- Intraforaminal Location of Thoracolumbar Radicular Arteries Providing an Anterior Radiculomedullary Artery Using Flat Panel Catheter Angiotomography
Ninety-four flat panel catheter angiotomography acquisitions obtained during the selective injection of intersegmental arteries providing an anterior radiculomedullary artery were reviewed. The location of radicular arteries could be ascertained in 78/94 flat panel catheter angiotomography acquisitions. Fifty-three acquisitions (67.9%) were on the left side, and 25 (32.1%), on the right, between T2 and L3. The arteries were found in the anterosuperior quadrant in 75 cases (96.2%), in the posterosuperior quadrant in 2 (2.6%), and in the anteroinferior quadrant in 1(1.3%). Needle placement in the anterosuperior quadrant (subpedicular approach) should be avoided during transforaminal epidural steroid injection. The authors advocate the posterolateral approach that allows placing the needle tip away from the documented position of ARMA contributors within the neural foramen, reducing the risk of intra-arterial injection or injury to the spinal vascularization.
- Risk of Thrombus Fragmentation during Endovascular Stroke Treatment
The authors evaluated the potential relationship between thrombus histology and clot stability in 85 patients with anterior circulation stroke treated with thrombectomy. The number and location of emboli after retrieving the primary thrombus, the number of maneuvers, and TICI scores were evaluated. H&E and neutrophil elastase staining of retrieved clots was performed. An inverse correlation between maneuvers required for thrombus retrieval and the number of distal and intermediate emboli was observed. Younger patients were at higher risk for periprocedural thrombus fragmentation. Bridging thrombolysis tended to be associated with fewer maneuvers but more emboli. They conclude that younger age, easy-to-retrieve thrombi, and bridging thrombolysis may be risk factors for periprocedural thrombus fragmentation. Higher neutrophil levels in the thrombus tissue were related to an increased risk of periprocedural thrombus fragmentation.
- Evaluation of Collaterals and Clot Burden Using Time-Resolved C-Arm Conebeam CT Angiography in the Angiography Suite: A Feasibility Study
Ten C-arm conebeam CT perfusion datasets from 10 subjects with acute ischemic stroke acquired before endovascular treatment were retrospectively processed to generate time-resolved conebeam CTA. From time-resolved conebeam CTA, 2 experienced readers evaluated the clot burden and collateral flow in consensus by using previously reported scoring systems and assessed the clinical value of this novel imaging technique. The 2 readers agreed that time-revolved C-arm conebeam CTA was the preferred method for evaluating the clot burden and collateral flow compared with other conventional imaging methods. They conclude that comprehensive evaluations of clot burden and collateral flow are feasible by using time-resolved C-arm conebeam CTA data acquired in the angiography suite.
- Feasibility of Flat Panel Detector CT in Perfusion Assessment of Brain Arteriovenous Malformations: Initial Clinical Experience
Five patients with brain arteriovenous malformations were studied with flat panel detector CT, DSC-MR imaging, and vessel-encoded pseudocontinuous arterial spin-labeling. Flat panel detector CT, which was originally thought to measure blood volume, correlated more closely with ASL-CBF and DSC-CBF than with DSC-CBV. Flat panel detector CT perfusion depends on the time point chosen for data collection, which is triggered early in patients with AVMs. This finding, in combination with high data variability, makes flat panel detector CT inappropriate for perfusion assessment in brain AVMs.
AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates