Intraoperative Computed Tomography Angiography: A Novel Completion Imaging Modality for Carotid Endarterectomy

2017 ◽  
Vol 13 (6) ◽  
pp. 739-745 ◽  
Author(s):  
Anish N Sen ◽  
Jared Fridley ◽  
Sherly Sebastian ◽  
Edward A M Duckworth
Keyword(s):  
Computed Tomography ◽  
Carotid Endarterectomy ◽  
Computed Tomography Angiography ◽  
Medical Records ◽  
Imaging Modality ◽  
Neurological Complication ◽  
Internal Carotid Artery Stenosis ◽  
Intraoperative Computed Tomography ◽  
Patch Angioplasty ◽  
Significant Difference

Abstract BACKGROUND Intraoperative computed tomography angiography (ICTA) is a novel completion imaging modality for carotid endarterectomy (CEA). No studies exist in the literature describing ICTA use in CEA. OBJECTIVE To evaluate the feasibility and efficacy of ICTA as a method of immediately evaluating the technical results of CEA. METHODS Twenty-three consecutive CEAs were performed by a single neurosurgeon over an 8-month period. Of this series, 12 utilized ICTA for completion imaging, 10 utilized duplex ultrasonography (US), and 1 utilized no intraoperative completion imaging. Electronic medical records were reviewed to assess demographics, CTA results, US results, and need for revisions. RESULTS Patients included 13 men (62%) and 8 women (38%). All patients had symptomatic internal carotid artery stenosis. Polytetrafluoroethylene (PTFE) patch angioplasty was used in 16 cases (70%). Average operative times were comparable between cases that utilized CTA and US, 180 and 175 min, respectively. Major technical defects were identified in one of the 12 cases utilizing ICTA and none of the 10 cases utilizing intraoperative US. The technical defect was revised without subsequent neurological complication. One patient had a postoperative intracerebral hemorrhage requiring surgical evacuation. Fifteen patients were followed for up to 3 months with no postoperative stroke or transient ischemic attacks. CONCLUSION ICTA is a potentially safe and effective completion imaging modality compared to traditional alternatives, enabling the identification of technical deficits intraoperatively. While no statistically significant difference in operative times were noted between intraoperative CTA and US use, numerous steps must be taken to maximize the efficiency of ICTA.

Benefit of a Sharp Computed Tomography Angiography Reconstruction Kernel for Improved Characterization of Intracranial Aneurysms

2013 ◽  
Vol 10 (1) ◽  
pp. 97-105 ◽  
Author(s):  
Brian O'Meara ◽  
Jason P. Rahal ◽  
Alexandra Lauric ◽  
Adel M. Malek
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Imaging Modality ◽  
Cerebral Aneurysms ◽  
Matched Pair ◽  
Aneurysm Neck ◽  
Smooth Kernel ◽  
Significant Difference ◽  
Reconstruction Kernel

Abstract BACKGROUND: Computed tomography angiography (CTA) is the first-line imaging modality used for cerebral aneurysms because of its speed and sensitivity for detection, although digital subtraction angiography is often required for more detailed aneurysm shape delineation. OBJECTIVE: To determine whether a sharper CTA reconstruction kernel can better characterize an aneurysm and improve decision-making before intervention. METHODS: Fifteen patients presenting with aneurysmal subarachnoid hemorrhage underwent 64-row CTA. CTA data were reconstructed using the default H20f smooth kernel and a H60f sharp kernel and compared with contemporaneous catheter 3-dimensional rotational angiography (3DRA). Aneurysm neck, width, and aspect ratio measurements were made using intensity line plots of identical projections on all imaging datasets and compared by matched-pair statistics. RESULTS: Aneurysm neck measurements from the H20f smooth kernel revealed overestimation compared with both the sharp kernel (greater by 0.64 ± 0.21 mm, P < .01) and 3DRA (greater by 0.68 ± 0.19 mm, P < .01). There was no statistically significant difference between 3DRA and the sharp kernel CTA measurements. Neck measurements correlated well between the H60f kernel and 3DRA but not between the H20f Kernel and 3DRA (R 0.97 vs 0.86). CONCLUSION: H60f sharp CTA kernel reconstruction provides more accurate anatomic characterization of cerebral aneurysms than the H20f smooth kernel at the expense of less visually pleasing reconstructions. Because it does not require additional contrast, radiation, or imaging hardware and is more similar to 3DRA, it may aid in selecting the appropriate treatment strategy before to evaluation by catheter-based angiography.

Computed tomography angiography and microsurgical flaps for traumatic wounds: What is the added value?

2021 ◽  
pp. 1-9
Author(s):  
Lucas Sousa Macedo ◽  
Renato Polese Rusig ◽  
Gustavo Bersani Silva ◽  
Alvaro Baik Cho ◽  
Teng Hsiang Wei ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Upper Limb ◽  
Computed Tomography Angiography ◽  
Lower Limb ◽  
High Energy ◽  
Lower Limbs ◽  
Added Value ◽  
Vascular Lesions ◽  
Limb Injuries ◽  
Significant Difference

BACKGROUND: Microsurgical flaps are widely used to treat complex traumatic wounds of upper and lower limbs. Few studies have evaluated whether the vascular changes in preoperative computed tomography angiography (CTA) influence the selection of recipient vessel and type of anastomosis and the microsurgical flaps outcomes including complications. OBJECTIVE: The aim of this study was to evaluate if preoperative CTA reduces the occurrence of major complications (revision of the anastomosis, partial or total flap failure, and amputation) of the flaps in upper and lower limb trauma, and to describe and analyze the vascular lesions of the group with CTA and its relationship with complications. METHODS: A retrospective cohort study was undertaken with all 121 consecutive patients submitted to microsurgical flaps for traumatic lower and upper limb, from 2014 to 2020. Patients were divided into two groups: patients with preoperative CTA (CTA+) and patients not submitted to CTA (CTA–). The presence of postoperative complications was assessed and, within CTA+, we also analyzed the number of patent arteries on CTA and described the arterial lesions. RESULTS: Of the 121 flaps evaluated (84 in the lower limb and 37 in the upper limb), 64 patients underwent preoperative CTA. In the CTA+ group, 56% of patients with free flaps for lower limb had complete occlusion of one artery. CTA+ patients had a higher rate of complications (p = 0.031), which may represent a selection bias as the most complex limb injuries and may have CTA indicated more frequently. The highest rate of complications was observed in chronic cases (p = 0.034). There was no statistically significant difference in complications in patients with preoperative vascular injury or the number of patent arteries. CONCLUSIONS: CTA should not be performed routinely, however, CTA may help in surgical planning, especially in complex cases of high-energy and chronic cases, since it provides information on the best recipient artery and the adequate level to perform the microanastomosis, outside the lesion area.

scholarly journals Agreement of Magnetic Resonance Imaging With Computed Tomography in the Assessment for Acute Skull Fractures in a Canine and Feline Cadaver Model

2021 ◽  
Vol 8 ◽  
Author(s):  
Silke Hecht ◽  
Kimberly M. Anderson ◽  
Aude Castel ◽  
John F. Griffin ◽  
Adrien-Maxence Hespel ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Head Trauma ◽  
Imaging Modality ◽  
Small Animal ◽  
Skull Fractures ◽  
Resonance Imaging ◽  
Significant Difference ◽  
Mri Sequences

Computed tomography (CT) is the imaging modality of choice to evaluate patients with acute head trauma. However, magnetic resonance imaging (MRI) may be chosen in select cases. The objectives of this study were to evaluate the agreement of MRI with CT in the assessment for presence or absence of acute skull fractures in a canine and feline cadaver model, compare seven different MRI sequences (T1-W, T2-W, T2-FLAIR, PD-W, T2*-W, “SPACE” and “VIBE”), and determine agreement of four different MRI readers with CT data. Pre- and post-trauma CT and MRI studies were performed on 10 canine and 10 feline cadaver heads. Agreement of MRI with CT as to presence or absence of a fracture was determined for 26 individual osseous structures and four anatomic regions (cranium, face, skull base, temporomandibular joint). Overall, there was 93.5% agreement in assessing a fracture as present or absent between MRI and CT, with a significant difference between the pre and post trauma studies (99.4 vs. 87.6%; p < 0.0001; OR 0.042; 95% CI 0.034–0.052). There was no significant difference between dogs and cats. The agreement for the different MRI sequences with CT ranged from 92.6% (T2*-W) to 94.4% (PD-W). There was higher agreement of MRI with CT in the evaluation for fractures of the face than other anatomic regions. Agreement with CT for individual MRI readers ranged from 92.6 to 94.7%. A PD-W sequence should be added to the MR protocol when evaluating the small animal head trauma patient.

Measurement of Lingual Artery Using Ultrasound Versus Computed Tomography Angiography for Midline Glossectomy in Patients With Obstructive Sleep Apnea

2021 ◽  
pp. 000348942110626
Author(s):  
Chenhai Zheng ◽  
Lei Shi ◽  
Dengxiang Xing ◽  
Jie Qin ◽  
Peipei Ji ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Computed Tomography Angiography ◽  
Lingual Artery ◽  
Obstructive Sleep ◽  
Significant Difference

Objective: To clarify the differences in assessing the course of the lingual artery between lingual artery computed tomography angiography (CTA) and ultrasound (US). Methods: Twenty-six OSA patients were included in this study and accomplished lingual artery CTA and US, respectively. The differences in the depths of the lingual arteries and the distances between the bilateral lingual arteries on 3 measurement levels based on lingual artery CTA and US were compared. Results: The depths of the lingual arteries on 3 measurement levels by CTA were deeper than those by US ( P < .01). There was no significant difference in the distances between bilateral lingual arteries on 3 measurement levels between CTA and US ( P > .05). Conclusions: The parameters of lingual artery measured by lingual artery US were similar to or smaller than those measured by lingual artery CTA. Like lingual artery CTA, lingual artery US could be used as an effective method to ensure the safety of the operation.

Correlation between computed tomography angiography and histology of carotid artery atherosclerosis: Can semi-automated imaging software predict a plaque's composition?

2021 ◽  
pp. 159101992110310
Author(s):  
John C Benson ◽  
Valentina Nardi ◽  
Melanie C Bois ◽  
Luca Saba ◽  
Waleed Brinjikji ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Computed Tomography Angiography ◽  
Necrotic Core ◽  
Intraplaque Hemorrhage ◽  
Histological Evaluation ◽  
Plaque Volume ◽  
Volumetric Imaging ◽  
Carotid Artery Atherosclerosis

Background Using computed tomography angiography to differentiate between components of carotid atherosclerotic lesions remains largely elusive. This study sought to validate a semi-automated software for computed tomography angiography plaque analysis using histologic comparisons. Materials and Methods A retrospective review was performed of consecutive patients that underwent a carotid endarterectomy, with pre-procedural computed tomography angiography imaging of the cervical arterial vasculature available for review. Images were evaluated using a commercially-available software package, which produced segmented analyses of intraplaque components (e.g. intraplaque hemorrhage, lipid-rich necrotic core, and calcifications). On imaging, each component was assessed in terms of its (1) presence or absence, and (2) both volume and proportion of the total plaque volume (if present). On histological evaluation of carotid endarterectomy specimens, each component was evaluated as an estimated proportion of total plaque volume. Results Of 80 included patients, 30 (37.5%) were female. The average age was 69.7 years (SD = 9.1). Based on imaging, intraplaque hemorrhage was the smallest contributor to plaque composition (1.2% of volumes on average). Statistically significant linear associations were noted between the proportion of intraplaque hemorrhage, lipid-rich necrotic core, and calcifications on histology and the volume of each component on imaging ( p values ranged from 0.0008 to 0.01). Area under curve were poor for intraplaque hemorrhage and lipid-rich necrotic core (0.59 and 0.61, respectively) and acceptable for calcifications (0.73). Conclusion Semi-automated analyses of computed tomography angiography have limited diagnostic accuracy in the detection of intraplaque hemorrhage and lipid-rich necrotic core in carotid artery plaques. However, volumetric imaging measurements of different components corresponded with histologic analysis.

scholarly journals Role of multi-parametric ultrasound in transient perivascular inflammation of the carotid artery syndrome

Ultrasound ◽  
2019 ◽  
Vol 27 (2) ◽  
pp. 77-84 ◽  
Author(s):  
Vasileios Rafailidis ◽  
Ioannis Chryssogonidis ◽  
Thomas Tegos ◽  
Sasan Partovi ◽  
Afroditi Charitanti-Kouridou ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Carotid Artery ◽  
Contrast Enhancement ◽  
Computed Tomography Angiography ◽  
Imaging Modality ◽  
Power Doppler ◽  
Luminal Narrowing ◽  
Perivascular Inflammation

Introduction The term “carotidynia” has been used to describe a symptom or a nosologic entity characterized by pain in the lateral neck region and over the carotid bifurcation. Recent advances in diagnostic imaging and the introduction of diagnostic criteria have led to the adoption of term “Transient perivascular inflammation of the carotid artery” (TIPIC) syndrome. Method A retrospective analysis of the Radiology Department’s database was performed to identify cases with the diagnosis of TIPIC syndrome. The purpose was to identify ultrasound images including B-mode technique, colour, power Doppler technique and contrast-enhanced ultrasound (CEUS). Findings In total, five patients with the diagnosis of TIPIC syndrome are presented in this review. TIPIC syndrome is a clinic-radiologic entity characterized by pain over the carotid area, a symptom referring to a wide differential diagnosis where imaging plays a crucial role for proper diagnosis and treatment. Characteristic imaging findings on conventional ultrasound and CEUS are presented in this review. Discussion TIPIC syndrome can be investigated with virtually any imaging modality. Ultrasound typically reveals perivascular infiltration and a hypoechoic intimal plaque, while no significant luminal narrowing is appreciated. Computed tomography angiography and magnetic resonance angiography also demonstrate these vascular wall changes primarily affecting the distal common carotid artery, the carotid bulb and possibly the internal carotid artery proximal part. Contrast enhancement is a very characteristic and constant finding of TIPIC lesions, suggestive of the inflammatory nature of the disease and can be appreciated on computed tomography angiography and magnetic resonance angiography. CEUS has been recently used and successfully observed contrast enhancement of the lesions, similar to computed tomography angiography and magnetic resonance angiography. Conclusion Ultrasound remains the first-line modality for the evaluation of TIPIC syndrome, capable of providing all the information needed, especially if supplemented with the administration of microbubbles so that the enhancement of lesions can be evaluated.

A Randomized Trial of Synthetic Patch versus Direct Primary Closure in Carotid Endarterectomy

Neurosurgery ◽  
2006 ◽  
Vol 59 (4) ◽  
pp. 822-829 ◽  
Author(s):  
Pippa G. Al-Rawi ◽  
Carole L. Turner ◽  
Vicknes Waran ◽  
Ivan Ng ◽  
Peter J. Kirkpatrick
Keyword(s):  
Clinical Outcome ◽  
Carotid Endarterectomy ◽  
Duplex Ultrasound ◽  
Vessel Occlusion ◽  
Direct Closure ◽  
Patch Angioplasty ◽  
Significant Difference ◽  
Vessel Patency ◽  
Closure Group ◽  
Patch Group

Abstract OBJECTIVE: To define whether or not direct microscopic closure with or without the use of a vascular patch is advantageous in terms of clinical outcome and late vessel occlusion rates after microsurgical carotid endarterectomy. METHODS: Three hundred thirty-eight elective carotid endarterectomies in 315 patients were randomized to direct arteriotomy or closure with a polyester collagen-coated vascular patch. Ten procedures did not follow the randomization process because of technical difficulties and were excluded. Vessel patency (duplex ultrasound) and outcome were assessed during and immediately after surgery and at 4 and 12 months after surgery. RESULTS: Four-month ultrasound assessment (n = 321) identified five occluded vessels: two in the patch group (n = 149) and three in the direct closure group (n = 172). Six patients in the patch group had died or were significantly disabled at 4 months, compared with five in the direct closure group. At the 12-month assessment (n = 313), eight vessels had occluded: five from the patched group (n = 146) and three from the direct closure group (n = 167). Eight patients in the patch group had died or were significantly disabled, compared with four in the direct closure group. No statistically significant difference between the two groups in terms of vessel occlusion, morbidity, or mortality was seen (P &gt; 0.1). CONCLUSION: No difference in vessel patency and clinical outcome has been identified after microscopic patch angioplasty and direct arteriotomy repair. The authors conclude that there is no benefit from the routine use of patch angioplasty in microscopic carotid endarterectomy.

scholarly journals Computed Tomography Angiography (CTA) Features of Aortic Floating Thrombus: Five Case Reports and Literature Review

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Bo Zhang ◽  
Ji Zhang ◽  
Lin-Yun Wu ◽  
Zhong Wei Tian ◽  
Hong Yu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Therapeutic Strategy ◽  
Imaging Modality ◽  
Case Reports ◽  
Medication Use ◽  
Therapeutic Effects ◽  
Dynamic Changes ◽  
Floating Thrombus ◽  
Laboratory Biomarkers

: Aortic floating thrombus (AFT) is a rare disease, which is often misdiagnosed as a tumor or another disease. Here, we report five cases of AFT, confirmed by computed tomography angiography (CTA). The patients’ laboratory biomarkers, clinical treatment, dynamic changes, and CTA features, including the AFT location, morphology, size, and aortic segment involvement, were retrospectively analyzed. CTA was the main imaging modality for detecting AFT, as it could depict lesions and determine the therapeutic effects accurately. Overall, the therapeutic strategy should be selected individually, depending on the patient’s physical health; conservative medication use is also recommended.

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