Presenter of 5 Presentations
Young Investigator Awards
- Zafarjon K. Abdullaev (Uzbekistan)
- Ayush Agarwal (India)
- Vivek Agarwal (India)
- Anvar Azimov (Uzbekistan)
- Ashu Bhasin (India)
- Byambasuren Luvsansuren (Mongolia)
- Surenjav Chimed (Mongolia)
- Nha Dao (Viet Nam)
- Adekunle G. Fakunle (Nigeria)
- Dmytro Filimonov (Ukraine)
- Manisha K Yalapalli (India)
- Soumya Krishnamoorthy (India)
- Pradeep Kumar (India)
- ANKITA MAHESHWARI (India)
- Trung Q. Nguyen (Viet Nam)
- Piyush Ojha (India)
- VISHNU SWARUP (India)
- Faris K. Syah (Indonesia)
- Hang T. Tran (Viet Nam)
- Shriram Varadharajan (India)
PREDICTING CEREBRAL HYPERPERFUSION BY NON INVASIVE ASSESSMENT OF CEREBRAL MICROVASCULAR CHANGES USING ARTERIAL SPIN LABELLING MRI FOLLOWING SURGICAL BYPASS IN MOYAMOYA DISEASE
PREDICTING CEREBRAL HYPERPERFUSION BY NON INVASIVE ASSESSMENT OF CEREBRAL MICROVASCULAR CHANGES USING ARTERIAL SPIN LABELLING MRI FOLLOWING SURGICAL BYPASS IN MOYAMOYA DISEASE
Abstract
Background and Aims
Cerebral hyperperfusion syndrome (CHPS) can result after anastomotic surgery as the reperfusion is established in chronically ischemic cerebral territories in patients of moyamoya disease (MMD). In this study, we have evaluated the feasibility of arterial spin labelling (ASL) perfusion MRI to predict cerebral hyperperfusion syndrome based on changes of cerebral blood flow (CBF) after revascularisation surgery in patients of MMD.
Methods
Our prospective study included 28 patients of MMD who underwent superficial temporal artery-middle cerebral artery (STA-MCA) bypass with or without dural/muscle synangiosis. ASL MRI was performed before and 1-7 days after surgery. On the side planned for operation, 5-mm ROI circle was drawn on the predetermined regions in frontal lobe, temporal lobe, parietal lobe and basal ganglia in proximal and distal territories of MCA to calculate ipsilateral CBF values (CBFi). An attempt was made to select the same location on contralateral side (non-operative) (CBFc) for each measurement for calculation of hemispheric normalised CBF (nCBFh) ratios. To adjust for inter individual variation among MR imagers and CBF, additional regions of interest were drawn within the cerebellum (CBFcbl) for cerebellar CBF normalised ratios (nCBFCbl).
Results
5 (18%) patients had immediate postoperative symptoms suggestive of CHPS. Sensitivity and specificity of ASL perfusion to detect CHPS was 47-100% and 45-88% respectively. The incidence of CHPS in postoperative patients of moyamoya disease ranged from 6.83 to 40.70%.
Conclusions
CHPS can lead to clinical deterioration after bypas surgery in MMD. ASL perfusion is an appropriate alternative to standard nuclear medicine studies to dectect CHPS after STA-MCA bypass in moyamoya patients.
EMERGENCY CAROTID STENTING IN PATIENTS OF ACUTE STROKE WITH TANDEM OCCLUSION: OUR EXPERIENCE FROM TERTIARY CARE CENTER IN NORTH-WEST INDIA
Abstract
Background and Aims
Acute internal carotid artery (ICA) stenosis/occlusion with tandem occlusion of middle cerebral artery (MCA) hampers distal access for mechanical thrombectomy (MT) demanding controversial decision for simultaneous ICA stenting. The purpose of this paper is to evaluate the safety of emergency ICA stenting in combination with MT for acute ischemic stroke with tandem occlusions.
Methods
Retrospective analysis of 5 patients in whom emergency ICA stenting with MT was done from October 2021 to March 2022. All the patients with acute ischemic stroke (AIS) within 24hours of last seen well were included. CT angiogram was done in all the patients. IV thrombolysis was done in 2 patients. Dual anti-platelets were given in all the patients.
Results
Successful revascularization (Thrombolysis in cerebral infarction scale [TICI] ≥2c) was achieved in 5(100%). Good outcome at discharge (mRS ≤2) was achieved in all 5(100%) patients. None of the patients had symptomatic intracranial hemorrhage (sICH). Asymptomatic hemorrhage was noted in the infarcted area in one patient. Four out of five patients (80%) were treated with MT first followed by ICA stenting. Balloon angioplasty was attempted in all the patients. Four patients had >90% ICA stenosis and one had complete occlusion.
Conclusions
Emergency carotid stenting appears to be safe in patients with hemodynamically significant stenosis/complete occlusion especially if it hampers the process of concomitant distal MT.
CORRELATION OF MCA VELOCITIES ON TRANSCRANIAL DOPPLER WITH THE DEGREE OF VASOSPASM ON DIGITAL SUBTRACTION ANGIOGRAPHY
Abstract
Background and Aims
Delayed cerebral ischaemia (DCI) due to vasospasm can lead to worse prognosis in aneurysmal subarachnoid haemorrhage (SAH) patients. Transcranial Doppler (TCD) is a non-invasive tool for detecting and monitoring vasospasm. Through our study, we have tried to correlate MCA velocities with degree of vasosapsm seen on digital subtraction angiography.
Methods
Retrospective analysis of 5 patients of aneurysmal SAH was done. TCD was done to assess vasospasm from day 3 through day 10 of SAH. DSA was also done in all these patients with intraarterial vasodilator injection. Mild, Moderate and severe MCA stenosis was graded on DSA based on the ratio of involved MCA with cavernous ICA. Correlation with Peak Systolic Velocity (PSV) of MCA on TCD was done.
Results
Three patients had severe vasospasm and two had moderate vasospasm. Intraarterial (IA) nimodipine was used in four patients and milrinone in one patient. All the patients with severe vasospasm had MCA PSV > 150 cm/s, while patients with moderate vasospasm had MCA PSV between 120-150cm/s. Complete resolution of vasospasm was seen in 3 patients (two after IA milrinione and one after IA nimodipine). Corresponding MCA PSV ranged between 60-80 cm/s. Two patients had residual mild vasospasm on DSA. Corresponding MCA PCV ranged between 90-100cm/s.
Conclusions
TCD has an important role in the non-invasive radiation free detection and monitoring of vasospasm after SAH. MCA PSV correlate well with DSA appearance of vasospasm.