Neuroradiology presents…... Cerebrovascular Disease David M. Pelz, MD, FRCPC Neuroradiology, LHSC.

Slides:

Advertisements

Similar presentations

Cerebrovascular disease of Brain CT

Advertisements

Advanced Treatment Options for Stroke Patients Vickie Gordon PhD, ACNP-BC, CNRN.

Ischemic Stroke without Infarctions: Occlusion and stenosis of carotid arteries ASN Conference September 12 th, 2013.

Cerebral Angiography Jessica Birt CIT Noah’s Ark----- 

Advances in Interventional Neuroradiology Dr James F Peerless March 2014.

Carotid Endarterectomy versus Stenting: Where do we stand today? Vascular Conference March 23, 2010.

Surgery for Cerebrovascular Diseases(CVDs) Jian-min Zhang Dept. of Neurosurgery 2nd Affiliated Hospital Zhejiang University College of Medicine.

Endovascular Management of Intracranial and Extracranial Atherosclerosis Rishi Gupta, MD Associate Professor of Neurology, Neurosurgery, and Radiology.

Carotid Artery Disease Lenore C. Ocava, MD Vascular Neurology AECOM/Jacobi Medical Center.

Neuroendovascular Surgeon consulted by ER physician for a patient who presented with severe headaches and left eye drooping: Procede to evaluate the patien.

Aneurysm Surgery: Past, Present and Future Mario Zuccarello, M.D. University of Cincinnati, Dept of Neurosurgery Mayfield Clinic.

Cerebrovascular diseases. Vascular occlusive diseases (ischemic stroke) Intracerebral hemorrhage (hemorrhagic stroke)

Consultant Neuroradiologist

Rashad MAHMUDOV Central Hospital of Oilworkers, Baku-Azerbaijan

Angiography and Arteriography SPRING 2009 FINAL

CAROTID ARTERY DISEASE. Epidemiology 3 rd most common cause of death in the US Most common cause of long term disability 500,000 CVAs annually Contributes.

Epidemiology in HK  Stroke is major cause of morbidity and mortality around the world  4th cause of mortality in HK resulting in >3000 deaths every.

Cerebrovascular Evaluation INTERNAL CAROTID ARTERY THROMBUS Sickle Cell Disease Watson Smith, RDMS, RVT From the D. E. Strandness, Jr. Vascular Laboratory.

The Evolving Management of Pediatric Stroke Christopher A. Miller, MD July 21, 2012.

This lecture was conducted during the Nephrology Unit Grand Ground by a Sub-intern under Nephrology Division, Department of Medicine in King Saud University.

N EURORADIOLOGY. S TROKE ISCHEMICHEMORRHAGIC N ontraumatic intracranial hemorrhage HYPERTENSION RUPTURE ANEURYSM VASCULAR MALFORMATIONS COAGULOPATHY.

Neuroradiology 1.MRI (diffusion) early ischemic stroke 2.CT for trauma and CVA/stroke to exclude hemorrhage 3.MRA or DSA for Aneurysm (SAH)

Vascular D&C M. Uchiyama02/01/2013. Introduction  Complication  R MCA distribution embolic stroke  Procedure  R carotid angiography with planned,

BASILAR ANEURYSM DOES THIS CASE NEED FURTHER MANAGEMENT ? IF SO, WHAT IS BETTER; OPEN SURGERY &CLIPPING OR AGAIN ENDOVASCULAR COILING ?

Basilar Artery Anterior inferior cerebellar artery Superior cerebellar artery Posterior cerebral artery –Posterior choroidal arteries Blood supply to.

Cerebrovascular diseases. Vascular occlusive diseases (ischemic stroke) Intracerebral hemorrhage (hemorrhagic stroke)

Dr. Meg-angela Christi M. Amores

Safety of Cerebral Digital Subtraction Angiography in Pediatric Patients with Sickle Cell Disease. Emily Wyse, BS 1 Jessica Carpenter, MD 2 Suresh Magge,

H.Ghanaati; M.D. Associate Professor of Radiology Tehran University Of Medical Sciences Outcomes of intracranial aneurysms treated with coils: A six-month.

Post. Circulation aneurysms M.MOLAVI MD.

August Medical student course Joseph Philip MD

Endovascular Surgical Neuroradiology

Endovascular treatment of intra- and extra cranial malformation

Combined Use of Color Duplex Ultrasonography and B-flow Imaging for Evaluation of Patients with Carotid Artery Stenosis AJNR Am J Neuroradiol 25: ,

Clipping in Awake Surgery as End-Stage in a Complex Internal Carotid Artery Aneurysm After Failure of Multimodal Endovascular and Extracranial-Intracranial.

Ultra-Low Contrast Volumes Reduces Contrast-Induced Nephropathy in Patients With Chronic Kidney Disease Undergoing Neurointerventional Procedures eP-150.

Thrombectomy in Acute Stroke

What’s new in carotid intervention?

Fig. 1. Digital subtraction angiography (DSA) images of a 39-year-old woman presented with subarachnoid hemorrhage (SAH). The anterior-posterior (AP) and.

Cardiovascular Research Technology Conference (CRT 17)

Cerebral aneurysm-single center experience

Stroke: Incidence, Cost, Functional Anatomy, Prevention

Done By: Dr. Faisal Al-Thekair

Stroke imaging M3 radiology August 2014.

Diagnostic Medical Sonography Program

Adult moyamoya disease with peripheral artery involvement

Unruptured Aneurysms Pipeline Onyx Coils Jawad F. Kirmani, MD.

راهنمای بالینی اقدامات پیش بیمارستانی

Treatment of a symptomatic intrathoracic internal carotid artery

Treatment of a symptomatic intrathoracic internal carotid artery

Modified Rankin score 0-2

Differential outcomes of carotid stenting and endarterectomy performed exclusively by vascular surgeons in the Carotid Revascularization Endarterectomy.

Acutely ruptured PICA aneurysm in a 46-year-old woman.

Vascular disease in the antiphospholipid syndrome: A comparison with the patient population with atherosclerosis Cynthia K. Shortell, MD, Kenneth Ouriel,

Figure 1 Management of acute ischaemic stroke after ICA-T occlusion

Carotid Stenting in Acute Ischemic Stroke Resulting from Tandem Occlusions STEWART WEBER, MD.

Zachary C. Schmittling, MD, Robert B. McLafferty, MD, Jeffrey S

Accuracy and utility of three-dimensional contrast-enhanced magnetic resonance angiography in planning carotid stenting Carlos H. Timaran, MD, Eric B.

Carotid endarterectomy and intracranial thrombolysis: Simultaneous and staged procedures in ischemic stroke Hans-Henning Eckstein, MD, Hardy Schumacher,

Contralateral hyperacute intracerebral hemorrhage after carotid artery stenting with contralateral internal carotid artery occlusion Hirokazu Takami,

Concomitant asymptomatic internal carotid artery and persistent primitive hypoglossal artery stenosis treated by endovascular stenting with proximal embolic.

In this circle of Willis figure model (A), an AVM nidus in relation to a branch of the left middle cerebral artery is noted. In this circle of Willis figure.

Case 2.A, Right internal carotid artery (ICA) angiogram, oblique view, showing a 4-mm aneurysm at the right middle cerebral artery (MCA) bifurcation.B,

Suggested imaging protocols for patients presenting with acute stroke symptoms based on the clinical scenario and the therapeutic options considered and.

Michael J. Gough, ChM, FRCS Journal of Vascular Surgery

Endovascular coil occlusion of an enlarging carotid artery pseudoaneurysm. Endovascular coil occlusion of an enlarging carotid artery pseudoaneurysm. Sagittal.

30-year-old man with subarachnoid hemorrhage at presentation in 1994.

62-year-old woman with incidentally discovered bilateral cavernous sinus aneurysms. 62-year-old woman with incidentally discovered bilateral cavernous.

Case 3.A, CT angiography revealing bilateral asymptomatic middle cerebral artery (MCA) bifurcation aneurysms and an additional aneurysm at the left distal.

Procedural and follow-up angiograms of a 28-year-old female patient with a history of subarachnoid hemorrhage due to rupture of a contralateral MCA bifurcation.

Presentation transcript:

Neuroradiology presents…..

Cerebrovascular Disease David M. Pelz, MD, FRCPC Neuroradiology, LHSC

Cerebrovascular Disease Normal Anatomy Stroke Hemorrhage - Aneurysms, AVMs External Carotid

Normal Anatomy Historical Angiography Duplex Ultrasound (DUS) MR Angiography (MRA) CT Angiography (CTA)

Origins Roentgen

Egas Moniz

Moniz

Direct Puncture Carotid Vertebral APLateralAP Lateral

Sven Seldinger

Modern Angiography - DSA Digital Subtraction Angiography

Risks of Angiography Stroke - 1:1000 Contrast reaction - 1:1,000,000 Groin hematoma - 1:500 Vasovagal reactions, etc.

Auto Angiography

Normal Anatomy -DSA

Normal Anatomy - Carotid APLateral

Normal Anatomy - Vertebral APLateral

3D-CRA

Duplex Ultrasound (DUS)

MR Angiography - MRA TOF -Circle of Willis CEMRA - Contrast-enhanced

CT Angiography - CTA Circle of Willis Carotid bifurcation

Stroke Normal

NASCET North American Symptomatic Endarterectomy Trial

KFC

John Hunter ( ) “Blood goes where it is needed”

Collateral supply to the brain Circle of Willis EC-IC

Duplex Ultrasound

DUS and CTA - ? Good enough for surgery

MRA of carotid disease ? Good enough for surgery

Carotid Angioplasty/Stenting (CAS)

Pre- Post-

Endarterectomy vs CAS Over 12,000 worldwide, symptomatic and asymptomatic pts, anecdotal evidence CAVATAS - 10% risk for both CREST - 5 yrs, 2500 pts, RCT

Pre- Post- Intracranial Disease

Thrombolysis for acute stroke

Basilar artery occlusion Pre- Post-

Thrombolysis in Acute Stroke “Time is brain” IV r-TPA within 3 hrs, most practical IA - large vessel occlusions (MCA or basilar), up to 6 hrs Still no conclusive evidence favouring IA or IV

Cerebral Aneurysms

Endovascular Therapy of Cerebral Aneurysms

Coiling of Cerebral Aneurysms LateralAP

Post- GDC Coiling

Stents and Coils AP lateral

Clipping vs.. Coiling

International Subarachnoid Aneurysm Trial (ISAT)

Cerebral Arteriovenous Malformations (AVMs)

Endovascular Therapy of Brain AVMs NBCA

Pre-Post-

MRA

External Carotid Artery

External Carotid Artery - Lat

External Carotid Artery - AP

Epistaxis

Juvenile Nasal Angiofibroma

Tumours

Chemodectomas Carotid body tumour Glomus Vagale Glomus jugulare Glomus tympanicum

“ Mother - in - Law”

The End