neuroradiology presents…... cerebrovascular disease david m. pelz, md, frcpc neuroradiology, lhsc
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 - 1896
Egas Moniz - 1934
Moniz - 1934
Direct PunctureCarotid Vertebral
AP Lateral AP Lateral
Sven Seldinger - 1953
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
AP Lateral
Normal Anatomy - Vertebral
AP Lateral
3D-CRA
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Duplex Ultrasound (DUS)
MR Angiography - MRA
TOF -Circle of Willis
CEMRA - Contrast-enhanced
CT Angiography - CTA
Circle of WillisCarotid bifurcation
Stroke
Normal
NASCET
North American Symptomatic Endarterectomy Trial
KFC
John Hunter (1728-1793)
“Blood goes where it is needed”
Collateral supply to the brain
Circle of WillisEC-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
1
2
3
4
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
Lateral AP
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”
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The End