المؤلفون: Caton, MT, Narsinh, KH, Baker, A, Dowd, CF, Higashida, RT, Cooke, DL, Hetts, SW, Halbach, VV, Amans, MR

المصدر: AJNR. American journal of neuroradiology. 42(8)

مصطلحات موضوعية: Foramen Magnum, Cranial Sinuses, Humans, Central Nervous System Vascular Malformations, Cerebral Angiography, Retrospective Studies, Phenotype, Middle Aged, Female, Male, Neurosciences, Brain Disorders, Clinical Sciences, Nuclear Medicine & Medical Imaging

الوصف: Background and purposeAVFs of the foramen magnum region, including fistulas of the marginal sinus and condylar veins, have complex arterial supply, venous drainage, symptoms, and risk features that are not well-defined. The purpose of this study was to present the angioarchitectural and clinical phenotypes of a foramen magnum region AVF from a large, single-center experience.Materials and methodsWe retrospectively reviewed cases from a 10-year neurointerventional data base. Arterial and venous angioarchitectural features and clinical presentation were extracted from the medical record. Venous drainage patterns were stratified into 4 groups as follows: type 1 = unrestricted sinus drainage, type 2 = sinus reflux (including the inferior petrosal sinus), type 3 = reflux involving sinuses and cortical veins, and type 4 = restricted cortical vein outflow or perimedullary congestion.ResultsTwenty-eight patients (mean age, 57.9 years; 57.1% men) had 29 foramen magnum region AVFs. There were 11 (37.9%) type 1, nine (31.0%) type 2, six (20.7%) type 3, and 3 (10.3%) type 4 fistulas. Pulsatile tinnitus was the most frequent symptom (82.1%), followed by orbital symptoms (31.0%), subarachnoid hemorrhage (13.8%), cranial nerve XII palsy (10.3%), and other cranial nerve palsy (6.9%). The most frequent arterial supply was the ipsilateral ascending pharyngeal artery (93.1% ipsilateral, 55.5% contralateral), vertebral artery (89.7%), occipital artery (65.5%), and internal carotid artery branches (48.3%).ConclusionsWe present the largest case series of foramen magnum region AVFs to date and show that clinical features relate to angioarchitecture. Orbital symptoms are frequent when sinus reflux is present. Hemorrhage was only observed in type 3 and 4 fistulas.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/5fc9j81zTest

المؤلفون: Copelan, AZ, Smith, ER, Drocton, GT, Narsinh, KH, Murph, D, Khangura, RS, Hartley, ZJ, Abla, AA, Dillon, WP, Dowd, CF, Higashida, RT, Halbach, VV, Hetts, SW, Cooke, DL, Keenan, K, Nelson, J, Mccoy, D, Ciano, M, Amans, MR

المصدر: AJNR. American journal of neuroradiology. 41(12)

مصطلحات موضوعية: Humans, Brain Infarction, Iodine Compounds, Contrast Media, Image Interpretation, Computer-Assisted, Retrospective Studies, Software, Aged, Aged, 80 and over, Middle Aged, Female, Male, Perfusion Imaging, Neuroimaging, Computed Tomography Angiography, Brain Disorders, Stroke, Neurosciences, Biomedical Imaging, Clinical Sciences, Nuclear Medicine & Medical Imaging

الوصف: Background and purposeAutomated CTP software is increasingly used for extended window emergent large-vessel occlusion to quantify core infarct. We aimed to assess whether RAPID software underestimates core infarct in patients with an extended window recently receiving IV iodinated contrast.Materials and methodsWe reviewed a prospective, single-center data base of 271 consecutive patients who underwent CTA ± CTP for acute ischemic stroke from May 2018 through January 2019. Patients with emergent large-vessel occlusion confirmed by CTA in the extended window (>6 hours since last known well) and CTP with RAPID postprocessing were included. Two blinded raters independently assessed CT ASPECTS on NCCT performed at the time of CTP. RAPID software used relative cerebral blood flow of

الوصول الحر: https://escholarship.org/uc/item/79f9v9w7Test

المؤلفون: Narsinh, KH, Mueller, K, Nelson, J, Massachi, J, Murph, DC, Copelan, AZ, Hetts, SW, Halbach, VV, Higashida, RT, Abla, AA, Amans, MR, Dowd, CF, Kim, H, Cooke, DL

المصدر: AJNR. American journal of neuroradiology. 41(12)

مصطلحات موضوعية: Humans, Intracranial Arteriovenous Malformations, Observer Variation, Angiography, Digital Subtraction, Reproducibility of Results, Adult, Middle Aged, Female, Male, Neurosciences, Clinical Sciences, Nuclear Medicine & Medical Imaging

الوصف: Background and purposeHemodynamic features of brain AVMs may portend increased hemorrhage risk. Previous studies have suggested that MTT is shorter in ruptured AVMs as assessed on quantitative color-coded parametric DSA. This study assesses the interrater reliability of MTT measurements obtained using quantitative color-coded DSA.Materials and methodsThirty-five color-coded parametric DSA images of 34 brain AVMs were analyzed by 4 neuroradiologists with experience in interventional neuroradiology. Hemodynamic features assessed included MTT of the AVM and TTP of the dominant feeding artery and draining vein. Agreement among the 4 raters was assessed using the intraclass correlation coefficient.ResultsThe interrater reliability among the 4 raters was poor (intraclass correlation coefficient = 0.218; 95% CI, 0.062-0.414; P value = .002) as it related to MTT assessment. When the analysis was limited to cases in which the raters selected the same image to analyze and selected the same primary feeding artery and the same primary draining vein, interrater reliability improved to fair (intraclass correlation coefficient  = 0.564; 95% CI, 0.367-0.717; P

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/0fr4g2mwTest

المؤلفون: Hetts, SW, Yen, A, Cooke, DL, Nelson, J, Jolivalt, P, Banaga, J, Amans, MR, Dowd, CF, Higashida, RT, Lawton, MT, Kim, H, Halbach, VV

المصدر: AJNR. American journal of neuroradiology. 38(12)

مصطلحات موضوعية: Arteries, Brain, Humans, Brain Ischemia, Central Nervous System Vascular Malformations, Embolization, Therapeutic, Risk Factors, Retrospective Studies, Adult, Aged, Middle Aged, Female, Male, Stroke, Neurosciences, Brain Disorders, Clinical Research, Clinical Sciences, Nuclear Medicine & Medical Imaging

الوصف: Background and purposeAlthough intracranial dural arteriovenous fistulas are principally supplied by dural branches of the external carotid, internal carotid, and vertebral arteries, they can also be fed by pial arteries that supply the brain. We sought to determine the frequency of neurologic deficits following treatment of intracranial dural arteriovenous fistulas with and without pial artery supply.Materials and methodsOne hundred twenty-two consecutive patients who underwent treatment for intracranial dural arteriovenous fistulas at our hospital from 2008 to 2015 were retrospectively reviewed. Patient data were examined for posttreatment neurologic deficits; patients with such deficits were evaluated for imaging evidence of cerebral infarction. Data were analyzed with multivariable logistic regression.ResultsOf 122 treated patients, 29 (23.8%) had dural arteriovenous fistulas with pial artery supply and 93 (76.2%) had dural arteriovenous fistulas without pial arterial supply. Of patients with pial artery supply, 4 (13.8%) had posttreatment neurologic deficits, compared with 2 patients (2.2%) without pial artery supply (P = .04). Imaging confirmed that 3 patients with pial artery supply (10.3%) had cerebral infarcts, compared with only 1 patient without pial artery supply (1.1%, P = .03). Increasing patient age was also positively associated with pial supply and treatment-related complications.ConclusionsPatients with dural arteriovenous fistulas supplied by the pial arteries were more likely to experience posttreatment complications, including ischemic strokes, than patients with no pial artery supply. The approach to dural arteriovenous fistula treatment should be made on a case-by-case basis so that the risk of complications can be minimized.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/4kb6b2rsTest

المؤلفون: Settecase, F, Hetts, SW, Nicholson, AD, Amans, MR, Cooke, DL, Dowd, CF, Higashida, RT, Halbach, VV

المصدر: AJNR. American journal of neuroradiology. 37(4)

مصطلحات موضوعية: Cerebral Arteries, Humans, Nervous System Diseases, Intracranial Aneurysm, Intracranial Arteriovenous Malformations, Subarachnoid Hemorrhage, Rupture, Recurrence, Ethanol, Cerebral Angiography, Sclerotherapy, Injections, Intra-Arterial, Adolescent, Adult, Middle Aged, Infant, Female, Male, Endovascular Procedures, Alcoholism, Alcohol Use and Health, Stroke, Neurosciences, Pediatric, Brain Disorders, Substance Misuse, Cardiovascular, Clinical Sciences, Nuclear Medicine & Medical Imaging

الوصف: In the endovascular treatment of cerebral arteriovenous malformations, ethanol sclerotherapy is seldom used due to safety concerns. However, when limited reflux of an embolic agent is permissible or when there is a long distance to the target, ethanol may be preferable. We reviewed 10 patients with 14 cerebral AVM feeding artery aneurysms or intranidal aneurysms treated with intra-arterial ethanol sclerotherapy at our institution between 2005 and 2014. All patients presented with acute intracranial hemorrhage. Thirteen of 14 aneurysms were treated primarily with 60%-80% ethanol into the feeding artery. Complete target feeding artery and aneurysm occlusion was seen in all cases; 8/13 (62%) were occluded by using ethanol alone. No retreatments or recurrences were seen. One permanent neurologic deficit (1/13, 7.7%) and no deaths occurred. In a subset of ruptured cerebral AVMs, ethanol sclerotherapy of feeding artery aneurysms and intranidal aneurysms can be performed with a high degree of technical success and a low rate of complication.

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الوصول الحر: https://escholarship.org/uc/item/2c8308qhTest

المؤلفون: Hetts, SW, Tsai, T, Cooke, DL, Amans, MR, Settecase, F, Moftakhar, P, Dowd, CF, Higashida, RT, Lawton, MT, Halbach, VV

المصدر: AJNR. American journal of neuroradiology. 36(10)

مصطلحات موضوعية: Humans, Intracranial Hemorrhages, Intracranial Hypertension, Central Nervous System Vascular Malformations, Disease Progression, Cerebral Angiography, Treatment Outcome, Radiosurgery, Retrospective Studies, Venous Pressure, Adolescent, Adult, Aged, Aged, 80 and over, Middle Aged, Child, Child, Preschool, Infant, Infant, Newborn, Female, Male, Statistics as Topic, Young Adult, Clinical Research, Neurosciences, Clinical Sciences, Nuclear Medicine & Medical Imaging

الوصف: Background and purposeA minority of intracranial dural arteriovenous fistulas progress with time. We sought to determine features that predict progression and define outcomes of patients with progressive dural arteriovenous fistulas.Materials and methodsWe performed a retrospective imaging and clinical record review of patients with intracranial dural arteriovenous fistula evaluated at our hospital.ResultsOf 579 patients with intracranial dural arteriovenous fistulas, 545 had 1 fistula (mean age, 45 ± 23 years) and 34 (5.9%) had enlarging, de novo, multiple, or recurrent fistulas (mean age, 53 ± 20 years; P = .11). Among these 34 patients, 19 had progressive dural arteriovenous fistulas with de novo fistulas or fistula enlargement with time (mean age, 36 ± 25 years; progressive group) and 15 had multiple or recurrent but nonprogressive fistulas (mean age, 57 ± 13 years; P = .0059, nonprogressive group). Whereas all 6 children had fistula progression, only 13/28 adults (P = .020) progressed. Angioarchitectural correlates to chronically elevated intracranial venous pressures, including venous sinus dilation (41% versus 7%, P = .045) and pseudophlebitic cortical venous pattern (P = .048), were more common in patients with progressive disease than in those without progression. Patients with progressive disease received more treatments than those without progression (median, 5 versus 3; P = .0068), but as a group, they did not demonstrate worse clinical outcomes (median mRS, 1 and 1; P = .39). However, 3 young patients died from intracranial venous hypertension and intracranial hemorrhage related to progression of their fistulas despite extensive endovascular, surgical, and radiosurgical treatments.ConclusionsFew patients with dural arteriovenous fistulas follow an aggressive, progressive clinical course despite treatment. Younger age at initial presentation and angioarchitectural correlates to venous hypertension may help identify these patients prospectively.

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الوصول الحر: https://escholarship.org/uc/item/64c2z29rTest

المؤلفون: Alexander, MD, Cooke, DL, Nelson, J, Guo, DE, Dowd, CF, Higashida, RT, Halbach, VV, Lawton, MT, Kim, H, Hetts, SW

المصدر: AJNR. American journal of neuroradiology. 36(5)

مصطلحات موضوعية: Veins, Humans, Intracranial Arteriovenous Malformations, Cerebral Hemorrhage, Prognosis, Aged, Middle Aged, Female, Male, Multimodal Imaging, Neurosciences, Stroke, Brain Disorders, Clinical Sciences, Nuclear Medicine & Medical Imaging

الوصف: Background and purposeIntracranial hemorrhage is the most serious outcome for brain arteriovenous malformations. This study examines associations between venous characteristics of these lesions and intracranial hemorrhage.Materials and methodsStatistical analysis was performed on a prospectively maintained data base of brain AVMs evaluated at an academic medical center. DSA, CT, and MR imaging studies were evaluated to classify lesion side, drainage pattern, venous stenosis, number of draining veins, venous ectasia, and venous reflux. Logistic regression analyses were performed to identify the association of these angiographic features with intracranial hemorrhage of any age at initial presentation.ResultsExclusively deep drainage (OR, 3.42; 95% CI, 1.87-6.26; P < .001) and a single draining vein (OR, 1.98; 95% CI, 1.26-3.08; P = .002) were associated with hemorrhage, whereas venous ectasia (OR, 0.52; 95% CI, 0.34-0.78; P = .002) was inversely associated with hemorrhage.ConclusionsAnalysis of venous characteristics of brain AVMs may help determine their prognosis and thereby identify lesions most appropriate for treatment.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/0sj8g72fTest

المؤلفون: Amans, MR, Stout, C, Dowd, CF, Higashida, RT, Hetts, SW, Cooke, DL, Narvid, JA, Halbach, VV

المصدر: Austin Journal of Cerebrovascular Diseases. 1(2)

مصطلحات موضوعية: Pulsatile Tinnitus, Sigmoid Sinus Diverticulum, Coil Embolization

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/6vq7j3x6Test

المؤلفون: Hetts, SW, Cooke, DL, Nelson, J, Gupta, N, Fullerton, H, Amans, MR, Narvid, JA, Moftakhar, P, McSwain, H, Dowd, CF, Higashida, RT, Halbach, VV, Lawton, MT, Kim, H

المصدر: American Journal of Neuroradiology. 35(7)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Neurosciences, Pediatric, Cerebrovascular, Brain Disorders, Clinical Research, Congenital Structural Anomalies, Adolescent, Adult, Age Distribution, Aged, Aged, 80 and over, Angiography, California, Causality, Cerebral Hemorrhage, Child, Child, Preschool, Comorbidity, Female, Humans, Incidence, Infant, Infant, Newborn, Intracranial Arteriovenous Malformations, Male, Middle Aged, Risk Factors, Survival Rate, Young Adult, Nuclear Medicine & Medical Imaging, Clinical sciences, Physical chemistry

الوصف: Background and purposeThe imaging characteristics and modes of presentation of brain AVMs may vary with patient age. Our aim was to determine whether clinical and angioarchitectural features of brain AVMs differ between children and adults.Materials and methodsA prospectively collected institutional data base of all patients diagnosed with brain AVMs since 2001 was queried. Demographic, clinical, and angioarchitecture information was summarized and analyzed with univariable and multivariable models.ResultsResults often differed when age was treated as a continuous variable as opposed to dividing subjects into children (18 years or younger; n = 203) versus adults (older than 18 years; n = 630). Children were more likely to present with AVM hemorrhage than adults (59% versus 41%, P < .001). Although AVMs with a larger nidus presented at younger ages (mean of 26.8 years for >6 cm compared with 37.1 years for

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/53g7g7rjTest
https://escholarship.org/content/qt53g7g7rj/qt53g7g7rj.pdfTest

المؤلفون: Alexander, MD, Meyers, PM, English, JD, Stradford, TR, Sung, S, Smith, WS, Halbach, VV, Higashida, RT, Dowd, CF, Cooke, DL, Hetts, SW

المصدر: AJNR. American journal of neuroradiology. 35(6)

مصطلحات موضوعية: Humans, Intracranial Arteriosclerosis, Treatment Outcome, Angioplasty, Preoperative Care, Retrospective Studies, Blood Vessel Prosthesis, Stents, Adult, Aged, Middle Aged, United States, Female, Male, Neurosciences, Stroke, Bioengineering, Brain Disorders, Cardiovascular, Assistive Technology, Atherosclerosis, Clinical Trials and Supportive Activities, Clinical Research, Clinical Sciences, Nuclear Medicine & Medical Imaging

الوصف: Background and purposeDifferent types of symptomatic intracranial stenosis may respond differently to interventional therapy. We investigated symptomatic and pathophysiologic factors that may influence clinical outcomes of patients with intracranial atherosclerotic disease who were treated with stents.Materials and methodsA retrospective analysis was performed of patients treated with stents for intracranial atherosclerosis at 4 centers. Patient demographics and comorbidities, lesion features, treatment features, and preprocedural and postprocedural functional status were noted. χ(2) univariate and multivariate logistic regression analysis was performed to assess technical results and clinical outcomes.ResultsOne hundred forty-two lesions in 131 patients were analyzed. Lesions causing hypoperfusion ischemic symptoms were associated with fewer strokes by last contact [χ(2) (1, n = 63) = 5.41, P = .019]. Nonhypoperfusion lesions causing symptoms during the 14 days before treatment had more strokes by last contact [χ(2) (1, n = 136), 4.21, P = .047]. Patients treated with stents designed for intracranial deployment were more likely to have had a stroke by last contact (OR, 4.63; P = .032), and patients treated with percutaneous balloon angioplasty in addition to deployment of a self-expanding stent were less likely to be stroke free at point of last contact (OR, 0.60; P = .034).ConclusionsMore favorable outcomes may occur after stent placement for lesions causing hypoperfusion symptoms and when delaying stent placement 7-14 days after most recent symptoms for lesions suspected to cause embolic disease or perforator ischemia. Angioplasty performed in addition to self-expanding stent deployment may lead to worse outcomes, as may use of self-expanding stents rather than balloon-mounted stents.

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الوصول الحر: https://escholarship.org/uc/item/3x18p5mqTest