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Angiographic CT after Intravenous Contrast Agent Application: A Noninvasive Follow-Up Tool after Intracranial Angioplasty and Stenting

Angiographic CT after Intravenous Contrast Agent Application: A Noninvasive Follow-Up Tool after... BACKGROUND AND PURPOSE: ICAS is one of the therapeutic options in symptomatic cerebral artery stenosis. iaDSA is the current criterion standard examination after ICAS for the detection of ISR. In this study, we evaluated ivACT as a potential noninvasive follow-up alternative. MATERIALS AND METHODS: In 17 cases, ivACT and iaDSA were performed after ICAS. Both procedures were carried out on a flat-panel-detector-equipped angiography system. Postprocessing of ivACT acquisitions was performed on a dedicated workstation producing multiplanar reformations of the stent region and other intracranial arteries. Restenotic lesions were compared with iaDSA measurements. All studies were independently evaluated by 2 experienced neuroradiologists blinded to patients data. RESULTS: In 5 cases, ISR was diagnosed on iaDSA images. All restenotic lesions were reliably detected (sensitivity, 100%; 95%CI, 48%–100%) and could be correctly quantified on ivACT images in comparison with iaDSA. The neuroradiologists correctly excluded ISR in 11 of 12 lesions after viewing the ivACT examinations (specificity, 92%; 95%CI, 62%–100%). Measurements of ISR on ivACT were highly correlated to iaDSA (Pearson r = 0.94, P < .01). CONCLUSIONS: IvACT is a promising noninvasive follow-up examination after ICAS. With its high spatial resolution, it can reliably detect or exclude ISR. Contrary to iaDSA, there is no need for a recovery period after ivACT and the risk of neurologic complications is practically lowered to zero. Abbreviations A2 second segment of anterior cerebral artery ACT angiographic CT BA basilar artery C3 third segment of ICA CI confidence interval CTDI w weighted CT dose index ΔDSA% change of stenosis percentage at follow-up iaDSA compared with measurements on iaDSA after stenting DSA post digital subtraction angiography after stenting DSA pre digital subtraction angiography before stenting DWI diffusion-weighted imaging IA focal lesion involving the end of the stent iaDSA intra-arterial digital subtraction angiography IB focal lesion involving the body of the stent IC multiple restenotic foci involving <50% of the stented segment ICA internal carotid artery ICAS intracranial artery angioplasty and stenting II diffuse intrastent lesion ISR in-stent restenosis ivACT ACT after intravenous contrast medium application M1 first segment of middle cerebral artery MDCTA multidetector CT angiography PTA percutaneous transluminal angioplasty rePTA repeated PTA after ICAS TIA transient ischemic attack V4 intracranial segment of vertebral artery http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Angiographic CT after Intravenous Contrast Agent Application: A Noninvasive Follow-Up Tool after Intracranial Angioplasty and Stenting

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Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2010 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A2168
pmid
20634309
Publisher site
See Article on Publisher Site

Abstract

BACKGROUND AND PURPOSE: ICAS is one of the therapeutic options in symptomatic cerebral artery stenosis. iaDSA is the current criterion standard examination after ICAS for the detection of ISR. In this study, we evaluated ivACT as a potential noninvasive follow-up alternative. MATERIALS AND METHODS: In 17 cases, ivACT and iaDSA were performed after ICAS. Both procedures were carried out on a flat-panel-detector-equipped angiography system. Postprocessing of ivACT acquisitions was performed on a dedicated workstation producing multiplanar reformations of the stent region and other intracranial arteries. Restenotic lesions were compared with iaDSA measurements. All studies were independently evaluated by 2 experienced neuroradiologists blinded to patients data. RESULTS: In 5 cases, ISR was diagnosed on iaDSA images. All restenotic lesions were reliably detected (sensitivity, 100%; 95%CI, 48%–100%) and could be correctly quantified on ivACT images in comparison with iaDSA. The neuroradiologists correctly excluded ISR in 11 of 12 lesions after viewing the ivACT examinations (specificity, 92%; 95%CI, 62%–100%). Measurements of ISR on ivACT were highly correlated to iaDSA (Pearson r = 0.94, P < .01). CONCLUSIONS: IvACT is a promising noninvasive follow-up examination after ICAS. With its high spatial resolution, it can reliably detect or exclude ISR. Contrary to iaDSA, there is no need for a recovery period after ivACT and the risk of neurologic complications is practically lowered to zero. Abbreviations A2 second segment of anterior cerebral artery ACT angiographic CT BA basilar artery C3 third segment of ICA CI confidence interval CTDI w weighted CT dose index ΔDSA% change of stenosis percentage at follow-up iaDSA compared with measurements on iaDSA after stenting DSA post digital subtraction angiography after stenting DSA pre digital subtraction angiography before stenting DWI diffusion-weighted imaging IA focal lesion involving the end of the stent iaDSA intra-arterial digital subtraction angiography IB focal lesion involving the body of the stent IC multiple restenotic foci involving <50% of the stented segment ICA internal carotid artery ICAS intracranial artery angioplasty and stenting II diffuse intrastent lesion ISR in-stent restenosis ivACT ACT after intravenous contrast medium application M1 first segment of middle cerebral artery MDCTA multidetector CT angiography PTA percutaneous transluminal angioplasty rePTA repeated PTA after ICAS TIA transient ischemic attack V4 intracranial segment of vertebral artery

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Nov 1, 2010

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