The role of imaging in assessment of the brain hemodynamics after a direct transtemporal external-to-internal carotid artery bypass surgery

Congress:

ECR 2019

Poster Number:

C-3442

Type:

Educational Exhibit

Keywords:

Outcomes, Haemodynamics / Flow dynamics, Education and training, Treatment effects, Ultrasound, MR, CT-Angiography, Vascular, Neuroradiology brain

Authors:

G. Guzgunov, D. V. Georgieva, D. R. Petkov, A. P. D. E. Krastev , P. Chupetlovski, D. M. Al-Amin, PhD; Sofia/BG

DOI:

10.26044/ecr2019/C-3442

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-3442

Fig. 1: CTA VRT image showing patient with good patency of the anastomosis and aneurysm...

Fig. 3: Prolongation of MTT in the left middle cerebral artery territory in patient...

Fig. 4: Decreased TTP in left middle cerebral artery territory (same patient)

Fig. 2: Lack of flow on time-of-flight MR angiography in patient with occlusion of the...

Learning objectives

To evaluate different imaging techniques for immediate assessment of the surgical results and for long term follow-up of the patients undergoing a direct transtemporal external-to-internal carotid artery bypass surgery To propose an algorithm for follow-up of these patients

Background

Direct transtemporal external-to-internal carotid artery bypass is technique used for treatment of patients with chronic occlusion of internal carotid artery which became symptomatic and also for aneurysms not suitable for endovascular treatment [1,2].This method shows good results in treatment in these patients [3,4,5]. With the revival of this nearly extinct technique [6] radiologists are tasked with making a choice of the appropriate imaging technique for immediate assessment of the surgical results and long-term follow-up of the operated patients. A number of imaging tools are available,...

Findings and procedure details

Although catheter angiographyremains the most sensitive modality regarding the patency of the anastomosis [7], it is an invasive and time-consuming procedure.In our institution we developed algorithmthat includes CTA for assessment of the continuity of the vessels and the patency of anastomosis early after the surgery(Fig.1).In case of emergencyTCD will typically provide adequate information regarding patency of the anastomosis and the intracranial hemodynamic. In case of late complications, including contralateralinternal carotid artery (ICA) stenosis with steal-phenomenon brain perfusion techniques are invaluable, provided that a baseline perfusion...

Conclusion

With combining multimodality methods, weprovide useful protocol for assessment of the brain hemodynamics in patients underwentdirect transtemporal external-to-internal carotid artery bypass surgery that from our point of view showsgood long term results.

Personal information

Email:[email protected]

References

Extracranial-intracranial bypass: Resurrection of a nearly extinct operation Presented at the Thirty-sixth Annual Symposium of the Society for Clinical Vascular Surgery, Las Vegas, Nev, March 5-8, 2008. Ryan M. GobbleEmail the author MD Ryan M. Gobble, Han Hoang, MD, Jafar Jafar, MD, Mark Adelman, MD Extracranial-Intracranial Bypass Surgery for Stroke Prevention in Hemodynamic Cerebral Ischemia: The Carotid Occlusion Surgery Study: A Randomized Trial William J. Powers, William R. Clarke, Robert L. Grubb, Jr, Tom O Videen, Harold P. Adams, Jr, Colin P. Derdeyn JAMA. Author...