Whole-brain CT perfusion combined with CT angiography for ischemic complications following microsurgical clipping and endovascular coiling of ruptured intracranial aneurysms
| Autor: | Jian Rui Li, Qian Chen, Zong Jun Zhang, Long Jiang Zhang, Chang Sheng Zhou, Guangming Lu, Xiao Qing Cheng, Wei Huang |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty Microsurgery medicine.medical_treatment Ischemia Infarction Perfusion scanning Aneurysm Ruptured 030218 nuclear medicine & medical imaging Brain Ischemia 03 medical and health sciences 0302 clinical medicine Aneurysm Physiology (medical) medicine Humans cardiovascular diseases Endovascular coiling medicine.diagnostic_test business.industry Endovascular Procedures Brain Vasospasm Intracranial Aneurysm General Medicine Middle Aged medicine.disease Surgery Cerebral Angiography Treatment Outcome Neurology Cerebral blood flow Cerebrovascular Circulation Angiography cardiovascular system Female Neurology (clinical) Radiology business 030217 neurology & neurosurgery |
| Zdroj: | Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 26 |
| ISSN: | 1532-2653 |
| Popis: | Ischemic complications associated with microsurgical clipping and endovascular coiling affects the outcome of patients with intracranial aneurysms. We prospectively evaluated 58 intracranial aneurysm patients who had neurological deterioration or presented with poor grade (Hunt-Hess grades III and IV), aneurysm size >13 mm and multiple aneurysms after clipping or coiling. Thirty patients had ischemic complications (52%) as demonstrated by whole-brain CT perfusion (WB-CTP) combined with CT angiography (CTA). Half of these 30 patients had treatment-associated reduction in the diameter of the parent vessels (n=6), ligation of the parent vessels or perforating arteries (n=2), and unexplained or indistinguishable vascular injury (n=7); seven of these 15 (73%) patients suffered infarction. The remaining 15 patients had disease-associated cerebral ischemia caused by generalized vasospasm (n=6) and focal vessel vasospasm (n=9); six of these 15 (40%) patients developed infarction. Three hemodynamic patterns of ischemic complications were found on WB-CTP, of which increased time to peak, time to delay and mean transit time associated with decreased cerebral blood flow and cerebral blood volume were the main predictors of irreversible ischemic lesions. In conclusion, WB-CTP combined with CTA can accurately determine the cause of neurological deterioration and classify ischemic complications. This combined approach may be helpful in assessing hemodynamic patterns and monitoring operative outcomes. |
| Databáze: | OpenAIRE |
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