NEURORADIOLOGYC ollateral status is an important predictor of radiologic and clinical outcome in patients with acute ischemic stroke (AIS) due to anterior circulation occlusions (1,2). Blood flow can reach the ischemic territory through collaterals and may contribute to prolonged penumbral sustenance (3,4). Although digital subtraction angiography is considered the standard modality with which to assess collateral flow (4), it is impractical to use for assessment in an acute setting since it is essential to shorten the time to reperfusion.With the development of mechanical thrombectomy, advanced imaging modalities have been developed for use in baseline assessment. CT perfusion imaging is routinely used in many stroke centers as an additional tool to assess tissue at risk. However, CT perfusion is time consuming in terms of acquisition, postprocessing, and interpretation. It is highly dependent on different postprocessing methods and software and is easily affected by motion artifacts (5-7). By comparison, CT angiography takes less time and can yield information on collateral status using appropriate methods of acquisition and reconstruction. Singlephase CT angiography depicts the cerebral circulation at a single snapshot which depends on the timing of CT angiography acquisition after contrast material injection; this may lead to inaccurate estimation of the circulation (1,8). Multiphase CT angiography has already been routinely used for patient selection and outcome prediction in clinical research (9). When compared with single-phase
The rising prevalence of metabolic disorders such as obesity and type 2 diabetes mellitus (T2DM) poses a major challenge to global health. Existing therapeutic approaches have limitations, and there is a need for new, safe, and less invasive treatments. Interventional metabolic therapy is a new addition to the treatment arsenal for metabolic disorders. This review focuses on two interventional techniques: bariatric arterial embolization (BAE) and endovascular denervation (EDN). BAE involves embolizing specific arteries feeding ghrelin‐producing cells to suppress appetite and promote weight loss. EDN targets nerves that regulate metabolic organs to improve glycemic control in T2DM patients. We describe the current state of these techniques, their mechanisms of action, and the available safety and effectiveness data. We also propose a new territory called “Interventional Metabology” to encompass these and other interventional approaches to treating metabolic disorders.
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