Journal of neuroimaging : official journal of the American Society of Neuroimaging
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Intravascular ultrasound (IVUS) has provided invaluable real-time information during carotid artery stenting (CAS). We present a case of IVUS-guided thrombus extraction during CAS. A 46-year-old man underwent an urgent right CAS under proximal flow reversal for embolic protection for a hemodynamically significant symptomatic near-occlusion of the internal carotid artery. ⋯ Ultimately, the thrombus was removed with the use of a multipurpose-angled catheter under IVUS guidance. The artery reconstituted almost completely after stent placement, and the patient's condition improved significantly. IVUS identification of intraluminal thrombus allowed additional maneuvers to be performed to prevent distal embolization and postprocedure stroke.
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Neurologists have a long history of involvement in cerebral angiography; however, the roots of neurologist involvement in therapeutic endovascular procedures have not been previously documented. As outlined in this article, it has taken the efforts of several early pioneers to lay the ground work for interventional neurology, a specialty that has become one of the fastest growing neurological subspecialties. The ground work, along with a great clinical need, has allowed the modern interventional neurologist to tackle some of the most intractable diseases, especially those affecting the cerebral vasculature. The institutionalization of interventional neurology as a subspecialty was first advocated in 1995 in an article entitled, "Interventional Neurology, a subspecialty whose time has come." The institutions created in the wake of this article have provided the framework that has allowed interventional neurology to transition from "a subspecialty whose time has come" to a subspecialty that is here to stay and thrive.
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Susceptibility-weighted imaging (SWI) microscopy on a 7.0T system demonstrated the corticomedullary junction (CMJ) to be a high-susceptibility region (HSR) in young normal subjects, suggesting that functional alteration of cortical microcirculation could be assessed with this imaging method. ⋯ CMJ-HSR expands significantly as a function of aging. Since CMJ-HSR represents a functionally distinct area with relatively slow venous flow, the observed expansion is believed to reflect alteration in cerebral microcirculation with increased age, providing another clue for pathogenesis of Alzheimer's disease.
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The use of head computed tomography (CT) is standard in the management of acute brain injury; however, there are inherent risks of transport of critically ill patients. Portable CT can be brought to the patient at any location. ⋯ Portable head CT can reliably and consistently be performed at the patient's bedside. This should lead to decreased transportation-related morbidity and improved rapid decision making in the ICU, OR, and other locations. Further studies to confirm this clinical advantage are needed.
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In multiple sclerosis (MS), the presence of lesions and normal-appearing white matter damage may affect the reliability of diffusion tensor (DT) magnetic resonance imaging (MRI)-based tractography. We compared the performance of an individual-based method for corpus callosum (CC) fiber tracking in MS with those of two atlas-based methods. ⋯ CC DT tractography using an individual-based method is more sensitive than the atlas-based ones to tract-specific alterations related to MS disability. An atlas-based method with nonlinear registration can be a valid alternative when an automated postprocessing is warranted, such as in the case of high volumes of data.