Similar outcomes of arteriovenous fistulae created under general or regional anesthesia.

Background: There is growing evidence that type of anesthesia can significantly change vascular access surgery outcomes. Still, there is limited evidence on the impact of regional anesthesia (RA) on patency and failure rates compared to general anesthesia (GA). The aim of this study was to compare the outcomes of RA and GA in patients who underwent vascular access creation at our center.

Mid-term proximal sealing zone evaluation after fenestrated endovascular aortic aneurysm repair.

Background: Fenestrated endovascular aortic aneurysm repair (FEVAR) is used in pararenal abdominal aortic aneurysms to achieve a durable proximal seal. This study investigated the mid-term course of the proximal fenestrated stent graft (FSG) sealing zone on the first and latest available post-FEVAR computed tomographic angiography (CTA) scan in a single-center series.

Methods: In 61 elective FEVAR patients, the shortest length of circumferential apposition between the FSG and the aortic wall (shortest apposition length [SAL]) was retrospectively assessed on the first and last available postoperative CTA scans.

Near-infrared spectroscopy monitoring during endovascular treatment for acute ischaemic stroke.

Introduction: The aim of endovascular treatment (EVT) for acute ischaemic stroke is to relieve the cerebral tissue hypoxia in the area supplied by the occluded artery. Near-infrared spectroscopy (NIRS) monitoring is developed to assess regional cerebral tissue oxygen haemoglobin saturation (rSO). We aimed to investigate whether NIRS can detect inter- and intra-hemispheric rSO differences during EVT.

Optimal management of asymptomatic carotid stenosis in 2021: the jury is still out. An international, multispecialty, expert review and position statement.

The recommendations of international guidelines for the management of asymptomatic carotid stenosis (ACS) often vary considerably and extend from a conservative approach with risk factor modification and best medical treatment (BMT) alone, to a more aggressive approach with a carotid intervention plus BMT. The aim of the current multispecialty position statement was to reconcile the conflicting views on the topic. A literature review was performed with a focus on data from recent studies.

Sensitivity of prehospital stroke scales for different intracranial large vessel occlusion locations.

Introduction: Prehospital stroke scales have been proposed to identify stroke patients with a large vessel occlusion to allow direct transport to an intervention centre capable of endovascular treatment (EVT). It is unclear whether these scales are able to detect not only proximal, but also more distal treatable occlusions. Our aim was to assess the sensitivity of prehospital stroke scales for different EVT-eligible occlusion locations in the anterior circulation.

Quantification of muscle mass in the legs of patients with peripheral arterial occlusive disease: associations between volumetric and cross-sectional single-slice measurements for identification of atrophy and focal sarcopenia.

Background: Sarcopenia, commonly determined by measuring skeletal muscle mass index (SMI) at the third lumbar level, has been identified as a predictor of clinical outcome in a variety of diseases. For patients with peripheral arterial occlusive disease (PAOD), we hypothesized that lower extremity SMI (LESMI) might be a more precise predictor of outcome and the extent of chronic ischemia than the systemic muscle mass at the L3 level. We investigated the association between complete muscle volume and muscle area derived with single-slice 2-dimensional measurements in the legs to identify at which level cross-sectional single-slice measurements are most representative of the muscle volume and investigated whether LESMI is associated with systemic sarcopenia and PAOD severity.

Hyperspectral imaging for noninvasive tissue perfusion measurements of the lower leg: review of literature and introduction of a standardized measurement protocol with a portable system.

Introduction: Hyperspectral imaging (HSI) is a noninvasive technique for transcutaneous measurements of tissue perfusion. This study (1) provides a review of the current literature on HSI for tissue perfusion measurements of the lower leg and (2) introduces a standardized measurement protocol for HSI measurements with a portable system.

Evidence Acquisition: A literature search was performed for studies on tissue perfusion measurements with HSI in the lower extremity.

Successful percutaneous treatment of biliary stenosis after living donor liver transplantation in a child.

We report the case of a 16-year-old boy with primary clerosing holangitis associated with inflammatory bowel disease who was initially treated and controlled pharmacologically. He underwent living donor liver transplantation (LDLT) after he developed progressive biliary tract abnormalities and portal hypertension accompanied by recurrent bile duct infections. Two months following LDLT, the hepaticojejunostomy anastomosis became occluded and it was treated surgically.

Relationship between haemodynamic impairment and collateral blood flow in carotid artery disease.

Collateral blood flow plays a pivotal role in steno-occlusive internal carotid artery (ICA) disease to prevent irreversible ischaemic damage. Our aim was to investigate the effect of carotid artery disease upon cerebral perfusion and cerebrovascular reactivity and whether haemodynamic impairment is influenced at brain tissue level by the existence of primary and/or secondary collateral. Eighty-eight patients with steno-occlusive ICA disease and 29 healthy controls underwent MR examination.

Cerebrovascular reactivity in the caudate nucleus, lentiform nucleus and thalamus in patients with carotid artery disease.

Background And Purpose: To assess the effect of unilateral large vessel disease upon the cerebral hemodynamic autoregulatory status in the basal ganglia of patients with steno-occlusive internal carotid artery (ICA) disease.

Materials And Methods: Twenty-five healthy volunteers and 38 patients with a unilateral symptomatic steno-occlusive ICA lesion and were investigated; 20 with a stenosis >50% and 18 with an occlusion. Cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) were assessed with pseudo-continuous arterial spin labeling (ASL) magnetic resonance (MR) imaging before and after administration of acetazolamide.

Safety and Outcome of Intra-Arterial Treatment for Basilar Artery Occlusion.

Importance: After the many positive results in thrombectomy trials in ischemic stroke of the anterior circulation, the question arises whether these positive results also apply to the patient with basilar artery occlusion (BAO).

Objective: To report up-to-date outcome data of intra-arterial (IA) treatment in patients with BAO and to evaluate the influence of collateral circulation on outcome.

Design, Setting, And Participants: Single-center retrospective case series of 38 consecutive patients with BAO who underwent IA treatment between 2006 and 2015 at a comprehensive stroke center.

Misinterpretation of ischaemic infarct location in relationship to the cerebrovascular territories.

Purpose: Cerebral perfusion territories are known to vary widely among individuals. This may lead to misinterpretation of the symptomatic artery in patients with ischaemic stroke to a wrong assumption of the underlying aetiology being thromboembolic or hypoperfusion. The aim of the present study was to investigate such potential misinterpretation with territorial arterial spin labelling (T-ASL) by correlating infarct location with imaging of the perfusion territory of the carotid arteries or basilar artery.

Trauma-Specific Brain Abnormalities in Suspected Mild Traumatic Brain Injury Patients Identified in the First 48 Hours after Injury: A Blinded Magnetic Resonance Imaging Comparative Study Including Suspected Acute Minor Stroke Patients.

We assessed the utility of a brief MRI protocol, appropriate for the acute setting, to detect acute traumatic brain injury (TBI) in patients with suspected mild TBI (mTBI) and distinguish traumatic from nontraumatic brain injury by comparing trauma with nontrauma patients. Twenty-two patients with suspected mTBI were included in this exploratory study over a period of 9 months. Median time from injury to MR scanning was 5.

Selective Arterial Spin Labeling: Techniques and Neurovascular Applications.

Knowledge of the distribution of blood flowing from the heart to the brain-feeding arteries is important for the understanding and diagnosis of cerebrovascular diseases. Due to anatomical variations and anomalies within the cerebrovasculature, together with changes caused by various cerebrovascular diseases, there is high variability in the distribution of blood to the parenchyma. This article reviews the various methods that are available for determining the flow territories of the brain-feeding arteries and provides an overview of the different territorial arterial spin labeling (ASL) magnetic resonance imaging (MRI) techniques that have been introduced during the past 2 decades.

Assessing reperfusion with whole-brain arterial spin labeling: a noninvasive alternative to gadolinium.

Background And Purpose: Arterial spin labeling (ASL) is a perfusion imaging technique that does not require gadolinium. The study aimed to assess the reliability of ASL for evaluating reperfusion in acute ischemic stroke in comparison with dynamic susceptibility contrast (DSC) imaging.

Methods: The study included 24 patients with acute ischemic stroke on admission and 24-hour follow-up ASL and DSC scans.

Arterial spin labeling perfusion MRI in children and young adults with previous ischemic stroke and unilateral intracranial arteriopathy.

Background: Little is known about cerebral blood flow (CBF) in young patients with ischemic stroke caused by an intracranial arteriopathy. Arterial spin labeling (ASL) perfusion is a noninvasive technique for measuring CBF. We aimed to investigate whether, in young patients with unilateral intracranial arteriopathy and previous ischemic stroke, CBF is compromised in noninfarcted brain areas of the symptomatic hemisphere and whether this is related to the severity of the arteriopathy.

Arterial spin labeling magnetic resonance perfusion imaging in cerebral ischemia.

Purpose Of Review: Arterial spin labeling (ASL) is a noninvasive magnetic resonance perfusion imaging method for visualizing and quantifying whole-brain perfusion that does not require exogenous contrast agents. The goal of this review article is to explain the principles of ASL perfusion imaging and review the strengths and limitations of different ASL methods.

Recent Findings: There are several different approaches that vary mainly on the basis of the technique that is used to label the inflowing arterial blood.

Validation of planning-free vessel-encoded pseudo-continuous arterial spin labeling MR imaging as territorial-ASL strategy by comparison to super-selective p-CASL MRI.

Purpose: Vessel-encoded (VE) pseudo-continuous arterial spin labeling (p-CASL) is a territorial ASL (T-ASL) technique to identify the perfusion territories of cerebral arteries. The aim of this study was to validate the output of three Vessel-encoded p-CASL image processing methods, k-means clustering with and without subsequent linear analysis and a Bayesian framework, by comparison with the perfusion maps acquired with super-selective p-CASL.

Methods: The comparison was done quantitatively using the Hausdorff distance and Dice similarity coefficient in the territories of the right and left internal carotid arteries, the basilar artery, and the right and left vertebral arteries.

In vivo visualization of the PICA perfusion territory with super-selective pseudo-continuous arterial spin labeling MRI.

In this work a method is described to discern the perfusion territories in the cerebellum that are exclusively supplied by either or both vertebral arteries. In normal vascular anatomy the posterior inferior cerebellar artery (PICA) is supplied exclusively by its ipsilateral vertebral artery. The perfusion territories of the vertebral arteries were determined in 14 healthy subjects by means of a super-selective pseudo-continuous ASL sequence on a 3T MRI scanner.

Visual versus automated evaluation of chest computed tomography for the presence of chronic obstructive pulmonary disease.

Background: Incidental CT findings may provide an opportunity for early detection of chronic obstructive pulmonary disease (COPD), which may prove important in CT-based lung cancer screening setting. We aimed to determine the diagnostic performance of human observers to visually evaluate COPD presence on CT images, in comparison to automated evaluation using quantitative CT measures.

Methods: This study was approved by the Dutch Ministry of Health and the institutional review board.

Mapping of cerebral perfusion territories using territorial arterial spin labeling: techniques and clinical application.

A knowledge of the exact cerebral perfusion territory which is supplied by any artery is of great importance in the understanding and diagnosis of cerebrovascular disease. The development and optimization of territorial arterial spin labeling (T-ASL) MRI techniques in the past two decades have made it possible to visualize and determine the cerebral perfusion territories in individual patients and, more importantly, to do so without contrast agents or otherwise invasive procedures. This review provides an overview of the development of ASL techniques that aim to visualize the general cerebral perfusion territories or the territory of a specific artery of interest.

Whole-brain arterial spin labeling perfusion MRI in patients with acute stroke.

Background And Purpose: Perfusion MRI can be used to identify patients with acute ischemic stroke who may benefit from reperfusion therapies. The risk of nephrogenic systemic fibrosis, however, limits the use of contrast agents. Our objective was to evaluate the ability of arterial spin labeling (ASL), an alternative noninvasive perfusion technique, to detect perfusion deficits compared with dynamic susceptibility contrast (DSC) perfusion imaging.

Pseudocontinuous arterial spin labeling quantifies relative cerebral blood flow in acute stroke.

Background And Purpose: The aim of this study was to test whether arterial spin labeling (ASL) can detect significant differences in relative cerebral blood flow (rCBF) in the core, mismatch, and reverse-mismatch regions, and whether rCBF values measured by ASL in those areas differ from values obtained using dynamic susceptibility contrast (DSC) MRI.

Methods: Acute stroke patients were imaged with diffusion-weighted imaging (DWI) and perfusion-weighted imaging (ASL and DSC) MRI. An expert reader segmented the ischemic lesion on DWI and the DSC time-to-peak (TTP) maps.

Time course of vascular reactivity using repeated phase-contrast MR angiography in patients with carotid artery stenosis.

Background And Purpose: Cerebral vascular reactivity assessment is typically performed with 2 perfusion measurements before and after a vasodilatory challenge. The aim of this study was to assess the time course of the vasodilatory effect in the brain-feeding arteries after a challenge with acetazolamide in patients with a stenosis of the internal carotid artery (ICA).

Methods: Twenty-one patients with a symptomatic ICA stenosis and 18 healthy control subjects underwent 2-dimensional phase-contrast MR angiography to repeatedly measure the blood flow (mL/min) in both ICAs at baseline and in 5-minute intervals for 30 minutes after intravenous administration of acetazolamide.

Cerebrovascular reactivity within perfusion territories in patients with an internal carotid artery occlusion.

Background: Arterial spin labelling (ASL) is an MRI technique for measuring perfusion at the brain tissue level. The aim of the study was to investigate cerebrovascular reactivity (CVR) at brain-tissue level in patients with an internal carotid artery (ICA) occlusion by combining ASL-MRI with a vascular challenge, and determine whether the CVR varies within the perfusion territory of the brain-feeding arteries.

Methods: Sixteen patients with a symptomatic ICA occlusion and 16 age-matched healthy control subjects underwent perfusion and perfusion-territory selective ASL-MRI before and after acetazolamide administration.