Digital subtraction angiography in cerebrovascular disease: current practice and perspectives on diagnosis, acute treatment and prognosis

Shaban, Shirin; Huasen, Bella; Haridas, Abilash; Killingsworth, Murray C.; Worthington, John; Jabbour, Pascal; Bhaskar, Sonu

doi:10.1007/s13760-021-01805-z

Cited by 33 publications

(20 citation statements)

References 121 publications

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“…Multiphase CT angiography (mCTA) plays an important role in the localisation of occlusion as well as in the evaluation of spatial and temporal profile of the collateral status and its patency [ 1 , 37 ]. Rapid assessment of collateral circulation downstream of occlusion is of value in the selection of candidates for EVT [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Stroke Aetiology and Collateral Status in Acute Ischemic Stroke Patients Receiving Reperfusion Therapy—A Meta-Analysis

Sinha

Stanwell

Beran

et al. 2021

Neurology International

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Background: The interplay between collateral status and stroke aetiology may be crucial in the evaluation and management of acute ischemic stroke (AIS). Our understanding of this relationship and its level of association remains sub-optimal. This study sought to examine the association of pre-intervention collateral status with stroke aetiology, specifically large artery atherosclerosis (LAA) and cardio-embolism (CE), in AIS patients receiving reperfusion therapy, by performing a meta-analysis. Methods: Relevant search terms were explored on Medline/PubMed, Embase and Cochrane databases. Studies were included using the following inclusion criteria: (a) patients aged 18 or above; (b) AIS patients; (c) patients receiving reperfusion therapy; (d) total cohort size of >20, and (e) qualitative or quantitative assessment of pre-intervention collateral status on imaging using a grading scale. Random-effects meta-analysis was performed to investigate the association of aetiology with pre-intervention collateral status, and forest plots of risk ratio (RR) were generated. Results: A meta-analysis was conducted on seven studies, with a cumulative cohort of 1235 patients, to assess the association of pre-intervention collateral status with stroke aetiology. Patients with LAA were associated significantly with an increased rate of good collaterals (RR 1.24; 95% CI 1.04–1.50; p = 0.020, z = 2.33). Contrarily, CE aetiology was associated significantly with a decreased rate of good collaterals (RR 0.83; 95% CI 0.71–0.98; p = 0.027, z = −2.213). Conclusions: This study demonstrates that, in AIS patients receiving reperfusion therapy, LAA and CE aetiologies are associated significantly with collateral status.

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Section: Discussionmentioning

confidence: 99%

Stroke Aetiology and Collateral Status in Acute Ischemic Stroke Patients Receiving Reperfusion Therapy—A Meta-Analysis

Sinha

Stanwell

Beran

et al. 2021

Neurology International

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“…Computerized tomography (CT)/computerized tomography venography (CTV) and magnetic resonance imaging (MRI)/magnetic resonance venous imaging (MRV) can be used as the preferred examination methods for arterial and CVT. Digital subtraction angiography (DSA) is the gold standard for both diagnosis ( 4 , 155 ) ( Figure 2 ). Aside from imaging studies, the necessary hematology, coagulation, and biochemical tests should be performed ( 4 ) ( Figure 2 ).…”

Section: The Clinical Heterogeneity Of Cerebral Venous Thrombosismentioning

confidence: 99%

Venous stroke–a stroke subtype that should not be ignored

et al. 2022

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Based on the etiology, stroke can be classified into ischemic or hemorrhagic subtypes, which ranks second among the leading causes of death. Stroke is caused not only by arterial thrombosis but also by cerebral venous thrombosis. Arterial stroke is currently the main subtype of stroke, and research on this type has gradually improved. Venous thrombosis, the particular type, accounts for 0.5–1% of all strokes. Due to the lack of a full understanding of venous thrombosis, as well as its diverse clinical manifestations and neuroimaging features, there are often delays in admission for it, and it is easy to misdiagnose. The purpose of this study was to review the pathophysiology mechanisms and clinical features of arterial and venous thrombosis and to provide guidance for further research on the pathophysiological mechanism, clinical diagnosis, and treatment of venous thrombosis. This review summarizes the pathophysiological mechanisms, etiology, epidemiology, symptomatology, diagnosis, and treatment heterogeneity of venous thrombosis and compares it with arterial stroke. The aim is to provide a reference for a comprehensive understanding of venous thrombosis and a scientific understanding of various pathophysiological mechanisms and clinical features related to venous thrombosis, which will contribute to understanding the pathogenesis of intravenous stroke and provide insight into diagnosis, treatment, and prevention.

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“…In recent times, the combined use of two-dimensional (2D) digital subtraction angiogram (DSA) and three-dimensional (3D) DSA is the current practice that helps in the evaluation of the angioarchitecture of arteriovenous malformations [ 6 , 7 ]. Computer-assisted radio monitoring (CARM) and cone-beam computed tomography systems are the methodologies used for developing and measuring volume in the vascular body and are the primary techniques encompassed in four-dimensional (4D) DSA (or time-resolved DSA) [ 8 , 9 ]. The only limitation of digital subtraction angiogram is the contrast-induced procedure and its risk of possessing ionizing radiation; however, the advantages outweigh the risk by a huge margin [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review Comparing Digital Subtraction Angiogram With Magnetic Resonance Angiogram Studies in Demonstrating the Angioarchitecture of Cerebral Arteriovenous Malformations

Raman¹,

Uprety²,

Calero³

et al. 2022

Cureus

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In brain arteriovenous malformations (AVMs), there is mismatched communication between arteries and veins, causing a nidal bed between them. This systematic review explores whether a magnetic resonance angiogram (MRA) can be used as a diagnostic imaging tool instead of a digital subtraction angiogram (DSA). Utilizing PubMed, Cochrane, and Google Scholar, as well as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for article selection, a literature search was conducted over the past five years. Eleven studies were included, with a majority of the articles suggesting a potential for consideration. Arterial spin labeling (ASL) versus time-of-flight (TOF) scans was a comparison study, in addition to the study on pseudo-continuous arterial spin labeling (pc-ASL), which proved its high sensitivity in comparison with DSA scans. Other studies included quantitative magnetic resonance angiogram (Q-MRA) measuring the blood flow and susceptibility weighted imaging (SWI) modality. Although promising, digital subtraction angiogram (DSA) scans have diagnostic superiority. In addition, articles discussed follow-up magnetic resonance angiogram (MRA) scans after surgery. Overall, digital subtraction angiogram remains the gold standard due to its superior spatial resolution and hemodynamic properties; these are the key limitations of magnetic resonance studies. MRA has demonstrated its ability to reproduce high-quality diagnostic images for arteriovenous malformation (AVM) angioarchitecture; however, coupled with their limitations, not many studies with large sample sizes over longer periods have been conducted, and we urge more research into it.

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Digital subtraction angiography in cerebrovascular disease: current practice and perspectives on diagnosis, acute treatment and prognosis

Cited by 33 publications

References 121 publications

Stroke Aetiology and Collateral Status in Acute Ischemic Stroke Patients Receiving Reperfusion Therapy—A Meta-Analysis

Stroke Aetiology and Collateral Status in Acute Ischemic Stroke Patients Receiving Reperfusion Therapy—A Meta-Analysis

Venous stroke–a stroke subtype that should not be ignored

A Systematic Review Comparing Digital Subtraction Angiogram With Magnetic Resonance Angiogram Studies in Demonstrating the Angioarchitecture of Cerebral Arteriovenous Malformations

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