Objectives The goal of this study was to investigate carotid plaque characteristics in symptomatic versus asymptomatic patients with the use of nonocclusive optical coherence tomography (OCT). ...Background The identification of asymptomatic patients with carotid disease who are at risk of stroke remains a challenge. There is an increasing awareness that plaque characteristics may best risk-stratify this population. We hypothesized that OCT, a new high-resolution (∼10 μm) imaging modality, might be useful for the identification of low-risk versus high-risk carotid plaque features and help us to understand the relationship between carotid diameter stenosis and plaque morphology to ischemic stroke. Methods Fifty-three patients undergoing diagnostic carotid angiography were studied with OCT. Data analysis was carried out by imaging experts who were unaware of the clinical characteristics of the study population. Results Plaque with American Heart Association type VI complicated features was more common in symptomatic than asymptomatic patients (74.1% vs. 36.4%, p = 0.02). This was largely driven by differences in the incidence of thin-cap fibroatheroma with rupture (40.7% vs. 13.6%, p = 0.056) and thrombus (67.7% vs. 36.4%, p = 0.034). Conversely, non–type VI plaques were more common in asymptomatic than symptomatic patients (63.6% vs. 25.9%, p = 0.02). No association between the degree of stenosis and plaque morphology was identified. Conclusions This retrospective analysis of carotid OCT data supports the hypothesis that the evaluation of carotid plaque characteristics with this high-resolution imaging technique has the potential to alter the understanding and treatment of carotid artery disease.
Intravascular optical coherence tomography is a high-resolution invasive imaging modality that allows the evaluation of vascular responses after stent implantation in a micron-scale level. We ...describe for the first time two patients with very late vascular response after carotid artery stenting that exhibit two different patterns of low-signal intensity (LSI), “ill-appearing” neointima: the first patient shows layered LSI neointima leading to stent restenosis, coupled with the presence of intraluminal thrombus, whereas the second patient demonstrates another pattern of non-restenotic LSI stent strut coverage, suggestive of lipid laden neointima (ie, “neoatherosclerosis”), recently associated with stent failure in coronary arteries.
Background and Purpose: Adjunctive treatments like balloon-assisted coil embolization (BACE) and stent-assisted coil embolization play a major role in the treatment of wide-neck and large ...intracranial aneurysms. The TransForm™ Occlusion Balloon Catheter (TOBC) registry is intended to evaluate the safety, efficacy, and efficiency of BACE using the TOBC. Method and Study Design: The TOBC registry is a prospective multicenter registry trial. Seven sites in the USA and 1 site in Spain participated and enrolled 81 patients. Results: The performance and safety of the TOBC was evaluated based on scoring for different variables. Scores were measured using a semiquantitative rating scale (1 = excellent, 5 = poor). The mean scores for these variables were as follows: visibility under fluoroscopy, 1.8; ability to reach the intended site, 1.6; stability during first positioning, 1.5; stability during inflation, 1.6; stability during deflation, 1.6; ability to temporarily stop flow, 1.6; and ability to assist in coil embolization, 1.7. The mean inflation and deflation times were 4.9 and 5.6 s, respectively. Complete obliteration of the aneurysm (Raymond class I) was achieved in 69.4% of the BACE cases. Thrombus formation occurred in 4/81 (4.8%) of the cases. In all cases, the thrombus resolved with medications, no patient suffered an infarction, and an underlying hypercoagulable state from subarachnoid hemorrhage was considered a contributing factor. Vessel rupture occurred in 1/81 (1.2%) of the cases, but was unrelated to TOBC use. Conclusion: BACE using the TOBC is safe and effective. All variables assessed for performance showed good-to-excellent results.
The purpose of this article is to illustrate the effectiveness and utility of percutaneous sacroplasty in the treatment of sacral insufficiency fractures. We also outline the technical considerations ...in performing the procedure.
Percutaneous sacroplasty is an effective treatment for sacral insufficiency fractures. Most patients experience significant relief within the first 48 hr.
We report CT findings in seven patients with diffuse cerebral edema and increased attenuation in the basilar cisterns resembling subarachnoid hemorrhage. On the basis of autopsy (three cases) and ...lumbar puncture (four cases) findings, true subarachnoid hemorrhage was reasonably excluded. Pathophysiologic changes that occur with diffuse cerebral edema are explored, with proposed explanations for the appearance of a pseudo-subarachnoid hemorrhage.
Absence of the internal carotid artery (ICA) is a rare congenital anomaly. The embryology of the ICA and the common collateral pathways associated with its congenital absence are reviewed, with four ...new cases provided for illustration. While collateral blood flow may allow these patients to remain asymptomatic, two of our patients presented with transient ischemic attacks. Recognition of this anomaly has important implications during planned carotid or transsphenoidal surgery, in thromboembolic disease, and in the surveillance and detection of associated cerebral aneurysms.
The authors report two cases of traumatic carotid-cavernous fistulas treated successfully with combined N-butyl cyanoacrylate glue and coil embolization via a transarterial approach. In both cases ...complete occlusion of the fistula was achieved, with preservation of the parent carotid artery. Casting of the cavernous sinus with a liquid embolic agent was well tolerated and produced no complications of cranial nerve palsy. This technique provides interventionalists with yet another treatment option in these often complex cases.
Methylmalonic acidemia (MMA) is a multifactorial autosomal recessive inborn error of organic acid metabolism, often presenting with neurologic findings. We report the imaging findings in a case of a ...child with classic neurological and laboratory findings for MMA. Imaging studies demonstrated abnormalities within the basal ganglia, particularly the globi pallidi (GP). Diffusion-weighted abnormalities seen in patients with MMA during an acute episode of metabolic acidosis and at follow-up are discussed. The authors are aware of only one prior report of serial examinations demonstrating resolution of restricted diffusion in the GP. The biochemical and pathophysiologic basis of the imaging findings of MMA are explained.
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