Stephan A Munich1,2, Marshall C Cress1,2, Leonardo Rangel-Castilla1,2, Ashish Sonig1,2, Chandan Krishna1,2, Elad I Levy1,2,3,4, Kenneth V Snyder1,2,3,4,5, Adnan H Siddiqui1,2,3,4,6. 1. Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA. 2. Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, NY, USA. 3. Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA. 4. Canon Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY, USA. 5. Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA. 6. Jacobs Institute, Buffalo, NY, USA.
Abstract
BACKGROUND AND PURPOSE: Traditional methods of computed tomographic angiography (CTA) can be unreliable in detecting carotid artery pseudo-occlusions or in accurately locating the site of carotid artery occlusion. With these methods, lack of adequate distal runoff due to pseudo-occlusion or intracranial occlusion can result in the inaccurate diagnoses of complete occlusion or cervical carotid occlusion, respectively. The site of carotid occlusion has important therapeutic and interventional considerations. We present several cases in which 4D CTA was utilized to accurately and noninvasively diagnose carotid pseudo-occlusion and intracranial internal carotid artery (ICA) occlusion. METHODS: We identified five patients who presented to our institute with ischemic stroke symptoms and evaluated images from traditional CTA protocols and 4D CTA protocols in each of these patients, comparing diagnoses rendered by each imaging technique. RESULTS: In two patients, traditional CTA suggested the presence of complete ICA occlusion. However, 4D CTA demonstrated pseudo-occlusion. Similarly, in three patients, traditional CTA demonstrated cervical ICA occlusion, whereas the 4D CTA demonstrated intracranial ICA occlusion. CONCLUSION: 4D CTA may be a more effective noninvasive imaging technique than traditional CTA to detect intracranial carotid artery occlusions and carotid artery pseudo-occlusions. Accurate, rapid, and noninvasive diagnosis of carotid artery lesions may help tailor and expedite endovascular intervention.
BACKGROUND AND PURPOSE: Traditional methods of computed tomographic angiography (CTA) can be unreliable in detecting carotid artery pseudo-occlusions or in accurately locating the site of carotid artery occlusion. With these methods, lack of adequate distal runoff due to pseudo-occlusion or intracranial occlusion can result in the inaccurate diagnoses of complete occlusion or cervical carotid occlusion, respectively. The site of carotid occlusion has important therapeutic and interventional considerations. We present several cases in which 4D CTA was utilized to accurately and noninvasively diagnose carotid pseudo-occlusion and intracranial internal carotid artery (ICA) occlusion. METHODS: We identified five patients who presented to our institute with ischemic stroke symptoms and evaluated images from traditional CTA protocols and 4D CTA protocols in each of these patients, comparing diagnoses rendered by each imaging technique. RESULTS: In two patients, traditional CTA suggested the presence of complete ICA occlusion. However, 4D CTA demonstrated pseudo-occlusion. Similarly, in three patients, traditional CTA demonstrated cervical ICA occlusion, whereas the 4D CTA demonstrated intracranial ICA occlusion. CONCLUSION: 4D CTA may be a more effective noninvasive imaging technique than traditional CTA to detect intracranial carotid artery occlusions and carotid artery pseudo-occlusions. Accurate, rapid, and noninvasive diagnosis of carotid artery lesions may help tailor and expedite endovascular intervention.
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Authors: Henk A Marquering; Paul J Nederkoorn; Ludo F Beenen; Geert J Lycklama à Nijeholt; René van den Berg; Yvo B Roos; Charles B Majoie Journal: Clin Neurol Neurosurg Date: 2013-03-01 Impact factor: 1.876
Authors: Zhong-Song Shi; David S Liebeskind; Bin Xiang; Sijian Grace Ge; Lei Feng; Gregory W Albers; Ronald Budzik; Thomas Devlin; Rishi Gupta; Olav Jansen; Tudor G Jovin; Monika Killer-Oberpfalzer; Helmi L Lutsep; Juan Macho; Raul G Nogueira; Marilyn Rymer; Wade S Smith; Nils Wahlgren; Gary R Duckwiler Journal: Stroke Date: 2014-05-29 Impact factor: 7.914