Journal of neuroimaging : official journal of the American Society of Neuroimaging
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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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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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Studies have demonstrated that computed tomography (CT) angiography source images (CTA-SI) acquired under near-steady-state contrast concentration provide infarct core estimates equivalent to diffusion-weighted images (DWI). We sought to test this relationship using our current CTA protocol optimized for faster scan acquisition. ⋯ CTA-SI performed using a fast-acquisition protocol overestimates the infarct core on DWI. Substantial differences are observed in over 25% of cases, and are associated with reduced collateralization.
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Limited data exist regarding the long-term clinical and angiographic outcomes of patients with spontaneous cervico-cranial arterial dissection treated with stent placement. ⋯ This study demonstrates the feasibility, safety, and intermediate term effectiveness of endovascular stent reconstruction of spontaneous, cervico-cranial arterial dissection.
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Case Reports
Alterations in surgical plan based on intraoperative portable head computed tomography imaging.
Intraoperative imaging offers potential for utility in many clinical scenarios. Portable computed tomography (CT) offers a versatile potential alternative when immediate imaging may alter the surgical plan and magnetic resonance imaging is not practical. ⋯ In select cases, intraoperative portable head CT leads to changes in the surgical plan in 32% of cases. This potentially prevents a return to the operating room and offers a cost-effective alternative to fixed intraoperative imaging facilities.