Vessel territory mapping after cerebral revascularization surgery using selective angiographic flat detector perfusion imaging.

Annelies Mondelaers,Laetitia Yperzeele,Maurits Voormolen,Thijs Van Der Zijden,Tomas Menovsky

doi:10.31083/j.jin.2021.01.359

Abstract

The technical feasibility and diagnostic potential of angiographic flat-detector perfusion imaging technique, combining digital subtraction angiography with a flat-detector computed tomography steady-state perfusion imaging, was explored in patients treated with direct or indirect revascularization surgery. This short communication is about an imaging modality with great potential for evaluation, comparison and grading of vascular perfusion territory areas and anatomical location selectively perfused by direct and indirect cerebral bypasses.

Highlights

Direct and indirect extracranial (EC)-intracranial (IC) revascularization surgery is an important treatment option for specific cerebrovascular conditions
In contrast to conventional perfusion imaging techniques, this examination can be performed of the entire brain and through selective contrast injection in the bypassed artery or ipsilateral external carotid artery. This allows an exact delineation of the bypass supply area and its volume compared to the total brain volume
Selective contrast injection in bypass arteries or external carotid artery in case of burr holes was done by 4 French diagnostic catheters, using 4 mL contrast medium (Iomeron® 300, Bracco) mixed with 16 mL saline, injected at a rate of 2 mL/s injection rate

Summary

Introduction

Direct and indirect extracranial (EC)-intracranial (IC) revascularization surgery is an important treatment option for specific cerebrovascular conditions. The clinical significance of this imaging modality for individual patients is somewhat limited Application of this technique in the postoperative setting allows more precise evaluation in terms of bypass patency and dynamics, in hybrid operating rooms, evaluating freshly constructed bypasses, and for comparison of different types of bypass (direct vs indirect, low vs high flow) for research purposes or clinical practice in general. This paper illustrates this technique’s technical feasibility and diagnostic potential in patients treated by direct or indirect revascularization surgery

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