Computed tomographic angiography findings in 103 patients following vascular events in the posterior circulation; potential and clinical relevance

Graf, Julia; Skutta, Bernd; Kuhn, Fritz-Peter; Ferbert, A.

doi:10.1007/s004150070089

Cited by 49 publications

(26 citation statements)

References 15 publications

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“…Had these studies been relied upon solely, the patient would have been at substantial risk of morbidity and even mortality. Previous studies have demonstrated the limitations of MRA and CTA in imaging the posterior circulation [9,10]. Our patient illustrates that conventional angiogram remains the gold standard for visualizing the posterior circulation, because both CTA and MRA failed to identify the fenestrated vessels.…”

Section: Case Reportmentioning

confidence: 76%

An 18-year-old man with fenestrated vertebral arteries, recurrent stroke and successful angiographic coiling

Bernard

Mull

Handler

et al. 2007

Journal of the Neurological Sciences

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Fenestration of vertebral arteries has been reported in association with thromboembolic brain infarctions. However, few cases have been reported in which recurrent infarction occurred in spite of adequate anticoagulation. We report a young man with fenestrated vertebral arteries and stroke who failed to respond to standard anticoagulation therapy but did well with angiographic coil obliteration of an abnormal vertebral segment. An 18-year-old left-handed man presented with acute onset of dizziness and headache. No trauma or other stroke risk factors were identified. Left cerebellar infarction was seen on CT, but the cause could not be identified by brain and neck MRI, MRA, or CTA. Bilateral fenestrated vertebral arteries were identified with conventional angiography. Although the patient recovered fully and was treated with anticoagulation, he suffered a recurrent stroke 1 month later involving the right cerebellum while he was on a therapeutic dose of warfarin. Repeat arteriography showed a spontaneous dissection within one of the fenestrated vertebral segments. Since receiving angiographic coil obliteration of the pathologic segment, he has been free of all symptoms. We conclude that the patient sustained recurrent thromboembolic events in his posterior circulation due to spontaneous dissection within a fenestrated vertebral artery segment. Conventional angiography and emergent interventional embolization were essential to his diagnostic evaluation and therapeutic intervention.

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Section: Case Reportmentioning

confidence: 76%

An 18-year-old man with fenestrated vertebral arteries, recurrent stroke and successful angiographic coiling

Bernard

Mull

Handler

et al. 2007

Journal of the Neurological Sciences

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“…242, 252 The accuracy of CTA for evaluation of large-vessel intracranial stenoses and occlusions is very high, [253][254][255][256] and in some cases its overall accuracy approaches or exceeds that of digital subtraction angiography (DSA). 253, 257 The sensitivity and specificity of CTA for the detection of intracranial occlusions ranges between 92% and 100% and between 82% and 100%, respectively, with a positive predictive value of 91% to 100%.…”

Section: Ct Angiographymentioning

confidence: 99%

“…202,210,212,219 "Core" ischemia can be defined accurately by perfusion CT depending on equipment and programming. Various studies have used different hemodynamic parameters, such as mean transit time, cerebral blood volume, and cerebral blood flow, [252][253][254][255][256][257][258]260,[264][265][266][267][268][269][270][271][272][273][274][275]350 different thresholds for determining hemodynamic abnormality (eg, degree of reduction in cerebral blood volume and absolute versus relative threshold), and different thresholds for the amount of penumbral tissue that warrants treatment (eg, 20%, 100%, or 200% the size of the infarct core). 206,207,213,[215][216][217][347][348][349] The International Stroke Imaging Repository (STIR) consortium is currently addressing these issues and is attempting to standardize imaging methodology, processing, and interpretation.…”

Section: Perfusion Ct and Mrimentioning

confidence: 99%

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Jauch¹,

Saver²,

Adams³

et al. 2013

Stroke

5,331

1,801

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Background and Purpose-The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates. Methods-Members of the writing committee were appointed by the American Stroke Association Stroke Council's Scientific Statement Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Panel members were assigned topics relevant to their areas of expertise, reviewed the stroke literature with emphasis on publications since the prior guidelines, and drafted recommendations in accordance with the American Heart Association Stroke Council's Level of Evidence grading algorithm. Results-The goal of these guidelines is to limit the morbidity and mortality associated with stroke. The guidelines support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit. The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general physiological optimization for cerebral resuscitation. The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. Guidelines for the Early Management of PatientsThis statement was approved by the American Heart Association Science Advisory and Coordinating Committee on December 12, 2012. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.The Executive Summary is available as an online-only Data Supplement with this article at http://stroke.ahajournals.org/lookup/suppl/ doi:10.1161/STR.0b013e318284056a/-/DC1.The American Heart Association requests that this document be cited as follows: Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW Jr, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H; on behalf of the American Heart Association Stroke Council, Council on Cardio...

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“…Few studies have examined the accuracy of CTA to detect and quantify intracranial arterial stenosis. [15][16][17] We sought to examine the accuracy of CTA in evaluating ICAD as compared with DSA as the gold standard.…”

mentioning

confidence: 99%

How Accurate Is CT Angiography in Evaluating Intracranial Atherosclerotic Disease?

Nguyen‐Huynh

Wintermark

English

et al. 2008

Stroke

206

109

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Background and Purpose-Digital subtraction angiography (DSA) is regarded as the gold standard in assessing degree of stenosis in intracranial vessels. However, it is invasive and can only be carried out at specialized centers. We sought to compare CT angiography (CTA) to DSA for detection and measurement of stenosis in large intracranial arteries. Methods--We identified all subjects admitted with ischemic stroke or transient ischemic attack and with CTA and DSA studies of good quality completed within 30 days of each other between April 2000 and May 2006 at a single medical center. Two readers blinded to clinical information reviewed each CTA and DSA independently. Each reader located and measured stenosis of 15 prespecified large intracranial arterial segments per study at the same level of magnification. These stenotic lesions were most likely atherosclerotic in etiology. All measurements were made with Wiha digiMax 6" digital calipers. The degree of stenosis was calculated using the published method for the Warfarin-Aspirin Symptomatic Intracranial Disease study. All disagreements of greater than 10% were reviewed by a third reader who decided between the 2 prior measurements. Segments were excluded from analyses if they were judged to be congenitally hypoplastic or seen only through collaterals or cross-filling. Intraclass correlation, sensitivity, and specificity were calculated using DSA as the reference standard. Results-Forty-one pairs of CTA and DSAs from 41 patients were reviewed. CTAs were completed within 28 days before 13 days after DSA, with a median of 1 day. A total of 475 pairs of major intracranial arterial segment were analyzed. Intraclass correlation between degree of stenosis based on CTA and DSA for all segments was 0.98 (Pϭ0.001). CTA detected large arterial occlusion with 100% sensitivity and specificity. For detection of Ն50% stenosis, CTA had 97.1% sensitivity and 99.5% specificity. To detect all lesions Ն50% as determined by DSA, the cut off point on CTA appeared to be at Ն30%, with a false-positive rate of 2.4%. Conclusions-Compared to DSA, CTA has high sensitivity and specificity for detecting Ն50% stenosis of large intracranial arterial segments. CTA is minimally invasive and may be a useful screening tool for intracranial arterial disease and occlusion.

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Computed tomographic angiography findings in 103 patients following vascular events in the posterior circulation; potential and clinical relevance

Cited by 49 publications

References 15 publications

An 18-year-old man with fenestrated vertebral arteries, recurrent stroke and successful angiographic coiling

An 18-year-old man with fenestrated vertebral arteries, recurrent stroke and successful angiographic coiling

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

How Accurate Is CT Angiography in Evaluating Intracranial Atherosclerotic Disease?

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