Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Nov 2013
ReviewIntracranial endovascular balloon test occlusion: indications, methods, and predictive value.
Abrupt interruption of the internal carotid artery without a balloon test occlusion (BTO) carries a 26% risk of cerebral infarction. BTO is a test used to decrease this risk by evaluating the efficacy of the collateral circulation. Clinical tolerance of parent vessel occlusion can be assessed by a BTO with several variables, including the clinical examination, angiographic assessment, stump pressure, induced hypotension, perfusion scanning, transcranial Doppler ultrasonography, and neurophysiologic monitoring. This review discusses the indications, methods, predictive value, and complications of BTO.
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Neuroimaging Clin. N. Am. · Nov 2013
ReviewEndovascular treatment of cerebral dural and pial arteriovenous fistulas.
Dural arteriovenous fistulas (DAVFs) are arteriovenous shunts from a dural arterial supply to a dural venous channel, typically supplied by pachymeningeal arteries and located near a major venous sinus. Pial arteriovenous fistulas (PAVFs) are composed of one or more arterial feeders draining into a single vein in the absence of an intervening nidus. Fistulas manifesting features of high risk for rupture should be treated aggressively, the spectrum of treatment varies from endovascular, surgical resection, and stereotactic radiosurgery. This article describes the natural history, clinical presentation, and treatment of dural and pial fistulas, with emphasis on endovascular treatment.
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Carotid occlusive disease is one of several etiologic factors for stroke. Of all strokes, an estimated 88% are ischemic in nature. ⋯ Traditionally, carotid artery stenosis has been treated with carotid endarterectomy (CEA); however, carotid artery balloon angioplasty and stent placement has enjoyed significant technological advances over the last decade and can now offer a comparable treatment alternative to CEA. In this review, the authors concentrate their discussion on the treatment of carotid atherosclerotic disease with particular attention on the endovascular treatment.
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Acute ischemic stroke affects 3.3 of 100,000 children per year. The causes of AIS in children can be broadly divided into the following 6 categories: cardiac disese, sickle cell disease, moyamoya, arterial dissection, other arteriopathies, and other causes. ⋯ Magnetic resonance imaging (MRI) and cerebral angiography play an important role in the determining the causes of an AIS in children. Medical approaches, including anticoagulation, anti-inflammatories, and antiplatelet therapies, surgical revascularization and endovascular approaches may have a role in the management of AIS in children.
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Intracranial arteriovenous shunts (AVSs) in children can be divided into pial arteriovenous malformations, vein of Galen malformations, and arteriovenous fistulae (AVF). Dural AVF and dural sinus malformations are rare entities within this group. ⋯ Thus, the clinical presentation reflects this difference in the underlying anatomy, physiology, and disorder between children and adults. In this article, we briefly review the presentation, natural history and management of these entities.