Angiography and Computed Tomography in Cerebro-Arterial Occlusive Diseases

ISBN-13: 9783642685569 / Angielski / Miękka / 2011 / 290 str.

G. B. Bradac; R. Oberson; J. -M Taveras

Opis

In this age when we are witnessing a veritable explosion in new modalities in diagnos tic imaging we continue to have a great need for detailed studies of the vascularity of the brain in patients who have all types of cerebral vascular disease. Much of the understanding of cerebral vascular occlusive lesions which we developed in the last two decades was based on our ability to demonstrate the vessels that were affected. Much experimental work in animals had been done where major cerebral vessels were obstructed and the effects of these obstructions on the brain observed pathologically. However, it was not until cerebral angiography could be performed with the detail that became possible in the decades of the '60 's and subsequently that we could begin to understand the relationship of the obstructed vessels observed angiographically to the clinical findings. In addition, much physiologic information was obtained. For instance, the concept ofluxury perfusion which is used to describe non-nutritional flow through the tissues was observed first angiographically although the term was not used until LASSEN described it as a pathophysiological phenomenon observed during cerebral blood flow studies with radioactive isotopes. The concept of embolic occlusions of the cerebral vessels as against thrombosis was clarified and the relative frequency of thrombosis versus embolism was better understood. The concept of collateral circulation of the brain through so-called meningeal end-to end arterial anastomoses was vastly better understood when serial angiography in obstructive cerebral vascular disease was carried out with increasing frequency."

Spis treści

1 Etiopathology.- 1.1 Atherosclerosis.- 1.2 Lesions not Due to Atherosclerosis.- 1.2.1 Arteritis.- 1.2.1.1 Arteritis in Infectious Processes.- 1.2.1.2 Necrotizing Angiitis.- 1.2.1.3 Thromboangiitis Obliterans and Takayasu’s Arteritis.- 1.2.1.4 Moyamoya Disease.- 1.2.1.5 Arteritis in Collagenous Diseases.- 1.2.1.6 Arteritis in Neurocutaneous Diseases.- 1.2.1.7 Arteritis in Blood Diseases.- 1.2.1.8 Arteritis in Metabolic Diseases.- 1.2.1.9 Arteritis from Drug Abuse.- 1.2.1.10 Miscellaneous.- 1.2.2 Fibromuscular Hyperplasia (FMH).- 1.2.3 Occlusions in Cardiac Diseases and Lesions in Hypertensive Patients.- 2 Angiography.- 2.1 Indications.- 2.2 Hazards.- 2.3 Technique.- 2.3.1 General Considerations.- 2.3.2 Catheter and Guide Wire.- 2.3.3 Anesthesia.- 2.3.4 Other Technical Aspects.- 2.3.5 Routine Technique.- 3 Angiographic Findings.- 3.1 Normal Arteriocerebral Angiograms.- 3.2 Lesions of the Extracranial Segments of the Cerebral Arteries.- 3.2.1 Atherosclerotic Lesions of the Carotid Artery.- 3.2.1.1 Stenotic and Ulcerative Lesions.- 3.2.1.2 Occlusive Lesions.- 3.2.2 Atherosclerotic Lesions of the Vertebrobasilar System.- 3.2.2.1 Lesions of the Vertebral Artery.- 3.2.2.2 Lesions of the Subclavian and Innominate Arteries.- 3.2.3 Generalized Atherosclerosis Without Stenosis or Occlusion.- 3.2.4 Multiple Atherosclerotic Lesions.- 3.2.5 Tortuosity.- 3.2.6 Extracranial Lesions not due to Atherosclerosis.- 3.3 Lesions of the Carotid Siphon.- 3.3.1 Lesions in Young Patients and Children.- 3.3.2 Lesions in Older Patients.- 3.4 Lesions in the Region of the Middle Cerebral Artery.- 3.4.1 Lesions of the Main Trunk.- 3.4.2 Lesions of the Peripheral Branches.- 3.4.3 A Vessel-Poor Area.- 3.4.4 Blush and Early Venous Filling.- 3.4.5 Generalized Lesions.- 3.5 Lesions of the Posterior Cerebral and Basilar Arteries.- 3.5.1 Lesions in the Region of the Posterior Cerebral Artery.- 3.5.2 Lesions of the Basilar Artery.- 3.6 Other Pathologic Findings in the Vertebrobasilar System.- 3.6.1 Tortuosity of Vessels.- 3.6.2 Occlusion or Stenosis of Minor Branches of the Basilar and Intracranial Vertebral Arteries.- 3.7 Lesions in the Region of the Anterior Cerebral Artery.- 3.8 Lesions in the Region of the Anterior Choroidal Artery.- 3.9 Lesions in the Region of the Lenticulostriate Arteries.- 3.10 Rare Lesions of the Intracranial Vessels.- 3.11 Collateral Flow.- 3.12 The Negative Angiogram.- 3.13 Indication and Modalities of Surgical Therapy.- 3.13.1 Classic Techniques (Endarterectomy, Bypass).- 3.13.2 Extraintracranial Arterial Bypass.- 3.13.3 Indication for Extraintracranial Arterial Bypass.- 4 Computed Tomography in the Diagnosis of Cerebrovascular Occlusive Diseases.- 4.1 Patients with Transient Ischemic Attacks.- 4.2 Patients with Completed Stroke.- 4.2.1 Appearance of Infarction in CT.- 4.2.2 Infarction and Mass Effect.- 4.2.3 Contrast Medium in Infarction.- 4.2.4 Correlation Between Angiography and CT in Patients with Infarction.- 4.2.5 Hemorrhagic Infarction.- 4.2.6 Intracerebral Hematoma.- 4.2.7 CT and Moyamoya.- 5 Other Investigations in the Diagnosis of Cerebrovascular Occlusive Diseases.- 5.1 Carotid Auscultation.- 5.2 Ophthalmodynamometry.- 5.3 Doppler Ultrasound.- 5.4 Radionuclide Brain Scan.- 5.5 Regional Central Blood Flow Measurements.- 5.6 Intravenous Angiography.- 6 Some Conclusive Considerations on the Pathogenesis of TIAs and Infarctions.- 6.1 TIA in the Carotid Sector.- 6.2 TIA in the Vertebrobasilar Sector.- 6.3 Infarction.- 7 Conclusions on the Use of Diagnostic Procedures.- References.