Interventional Radiology and Stroke Flashcards

1
Q

Recognize the treatment of acute infarcts

A

EARLIER INTERVENTION = GREATER BENEFIT!!

  1. TPA: Within 4.5 hours after, Extend time window significantly in basilar artery thrombosis
  2. Reopro: GPIIbIIIa platelet inhibitor often given with TPA
  3. Mechanical thrombectomy: MERCI, Penumbra
  4. Off-label devices currently in development: Balloons, Stents
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2
Q

Infarction on CT

A
  • Focal hypodense area in cortical, subcortical, or deep gray or white matter, following vascular territory, or watershed distribution.
  • 1-6 hours: obscuration of gray/white matter contrast and effacement of sulci, or “insular ribbon.”
  • 6 hours to 4 days: progressive swelling, hypodensity, structures pushed around
  • 4-14 days: return to normal density and volume
  • > 14 days: varying degrees of hypodensity and volume loss (ventricles and sulci look bigger as a result of brain volume decrease)
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3
Q

Acute Infarction on MRI

A
  • Subtle low signal (hypointense) on T1, often difficult to see at the acute stage
  • High signal (hyperintense) on spin density and/or T2-weighted and proton density-weighted images starting 8 hours after onset; should follow vascular distribution.
  • Mass effect maximal at 24 h
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4
Q

Subacute Infarction on MRI

A

Low signal on T1 or high signal on T2-weighted images.

  • Follows vascular distribution.
  • Revascularization and blood-brain barrier breakdown may cause parenchymal enhancement with contrast agents.
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5
Q

Old Infarction on MRI

A

Low signal on T1, high signal on T2.

  • Mass effect disappears after 1 month
  • Loss of tissue with large infarcts
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6
Q

Perfusion CT in the workup of an acute infarct

A
  • Inject IV contrast into antecubital fossa
  • Continuous imaging at 2-4 locations for about a minute
  • Determines amount of blood flow, blood volume, and timing it takes the bolus to reach areas of the brain
  • Helps determine whether there is brain penumbra that can be saved
  • Need to know this to determine whether patient is a candidate for TPA therapy
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7
Q

CT Angiography in the workup of acute infarcts

A
  • Inject IV contrast into internal carotid artery
  • Thin image sections taken to visualize vascular anatomy
  • Helps identify site of occlusion, infarct core, and collateral flow
  • Helps determine whether intervention (TPA, MERCI, Penumbra) worked
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8
Q

Who is a candidate of TPA

A

Completed Infarct: No TPA
(Increased time to start, increased time to peak, Decreased blood volume)

Brain at Risk: TPA Candidate (Increased time to start, increased time to peak, Normal OR Increased blood volume)

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