Internal Carotid Artery Lesions Research Articles

Cervical ICA pseudo-occlusion on single phase CTA in patients with acute terminal ICA occlusion: what is the mechanism and can delayed CTA aid diagnosis?

BackgroundSingle-phase CT angiography (CTA) forms the basis of hyperacute stroke imaging but many patients with terminal internal carotid artery (ICA) occlusion exhibit a pseudo-occlusion of the cervical ICA whereby a...

Abstract WMP40: A Comparison of Three Different Endovascular Approaches for Extracranial Internal Carotid Artery Lesions in the Setting of Tandem Occlusions

Background: Endovascular treatment (EVT) of extracranial internal carotid artery (ICA) lesions in the setting of tandem occlusions is a challenge, being angioplasty alone (AA) or angioplasty+stenting (AS) the two current approaches. Hemorrhagic transformation (HT) is a major problem when a conventional [self-expanding (SX)] stent is placed, regarding the need of early double antiplatelet therapy. Interestingly, balloon-expanding (BX) stents, due to their less thrombogenicity, may constitute an alternative, so they do not need early antiplatelets. We aimed to study differences in ICA restenosis, HT, clinical outcome and stroke recurrence between patients treated with AA or AS. Methods: Prospective study of consecutive patients with non-cardioembolic ischemic stroke and tandem occlusions, who underwent <6hours EVT from April 2013 to April 2017. We compared rate of ICA high-degree stenosis/occlusion at 24h, HT, clinical outcome (change in NIHSS at 24h and at discharge over NIHSS at admission, and mRS≥2 at 3 months) and stroke recurrence within 3 months between AA and AS (SX and BX stents) groups. Results: Ninety-two patients fulfilled inclusion criteria: mean age 64.6±12.6 years. Forty (43.5%) received AA and 52 (56.5%) AS (61.5% SX stents, 38.5% BX stents). Both groups were comparable in baseline characteristics. Fifty (54.3%) received IV rtPA. Patients who underwent AA presented ICA high-degree stenosis/occlusion at 24h more frequently than those who underwent AS (86.5% vs. 21.2%, p <0.001). No differences were found in HT, clinical outcome and stroke recurrence ( p >0.05 for all comparisons). In the AS group, all SX stents received antiplatelets after EVT, whereas in 75% of cases in the BX group no antiplatelets were started within 24h. However, no differences were found in ICA high-degree stenosis /occlusion at 24h, clinical outcome and stroke recurrence ( p >0.05). We neither found differences in HT. Nevertheless, all cases were asymptomatic in the BX stents group. Conclusions: Emergent ICA stenting seems to have a lower risk of restenosis compared to AA, without a significant increase of HT and stroke recurrence or a worse clinical outcome. BX stents, without early antiplatelet therapy, are a promising alternative to conventional carotid stents.

Cerebral atherosclerosis: a biomarker profile

To assess the changes in several biomarkers in patients with atherosclerosis of brachiocephalic arteries and shape a biomarker profile of cerebral atherosclerosis as an integrative index. The study included 124 patients with atherosclerotic lesions of internal carotid arteries (82 men and 42 women) aged from 37 to 73 years. The patients were stratified by history of prior stroke into 'asymptomatic' and 'symptomatic'. Along with general clinical and neurological examinations, ultrasound analysis of brachiocephalic arteries, neuroimaging, identification of biomarkers reflecting different stages of atherogenesis and evaluation of pathomorphological parameters of atherosclerotic plaques removed during carotid endarterectomy surgery were performed. Concentrations of NO2, NO3 and NO in blood plasma significantly differed between groups: 58.4, 43.3 and 15 mcmol/l, respectively, in the symptomatic group and 45, 19.2 and 25.8 mcmol/l in the asymptomatic group. The pro-inflammatory character of changes in atherosclerosis was confirmed by the increase in the concentration of lipoprotein-associated phospholipase A2 in patients with stroke (354.72±44.16 ng/ml versus 298.45±54.12 ng/ml). The level of the atheroprotective marker adiponectin decreased significantly in 'symptomatic' patients. Significant changes towards the prothrombotic state of blood were identified via levels of blood markers of fibrinolytic activity: plasminogen tissue activator and plasminogen activator inhibitor-1. Together with other diagnostic methods, identification of biomarkers can increase the accuracy of prognosis and prevention of sudden cardiovascular death. The authors have developed a scale of biomarker 'burdeness' of the patient with cerebral atherosclerosis that may be a first step to individualized prevention of associated ischemic complications.

Клинические особенности глазного ишемического синдрома при атеросклеротических поражениях внутренней сонной артерии

Клинические особенности глазного ишемического синдрома при атеросклеротических поражениях внутренней сонной артерии

In-hospital outcomes of carotid endarterectomy depending on severity of contralateral lesion

To compare in-hospital outcomes of carotid endarterectomy (CEE) in patients with different lesion of contralateral internal carotid artery (ICA). There were 730 CEE procedures in patients with bilateral ICA lesion for the period 2011-2016. All patients were divided into 4 groups depending on contralateral ICA stenosis grade: group 1 - stenosis up to 60% (42.6%, n=311); group 2 - 60-90% (18.7%, n=137); group 3 - 90-99% (25.9%, n=189); group 4 - occlusion (12.7%, n=93). Endpoints were unfavorable cardiovascular events including death, myocardial infarction (MI), stroke/TIA, significant hemorrhage by BARC scale (Bleeding Academic Research Consortium). In-hospital mortality and incidence of MI, stroke/TIA were similar in all groups. However, there were no cardiovascular complications in patients with critical contralateral stenosis or occlusion. Bleeding followed by redo surgery was the most frequent complication. Overall incidence of adverse cardiovascular events did not exceed 1.23%. There was no correlation between contralateral ICA stenosis and incidence of in-hospital adverse events including death, MI, stroke/TIA. Currently, technique of CEE is well developed that is associated with low incidence of postoperative complications.

Spectral Signal Density of Carotid Plaque Using Dual-Energy Computed Tomography.

Plaque characterization using virtual monochromatic imaging derived from dual-energy computed tomography (CT) angiography requires the determination of normal signal density values of each plaque component. We sought to explore the signal density values of carotid plaque components using dual-energy compared to conventional single-energy CT angiography (CTA), and to establish the energy level with the largest differences between plaque components. The present prospective study involved consecutive patients referred for carotid artery evaluation by CTA. Two scans (single-energy and dual-energy CTA) were performed in all patients, and a single radiologist analyzed the data. Single-source dual-energy CTA allowed the generation of virtual monochromatic images from 40 to 140 keV. A total of 35 internal carotid artery lesions were examined in 20 symptomatic patients. The mean age was 72.3 ± 6.7 years, and 9 (45%) patients were male. Internal carotid artery geometrical variables including lumen area (P = .96), vessel area (P = .97), and percent area stenosis (P = .99) did not differ between groups (single-energy CTA, and dual-energy CTA at 40, 70, 100, and 140 keV). Differences between signal densities of different tissues were largest at 40 keV (calcium/lumen, P < .0001; fat/noncalcified, P < .0001). In the present pilot investigation, virtual monochromatic imaging at low-energy levels derived from dual-energy CTA allowed the largest differences in attenuation levels between tissues, without affecting vessel or plaque geometry.

Association between proximal internal carotid artery steno-occlusive disease and diffuse wall thickening in its petrous segment: a magnetic resonance vessel wall imaging study.

Significant stenosis or occlusion in carotid arteries may lead to diffuse wall thickening (DWT) in the arterial wall of downstream. This study aimed to investigate the correlation between proximal internal carotid artery (ICA) steno-occlusive disease and DWT in ipsilateral petrous ICA. Symptomatic patients with atherosclerotic stenosis (>0%) in proximal ICA were recruited and underwent carotid MR vessel wall imaging. The 3D motion sensitized-driven equilibrium prepared rapid gradient-echo (3D-MERGE) was acquired for characterizing the wall thickness and longitudinal extent of the lesions in petrous ICA and the distance from proximal lesion to the petrous ICA. The stenosis degree in proximal ICA was measured on the time-of-flight (TOF) images. In total, 166 carotid arteries from 125 patients (mean age 61.0±10.5years, 99 males) were eligible for final analysis and 64 showed DWT in petrous ICAs. The prevalence of severe DWT in petrous ICA was 1.4%, 5.3%, 5.9%, and 80.4% in ipsilateral proximal ICAs with stenosis category of 1%-49%, 50%-69%, 70%-99%, and total occlusion, respectively. Proximal ICA stenosis was significantly correlated with the wall thickness in petrous ICA (r=0.767, P<0.001). Logistic regression analysis showed that proximal ICA stenosis was independently associated with DWT in ipsilateral petrous ICA (odds ratio (OR)=2.459, 95% confidence interval (CI) 1.896-3.189, P<0.001]. Proximal ICA steno-occlusive disease is independently associated with DWT in ipsilateral petrous ICA.

Abstract WP139: The Correlation Between Supraorbital Artery Flow Patterns and Degree of Carotid Artery Stenosis

Objective: Patients with internal carotid artery (ICA) occlusion or severe stenosis usually have collateral via ophthalmic artery (OA). However, the relationship of blood flow patterns of OA and the degree of ICA stenosis has been rarely reported. Transcranial Doppler (TCD) is a promising modality to assess OA collateral when ICA lesion. Considered OA characteristics including tortuosity and anatomical variations, we try to evaluate the supraorbital artery (SA), the one of OA terminal branches, to analyze the relationship of flow with the degree of ICA stenosis. Materials and Methods: From Jun 2012 to Jan 2015, TCD were performed to 40 patients with ICA stenosis before and after carotid artery stenting (CAS). SA blood flow patterns were compared with the degree of ICA stenosis confirmed by conventional angiography. Results: 40 patients (29 men) were enrolled (mean age 64.9 yrs). Before CAS, the retrograde blood of SA was found in 40 patients. After stenting, the flow pattern reversed in 29 patients of these patients (29/40, 72.5%). The blood flow of SA was gradually reverse over time from angioplasty with balloon to several days after CAS. The patterns of these changes were categorized into four types: (A), flow spectrum completely reversed; (B), reverse flow spectrum associated with systolic notch; (C), flow spectrum forward at systolic and reverse at diastolic; (D), type flow spectrum entirely forward. Before balloon angioplasty (mean stenosis, 93.4%), A type was found in 39 of them, B type in 1 patient; after balloon dilatation (mean stenosis, 82.9%), 26 A types and 4 B, 5 C, 5 D types. Stent (mean stenosis, 14.9%), 1 A type, 4 B and 4 C, 29 D types. Conclusion: The flood flow patterns of SA may be associated with the degree of carotid stenosis evaluated with TCD and the blood flow may be reverse after CAS. This work was supported by the National Natural Science Foundation of China (Contractgrant number: 81471390 to N.M).

Хирургическое и эндоваскулярное лечение атеросклеротического поражения внутренней сонной артерии

Хирургическое и эндоваскулярное лечение атеросклеротического поражения внутренней сонной артерии

DYNAMICS OF HIGHGER MENTAL FUNCTION IN PATIENTS WITH OBLITERATING LESIONS OF INTERNAL CAROTID ARTERIES IN SURGICAL BRAIN REVASCUL

Obliterating atherosclerosis of internal carotid arteries is one of the main causes of ischemic stroke and discirculatory encephalopathy. It causes up to 40% of ischemic disorders of cerebral circulation. Currently, the strategy for stroke prevention is determined by the intensive development of surgical methods of treatment, primarily methods for managing lesions of brachiocephalic arteries. Based on the results of a number of international multicenter randomized studies, indications for reconstructive operations for BCA, tactics for managing patients in the postoperative period were formulated. A number of patients with atherosclerotic lesions of brachiocephalic arteries have reduced cognitive functions. The aim of the study is to compare cognitive functions (CF) in patients who underwent different surgical approaches in the treatment of obliterating atherosclerotic lesion of internal carotid arteries (ICA). MATERIAL AND METHODS. We studied higher mental functions (HMFs) in 116 patients with obliterating unilateral or bilateral lesion of ICA. The study of cognitive functions (MF) was performed prior to carotid endarterectomy (CE, group 1, n=73) and transluminal balloon angioplasty of ICAs (TBA of ICA, group 2, n=43), and on days 5–7 and 30–31 after cerebral revascularization (CR). To assess the overall severity of cognitive impairment, the summary indicators of main screening neuropsychological tests were used: MMSE; MoCA; Frontal Assessment Battery (FAB); Beck Depression Inventory and Hamilton Depression Rating Scale. RESULTS. Results Neuropsychologic disorders were reavealed in 98% of patients prior to surgery. An initially comparable condition of HMF in groups with CE and TBA of ICA was revealed. MMSE2 revealed a significant improvement in the results in group 1 both in comparison with the initial data (p 0.05). MMSE3 showed a significant improvement in the test results in each group compared to MMSE1 and MMSE2. MMSE3 results were significantly better (p 0.05)). During the second test, the depressive mood of patients was reduced (on the Hamilton scale 8.4 and 13.8 points. CONCLUSION When comparing HMFs in patients who underwent a different surgical approach (CE vs TBA of ICAs) in the treatment of obliterating atherosclerotic lesions of ICAs, we found that: 1) the maximum improvement in HMFs appears by the 30th day of the postoperative period in comparison with preoperative parameters; 2) the most significant improvement HMFs test parameters by the 30th day of the postoperative period is noted in the group where CE was used as the method of surgical revascularization of the brain.

Diagnosis and treatment of extracranial internal carotid artery lesion combined with cerebrovascular malformation

To analyze own experience of diagnosis and treatment of patients with extracranial internal carotid artery lesion and cerebrovascular malformations. There were 16 patients with combined lesion of extracranial and intracranial internal carotid artery for the period January 2013 - December 2014. Occlusive-stenotic lesion and tortuosity of ICA were observed in 11 and 5 cases respectively. Incidence of combined ICA lesion was 5.2% (16 out of 308 observations of extracranial internal carotid artery lesion). Surgical treatment was performed in 7 patients including two-stage intervention in 4 cases and simultaneous surgery in 3 cases. Mean time between neurosurgical and vascular stages was 6 months. Complications and mortality were absent. Two-stage surgical approach with intracerebral vascular malformation correction followed by extracranial ICA reconstruction may be safe and effective in patients with combined lesion of ICA. Further trials are necessary for certain conclusions.

Long-term Prognosis after Extracranial-intracranial Bypass Surgery for Symptomatic Cerebrovascular Occlusive Disease.

Prognosis after extracranial-intracranial (EC-IC) bypass surgery has only been studied for a few years and the benefits of this procedure are still controversial. In this single-center retrospective study, we examined the long-term prognosis of patients who underwent EC-IC bypass surgery. Subjects were patients with symptomatic internal carotid artery or intracranial lesion occlusive disease who underwent EC-IC bypass surgery between 1991 and 2003. Of these, long-term prognosis was examined in 57 patients (39 male, 18 female; mean age, 61.8 years) who showed good surgical outcomes 30 days after bypass surgery, measured as a 0-2 on the modified Rankin Scale (mRS). They were divided into 2 groups (survivors and non-survivors) and were analyzed to identify factors effecting long-term survival after bypass surgery. Sixteen patients (28%), whose mean follow-up period (survival time) was 8.3±3.8 years, died after the bypass surgery. The average follow-up period for the survivors was 12.0±1.1 years, which was significantly longer than that for the non-survivors (P<0.0001). At surgery, the non-survivors (mean age 71.5 years) were significantly older than the survivors (P=0.0012). Pneumonia and other respiratory diseases were a frequent cause of death (31.2%), but death by cerebrovascular disease also occurred (12.5%). The rate of recurrent ischemic stroke was 28%, with no significant difference between groups (survivors vs. non-survivors: 31.2% vs. 26.1%, P= 0.82). In the absence of perioperative complications, the long-term prognosis of patients who underwent EC-IC bypass surgery was very good.

BYPASS SURGERY IN PATIENTS WITH COMBINED ATHEROSCLEROTIC LESIONS OF COMMON AND INTERNAL CAROTID ARTERY

An analysis of data of carotid angiographies was made in 146 patients with chronic cerebrovascular disease. Combined lesions of the common and internal carotid artery with clinical signs were revealed in 2 (1,4%) patients. A crossed extraanatomic bypass from the left common carotid artery to the right internal carotid artery was performed in one patient. The orthotopic common-internal autovenous bypass on the right side was carried out for another patient. According to obtained results, the authors suggested that the orthotopic or extraanatomic common-internal carotid artery bypasses could be applied in case of impossibility of endovascular intervention, when patients had the combined atherosclerotic lesions of common carotid and internal carotid artery.

Cerebrovascular reactivity in the caudate nucleus, lentiform nucleus and thalamus in patients with carotid artery disease

To assess the effect of unilateral large vessel disease upon the cerebral hemodynamic autoregulatory status in the basal ganglia of patients with steno-occlusive internal carotid artery (ICA) disease. Twenty-five healthy volunteers and 38 patients with a unilateral symptomatic steno-occlusive ICA lesion and were investigated; 20 with a stenosis >50% and 18 with an occlusion. Cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) were assessed with pseudo-continuous arterial spin labeling (ASL) magnetic resonance (MR) imaging before and after administration of acetazolamide. When compared to controls, the CVR in patients with ICA stenosis was significantly lower in the middle cerebral artery (MCA) territory (P<0.05), and in the caudate (P<0.05) and lentiform nucleus (P<0.05) of the hemisphere ipsilateral to the stenosis. The CVR in the caudate nucleus contralateral to the stenosis was significantly lower (P<0.05) as well. In patients with ICA occlusion, the CVR in the hemisphere ipsilateral to the occlusion as well as in the contralateral hemisphere was significantly lower in the MCA territory (P<0.05), the caudate (P<0.05) and lentiform nucleus (P<0.05), and in the thalamus (P<0.05). Perfusion ASL MR imaging shows impaired cerebral hemodynamic autoregulation of the basal ganglia in patients with steno-occlusive ICA disease both in the hemisphere ipsilateral as well as in the hemisphere contralateral to the stenosis or occlusion.

Safety Outcomes Using a Proximal Protection Device in Carotid Stenting of Long Carotid Stenoses

Background: Embolic protection devices can prevent atherosclerotic emboli during carotid stenting. Newer proximal protection devices reverse flow in the internal carotid artery (ICA), leading to reduction in perioperative microemboli. The risk of stroke is high for carotid stenting of ICA lesions with a length >10 mm and/or angiographic string sign. Objective: We aimed to evaluate the safety outcomes of proximal embolic protection device usage in this high-risk group. Methods: This is a retrospective analysis of patients who underwent carotid stenting procedures with proximal embolic protection devices at a tertiary care center. High-risk features for adverse events with carotid stenting were identified. Peri- and postprocedural outcomes were recorded. We further compared outcomes in patients with a carotid stenosis length >10 mm to those with shorter stenosis. Results: From January 2011 to December 2014, we included 27 patients; 96.3% were symptomatic and 3.7% were asymptomatic. There was a stent placement technical success rate of 100%. No major stroke or coronary events were recorded. One minor stroke event developed in one patient. A carotid lesion length >10 mm and/or angiographic string sign was noted in 21/27 patients, with an average lesion length of 14.4 mm. One patient (4.8%) in this group developed a minor stroke event. Neither a coronary nor a major stroke event was recorded in this group. There was no significant difference in the complication rate between the long lesion and the control group. Conclusion: In our patient cohort, it was found that a proximal embolic protection device is safe for patients with carotid stenosis, including those with a carotid lesion length >10 mm and/or angiographic string sign.

Comparative analysis of the anterior transpetrosal approach with the endoscopic endonasal approach to the petroclival region

OBJECTIVE The endoscopic endonasal approach (EEA) offers direct access to midline skull base lesions, and the anterior transpetrosal approach (ATPA) stands out as a method for granting entry into the upper and middle clival areas. This study evaluated the feasibility of performing EEA for tumors located in the petroclival region in comparison with ATPA. METHODS On 8 embalmed cadaver heads, EEA to the petroclival region was performed utilizing a 4-mm endoscope with either 0° or 30° lenses, and an ATPA was performed under microscopic visualization. A comparison was executed based on measurements of 5 heads (10 sides). Case illustrations were utilized to demonstrate the advantages and disadvantages of EEA and ATPA when dealing with petroclival conditions. RESULTS Extradurally, EEA allows direct access to the medial petrous apex, which is limited by the petrous and paraclival internal carotid artery (ICA) segments laterally. The ATPA offers direct access to the petrous apex, which is blocked by the petrous ICA and abducens nerve inferiorly. Intradurally, the EEA allows a direct view of the areas medial to the cisternal segment of cranial nerve VI with limited lateral exposure. ATPA offers excellent access to the cistern between cranial nerves III and VIII. The quantitative analysis demonstrated that the EEA corridor could be expanded laterally with an angled drill up to 1.8 times wider than the bone window between both paraclival ICA segments. CONCLUSIONS The midline, horizontal line of the petrous ICA segment, paraclival ICA segment, and the abducens nerve are the main landmarks used to decide which approach to the petroclival region to select. The EEA is superior to the ATPA for accessing lesions medial or caudal to the abducens nerve, such as chordomas, chondrosarcomas, and midclival meningiomas. The ATPA is superior to lesions located posterior and/or lateral to the paraclival ICA segment and lesions with extension to the middle fossa and/or infratemporal fossa. The EEA and ATPA are complementary and can be used independently or in combination with each other in order to approach complex petroclival lesions.

TCTAP C-068 Complication

### Patient initials or identifier number SS ### Relevant clinical history and physical exam 85 Years old male presented with complain of recurrent TIA'SAS right hemiparesis. Carotid angiogrphy reveled 80% lesion of left internal carotid artery and 99% lesion of left external carotid artery. We

Is it possible that this patient is asymptomatic? The role of multidetector ct angiography in detection of ulcerated plaques in patients with asymptomatic carotid stenosis: Case report

Although intervention in patients with symptomatic carotid disease is generally accepted as beneficial, the management of asymptomatic disease is still controversial. We wanted to introduce and discuss treatment options in a patient with asymptomatic carotid stenosis and high embolic potential lesions of common and internal carotid artery detected by multidetector computed tomography (MDCT). A 78-year-old female patient was admitted to our institution for diagnostics and surgical treatment of asymptomatic high-grade carotid stenosis. Upon admission, color duplex ultrasonography of the carotid arteries revealed the left common carotid artery (CCA) stenosis of 50% and the ipsilateral internal carotid artery (ICA) stenosis of 60%, while the right CCA was narrowed by 60% and the ipsilateral ICA by 80%. Because of the left subclavian artery (LSA) occlusion, also described by ultrasonography, MDCT angiography was performed to assess arterial morphology for possible angioplasty. In addition to LSA occlusion, MDCT angiography surprisingly revealed significant left CCA (>80%) and ICA (>70%) narrowing by ulcerated plaques with high embolic potential. Surgical treatment of the left CCA and ICA was indicated and Dacron® tubular graft interposition was performed. The postoperative course was uneventful and the patient was discharged from the Institute on the third postoperative day. After the six-month follow-up the patient was doing well with well-preserved graft patency. Conclusion Although color duplex ultrasonography is reliable and safe imaging modality in carotid stenosis diagnosis, MDCT angiography plays a significant role in patients with asymptomatic carotid stenosis since plaques with high embolic potential could be detected, which, if left untreated, could have severe neurological ischemic consequences.

Imaging intracranial vessel wall pathology with magnetic resonance imaging: current prospects and future directions.

To date, the probable cause of ischemic stroke is often inferred from the size and location of the infarct, in combination with an evaluation of the heart and the presence of extracranial arterial occlusion or high-grade stenosis.1 Currently used conventional lumenography-based methods such as digital subtraction angiography, computed tomography angiography, and magnetic resonance (MR) angiography are used to determine the presence of such an acute occlusion or high-grade arterial stenosis. From extracranial studies, it is known that luminal narrowing may be absent in patients with severe atherosclerosis owing to arterial remodeling.2–4 Therefore, these methods do not provide information about the underlying pathological processes, which most often involve the vessel wall.5 Vessel wall changes such as vessel wall thickening, enhancement, or the presence of vulnerable atherosclerotic plaques without luminal stenosis are therefore often missed but might be of importance for a better understanding of ischemic stroke.6 Furthermore, intracranial atherosclerosis is an important cause of ischemic stroke7 and often involves the vessel wall. Patients with intracranial atherosclerosis have high recurrent stroke rates,8 and increasingly more attention is being directed to the assessment of the intracranial vessel wall, necessitating an imaging technique directly assessing the intracranial vessel wall. MR imaging (MRI) seems the most promising technique to reliably image intracranial vessel wall pathologies because of its superior soft tissue contrast. Recent advances in MRI9 have made it possible to obtain information about these abnormalities within the intracranial vessel wall, which provides an imaging tool to investigate the role of intracranial vessel wall abnormalities in the diagnosis of stroke. In this review, we discuss the current status of intracranial vessel wall MRI and its potential to identify different intracranial vessel wall pathologies. First, we present the state-of-the-art MRI methods to visualize the intracranial vessel wall …

Carotid I's, L's and T's: collaterals shape the outcome of intracranial carotid occlusion in acute ischemic stroke

BackgroundCollaterals may affect revascularization, ischemic severity, and clinical outcomes in acute stroke owing to internal carotid artery (ICA) occlusion.ObjectiveTo examine the hypothesis that morphology of occlusive thrombus and collateral flow...