Segmental retrograde aortography.

BACKGROUND AND PURPOSE: Carotid artery dissection (CAD) is a common cause of stroke in young patients. Clots formed at the low-flow zone in the false arterial lumen may give rise to distal emboli, and the mural hematoma may eventually occlude the artery. Anticoagulation is currently the accepted treatment, but it is unknown which patients will improve spontaneously, which will respond to anticoagulation, and which will have an exacerbation of ischemic symptoms despite therapy. Endovascular treatment of CAD may be an attractive alternative to anticoagulation, and methods of identifying patients who stand to benefit from such therapy need to be established. METHODS: We present here 3 cases of spontaneous symptomatic CAD in which endovascular stenting procedures were performed on the basis of a paradigm aimed at identifying potentially salvageable but at-risk brain tissue by combining clinical with MRI (diffusion and perfusion) and angiographic data. RESULTS: Diffusion-perfusion MRI mismatches and/or evidence of cerebral ischemia on angiographic parenchymography were identified in all patients. They did not respond to anticoagulation, were therefore treated with endovascular stents, and had excellent outcomes. CONCLUSIONS: Endovascular stent placement may be an immediate, effective, and safe method of restoring vessel lumen integrity. It may be considered for selected patients who are clinically symptomatic despite anticoagulant treatment and in whom neuroimaging methods suggest that the neurological signs originate from a viable, hypoperfused, ischemic penumbra.

Angiography↗

PubMed2003

3-dimensional colour power angiography for staging human placental development.

Maldevelopment of placental villous trees and their blood vessels results in impaired fetal growth, which can greatly compromise fetal, neonatal, childhood, and adulthood health. There are no means of directly assessing such maldevelopment. We have applied a new technique of imaging (colour power angiography [CPA]) with 3-dimensional reconstruction to assess directly villous development in human pregnancy in vivo in 20 uncomplicated pregnancies from 13 to 38 weeks' gestation. The chronology of villous trees was much the same in 3-dimensional CPA, scanning electron micrography, and classical histology from controls matched by age. This approach provides a unique opportunity to examine normal placental development directly, and should provide the bases for real-time investigation of placental pathology and a robust method for diagnosis and surveillance during pregnancy.

Angiography↗