RESUMEN
OBJECTIVE: Different technical and procedural methods have been introduced to develop low radiation dose protocols in neurointerventional examinations. We investigated the feasibility of minimizing radiation exposure dose by simply decreasing the detector dose during cerebral DSA and evaluated the comparative level of image quality using both subjective and objective methods. METHODS: In a prospective study of patients undergoing diagnostic cerebral DSA, randomly selected vertebral arteries (VA) and/or internal carotid arteries and their contralateral equivalent arteries were injected. Detector dose of 3.6 and 1.2â µGy/frame were selected to acquire standard dose (SD) and low dose (LD) images, respectively. Subjective image quality assessment was performed by two neurointerventionalists using a 5 point scale. For objective image quality evaluation, circle of Willis vessels were categorized into conducting, primary, secondary, and side branch vessels. Two blinded observers performed arterial diameter measurements in each category. Only image series obtained from VA injections opacifying the identical posterior intracranial circulation were utilized for objective assessment. RESULTS: No significant difference between SD and LD images was observed in subjective and objective image quality assessment in 22 image series obtained from 10 patients. Mean reference air kerma and kerma area product were significantly reduced by 61.28% and 61.24% in the LD protocol, respectively. CONCLUSIONS: Our study highlights the necessity for reconsidering radiation dose protocols in neurointerventional procedures, especially at the level of baseline factory settings.
Asunto(s)
Angiografía de Substracción Digital/normas , Arteria Carótida Interna/diagnóstico por imagen , Dosis de Radiación , Exposición a la Radiación/normas , Arteria Vertebral/diagnóstico por imagen , Adulto , Anciano , Angiografía de Substracción Digital/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Exposición a la Radiación/prevención & control , Método Simple CiegoRESUMEN
Basilar perforator aneurysms are rare and a communication between a basilar perforator and a separate pseudoaneurysm cavity is extremely rare. We describe a case presenting with high grade subarachnoid hemorrhage which on further investigation delineated a 2-3 mm dissecting basilar perforator aneurysm communicating superiorly into a contained 6 mm pseudoaneurysm cavity. This case illustrates an unusual neurovascular pathology with low potential for successful endovascular treatment such as coil embolization or intracranial flow diverter stenting. Conservative medical management remains the main stay of treatment for such poor surgical candidates.
Asunto(s)
Aneurisma Falso/terapia , Aneurisma Intracraneal/terapia , Anciano , Aneurisma Falso/diagnóstico por imagen , Aneurisma Roto/cirugía , Angiografía de Substracción Digital , Antihipertensivos/uso terapéutico , Angiografía Cerebral , Angiografía por Tomografía Computarizada , Embolización Terapéutica , Procedimientos Endovasculares , Resultado Fatal , Humanos , Imagenología Tridimensional , Aneurisma Intracraneal/diagnóstico por imagen , Masculino , StentsRESUMEN
Congenital dural sinus malformations are rare but can be major causes of mortality and morbidity in the pediatric population if not detected and managed urgently. Lesions involving large draining sinus structures such as superior sagittal sinus and torcular herophili can result in significant intracranial circulation impairment mostly due to venous drainage disturbance. Early detection plays a pivotal role in the outcome of the patients. Rarely familial incidence of some types of arteriovenous malformations in isolation from other congenital hereditary disorders has been reported. Knowledge of the familial association of congenital dural sinus malformations may raise the awareness for considering the possibility of occurrence of these lesions in the relatives of index cases. Herein, we describe the occurrence of giant torcular dural shunt in two pediatric cousins treated with endovascular embolization.