Retreatment strategies for recurrent and residual aneurysms after treatment with flow-diverter devicesGoertz, Lukas; Hesse, Nina; Liebig, Thomas; Ahmad, Wael; Abdullayev, Nuran; Krischek, Boris; Kabbasch, Christoph; Dorn, Franziska
doi: 10.1007/s00234-020-02389-wpmid: 32140782
PurposeThe management of residual or persistent intracranial aneurysms after flow-diversion therapy is not well defined in the literature. In this multicentric study, we report clinical and angiographic outcomes of 11 patients that underwent retreatment for 12 aneurysms initially treated with flow-diverter stents.MethodsThe median patient age was 53 years. Aneurysms (median size, 7.3 mm) were located at the internal carotid artery in 9 cases, and at the posterior circulation in 3. Treatment strategies, complications, and angiographic outcome were retrospectively assessed.ResultsRetreatment was feasible in all cases and performed by overlapping flow-diverter implantation. Overall, 12 side vessels were covered during retreatment, whereof 10 (83.3%) remained patent until mid-term follow-up. There were no further technical or symptomatic complications and no treatment-related morbidity. Angiographic follow-up (median, 17 months) showed improved aneurysm occlusion in all patients. Complete or near-complete aneurysm occlusion was achieved in 11 aneurysms (91.7%).ConclusionRequired retreatment after failed flow-diversion therapy can be performed with adequate safety and efficacy by placement of additional flow-diverter stents.
High-resolution compressed-sensing time-of-flight MRA in a case of acute ICA/MCA dissectionDemerath, Theo; Bonati, Leo; El Mekabaty, Amgad; Schubert, Tilman
doi: 10.1007/s00234-020-02395-ypmid: 32198564
PurposeAcute, isolated intracranial dissection (ICD) represents a rare and challenging cause of acute stroke. DSA is considered to be the gold standard imaging modality in patients with ICD. The role of novel, high-resolution (HR) compressed-sensing (CS) time-of-flight (TOF) MRA techniques in ICDs is unclear.MethodsA 22-year-old male patient with an isolated right ICA/MCA intracranial dissection underwent “conventional” 3-T TOF MRA, HR CS TOF MRA and also DSA including digital rotational angiography.ResultsUnlike the “conventional” TOF MRA, HR CS TOF MRA provided comparable image quality to rotational angiography and a dissection membrane was clearly visible in both techniques.ConclusionIn this single case study, we demonstrated the feasibility of a novel HR CS TOF in a case of an acute isolated intracranial ICA/MCA dissection, which needs to be validated in a larger case series.
Multi-scale resting state functional reorganization in response to multiple sclerosis damageTommasin, Silvia; De Giglio, Laura; Ruggieri, Serena; Petsas, Nikolaos; Giannì, Costanza; Pozzilli, Carlo; Pantano, Patrizia
doi: 10.1007/s00234-020-02393-0pmid: 32189024
PurposeIn multiple sclerosis (MS), how brain functional changes relate to clinical conditions is still a matter of debate. The aim of this study was to investigate how functional connectivity (FC) reorganization at three different scales, ranging from local to whole brain, is related to tissue damage and disability.MethodsOne-hundred-nineteen patients with MS were clinically evaluated with the Expanded Disability Status Scale and the Multiple Sclerosis Functional Composite. Patients and 42 healthy controls underwent a multimodal 3 T MRI, including resting-state functional MRI.ResultsWe identified 16 resting-state networks via independent component analysis and measured within-network, between-network, and whole-brain (global efficiency and degree centrality) FC. Within-network FC was higher in patients than in controls in default mode, frontoparietal, and executive-control networks, and corresponded to low clinical impairment (default mode network versus Expanded Disability Status Scale r = − 0.31, p < 0.01; right frontoparietal network versus Paced Auditory Serial Addition Test r = 0.33, p < 0.01). All measures of between-network and whole-brain FC, except default mode network global efficiency, were lower in patients than in controls, and corresponded to high disability (i.e., basal ganglia global efficiency versus Timed 25-Foot Walk r = − 0.25, p < 0.03; default mode global efficiency versus Expanded Disability Status Scale r = − 0.44, p < 0.001). Altered measures of within-network, between-network, and whole-brain FC were combined in functional indices that were linearly related to disease duration, Paced Auditory Serial Addition Test and lesion load and non-linearly related to Expanded Disability Status Scale.ConclusionWe suggest that the combined evaluation of functional alterations occurring at different levels, from local to whole brain, could exhaustively describe neuroplastic changes in MS, while increased within-network FC likely represents adaptive compensatory processes, decreased between-network and whole-brain FC likely represent loss of functional network integration consequent to structural disruption.
MRI findings in Pott’s spine and correlating clinical progress with radiological findingsMisra, Usha Kant; Warrier, Siddharth; Kalita, Jayantee; Kumar, Sunil
doi: 10.1007/s00234-020-02402-2pmid: 32206826
PurposeTo document magnetic resonance imaging (MRI) changes in Pott’s spine and to correlate these with clinical findings and outcome.MethodsPatients with Pott’s spine having more than one set of MRI were included in the study. Patients were grouped according to timing of their second MRI. The MRI findings included changes in bone, disc, spinal cord, and soft tissue. The MRI changes were categorized into improvement, no change, or worsening. “Paradoxical worsening” was defined as radiological worsening in setting of clinical improvement, as described by improvement of Nurick’s grade. Outcome was defined by mRS scale at three, six, and 12 months. The MRI findings and outcome were correlated.ResultsThe results are based on 36 patients. The MRI changes included vertebral changes in form of spondylodiscitis in 33 (92%), epidural abscess in 29 (81%), spinal cord changes including edema and granuloma in 17 (47%), paravertebral abscess in 29 (81%), and vertebral body collapse in 12 (33.3%) patients. At three months, clinical improvement occurred in eight out of 12 patients, deterioration in two, and no change in two. Spinal MRI revealed improvement in one patient only; whereas eight had deterioration and three had no change. At six months, all nine patients improved clinically, but MRI showed improvement in only four, while another four showed deterioration and one had no change. In the nine and 12 months group, while all patients clinically improved, MRI showed minimal worsening.ConclusionIn Pott’s spine, the clinical improvement precedes the radiological improvement.
Double stenting in T configuration with safety micro-guidewire technique in a complex middle cerebral artery stenosisRodrigues, Marta; Figueiredo, Sofia; Rocha, João; Cunha, André; Castro, Sérgio; Veloso, Miguel; Barros, Pedro; Ribeiro, Manuel
doi: 10.1007/s00234-020-02400-4pmid: 32198563
Intracranial arterial stenosis is a frequently misdiagnosed cause of ischemic stroke, associated with high rates of recurrence under medical therapy alone. Endovascular intracranial angioplasty and stenting has increasingly been used worldwide for treatment of symptomatic intracranial stenoses, despite controversial results of the first randomized trials. Lesion morphology and etiology must be considered during endovascular treatment planning. Complex morphologies can lead to serious complications during the endovascular procedure. We present a case of a symptomatic complex middle cerebral artery stenosis that was successfully treated with a double stenting in T configuration, using a safety micro-guidewire technique. During follow-up, intracranial Doppler revealed a non-significant residual stenosis and the patient remained asymptomatic.
Cerebral hemodynamics associated with fluid-attenuated inversion recovery hyperintense vessels in patients with extracranial carotid artery stenosisNishimoto, Takuma; Ishihara, Hideyuki; Oka, Fumiaki; Shimokawa, Mototsugu; Suzuki, Michiyasu
doi: 10.1007/s00234-020-02385-0pmid: 32152648
PurposeFluid-attenuated inversion recovery hyperintense vessels (FHVs) are linked to sluggish or disordered blood flow. The purpose of this study is to compare FHVs with digital subtraction angiography (DSA) findings and cerebral hemodynamic changes on acetazolamide challenge SPECT and to determine the clinical and imaging metrics associated with FHVs in patients with extracranial carotid artery stenosis (ECAS).MethodsThe subjects were patients with chronic ECAS who underwent carotid artery stenting in our department between March 2011 and October 2018. Relationships of FHVs with age, sex, medical history, cerebral angiographic findings using DSA, and quantitative values of cerebral blood flow (CBF) were examined. The resting CBF (rCBF) and cerebrovascular reactivity (CVR) in the middle cerebral artery territory were measured quantitatively using SPECT with acetazolamide challenge. We used multivariate logistic regression analysis to identify independent predictors of FHVs.ResultsOf 173 patients included, 92 (53.2%) had FHVs. Patients with FHVs had more severe stenosis (P < 0.01) and more leptomeningeal collateral vessels (P < 0.01). FHV-positive cases had significantly reduced CVR compared with FHV-negative cases (P < 0.01), although there was no significant difference in rCBF between FHV-positive and FHV-negative cases. Logistic regression analysis showed that ipsilateral rCBF and ipsilateral CVR were significant predictors for FHVs (P < 0.01).ConclusionIn patients with ECAS, cerebral hemodynamic metrics, especially ipsilateral rCBF and ipsilateral CVR, are associated with the presence of FHVs.