Editor’s Choices
Perfusion Deficits Detected by Arterial Spin-Labeling in Patients with TIA with Negative Diffusion and Vascular Imaging • X.J. Qiao, N. Salamon, D.J.J. Wang, R. He, M. Linetsky, B.M. Ellingson, and W.B. Pope
The current definition of TIA calls for normal imaging including DWI. Here the authors used arterial spin-labeling perfusion to detect abnormalities in nearly 50 patients within 24 hours of symptom onset and in 36 controls. The sensitivity and specificity of ASL in TIA diagnosis was 55.8% and 90.7%, respectively, and in nearly 94% of readings abnormalities that matched the clinical neurologic deficits were identified by the 3 observers. Thus, ASL perfusion is promising in evaluating and understanding TIAs.
Arterial Spin-Labeled Perfusion Imaging Reflects Vascular Density in Nonfunctioning Pituitary Macroadenomas • N. Sakai, S. Koizumi, S. Yamashita, Y. Takehara, H. Sakahara, S. Baba, Y. Oki, H. Hiramatsu, and H. Namba
In this study, arterial spin-labeling perfusion was used as a means to assess the well-known angiogenic activity seen in pituitary macroadenomas. Eleven patients with macroadenoma were studied and their ASL results correlated with histologic total microvascular density. The authors found that routine contrast enhancement did not correlate with microvascular density but CBF did and it also correlated with hypervascularity at surgery or postoperative bleeding in 4 instances.
Stent-Assisted Coiling in Endovascular Treatment of 500 Consecutive Cerebral Aneurysms with Long-Term Follow-Up • S. Geyik, K. Yavuz, N. Yurttutan, I. Saatci, and H.S. Cekirge
Five hundred aneurysms treated with a variety of self-expanding stents were clinically assessed and followed angiographically at 6–7 months postprocedure. Thromboembolic phenomena occurred in 21 patients and intraoperative rupture in 4. Initial complete occlusion was achieved in 42.2% progressing to 90.8% at follow-up. Early and late recanalizations were noted in 8% and 2%, respectively.
Fellows’ Journal Club
Structural Abnormalities in Patients with Insular/Peri-insular Epilepsy: Spectrum, Frequency, and Pharmacoresistance • M.-C. Chevrier, C. Bard, F. Guilbert, and D.K. Nguyen
The authors reviewed imaging studies in 48 patients with insular/peri-insular epilepsy seen during a 9-year period. They found the following types of lesions: tumors (27%), cortical malformations (21%), vascular malformations (19%), and gliosis (17%,), and normal results in 8% of subjects. Refractoriness to treatment was seen in all lesions but predominantly in patients with cortical malformations.
Thrombus Attenuation Does Not Predict Angiographic Results of Mechanical Thrombectomy with Stent Retrievers • U. Yilmaz, C. Roth, W. Reith, and P. Papanagiotou
This article examines whether MCA clot attenuation on initial CT studies determines the outcome of endovascular recanalization. The study was performed in 70 patients and showed that there were no significant differences between thrombus attenuations and successful recanalizations or periprocedural clot fragmentations. This investigation differs from others in that clot attenuation did not predict recanalization.
Are Routine Intensive Care Admissions Needed after Endovascular Treatment of Unruptured Aneurysms? • A.M. Burrows, A.A. Rabinstein, H.J. Cloft, D.F. Kallmes, and G. Lanzino
In this series of 200 patients treated for unruptured intracranial aneurysms, 65% were sent to a routine floor instead of the intensive care unit as is commonly done. Only one patient required transfer to the ICU and thus the authors concluded that in patients without significant co-morbidities, intraoperative complications, or complex aneurysms, routine placement in the ICU after embolization is not warranted.
