Predictors of Unfavorable Outcome in Intracranial Angioplasty and Stenting in a Single-Center Comparison: Results from the Borgess Medical Center-Intracranial Revascularization Registry • F. Al-Ali, T. Cree, S. Hall, S. Louis, K. Major, S. Smoker, and S. Walker
Is it better to perform angioplasty or stent intracranial stenoses? In a registry of 140 patients the overall stroke rate after procedures was 13%, with the lowest rate in those treated with angioplasty only (4.5%) versus those who received stents (11–25%, depending on the technique used). Dilation success rate was higher with stenting and restenosis rate was higher with angioplasty only. Dissections more commonly occurred in the first 30 days postprocedure, infarcts more often originated from regions supplied by perforating arteries, and patients with eccentric stenoses were more likely to have stroke than those with concentric ones.
How Effective Is Endovascular Intracranial Revascularization in Stroke Prevention? Results from Borgess Medical Center Intracranial Revascularization Registry • F. Al-Ali, T. Cree, L. Duan, S. Hall, A. Jefferson, S. Louis, K. Major, S. Smoker, and S. Walker
The well-designed and well-known Warfarin-Aspirin Symptomatic Intracranial Disease study concluded that the risk of stroke was 18% at 1 year in patients with symptomatic and significant intracranial arterial stenosis and that warfarin offered no benefit over aspirin alone. Here, the authors compared those data with their own patients treated with angioplasty alone, balloon-assisted stents, and self-expanding stents. The overall 1-year stroke risk among their patients was 19% and the stroke probability per device was lowest for angioplasty and highest for the self-expanding stent.
Isolated Diffusion Restriction Precedes the Development of Enhancing Tumor in a Subset of Patients with Glioblastoma • A. Gupta, R.J. Young, S. Karimi, S. Sood, Z. Zhang, Q. Mo, P.H. Gutin, A.I. Holodny, and A.B. Lassman
We know that tumor contrast enhancement is preceded by development of increased perfusion and abnormal MR spectroscopy findings. Here, the authors determined that restricted diffusion also occurs before contrast enhancement in some glioblastomas. Visibly restricted apparent diffusion coefficient was found in 32% of patients undergoing treatment and 85% of those with nonenhancing low-ADC lesions went on to develop contrast enhancement at the site of restricted diffusion, implying tumor progression regardless of type of therapy. Conclusion: In a subset of patients with glioblastoma, development of a new focus of restricted diffusion during treatment may precede the development of new enhancing tumor.
Fellows’ Journal Club
The Relation of Carotid Calcium Volume with Carotid Artery Stenosis in Symptomatic Patients • H.A. Marquering, C.B.L.M. Majoie, L. Smagge, A.G. Kurvers, H.A. Gratama van Andel, R. van den Berg, and P.J. Nederkoorn
Is calcium volume a surrogate marker for carotid artery stenosis? These authors explored the relationship between calcium volume and stenosis as seen on CT angiography studies. In symptomatic sides calcium volumes were not related to stenosis degrees, and in asymptomatic sides were only weakly related. Their conclusion was that calcium volume cannot be used to estimate or predict degree of stenosis even in symptomatic patients.
Clinical Correlates of White Matter Blood Flow Perfusion Changes in Sturge-Weber Syndrome: A Dynamic MR Perfusion-Weighted Imaging Study • Y. Miao, C. Juhász, J. Wu, B. Tarabishy, Z. Lang, M.E. Behen, Z. Kou, Y. Ye, H.T. Chugani, and J. Hu
Brain ischemia in Sturge-Weber syndrome is probably venous in origin but it leads to changes in arterial perfusion in the affected regions. These authors used perfusion imaging and correlated its results with brain atrophy, seizures, and IQ in 14 children. High and low perfusion rates were found in 5 and 9 children, respectively. Brain atrophy, longer duration epilepsy, and more frequent seizures were more common with low perfusion but no relationship between perfusion and IQ was found. Decreased perfusion thus is associated with more severe and chronic clinical findings in patients with Sturge-Weber syndrome.
Diffusion-Weighted Imaging of Hyperacute Cerebral Hypoglycemia • P. Schmidt, J. Böttcher, A. Ragoschke-Schumm, H.J. Mentzel, G. Wolf, U.A. Müller, W.A. Kaiser, T.E. Mayer, and A. Saemann
In this interesting experiment, the authors set out to determine if acute hypoglycemia induces diffusion-weighted imaging–visible changes. Ten patients undergoing insulin stress testing were continuously imaged with DWI until their blood glucose levels were less than 2.0 mmol/L (lower limit of normal: 3.9 mmol/L). The authors found no DWI alterations in the brains of these patients, thus concluding acute hypoglycemia does not result in visible changes.