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
Findings and procedure details
Although catheter angiography remains the most sensitive modality regarding the patency of the anastomosis [7],
it is an invasive and time-consuming procedure. In our institution we developed algorithm that includes CTA for assessment of the continuity of the vessels and the patency of anastomosis early after the surgery(Fig.1). In case of emergency TCD will typically provide adequate information regarding patency of the anastomosis and the intracranial hemodynamic.
In case of late complications,
including contralateral internal carotid artery (ICA) stenosis with steal-phenomenon brain perfusion techniques are invaluable,
provided that a baseline perfusion map was taken.
This is why DSC is the modality of choice for assessment before signing out the patient.
DSC give us useful overview of the scale of area with insufficient perfusion in patients with symptomatic occlusion of the ICA that can be saved with timely bypass surgery (Fig.
3,4,5 and 6).
In contrast to the ACR guidelines for contrast administration we use one pass of bolus injection with 2ml/s flow rate in,
as far as blood brain barrier in this patient is expected to be intact and false MTT prolongation is not an issue.
After the procedure we compare the multiparametric maps in order to achieve precise assessment of the effects in the specific area of interest (Fig.
7,8,9 and 10).
TOF MRA can also be useful to evaluate if there is sufficient flow through the anastomosis (Fig.
11).