AJNR. American journal of neuroradiology
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AJNR Am J Neuroradiol · Jun 2014
Arterial spin-labeling evaluation of cerebrovascular reactivity to acetazolamide in healthy subjects.
Arterial spin-labeling MR imaging permits safe, repeated CBF measurement. We investigated the potential and technical factors of arterial spin-labeling imaging in assessing cerebrovascular reactivity to acetazolamide. ⋯ Arterial spin-labeling imaging allows evaluation of the distribution, magnitude, and time course of cerebrovascular response to acetazolamide. The influence of the postlabeling delay on the estimated cerebrovascular reactivity should be noted.
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AJNR Am J Neuroradiol · May 2014
Randomized Controlled Trial Multicenter StudyBioactive versus bare platinum coils in the treatment of intracranial aneurysms: the MAPS (Matrix and Platinum Science) trial.
The ability of polymer-modified coils to promote stable aneurysm occlusion after endovascular treatment is not well-documented. Angiographic aneurysm recurrence is widely used as a surrogate for treatment failure, but studies documenting the correlation of angiographic recurrence with clinical failure are limited. This trial compares the effectiveness of Matrix(2) polyglycolic/polylactic acid biopolymer-modified coils with bare metal coils and correlates the angiographic findings with clinical failure (ie, target aneurysm recurrence), a composite end point that includes any incident of posttreatment aneurysm rupture, retreatment, or unexplained death. ⋯ Tested Matrix(2) coils were not inferior to bare metal coils. Endovascular coiling of intracranial aneurysms was safe, and the rate of technical success was high. Target aneurysm recurrence is a promising clinical outcome measure that correlates well with established angiographic measurements.
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AJNR Am J Neuroradiol · May 2014
Safety of unilateral endovascular occlusion of the cervical segment of the vertebral artery without antecedent balloon test occlusion.
Antecedent balloon test occlusion is often performed prior to vertebral artery sacrifice, but there is limited data to suggest this adds a significant clinical benefit, especially in the setting of trauma. Furthermore, balloon test occlusion can be time-consuming, add to the technical complexity of the procedure, and increase the overall cost of treatment. The purpose of this study was to determine the safety of unilateral vertebral artery occlusion without antecedent balloon test occlusion as part of the treatment regimen in patients with traumatic vertebral artery dissection, cervical tumor, or intracranial aneurysm. ⋯ In this series, endovascular occlusion of a cervical segment of 1 vertebral artery was safely performed without antecedent balloon test occlusion. As long as both vertebral arteries were patent and converged at the vertebrobasilar junction, there was anatomic potential for retrograde filling of the distal intracranial vertebral artery to the level of the posterior inferior cerebellar artery origin, and there was no major vascular supply to the spinal cord arising from the target segment of the affected vessel. Dominant and nondominant vertebral arteries were safely occluded, and no infarcts were attributed to the treatment.
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AJNR Am J Neuroradiol · May 2014
Review Meta AnalysisCT perfusion for detection of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis.
Delayed cerebral ischemia is a significant cause of morbidity and mortality after aneurysmal SAH, leading to poor outcomes. The purpose of this study was to evaluate the usefulness of CTP in determining delayed cerebral ischemia in patients with aneurysmal SAH. ⋯ Perfusion deficits on CTP are a significant finding in determining delayed cerebral ischemia in aneurysmal SAH. This may be helpful in identifying patients with delayed cerebral ischemia before development of infarction and neurologic deficits.
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AJNR Am J Neuroradiol · May 2014
Review Meta AnalysisEndovascular treatment of anterior communicating artery aneurysms: a systematic review and meta-analysis.
Endovascular therapy has become an acceptable alternative to traditional clipping for the management of intracranial aneurysms. However, a limited number of studies have examined outcomes and complications specific to embolization of anterior communicating artery aneurysms. ⋯ Endovascular therapy for anterior communicating artery aneurysms is associated with a high rate of complete angiographic occlusion. However, the procedure-related permanent morbidity and mortality are not negligible for aneurysms in this location.