PubMed Health⌕ Search

Biomedical subjects

Mayank Goyal

Publications and source records attributed to Mayank Goyal.

18 recordsLinked to original sources
PubMed2006

Acute anterior circulation stroke: recanalization using clot angioplasty.

BACKGROUND AND PURPOSE: Different strategies have been employed to recanalize acutely occluded middle cerebral and internal carotid arteries (ICA) in the setting of acute stroke including intravenous and intra-arterial tPA. However, pharmaceutical thrombolysis alone, may not be effective in patients with a large amount of clot volume (complete M1, terminal internal carotid artery). We report our initial experience with endovascular clot disruption using a soft silicone balloon in addition to intravenous or intra-arterial thrombolysis with tPA. METHODS: This is a retrospective review of nine patients with symptoms of acute stroke from clot in the middle cerebral or internal carotid territories who were treated with intracranial balloon angioplasty. All patients presented with symptoms of acute anterior circulation stroke less than six hours from onset. Patients in whom computed tomography (CT) angiography confirmed the presence of large vessel clot (terminal ICA, M1 or proximal M2) were included in the study. A CT perfusion was performed providing maps of cerebral blood volume, flow and mean transit time. If the patient presented less than three hours from onset then intravenous tissue plasminogen activator (tPA) was also administered. Intra-arterial tPA was delivered into the clot. If the volume of clot was judged to be significant by the treating neurointerventionist, then a limited trial of tPA was administered intra-arterially followed by balloon angioplasty of persistant clot. The time from imaging to vessel recanalization was recorded. Clinical outcomes were assessed using the modified Rankin scale and Barthel Index. RESULTS: Diagnostic CT perfusion studies were performed in 7 (78%), all of which showed a significant amount of salvageable tissue as judged by the treating neurointerventionist and neurologist. Recanalization (TIMI 2 or 3) was possible in 8 (89%). There were no cases of symptomatic intracranial hemorrhage and 2 (22%) asymptomatic hemorrhages. The average time from performance of the initial emergency CT to vessel recanalization was 2.1 hours with mean time from symptom onset to vessel recanalization of 4.1 hours. Five (56%) patients had good outcomes, 1 (11%) had mild and 3 (33%) had moderate to severe disability. CONCLUSION: Clot angioplasty can potentially shorten recanalization times in well-selected patients and can be an effective complimentary procedure in patients with tPA resistant clot. Angioplasty can be performed with a very low complication rate using the technique described and may be associated with good outcomes.

Aged↗
PubMed2006

State-of-the-art imaging of acute stroke.

Stroke is a leading cause of mortality and morbidity in the developed world. The goals of an imaging evaluation for acute stroke are to establish a diagnosis as early as possible and to obtain accurate information about the intracranial vasculature and brain perfusion for guidance in selecting the appropriate therapy. A comprehensive evaluation may be performed with a combination of computed tomography (CT) or magnetic resonance (MR) imaging techniques. Unenhanced CT can be performed quickly, can help identify early signs of stroke, and can help rule out hemorrhage. CT angiography and CT perfusion imaging, respectively, can depict intravascular thrombi and salvageable tissue indicated by a penumbra. These examinations are easy to perform on most helical CT scanners and are increasingly used in stroke imaging protocols to decide whether intervention is necessary. While acute infarcts may be seen early on conventional MR images, diffusion-weighted MR imaging is more sensitive for detection of hyperacute ischemia. Gradient-echo MR sequences can be helpful for detecting a hemorrhage. The status of neck and intracranial vessels can be evaluated with MR angiography, and a mismatch between findings on diffusion and perfusion MR images may be used to predict the presence of a penumbra. The information obtained by combining various imaging techniques may help differentiate patients who do not need intravenous or intraarterial therapy from those who do, and may alter clinical outcomes.

Angiography↗
PubMed2005

Processing and interpretation times of CT angiogram and CT perfusion in stroke.

OBJECTIVE: To determine the mean time for acquiring computed tomogram perfusion (CTP) and CT angiogram (CTA) images in acute stroke. To determine and compare processing and interpretation times amongst three groups of radiologists with varying degree of expertise: two radiology residents (Group I), two neuroradiology fellows (Group II) and four consultant neuroradiologists (Group III). METHODS: The mean time of acquisition of CTA and CTP studies was calculated among ten patients presenting with acute stroke. All readers had to process the CTA and CTP images, interpret them (for presence or absence of thrombus and penumbra) and save them on the GE Advantage Windows workstation. The mean time for processing and interpreting these studies was calculated. RESULTS: The mean time for acquisition of CTA and CTP studies in the ten patients was 14.6 +/- 5.9 minutes. The time taken for CTA processing and interpretation in Groups I, II and III was 2.3 +/- 1.3 min, 1.6 +/- 0.4 min and 1.5 +/- 0.7 min respectively. The time required for CTP processing and interpretation by the same groups was 5.2 +/- 1.7 min, 4.5 +/- 1.5 min and 4.1 +/- 1.1 min respectively. There was a statistically significant difference of means between Groups I and III in the CTA and CTP processing and interpretation times (p=0.02, p=0.01 respectively) but no statistical difference between Groups I and II (p=0.15, p=0.22 respectively) or Groups II and III (p=0.31, p=0.30 respectively). CONCLUSION: The CTA and CTP studies can be performed, processed and interpreted quickly in acute stroke.

Adult↗
PubMed2004

Evaluation of carotid artery stenosis: contrast-enhanced magnetic resonance angiography compared with conventional digital subtraction angiography.

OBJECTIVE: To compare retrospectively high-resolution contrast-enhanced magnetic resonance angiography with centric k-space filling and digital subtraction angiography in the assessment of degree of carotid artery stenosis. METHODS: Two neuroradiologists independently evaluated 14 carotid arteries (in 7 patients), and the degree of carotid stenosis determined was compared to calculate interobserver reliability. Thirty-six carotid arteries (in 18 patients) were then assessed with both contrast-enhanced magnetic resonance angiography and digital subtraction angiography. The degree of stenosis was determined by consensus, and the findings of the 2 modalities were compared. RESULTS: Close interobserver agreement was found with an intraclass correlation coefficient of 0.98 (95% confidence interval 0.95-0.99). Sensitivity of 86% and specificity of 91% were found for contrast-enhanced magnetic resonance angiography detection of surgically significant carotid stenosis compared with digital subtraction angiography. The Spearman rank correlation test also found a significant correlation (R(s) = 0.90, p < 0.001) in the comparison of the classifications of degree of carotid artery stenosis. CONCLUSION: Contrast-enhanced magnetic resonance angiography shows excellent correlation with digital subtraction angiography for the evaluation of carotid artery disease and has the potential to replace it in the assessment of degree of carotid artery stenosis.

Angiography, Digital Subtraction↗
PubMed2004

MR imaging findings in delayed reversible myelopathy from lightning strike.

Delayed spinal cord injury following high-voltage electrical injury is a rare but well-documented phenomenon. The MR imaging features of this entity, however, have not been well documented. We report the MR imaging findings in a case of delayed sensory and motor deficits following a lightning strike. MR imaging revealed hyperintense signal within the cord on T2-weighted and STIR images extending from C1 to C3. Axial images localized the hyperintense signal to the posterolateral region of the spinal cord bilaterally. Follow-up MR imaging 6 weeks later demonstrated resolution of abnormal cord signal intensity.

Humans↗
PubMed2003

CT and MR imaging of intracerebral amyloidoma: case report and review of the literature.

Intracerebral amyloidoma is the least common form of amyloid deposition in the brain. CT and MR imaging features in a case of pathologically proved cerebral amyloidoma are presented, and the available literature is reviewed. Typical imaging features of this entity include solitary or multiple supratentorial white matter masses that are hyperattenuated on nonenhanced CT. They have little or no mass effect on surrounding structures, extend medially up to the lateral ventricle wall, and have fine, irregular, enhancing margins.

Amyloidosis↗
PubMed2002

Venous vascular malformations in pediatric patients: comparison of results of alcohol sclerotherapy with proposed MR imaging classification.

PURPOSE: To compare the clinical results of percutaneous sclerotherapy of venous vascular malformations (VVMs) with the authors' proposed magnetic resonance (MR) imaging classification. MATERIALS AND METHODS: MR findings and clinical results of percutaneous alcohol sclerotherapy in 59 pediatric patients with VVMs were retrospectively reviewed. Before treatment, lesions were graded with MR imaging on the basis of margins and size, respectively: grade 1, well defined, less than or equal to 5 cm; grade 2A, well defined, greater than 5 cm; grade 2B, ill defined, less than or equal to 5 cm; and grade 3, ill defined, greater than 5 cm. Regression models were used to test trends in therapy across the MR classification grades, including the repeat sclerotherapies, volumes of ethanol and metrizamide administered for each lesion, and number of access sites. Clinical response to sclerotherapy, which was evaluated with consensus by a multidisciplinary team, was graded as poor, good, or excellent. Association between MR imaging grade and clinical assessment was tested with the Fisher exact test. RESULTS: There were 14 grade 1 lesions, nine grade 2A, 15 grade 2B, and 21 grade 3. Twenty-four patients had a poor response to sclerotherapy; 19, good; and 16, excellent. Ten of 14 (71%) grade 1 lesions had an excellent response; none, a poor response. Twelve of 21 (57%) grade 3 lesions had a poor response; none, an excellent result. Grade 2 lesions were relatively equally distributed among the three categories, with the exception of nine of 15 (60%) grade 2B lesions that had a poor response (P <.001). There was a trend with increasing lesion grade for increasing numbers of sclerotherapy sessions, volumes of ethanol and metrizamide for each lesion, and numbers of access sites. CONCLUSION: There is a strong association between this proposed MR imaging classification and the results of percutaneous sclerotherapy.

Adolescent↗