| Predictive value of angiographic testing for tolerance to therapeutic occlusion of the carotid artery. | |
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MedLine Citation:
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PMID: 15661722 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: Controversy exists on how to assess a patient's tolerance before permanent carotid artery occlusion. We sought to determine the positive predictive value of synchronous opacification of hemispheric cortical veins at angiography of the contralateral carotid or vertebral artery as a predictor of tolerance to permanent carotid artery occlusion without development of ischemic injury. METHODS: Seventy-six angiographic test occlusions were performed in 74 consecutive patients considered for therapeutic occlusion. Angiography of collateral cerebral vessels was performed during test occlusion. Synchronous filling (a < 0.5-second delay of opacification between the cortical veins of the occluded and collateral vascular territories) was considered a predictor for tolerance to permanent occlusion. To detect clinically silent ischemic defects, MR imaging was performed before and 6-12 weeks after permanent occlusion. Positive predictive value (95% confidence interval [CI]) of synchronous venous filling for absence of ischemic deficits after permanent occlusion was calculated. RESULTS: No procedural complications of the test occlusion occurred. In 51 of 54 patients who passed the test, permanent occlusion was performed. Two patients, both in poor clinical condition after subarachnoid hemorrhage, died of diffuse vasospasm after permanent occlusion. Of the 49 surviving patients, one developed a transient discrete hemiparesis with small new hypoperfusion infarctions on MR images. All other patients remained neurologically unchanged with no new ischemic lesions on follow-up MR images. Positive predictive value of tolerance to carotid artery occlusion after passing the angiographic test was 98% (95% CI: 89-100%). CONCLUSION: The angiographic test occlusion protocol reliably predicts tolerance to therapeutic carotid artery occlusion. It is safe and easy to perform. |
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Authors:
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Willem Jan van Rooij; Menno Sluzewski; Marjan J Slob; Gabriël J Rinkel |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: AJNR. American journal of neuroradiology Volume: 26 ISSN: 0195-6108 ISO Abbreviation: AJNR Am J Neuroradiol Publication Date: 2005 Jan |
Date Detail:
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Created Date: 2005-01-21 Completed Date: 2005-05-24 Revised Date: 2008-02-14 |
Medline Journal Info:
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Nlm Unique ID: 8003708 Medline TA: AJNR Am J Neuroradiol Country: United States |
Other Details:
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Languages: eng Pagination: 175-8 Citation Subset: IM |
Affiliation:
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Department of Radiology, St. Elisabeth Ziekenhuis, Tilburg, the Netherlands. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Balloon Occlusion* Brain Ischemia / prevention & control, radiography* Carotid Artery Diseases / radiography, therapy* Carotid Artery, Internal / radiography* Cerebral Angiography* Cerebral Cortex / blood supply* Cerebral Infarction / prevention & control, radiography Cerebral Veins / radiography* Collateral Circulation / physiology Embolization, Therapeutic* Female Humans Image Processing, Computer-Assisted Intracranial Aneurysm / radiography, therapy* Magnetic Resonance Imaging* Male Middle Aged Patient Care Team Pilot Projects Predictive Value of Tests Prognosis Tomography, X-Ray Computed |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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