Cerebral Angiography Research Articles

Angioarchitecture of Twig-like Middle Cerebral Artery: the Looping Lenticulostriate Artery Anastomoses as an Angiographic Landmark for Hemorrhagic Presentation.

The twig-like middle cerebral artery (TL-MCA) is avascular anomaly reconstituting the MCA-M1 segment through aplexiform arterial network. Most patients with TL-MCA have ahigh risk of hemorrhage, but the associated vascular anatomical risk factors are poorly understood. To investigate the angioarchitecture of TL-MCA in detail to distinguish the radiological differences between hemorrhagic and non-hemorrhagic onset. 3214 cerebral digital subtraction angiography procedures were performed, and patients with TL-MCA were included and their clinical and anatomical characteristics were retrospectively reviewed. 12patients (median age47years, and 9women) with TL-MCA were included (incidence rate, 0.37%). Among them, four had hemorrhagic stroke, five had ischemic stroke, and three had no symptoms. Perforator anastomoses were identified in five patients (41.6%). Among the four patients with intraparenchymal hemorrhage (IPH), three had looping lenticulostriate artery (LSA) anastomoses and one had non-looping LSA anastomosis. One looping LSA anastomosis was discovered fortuitously in apatient explored for headaches. The recurrent artery of Heubner, which is responsible for the plexiform arterial network, was identified in 10patients (83.3%). Angiographic evolutions (de novo TL-MCA) were observed in three patients, and one patient experienced aclinical evolution of aTL-MCA with non-looping LSA anastomosis, progressing from no symptoms to IPH. In this small series, looping LSA anastomoses were mainly observed in TL-MCA with IPH. This anatomical disposition could represent apotential risk factor. The TL-MCA always affects the subpallial segment of the MCA-M1, and may be asubpallium-related pathology.

Anatomical Variation of Left Internal Mammary Artery and Thyrocervical Trunk: A Case Report.

We report a rare case of a left internal mammary artery (LIMA) originating from the left thyrocervical trunk (TCT), which arose directly from the aortic arch. A patient in their 70s presented with bilateral distal internal carotid artery aneurysms, diagnosed through computed tomography angiography performed for headache evaluation. Transfemoral cerebral angiography confirmed the aneurysms and incidentally revealed the anomalous origins of the TCT and LIMA, as well as a left vertebral artery directly arising from the aortic arch. This case emphasizes the importance of recognizing such rare anatomical variations prior to diagnostic or interventional procedures. Thorough preoperative evaluation is critical to avoid complications, particularly in coronary artery bypass grafting and head and neck tumor embolization.

Crescent-shaped intracranial hemorrhage in cerebral venous sinus thrombosis: A case report and review of literature

Cerebral venous sinus thrombosis (CVST) is a rare but serious condition involving blood clots in the cerebral venous system often linked to prothrombotic states. It can result in complications such as intracranial hemorrhage and neurological deficits. We present the case of a 16-year-old female with CVST affecting the superior sagittal sinus, who experienced severe headaches and seizures. Initial computed tomography imaging showed a hematoma in the right frontal lobe, suggesting sinus and cortical vein thrombosis. Magnetic resonance imaging, magnetic resonance angiography, and magnetic resonance venography confirmed subacute hemorrhage with perifocal edema, and cerebral angiography validated the diagnosis. Elevated D-dimer levels supported the findings. The patient was treated with fondaparinux and later transitioned to oral warfarin, leading to clinical improvement and reduced D-dimer levels within a week. This case highlights the importance of early diagnosis and anticoagulation therapy, even in hemorrhagic cases, to prevent long-term complications and emphasizes the need for awareness of CVST in similar scenarios.

Navigating the Surgical Landscape of Recurrent Carotid Body Tumors: Insights from a Case with Review of Literature

Carotid body tumors (CBTs) are rare neuroendocrine neoplasms originating from chemoreceptive paraganglia at the carotid bifurcation. While most CBTs are benign and slow-growing, recurrence after surgical resection can present significant clinical challenges due to altered anatomy and neurovascular involvement. This case report details the management of a 31-year-old woman with a left sided recurrent carotid body tumour (rCBT) – Shamblin III type. Preoperative imaging, including ultrasound, cerebral angiography, and contrast-enhanced computed tomography, confirmed the presence of a mass encasing the carotid vessels. Surgical resection was performed, requiring carotid artery reconstruction with an autologous great saphenous vein graft. The patient recovered without neurological deficits, underscoring the importance of meticulous surgical planning and vascular reconstruction in recurrent cases.

Utility of Computed Tomography Angiography of the Head in the Management of the Blunt Trauma Patient with Intracranial Hemorrhage.

Computed tomography angiography of the head (CTAH) is not routinely obtained during the initial evaluation of patients with traumatic intracranial hemorrhage (ICH); however, it is useful for diagnosing vascular pathologies that may have led to the bleed. The aims of this study were to identify traumatic ICH patient characteristics on presentation that are associated with positive CTAH findings to elucidate which ones should prompt a CTAH and compare outcomes of patients with positive and negative CTAH findings. This is a retrospective cohort study of 522 patients who had blunt traumatic ICH and subsequently received CTAH between January 1, 2017, and January 1, 2022. Patients were then sorted into two cohorts: positive and negative CTAH findings. The CTAH findings were our primary outcomes and included a spectrum of traumatic vascular injuries as well as nontraumatic vascular pathologies. Secondary outcomes included mortality, intensive care unit admission, intensive care unit length of stay, and neurological intervention rates. A total of 108 patients (20.7%) had positive CTAH findings. Patients with positive CTAH findings were more likely to be older, have lower heart rate, have more neurological deficits at admission, have fewer signs of external injury, and have increased need for cerebral angiogram and neuro-embolization. Patients with no pathologic CTAH findings were 3.9 times more likely to be alive at discharge. Initial heart rate and presence of neurological deficits on arrival were found to be independent predictors of positive CTAH findings. Empiric CTAH is not necessary in all traumatic ICH patients. However, given the increased rates of neurologic procedures and mortality in patients with positive findings on CTAH, we recommend obtaining CTAH in blunt traumatic ICH patients who present with neurological deficits. The presence of external injuries alone should not influence the clinician's decision to obtain a CTAH. Prognostic and Epidemiological; Level III.

Exploring Mixed Reality for Patient Education in Cerebral Angiograms: A Pilot Study.

Cerebral aneurysms (CAs) affect 3-5% of the general population, with saccular aneurysms being the most common type. Despite advances in treatment, patient understanding of CAs and associated procedures remains limited, impacting informed consent and treatment outcomes. This pilot study aims to evaluate the effectiveness of mixed reality (MR) technology in enhancing patient education and understanding of cerebral angiograms and aneurysm treatment, thereby improving the patient-surgeon communication process. A non-randomized single-center prospective study was conducted with 16 patients diagnosed with intracranial aneurysms. Participants used a Microsoft HoloLens to view an interactive 3D presentation about cerebral angiograms and aneurysm treatments. Pre- and post-intervention surveys assessed their knowledge and anxiety levels using a 5-point Likert scale. The Wilcoxon signed-rank test was used for statistical analysis. Post-intervention, the total survey scores improved significantly (average increase of 6.7 points, p<0.05). Seven out of eight survey questions showed significant knowledge improvement. The mean perceived ability to explain aneurysm treatment improved by 1.38 points and understanding of access points for procedures increased by 1.31 points (both p<0.05). The question regarding understanding of treatment risks did not show significant change (p>0.05). Anxiety levels decreased, with 75% of participants reporting reduced anxiety post-intervention. MR technology significantly enhances patient understanding and reduces anxiety regarding cerebral angiogram procedures and aneurysm treatments. These findings support the integration of MR in patient education to improve clinical outcomes and patient satisfaction. This approach offers a promising direction for future healthcare communication strategies, especially in complex procedures requiring detailed patient comprehension.

Ischemic Stroke in a Child with Sickle Cell Anemia, Patent Foramen Ovale and Moya-Moya Syndrome: The Challenges of Implementing a Secondary Prevention Strategy

Strokes, traditionally regarded as conditions affecting adults, can also occur in the pediatric population, where their rarity often delays diagnosis. This report describes the case of a seven-year-old boy with sickle cell anemia who was admitted with left-sided motor deficits. The patient had been febrile and recumbent the previous day. Laboratory tests revealed severe anemia (hemoglobin 6.7 g/dL). During hospitalization, a transthoracic echocardiogram identified a patent foramen ovale (PFO) with left-to-right atrial flow and dilation of the left heart chambers. Brain imaging revealed lesions in the vascular border zones, while cerebral angiography confirmed severe stenosis in the internal carotid artery and a Moyamoya pattern. Following an etiological investigation, the symptoms were attributed to an ischemic stroke. Empirical antimicrobial therapy, blood transfusions, and antiplatelet therapy were initiated. Two potential mechanisms for the stroke were identified: PFO and Moya-Moya syndrome (MMS). The coexistence of these rare conditions in a pediatric patient presented unique diagnostic and therapeutic challenges. MMS was considered the primary cause of the stroke due to characteristic imaging findings and the patient’s history of sickle cell anemia. This case highlights the complexities of managing pediatric strokes with dual pathologies and the importance of a multidisciplinary approach. It advances clinical understanding by demonstrating how PFO complicates secondary prevention in MMS and emphasizes the need for individualized treatment strategies and long-term follow-up to optimize outcomes.

The Relationship Between Tortuosity and Stenosis of Extracranial Internal Carotid Arteries and Vertebral Arteries Based on Cerebral Digital Subtraction Angiography and Vascular Risk Factors at Pelni Hospital

Background and purpose: Vascular dysfunction is the main key to cardiovascular, cerebrovascular, neurodegenerative diseases, and the aging process causes disruption of blood vessel function. Vascular Tortuosity (VT) and stenosis are types of blood vessel deformities resulting from vascular dysfunction. Both conditions can be diagnosed through cerebral Digital Subtraction Angiography (DSA) examination. This study aims to analyze the relationship between tortuosity and stenosis of extracranial internal carotid arteries and vertebral arteries on vascular risk factors at Pelni Hospital. Methode: This research was a descriptive observational study with a cross-sectional approach on 608 subjects with a history of stroke who met the inclusion criteria. Conducted from January to September 2024, analyzing demographic data and risk factors, the presence or absence of stenosis and Vascular Tortuosity through cerebral DSA, also correlation these factors. Result: From the 608 patients, 334 (54.9%) were male and 274 (45.1%) were female. Most of the subjects were aged 41-59 years (31.1%) with the most common risk factor being hypertension (76.6%). Carotid stenosis was significantly associated with age 51-59 years [odds ratio (OR): 2.452, 95% confidence interval (CI): 1.102-2.481, p=0.031)], female gender (OR): 1.665, 95% CI: 1.102-2.481, p=0.015; and hypertension (OR): 1.761, 95% CI: 1.099-2.821, p=0.019. Vertebral stenosis was significantly associated with female gender (OR): 2.160, 95% CI: 1.176-3.968, p=0.013; and diabetes (OR): 2.079, 95% CI: 1.015-4.255, p=0.045. Both stenosis conditions were significantly correlated with tortuosity conditions with OR: 2.320 for carotid, and OR: 12.090 for vertebral. Carotid tortuosity was significantly associated with diabetes (OR): 2.049, 95% CI: 1.051-4.000, p=0.035. Vertebral tortuosity was significantly associated with dyslipidemia (OR): 2.710, 95% CI: 1.099-6.711, p=0.030 and hypertension (OR): 2.079, 95% CI: 1.234-3.496, p=0.006. The combination of carotid stenosis and tortuosity was significantly associated with female gender (OR): 2.367, 95% CI: 1.378-4.066, p=0.002. The combination of stenosis and tortuosity in both arteries did not show a significant correlation with existing risk factors. Conclusion: Carotid stenosis is correlated with female gender, age, and hypertension. Vertebral stenosis is correlated with female gender and diabetes. Carotid tortuosity is correlated with diabetes. Vertebral tortuosity correlates with dyslipidemia and hypertension. The combination of carotid stenosis and tortuosity correlates with female gender. Keywords: Vascular Tortuosity, Stenosis, Cerebral Digital Subtraction Angiography

Clinical characteristics and predictive factors of thrombotic complications in children with acute mastoiditis: a single center retrospective study.

Among acute mastoiditis (AM) complications, cerebral venous sinus thrombosis (CVST) is particularly severe, leading to increased intracranial pressure and potential neurological sequelae. Predicting the development of such complications is challenging. The aims of the present study were to evaluate the incidence, clinical characteristics, and risk factors for the development of CVST in AM. A retrospective study was conducted on children hospitalized with AM at the Meyer Children's Hospital between 2016 and 2024. Patients were divided into two groups: those with CVST (group A) and those without (group B), comparing demographic, clinical, and laboratory data. CVST was diagnosed using computed tomography (CT) and cerebral magnetic resonance angiography (MRA). To identify predictors of CVST complications, univariate and bivariate binary regression models were used. Out of 100 patients with AM, 15 (15%) developed CVST. Patients with CVST more frequently presented with fever, neurological symptoms (headache, vomiting), elevated CRP, and white blood cell counts compared to those who did not (p < 0.001, p < 0.001, p < 0.001, and p = 0.001, respectively). Streptococcus pyogenes and Streptococcus pneumoniae were more commonly encountered in patients with thrombotic complications (p = 0.024 and p = 0.05). Multivariate regression identified white blood cell (WBC) count and elevated C-reactive protein (CRP) as independent predictors of CVST in AM patients (OR: 1.14, 95% CI: 1.03-1.26, and OR: 1.10, 95% CI 1.00-1.21, p = 0.010 and p = 0.049, respectively). Conclusions: CVST is a frequent and serious complication of AM. Neurological symptoms and systemic inflammation (WBC count and CRP) are predictive indicators of CVST. Further studies are needed to develop risk algorithms for early diagnosis and to reduce sequelae. What is known: • Cerebral venous sinus thrombosis (CVST) are severe complications of acute mastoiditis, potentially leading to neurologic sequelae What is new: • An elevated inflammatory burden, namely a high C-reactive protein level and white blood cell count predict thrombotic complications in children with acute mastoiditis.

Risk prediction for elderly cognitive impairment by radiomic and morphological quantification analysis based on a cerebral MRA imaging cohort.

To establish morphological and radiomic models for early prediction of cognitive impairment associated with cerebrovascular disease (CI-CVD) in an elderly cohort based on cerebral magnetic resonance angiography (MRA). One-hundred four patients with CI-CVD and 107 control subjects were retrospectively recruited from the 14-year elderly MRA cohort, and 63 subjects were enrolled for external validation. Automated quantitative analysis was applied to analyse the morphological features, including the stenosis score, length, relative length, twisted angle, and maximum deviation of cerebral arteries. Clinical and morphological risk factors were screened using univariate logistic regression. Radiomic features were extracted via least absolute shrinkage and selection operator (LASSO) regression. The predictive models of CI-CVD were established in the training set and verified in the external testing set. A history of stroke was demonstrated to be a clinical risk factor (OR 2.796, 1.359-5.751). Stenosis ≥ 50% in the right middle cerebral artery (RMCA) and left posterior cerebral artery (LPCA), maximum deviation of the left internal carotid artery (LICA), and twisted angles of the right internal carotid artery (RICA) and LICA were identified as morphological risk factors, with ORs of 4.522 (1.237-16.523), 2.851 (1.438-5.652), 1.373 (1.136-1.661), 0.981 (0.966-0.997) and 0.976 (0.958-0.994), respectively. Overall, 33 radiomic features were screened as risk factors. The clinical-morphological-radiomic model demonstrated optimal performance, with an AUC of 0.883 (0.838-0.928) in the training set and 0.843 (0.743-0.943) in the external testing set. Radiomics features combined with morphological indicators of cerebral arteries were effective indicators for early signs of CI-CVD in elderly individuals. Question The relationship between morphological features of cerebral arteries and cognitive impairment associated with cerebrovascular disease (CI-CVD) deserves to be explored. Findings The multipredictor model combining with stroke history, vascular morphological indicators and radiomic features of cerebral arteries demonstrated optimal performance for the early warning of CI-CVD. Clinical relevance Stenosis percentage and tortuosity score of the cerebral arteries are important risk factors for cognitive impairment. The radiomic features combined with morphological quantification analysis based on cerebral MRA provide higher predictive performance of CI-CVD.

The clinical impact of recent amphetamine exposure in aneurysmal subarachnoid hemorrhage patients.

Amphetamines possess sympathomimetic properties that can affect cerebral vasculature though conflicting reports exist about their effect on vasospasm risk and clinical outcomes in aneurysmal subarachnoid hemorrhage. This study aimed to characterize the impact of recent amphetamine use on vasospasm development in aneurysmal subarachnoid hemorrhage as well as neurological outcomes. We retrospectively screened 441 consecutive patients admitted with a diagnosis of subarachnoid hemorrhage who underwent at least one cerebral digital subtraction angiogram. Patients were excluded if no urinary toxicology screen was performed within 24 h of admission, if there was a diagnosis of non-aneurysmal subarachnoid hemorrhage, or if ictus was greater than 72 h from hospital admission. Vasospasm characteristics were collected from digital subtraction angiography and transcranial Doppler studies. 129 patients were included and 24 tested positive for amphetamines on urine drug screen. No significant differences were found in respect to patient age, sex, or admission clinical severity scales (Hunt-Hess and modified Fisher) based on amphetamine use. There was no difference in the severity of vasospasm or time to peak severity based on recent amphetamine use. A trend toward more isolated posterior circulation vasospasm was observed in the amphetamine present group (16.7% vs. 4.8%, p = 0.06), while there was higher incidence of anterior circulation vasospasm in the amphetamine absent group (79.2% vs. 94.3%, p = 0.03). There was no difference in delayed cerebral ischemia incidence, length of hospital stay, need for ventriculoperitoneal shunt placement, functional outcome at discharge or hospital mortality based on amphetamine use. Recent amphetamine use was not associated with worse vasospasm severity or delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage patients. Further investigations about localized effects in the posterior circulation and impact on long-term functional outcomes are warranted.

The method described by Czosnyka is particularly suitable for measuring CPPe in patients undergoing cerebral angiography.

The primary objective of this study was to estimate the effective cerebral perfusion pressure (CPPe), critical closing pressure (CrCP), and resistance-area product (RAP) of the intravascular common carotid artery using three different methods. These estimates were then compared to the reference method of linear regression (LR). In our previous study, we employed linear regression to evaluate the values of CrCP and RAP. To assess the consistency of results obtained from alternative assessment methods (CPPe, CrCP, and RAP) with the linear regression LR, we conducted a secondary analysis of the previously collected data. We estimated the CPPe, CrCP, and RAP of the intravascular common carotid artery using three different methods: Belford's method (mean/diastolic pressure), Czosnyka's method (systolic/diastolic pressure, CZO), and Schmidt's method (systolic/diastolic pressure, SCH), and compared these estimates with LR. CPPe is calculated as the difference between mean arterial pressure and CrCP. The primary outcome was the mean differences and biases between CPPe, CrCP, and RAP of intravascular common carotid artery, the secondary outcome was correlations and agreement among these various estimates of CPPe measurements. Nineteen patients were included in this analysis. The median age was 53.5 ± 11.6 years, with 73.7% being men. There were no significant differences in CPPe, RAP and CrCP between the right common carotid artery (RCCA) and the left common carotid artery (LCCA) by using three different methods. Compared to the LR, the mean differences in CPPe and CrCP values were no significant for LCCA according to SCH, CZO and BEL method. But for RAP, the three methods are different in terms of mean differences compared with the LR. CPPe and CrCP revealed a small mean bias compared CPPCZO with CPPLR. Comparing CPPLR measurements with CPPBEL, the mean bias was higher with wider LoA. BEL and CZO showed a strong correlation with LR in Pearson correlation coefficients. The CPPe, CrCP, and RAP values obtained using the CZO calculation methods are comparable to those measured using the reference method. These findings may provide valuable insights for patients undergoing digital subtraction brain angiography, aiding in the determination of the most suitable approach for individualized blood pressure management.

Hemodynamic evaluation of symptomatic and asymptomatic intracranial atherosclerotic stenosis using cerebral angiographic images: an exploratory study

BackgroundPrevious studies suggest that it may be inappropriate to determine treatment strategies solely based on the degree of stenosis for patients with intracranial atherosclerotic stenosis (ICAS). In order to better...

Research on predicting radiographic exposure time in imaging based on neural network prediction models.

To explore the anatomical and clinical factors that affect the radiographic exposure time in radial artery cerebral angiography and to establish a model. A total of 210 patients who underwent radial artery cerebral angiography at this center from September 2021 to May 2022 were selected, and their anatomical and clinical factors were analyzed to evaluate the correlation between these factors and the duration of radiographic exposure. A related neural network prediction model was established. (1) Hypertension (p = 0.014), the presence of a double subclavian innominate artery curve (p＜0.001) and a proximal left common carotid artery loop (p = 0.014) increased the fluoroscopy time. (2) Age (p = 0.002), diameter of the aortic arch (p < 0.001), width of the innominate artery (brachiocephalic artery) (p < 0.001), and angle between the innominate artery and aortic arch (p = 0.042) were positively correlated with the fluoroscopy time. (3) The length of the innominate artery was negatively correlated with the fluoroscopy time (p = 0.024). (4) The accuracy of the neural network model was 80.0 % with the training set and 76.9 % with the test set, indicating a relatively high prediction accuracy. The ROC curve analysis showed an area under the curve (AUC) of 0.821, indicating its good predictive performance. Age, hypertension, double curvature of the subclavian and innominate arteries, proximal left common carotid artery loop, diameter of the aortic arch, width and length of the innominate artery, and angle between the innominate artery and aortic arch can affect the fluoroscopy time for cerebral angiography in TRA.

The impact of access site on procedure time and post-anesthesia care unit (PACU) time in patients undergoing outpatient diagnostic angiograms: A propensity-score matched analysis stratified by body mass index.

Body mass index (BMI) is a modifiable risk factor that has been shown to affect outcomes in neurointervention. The impact of BMI on choice of access site (transradial access (TRA) or transfemoral access (TFA), remains undescribed to our knowledge. Our study analyzes outcomes of TRA and TFA stratified by BMI in patients undergoing diagnostic cerebral angiograms in an outpatient setting. This was a retrospective analysis of a prospectively maintained database of patients who underwent diagnostic cerebral angiograms at a single institution from January 2018-2024. Propensity scores were calculated using a 1:1 optimal match method based on significant covariates derived from a logistic regression model. Patients were grouped into 2 cohorts based on access site (TRA and TFA) and stratified into BMI subgroups: (underweight (BMI <18.5), normal weight (BMI 18.5-25.0), overweight (BMI 25.0-29.9) and obese (BMI >30). Linear regression analysis and chi-square test was used to compare procedure time and post-anesthesia care unit (PACU) time across cohorts. 678 patients were grouped into 2 cohorts (TRA and TFA) of 339 each. The average age of the cohort was 58 years, and 82.4 % was female. TRA significantly shortened procedure times in patients across normal and overweight subgroups of BMI compared to TFA. TRA shortened PACU times across all BMI subgroups compared to TFA. There was no significant association between access site complications or post-operative complications for TRA or TRF across BMI subgroups. TRA is a safe and feasible alternative to TFA in certain subgroups of patients undergoing elective diagnostic angiogram in the outpatient setting. This is evidenced by shorter procedure time across certain BMI subgroups and shorter recovery time in the PACU across all BMI subgroups.

Multidetector computed tomography angiography for diagnosis of traumatic aneurysms associated with penetrating head injuries.

To analyze the diagnostic efficacy of computed tomography angiography compared to digital cerebral angiography for the diagnosis of traumatic aneurysms (TAs) associated with combat-related penetrating head injuries and propose the most suitable angiography protocol in this clinical context. A retrospective analysis was conducted on patients admitted to the neurosurgical clinic for penetrating traumatic brain injuries between February, 2022 and July, 2024, for whom both cerebral multidetector computed tomography angiography (MCTA) and digital cerebral angiography (DCA) were available. The inclusion were patients (1) with penetrating head injuries, (2) with missile trajectory traverses through the Sylvian or great longitudinal fissure, (3) basal cisterns with/or major subarachnoid hemorrhage. The sensitivity, specificity, positive predictive value, and negative predictive value of MCTA were calculated. DCA was considered as the gold standard of diagnosis. The sensitivity, specificity, positive predictive value, and negative predictive value of MCTA were calculated. Descriptive statistics and nonparametric statistics were used to analyze the study results and their differences, respectively. A total of 40 patients with 45TAs were included in the study. Of these, 26 patients (65.0%) were found to have aneurysms on MCTA. The median diameter of the aneurysms diagnosed by MCTA was 4.9 (3.6, 4.8) mm (range of 2.5-10.4mm). However, the mean diameter of TAs not detected by MCTA but diagnosed by DCA was (3.0±1.3) mm (range of 1.3-4.9mm). MCTA demonstrated sensitivity and specificity of 35.5% and 99.5%, respectively, with positive and negative predictive values of 92.3% and 90.7%. A low sensitivity of MCTA for the diagnosis of TAs associated with combat-related penetrating head injuries was reported. When MCTA is inconclusive in the setting of radiologic predictors of cerebral artery injury, DSA may be required.

Anatomical study of variations in the configurations of the circle of Willis in relation to age, sex, and diameters of the components.

The circle of Willis (COW) refers to the anastomotic arterial network found on the brain base, tasked with provision of collateral circulation aimed at prevention of ischemia. The COW is of immense clinical importance especially with regard to the assessment of neurovascular diseases. Individuals portray significant variations in the COW's anatomical configuration. The present study seeks to evaluate the existing anatomical variations of the COW and within the anterior and posterior segments of the COW. Thus, the study seeks to evaluate the different anatomical variations of the COW and its segments and components within the study population. To attain the set objectives, the present study has utilized the angiographic images for studying the COW variants in patients who underwent cerebral angiography during assessment of different types of cerebral anomalies and conditions. Therefore, this study used conventional angiography as an important tool in the evaluation of the different variations in the COW, and is most appropriate for evaluation of smaller anatomical variations owing to its perfect spatial resolution and portrayal of COW anatomy. The study findings indicated the existence between age and sex, and anatomical variations of the COW, particularly with regard to diameters of COW components like basilar artery (BA), P1, and internal carotid arterys (ICAs). Males had bigger BA, P1 and ICA diameters than females, while individuals aged below 40 years had bigger BA, A1, posterior communicating artery, and ICA diameters than those aged above 40 years.

Incidental Findings on Whole-Body Computed Tomography Angiography in Patients With Suspected Acute Stroke.

Introduction Whole-body computed tomography angiography (CTA) may be useful during cerebral angiography and endovascular treatment (EVT), and identification of thrombi and malignant trunk tumors may be helpful in stroke typing and acute stroke care. Therefore, we aimed to assess the types and prevalence of incidental findings on whole-body CTA in this patient population. Methods This single-center, retrospective, observational study included consecutive patients with suspected acute stroke who underwent whole-body CTA in addition to brain CTA between April 2020 and August 2023. Whole-body CTA findings, including vascular lesions, malignancies, and thrombi, were retrospectively collected from medical records and radiology reports. We analyzed data from 290 patients (167 with ischemic stroke, 53 with subarachnoid hemorrhage, 38 with hemorrhagic stroke, and 32 with non-stroke). Results The median age was 76.0 years, and the median National Institutes of Health Stroke Scale score on admission was 10. One hundred twenty-three patients (42.4%) underwent digital subtraction angiography (DSA). Of the 38 whole-body CTA findings for patients with suspected acute stroke, 19 were vascular lesions, seven were malignancies, and 12 were thrombi. Conclusion These findings show that malignancy and thrombosis, in addition to vascular lesions, can be detected when whole-body CTA is performed in patients with suspected acute stroke.

High-resolution vessel wall MRI in Moyamoya disease: a systematic review and meta-analysis of diagnostic and prognostic applications.

Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by the narrowing of arteries at the brain's base. While cerebral angiography is the gold standard for diagnosis, high-resolution vessel wall magnetic resonance imaging (VW-MRI) has recently emerged as a non-invasive diagnostic tool. This systematic review aims to provide insights into the role of VW-MRI in enhancing the diagnosis and management of MMD. A systematic search was conducted in PubMed, Embase, Scopus, and Web of Science for relevant articles on December 5, 2023. Demographic data, the outer diameter of the vessel, vessel wall contrast enhancement (VW-CE) and its pattern, vessel wall thickening and its pattern, remodeling index, and vessel area were extracted. In the analysis proportions were pooled using a random-effects model with logit transformation where applicable. Quality assessment was conducted using the Newcastle-Ottawa scale. Of the 6035 identified studies in the primary search, 19 met the inclusion criteria. Among the reviewed studies, the most commonly reported variations in patients with MMD using VW-MRI was VW-CE (84.21%) and its pattern (52.63%). The pooled prevalence of enhanced lesions in MMD was 0.55 (95% CI: 0.29-0.79), with ratio of concentric lesions being 0.98 (95% CI: 0.72-1.00, I²: 37%). The remodeling index across three studies showed a pooled estimate of 0.41 (95% CI: 0.11-0.72, I²: 99%). VW-MRI emerges as a promising non-invasive tool for enhancing diagnosis of MMD, potentially aiding in disease differentiation and predicting complications. However, standardization and further research are essential to solidify VW-MRI's role.

In the era of transition from fiction to reality: Robotic-assisted neurointervention-a systematic review and meta-analysis.

In recent years, the application of robotic assistance in diagnostic and therapeutic endovascular neurointerventional procedures has gained notable attention. In this systematic review and meta-analysis, we aim to evaluate the feasibility, safety, and current indications of robotic-assisted neurointerventions and to assess the degree of robotic assistance and reasons for unplanned manual conversion from robotic assistance. We searched Medline, Scopus, Web of Science, and Cochrane Library databases following PRISMA guidelines and included studies with ≥ 4 patients reporting on robotic-assisted neurointerventions. We analyzed outcomes including technical success, manual conversion, procedure-related complications, morbidity, and mortality with a random-effects meta-analysis. We also identified causes of manual conversion and conducted subanalyses by procedure type and robotic system. Thirteen studies, comprising 538 robotic-assisted neurointerventions, were included. Procedures were primarily diagnostic cerebral angiograms (n = 348), cerebral aneurysm embolizations (n = 127), and carotid artery stenting (n = 37). The CorPath GRX (Corindus) robotic system was employed in the majority of cases (n = 355). Across all studies, the technical success rate was 93%, and the procedure-related complication rate was 0.7%. Manual steps were necessary in all cases due to inherent procedural requirements. Unplanned manual conversion from robotic assistance was necessary in 7% of cases. Further analysis of failures identified challenging anatomies, loss of working length, and mechanical failures as the most common reasons. This systematic review and meta-analysis found that, with a certain degree of manual assistance, robotic-assisted neurointervention is highly feasible, safe, and capable of performing DCA, CAS, and therapeutic neurointerventions that can be executed with a single microcatheter involving simple coiling, stent-assisted coiling, and flow diverter embolization. However, unplanned manual conversion is not uncommon. Improvements in working length and mechanical parts, including the cassette robotic arm and console, as well as CorPath GRX compatibility with 0.035-inch wires, may reduce the rates of manual conversion for current indications. Nonetheless, technical adaptations are essential to broaden the scope of therapeutic neurointervention indications.