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Research ArticleBrain

Angiographic CT after Intravenous Contrast Agent Application: A Noninvasive Follow-Up Tool after Intracranial Angioplasty and Stenting

M.-N. Psychogios, P. Schramm, J.-H. Buhk, A. Xyda, K. Gröschel, K. Jung and M. Knauth
American Journal of Neuroradiology November 2010, 31 (10) 1886-1891; DOI: https://doi.org/10.3174/ajnr.A2168
M.-N. Psychogios
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P. Schramm
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J.-H. Buhk
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A. Xyda
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K. Gröschel
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K. Jung
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M. Knauth
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Abstract

BACKGROUND AND PURPOSE: ICAS is one of the therapeutic options in symptomatic cerebral artery stenosis. iaDSA is the current criterion standard examination after ICAS for the detection of ISR. In this study, we evaluated ivACT as a potential noninvasive follow-up alternative.

MATERIALS AND METHODS: In 17 cases, ivACT and iaDSA were performed after ICAS. Both procedures were carried out on a flat-panel-detector-equipped angiography system. Postprocessing of ivACT acquisitions was performed on a dedicated workstation producing multiplanar reformations of the stent region and other intracranial arteries. Restenotic lesions were compared with iaDSA measurements. All studies were independently evaluated by 2 experienced neuroradiologists blinded to patients data.

RESULTS: In 5 cases, ISR was diagnosed on iaDSA images. All restenotic lesions were reliably detected (sensitivity, 100%; 95%CI, 48%–100%) and could be correctly quantified on ivACT images in comparison with iaDSA. The neuroradiologists correctly excluded ISR in 11 of 12 lesions after viewing the ivACT examinations (specificity, 92%; 95%CI, 62%–100%). Measurements of ISR on ivACT were highly correlated to iaDSA (Pearson r = 0.94, P < .01).

CONCLUSIONS: IvACT is a promising noninvasive follow-up examination after ICAS. With its high spatial resolution, it can reliably detect or exclude ISR. Contrary to iaDSA, there is no need for a recovery period after ivACT and the risk of neurologic complications is practically lowered to zero.

Abbreviations

A2
second segment of anterior cerebral artery
ACT
angiographic CT
BA
basilar artery
C3
third segment of ICA
CI
confidence interval
CTDIw
weighted CT dose index
ΔDSA%
change of stenosis percentage at follow-up iaDSA compared with measurements on iaDSA after stenting
DSApost
digital subtraction angiography after stenting
DSApre
digital subtraction angiography before stenting
DWI
diffusion-weighted imaging
IA
focal lesion involving the end of the stent
iaDSA
intra-arterial digital subtraction angiography
IB
focal lesion involving the body of the stent
IC
multiple restenotic foci involving <50% of the stented segment
ICA
internal carotid artery
ICAS
intracranial artery angioplasty and stenting
II
diffuse intrastent lesion
ISR
in-stent restenosis
ivACT
ACT after intravenous contrast medium application
M1
first segment of middle cerebral artery
MDCTA
multidetector CT angiography
PTA
percutaneous transluminal angioplasty
rePTA
repeated PTA after ICAS
TIA
transient ischemic attack
V4
intracranial segment of vertebral artery
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American Journal of Neuroradiology: 31 (10)
American Journal of Neuroradiology
Vol. 31, Issue 10
1 Nov 2010
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Angiographic CT after Intravenous Contrast Agent Application: A Noninvasive Follow-Up Tool after Intracranial Angioplasty and Stenting
M.-N. Psychogios, P. Schramm, J.-H. Buhk, A. Xyda, K. Gröschel, K. Jung, M. Knauth
American Journal of Neuroradiology Nov 2010, 31 (10) 1886-1891; DOI: 10.3174/ajnr.A2168

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Angiographic CT after Intravenous Contrast Agent Application: A Noninvasive Follow-Up Tool after Intracranial Angioplasty and Stenting
M.-N. Psychogios, P. Schramm, J.-H. Buhk, A. Xyda, K. Gröschel, K. Jung, M. Knauth
American Journal of Neuroradiology Nov 2010, 31 (10) 1886-1891; DOI: 10.3174/ajnr.A2168
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