Intracranial atherosclerotic disease: medical, biomechanical, imaging, and flow dynamics perspective

Intracranial stenosis is one of the most common disease entities encountered by neurointerventionists. The physical and hemodynamic properties of the lesion are determined by the experience of the clinician. Computerized analysis may provide more accurate values of these parameters which can be used during the procedure for improving patient care.

We present a case of a 55-year-old man who was having ischemic symptoms related to severe middle cerebral artery stenosis. Intralesional stent placement normalized the diameter of the vessel leading to cessation of the episodes of neurological events.

Discussants include a neurointerventionist, a neurovascular image analyst, and a neurovascular flow and hemodynamic analyst. Questions discussed included qualitative and quantitative analysis of stenosis; comparison of angiographic perfusion studies including analysis of delay in opacification, transit times and time density curves; role of automation in analysis of "emboli tolerance" and "no re-flow" phenomenon; and relationship of compliance and recoil in normal and diseased segments of a vessel during angioplasty or stent placement.