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Revascularization Treatment of Acute Cerebral Stenosis

Supported by intra-arterial syngo DynaPBV Body

Author: Qiang Zhang, M.D.
Department of Diagnostic Radiology, Military General Hospital of Beijing PLA, China


Patient history
A 47-year-old male patient with a 16-year history of hypertension and onset of diabetes mellitus 5 years ago presented with symptoms of paroxysmal numbness and weakness in his left extremities.
 

Diagnosis
Digital subtraction angiography (DSA) demonstrates a severe stenosis (80 %) in M1 segment of the right middle cerebral artery (MCA). A 3D intra-arterial syngo DynaPBV Body examination was performed to examine the viability of the right brain parenchyma.
 

Treatment
A 2.5 x 9 mm intracranial stent (Apollo, MicroPort, China) was implanted at the position of stenosis through balloon dilatation. The procedure was performed under general anesthesia. DSA examination showed the morphological improvement of the M1 segment of the right MCA. The stenosis was reduced to less than 10 %. After stenting, a syngo DynaPBV Body run was performed by using the sameacquisition and injection protocol as in diagnosis in order to quantitatively assess the quality of treatment. A significant improvement of the CBV value of the right brain hemisphere could be observed by the comparison pre- and post-stenting PBV imaging.
 

Comments
syngo DynaPBV Body provides a mean to assess cerebral blood volume (CBV) in the catheter suite. It is a powerful and convenient tool to visualize the revascularization with cerebral ischemia directly before and after intervention. Different from the common syngo DynaPBV Body examinations, in which an intra-venous injection protocol is used, in this case, a selective intra-arterial injection protocol was adopted. The pre- and posttreatment blood volume measurements were restricted to the right brain, the area that is supplied by the right common carotid artery. This way, the effect of revascularization on the right MCA could be best presented. More importantly, the usage of contrast agent in the intra-arterial injection was only 10 % of the amount used in intra-venous injection. Although this protocol has not been approved systematically, we believe that intra-arterial syngo DynaPBV Body measurement could have a large application potential in conjunction with interventional treatment of cerebrovascular diseases. Ongoing studies are necessary to further approve the measurement with selective intra-arterial injection and to explore its clinical benefits.

Intra-arterial PBV Examination protocol1

Imaging protocol

Contrast quality

8s DSA

16 cc (350 mg/cc)
diluted to 50 %

Injection rate1 cc/s
Injection duration16 s
X-ray delay8 s
Injection site

right common carotid artery

Reconstruction presetNeuro PBV

figure 1

[left] Pre-treatment: A severe stenosis in the M1 segmentof the right MCA. [right] Post-treatment: Right intracranial vasculature was improved by stenting.

figure 2

[left] Pre-treatment syngo DynaPBV Body imaging of the right brain hemisphere. [right] Post-treatment syngo DynaPBV Body imaging of the right brain hemisphere.

Date: Nov 01, 2011


Angiography - Case Studies

1 Results may vary. Data on file.

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