Medical-Biological Agency of Russia, 30, Volocolamskoye Highway, 123182 Moscow, Russia
| | - Natalia Linkova
- St. Petersburg Institute of Bioregulation and Gerontology, 3 Dynamo Ave., 197110 St. Petersburg, Russia
- St. Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovskii Ave., 191036 St. Petersburg, Russia
| | - Elena Kechaeva
- St. Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovskii Ave., 191036 St. Petersburg, Russia
| | - Dmitrii Medvedev
- St. Petersburg Institute of Bioregulation and Gerontology, 3 Dynamo Ave., 197110 St. Petersburg, Russia
| | - Alexander Krasichkov
- Department of Radio Engineering Systems of Electrotechnical University LETI, 5F Prof. Popova Str., 197022 St. Petersburg, Russia
| | - Anastasiia Dyatlova
- St. Petersburg Institute of Bioregulation and Gerontology, 3 Dynamo Ave., 197110 St. Petersburg, Russia
- St. Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovskii Ave., 191036 St. Petersburg, Russia
| | - Victoria Polyakova
- St. Petersburg Institute of Bioregulation and Gerontology, 3 Dynamo Ave., 197110 St. Petersburg, Russia
- St. Petersburg Research Institute of Phthisiopulmonology, 2-4 Ligovskii Ave., 191036 St. Petersburg, Russia
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Fernández-Gómez M, Zitan-Saidi L, Gallo-Pineda F, Hidalgo-Barranco C, Castro-Luna G. Single vs. Multiphase Computed Tomography angiography in acute internal carotid artery occlusion: An accuracy and interobserver agreement study. Clin Imaging 2023; 102:60-64. [PMID: 37595353 DOI: 10.1016/j.clinimag.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/05/2023] [Accepted: 07/27/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVE Accurate differentiation between the intracranial and extracranial location of the acute internal carotid artery (ICA) occlusion is essential for guiding treatment decisions and mechanical thrombectomy planning. Multiphase Computed Tomography angiography (mCTA) appears to be superior to Single-phase Computed Tomography angiography (sCTA) in the evaluation of acute ICA occlusions. The main objective of our research is to study the accuracy of mCTA compared to sCTA in distinguishing isolated acute intracranial ICA occlusion from extracranial or tandem occlusion. METHODS Two observers independently analyzed sCTA and mCTA of patients with acute ICA occlusion at two different time points. The location of the occlusion was categorized as intracranial or extracranial for both imaging techniques and then compared with digital subtraction angiography (gold standard). Sensitivity and specificity rates for isolated intracranial ICA occlusion on sCTA and mCTA were calculated. Kappa statistics were used to assess interobserver agreement. RESULTS The sensitivity of sCTA and mCTA was 48.28% (28.36%-68.19%) and 79.31% (62.84%-95.78%) respectively for the diagnosis of isolated intracranial ICA occlusion, with an almost perfect interobserver agreement between both observers (p < 0.001). CONCLUSIONS Our research suggests that mCTA is more accurate than sCTA in distinguishing isolated intracranial occlusions from extracranial or tandem occlusions.
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Affiliation(s)
- Miriam Fernández-Gómez
- Interventional Neuroradiology, Radiology Department, Torrecardenas University Hospital, Almería, Spain
| | - Laila Zitan-Saidi
- Radiology Department, Torrecardenas University Hospital, Almería, Spain
| | - Félix Gallo-Pineda
- Interventional Neuroradiology, Radiology Department, Torrecardenas University Hospital, Almería, Spain.
| | - Carlos Hidalgo-Barranco
- Interventional Neuroradiology, Radiology Department, Torrecardenas University Hospital, Almería, Spain
| | - Gracia Castro-Luna
- Department of Nursing, Physiotherapy, and Medicine, University of Almeria, Spain
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Mai DT, Vu DL, Nguyen QA, Huu AN, Nguyen MA, Dao VP. Simultaneous mechanical thrombectomy for bilateral acute internal carotid artery occlusion. Radiol Case Rep 2021; 17:142-146. [PMID: 34820038 PMCID: PMC8601968 DOI: 10.1016/j.radcr.2021.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/10/2021] [Indexed: 11/01/2022] Open
Abstract
Acute bilateral internal carotid occlusion was a very rare disease with a very poor prognosis. Clinical case reports according to the literature showed that mechanical thrombectomy was the most optimal treatment. We reported a clinical case of successful treatment with simultaneous thrombectomy in both occluded carotid arteries. A 62-year-old woman was admitted at our hospital within three hours of stroke onset secondary to an acute simultaneously bilateral carotid artery occlusion. On admission, her NIHSS (National Institutes of Health Stroke Scale) was 32. Non-contrast computed tomography right after that showed hyperacute infarction lesions in both hemispheres with right inferior temporal and insular cortex (Alberta Stroke Program Early CT Score - ASPECTS 8) and left putamen (ASPECTS 9). Her medical history included paroxysmal atrial fibrillation, prior ischemic stroke, pacemaker due to sick sinus syndrome. Her pre-stroke modified Rankin Scale score was 0 that she was fully recovered from previous stroke 4 months ago thanks to successful thrombectomy of the right internal carotid arteries (ICA). This time, the patient underwent again the simultaneous bilateral mechanical thrombectomy of both occluded ICA. The complete recanalization achieved on both sides with recanalization level of TICI-3 (thrombolysis in cerebral infarction) only in 38 mins after the groin puncture. She showed dramatic recovery and was discharged on day 28 with a Rankin Scale score of 2. Mechanical thrombectomy on bilateral ICA performed simultaneously will helps shorten the reperfusion time compared to the alternative one and thus, provides a better prognosis in acute ischemic stroke.
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Affiliation(s)
- Duy Ton Mai
- Stroke Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Dang Luu Vu
- Radiology Center, Bach Mai Hospital, Hanoi, Vietnam
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