Background and Purpose-The objective of this study was to evaluate the relative value of high-resolution, contrastenhanced MR angiography (CE MRA) with elliptical centric k-space ordering compared with intra-arterial x-ray angiography for imaging carotid stenosis. Methods-Thirty patients with suspected stenosis of the carotid arteries were examined with CE MRA (1.5-T scanner) and x-ray angiography (aortic arch survey and selective imaging of both common carotid arteries). For the first time, not only the extracranial carotid bifurcation but all the vessel segments from the aortic arch to the circle of Willis were assessed by independent investigators. Results-For the internal carotid artery in the region of the extracranial carotid bifurcation, there was a very close correlation between CE MRA and x-ray angiography (sensitivity, 100%; specificity, 92%). The initially suspected overestimation of stenosis on CE MRA in 3 cases was ultimately revealed to be an underestimation on x-ray angiography. CE MRA showed slightly poorer imaging of the basal vessel segments at the level of the aortic arch (because of breathing artifacts) and the intracranial vessel segments (because of small vessel caliber and venous superimposition due to delayed sequence starts). Conclusions-The MRA technique described here provides reliable results in the diagnosis of carotid stenosis and is thus suitable for replacing the invasive conventional x-ray angiography method in most cases. Further technical developments with regard to spatial resolution are still required for improved visualization of small vessels (terminal carotid branches and intracranial vessels).
The CRITISCH registry revealed ER as the most common first-line approach in CLI patients. Coronary artery disease and PMI <6 months were independent risk factors for the composite end point. Special attention should be also paid to CLI patients with renal insufficiency, with or without dialysis, and those undergoing BS.
Depletion of local recipient vessels as an obstacle for free flap reconstruction can be overcome by creating an arteriovenous loop. Even extensive defects are adequate for defect reconstruction using a single or, in extreme cases, bipedicled free flap.
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