Choi Joo Won, Qiao Yang, Mehta Tej I, Wilson Jessica N, Torigoe Trevor H, Tsappidi Samuel, Jonathan Zhang Y, Brown Stacy C, Hui Ferdinand K, Abruzzo Todd
John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA.
Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, Houston, TX, USA.
Interv Neuroradiol. 2024 Mar 13:15910199241236820. doi: 10.1177/15910199241236820.
Dynamic catheter-directed cerebral digital subtraction angiography (dcDSA) is the gold standard for diagnosing dynamic vascular occlusion syndromes such as bowhunter syndrome (BHS). Nonetheless, concerns about its safety exist and no standardized protocols have been published to date.
We describe our methodology and insights regarding the use of dcDSA in patients with BHS. We also perform a systematic literature review to identify cases of typical and atypical presentations of BHS wherein dcDSA was utilized and report on any procedural complications related to dcDSA.
Our study included 104 cases wherein dcDSA was used for the diagnosis of BHS. There were 0 reported complications of dcDSA. DcDSA successfully established diagnosis in 102 of these cases. Thirty-eight cases were deemed atypical presentations of BHS. Fourteen patients endorsed symptoms during neck flexion/extension. In eight cases, there was dynamic occlusion of bilateral vertebral arteries during a single maneuver. Three patients had multiple areas of occlusion along a single vertebral artery (VA). An anomalous entry of the VA above the C6 transverse foramen was observed in four patients. One patient had VA occlusion with neutral head position and recanalization upon contralateral lateral head tilt.
Our study highlights the safety and diagnostic benefits of dcDSA in characterizing the broad spectrum of BHS pathology encountered in clinical practice. This technique offers a powerful means to evaluate changes in cerebral blood flow and cervical arterial morphology in real time, overcoming the constraints of static imaging methods. Our findings pave the way for further studies on dcDSA to enhance cross-sectional imaging methods for the characterization of BHS and other dynamic vascular occlusion syndromes.
动态导管导向脑数字减影血管造影(dcDSA)是诊断诸如弓狩综合征(BHS)等动态血管闭塞综合征的金标准。尽管如此,人们对其安全性仍存在担忧,且迄今为止尚未发布标准化方案。
我们描述了在BHS患者中使用dcDSA的方法和见解。我们还进行了系统的文献综述,以确定使用dcDSA的BHS典型和非典型表现的病例,并报告与dcDSA相关的任何操作并发症。
我们的研究纳入了104例使用dcDSA诊断BHS的病例。报告的dcDSA并发症为0例。其中102例通过dcDSA成功确诊。38例被认为是BHS的非典型表现。14例患者在颈部屈伸时出现症状。8例在单次操作中双侧椎动脉出现动态闭塞。3例患者在单一椎动脉(VA)上有多个闭塞区域。4例患者观察到VA在C6横突孔上方异常进入。1例患者在头部中立位时VA闭塞,向对侧侧头倾斜时再通。
我们的研究强调了dcDSA在临床实践中表征BHS广泛病理特征方面的安全性和诊断益处。该技术提供了一种强大的手段来实时评估脑血流和颈动脉形态的变化,克服了静态成像方法的局限性。我们的研究结果为进一步研究dcDSA以增强用于表征BHS和其他动态血管闭塞综合征的横断面成像方法铺平了道路。