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Research ArticleInterventional

Sentinel Angiographic Signs of Cerebral Hyperperfusion after Angioplasty and Stenting of Intracranial Atherosclerotic Stenosis: A Technical Note

M. Ghuman, A.C.O. Tsang, J.M. Klostranec and T. Krings
American Journal of Neuroradiology September 2019, 40 (9) 1523-1525; DOI: https://doi.org/10.3174/ajnr.A6149
M. Ghuman
aFrom the Department of Medical Imaging (M.G.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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A.C.O. Tsang
bDivision of Neurosurgery (A.C.O.T.), Department of Surgery, The University of Hong Kong, Hong Kong
cDepartment of Medical Imaging (A.C.O.T., J.M.K., T.K.), Toronto Western Hospital, Toronto, Ontario, Canada.
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J.M. Klostranec
cDepartment of Medical Imaging (A.C.O.T., J.M.K., T.K.), Toronto Western Hospital, Toronto, Ontario, Canada.
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T. Krings
cDepartment of Medical Imaging (A.C.O.T., J.M.K., T.K.), Toronto Western Hospital, Toronto, Ontario, Canada.
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    Figure.

    A 66-year-old female patient (patient 1) who presented with left-sided transient ischemic symptoms. A, Noncontrast CT of the brain shows hypodensity consistent with previous ischemic infarct in the right corona radiata in the cerebral internal watershed zone. CT angiography and CT perfusion (not shown) revealed high-grade stenosis of right mid-M1 segment of the MCA with corresponding large areas of perfusion mismatch suggestive of salvageable ischemia, B and C, Pre- and postangioplasty right ICA angiograms demonstrate restoration of the severely compromised lumen of the proximal M1 MCA (white arrow), following angioplasty and stent placement. Note the medial shift of the watershed zone after revascularization, D, Late arterial phase angiographic image immediately postangioplasty and stent placement at a baseline systolic blood pressure of 158 mm Hg demonstrates early opacification of a vein that drains into the deep venous system (black arrows) with prominent capillary blush in the central MCA territory (white arrowheads). E and F, Capillary and venous phase images obtained at a systolic blood pressure of 100 mm Hg depict resolution of early arteriovenous shunting and restoration of homogeneity of the capillary stain, with the filling of the index vein in the normal venous phase. SBP indicates systolic blood pressure.

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American Journal of Neuroradiology: 40 (9)
American Journal of Neuroradiology
Vol. 40, Issue 9
1 Sep 2019
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Sentinel Angiographic Signs of Cerebral Hyperperfusion after Angioplasty and Stenting of Intracranial Atherosclerotic Stenosis: A Technical Note
M. Ghuman, A.C.O. Tsang, J.M. Klostranec, T. Krings
American Journal of Neuroradiology Sep 2019, 40 (9) 1523-1525; DOI: 10.3174/ajnr.A6149

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Sentinel Angiographic Signs of Cerebral Hyperperfusion after Angioplasty and Stenting of Intracranial Atherosclerotic Stenosis: A Technical Note
M. Ghuman, A.C.O. Tsang, J.M. Klostranec, T. Krings
American Journal of Neuroradiology Sep 2019, 40 (9) 1523-1525; DOI: 10.3174/ajnr.A6149
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