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Related Experiment Videos

Quantitative analysis of intracranial circulation using rapid-sequence DSA.

E S Kwan, A Hall, D R Enzmann

    AJR. American Journal of Roentgenology
    |June 1, 1986
    PubMed
    Summary

    This study used intravenous digital subtraction angiography (IVDSA) to measure contrast arrival times in cerebral arteries. It found significant delays in patients with tight carotid stenosis, indicating potential hemodynamic risk.

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    Area of Science:

    • Neurology
    • Radiology
    • Vascular Medicine

    Background:

    • Transient ischemic attacks (TIAs) and asymptomatic bruits can be linked to carotid artery stenosis.
    • Assessing hemodynamic significance of carotid stenosis is crucial for predicting stroke risk.
    • Intracranial collateral flow reserves play a role in compensating for extracranial arterial disease.

    Purpose of the Study:

    • To evaluate the effect of carotid stenosis on hemispheric differences in contrast arrival time (delta TMAX) using IVDSA.
    • To differentiate between well-compensated and poorly-compensated patients with carotid stenosis based on hemodynamic parameters.
    • To establish a quantitative method for detecting patients at risk of hemodynamic infarction.

    Main Methods:

    • High-frame-rate intravenous digital subtraction angiography (IVDSA) was performed in patients with TIAs and asymptomatic bruits.

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  • A control group of 20 patients with normal or mildly stenotic carotid arteries was used to establish normal delta TMAX values.
  • Time-density curve analysis with polynomial curve-fitting was employed to determine peak arrival time (TMAX) in anterior (ACA), middle (MCA), and posterior (PCA) cerebral artery distributions.

    • Main Results:

    • Normal delta TMAX values for MCA, ACA, and PCA distributions were established.
    • Patients with tight carotid stenosis or occlusion showed significantly prolonged delta TMAX in MCA and ACA distributions compared to controls (p < 0.001).
    • Symptomatic patients with tight carotid stenosis exhibited more pronounced delta TMAX prolongation than asymptomatic patients.

    Conclusions:

    • Quantitative analysis of delta TMAX using IVDSA can detect patients with carotid stenosis who are poorly compensated by collateral flow.
    • This method may identify patients at risk for hemodynamic infarction.
    • Serial DSA studies could correlate carotid stenosis progression with intracranial collateral reserve status.