Podcast
Questions and Answers
During superior vena cava venography, if the images do not clearly demonstrate the opacified subclavian and brachiocephalic veins, and the right atrium, what adjustment should be prioritized, assuming the injection rate remains constant?
During superior vena cava venography, if the images do not clearly demonstrate the opacified subclavian and brachiocephalic veins, and the right atrium, what adjustment should be prioritized, assuming the injection rate remains constant?
- Increase the frame rate per second (FPS) to better capture the bolus transit.
- Reposition the patient to be 2 inches to the left of the mid-sagittal plane to improve vessel alignment.
- Adjust collimation, source-to-image distance (SID), focal spot size, and object-to-image distance (OID) to optimize image quality. (correct)
- Switch from digital subtraction angiography (DSA) to standard fluoroscopy to visualize the vessel structures more clearly.
In cases of suspected superior vena cava thrombosis, why is catheter angiography preferred over needle injection for contrast media (CM) administration?
In cases of suspected superior vena cava thrombosis, why is catheter angiography preferred over needle injection for contrast media (CM) administration?
- Needle injection always requires a higher dose of contrast media, increasing the risk of contrast-induced nephropathy.
- Needle injection is not suitable for patients with contraindications to iodinated contrast media, whereas catheter angiography can use alternative contrast agents.
- Catheter angiography allows for a higher concentration of contrast media to be delivered directly into the superior vena cava, enhancing visualization. (correct)
- Catheter angiography decreases patient exposure due to the ability to use lower frame rates.
A patient presents with acute contralateral loss of motor control and sensation primarily affecting the lower body. Which arterial occlusion is MOST likely the cause?
A patient presents with acute contralateral loss of motor control and sensation primarily affecting the lower body. Which arterial occlusion is MOST likely the cause?
- Vertebral artery.
- Middle cerebral artery.
- Posterior cerebral artery.
- Anterior cerebral artery. (correct)
A patient undergoing cerebral venography exhibits signs of venous hemorrhagic stroke following contrast injection. What immediate action should be taken, considering the potential complications?
A patient undergoing cerebral venography exhibits signs of venous hemorrhagic stroke following contrast injection. What immediate action should be taken, considering the potential complications?
What is the MOST critical consideration when choosing between balloon embolectomy and angiojet thrombectomy for treating a cerebral venous thrombosis?
What is the MOST critical consideration when choosing between balloon embolectomy and angiojet thrombectomy for treating a cerebral venous thrombosis?
Following a mechanical thrombectomy for a middle cerebral artery occlusion, a patient shows signs of persistent neurological deficits. What immediate next step should be considered to optimize patient outcome?
Following a mechanical thrombectomy for a middle cerebral artery occlusion, a patient shows signs of persistent neurological deficits. What immediate next step should be considered to optimize patient outcome?
A patient with a known inherited blood disorder presents with symptoms suggestive of a cerebrovascular accident (CVA). Which diagnostic imaging modality should be prioritized initially to confirm the diagnosis and guide immediate management?
A patient with a known inherited blood disorder presents with symptoms suggestive of a cerebrovascular accident (CVA). Which diagnostic imaging modality should be prioritized initially to confirm the diagnosis and guide immediate management?
A patient is undergoing inferior petrosal sinus sampling (IPSS) for ACTH level measurement to evaluate Cushing's disease. What is the PRIMARY concern when positioning the catheter?
A patient is undergoing inferior petrosal sinus sampling (IPSS) for ACTH level measurement to evaluate Cushing's disease. What is the PRIMARY concern when positioning the catheter?
A patient with a confirmed diagnosis of Rt vertebral artery occlusion is scheduled for PTA and stent placement. What pre-procedural imaging is MOST critical for planning the intervention?
A patient with a confirmed diagnosis of Rt vertebral artery occlusion is scheduled for PTA and stent placement. What pre-procedural imaging is MOST critical for planning the intervention?
During an endovascular thrombectomy, small jets unintentionally fragment a thrombus outside of the suction catheter. What is the MOST immediate and significant risk associated with this?
During an endovascular thrombectomy, small jets unintentionally fragment a thrombus outside of the suction catheter. What is the MOST immediate and significant risk associated with this?
Flashcards
Cerebral Venography
Cerebral Venography
Imaging of cerebral veins to detect abnormalities.
Venography Indications
Venography Indications
AVM, thrombus, tumor evaluation, trauma, pre/post surgery, ACTH level sampling.
Superior Vena Cava Venography
Superior Vena Cava Venography
Primarily to rule out thrombus or occlusion in the SVC.
Cerebrovascular Accident (CVA)
Cerebrovascular Accident (CVA)
Signup and view all the flashcards
CVA Risk Factors
CVA Risk Factors
Signup and view all the flashcards
CVA Symptoms
CVA Symptoms
Signup and view all the flashcards
Anterior Cerebral Artery Occlusion Symptoms
Anterior Cerebral Artery Occlusion Symptoms
Signup and view all the flashcards
Middle Cerebral Artery Occlusion Symptoms
Middle Cerebral Artery Occlusion Symptoms
Signup and view all the flashcards
Posterior Cerebral Artery Occlusion Symptoms
Posterior Cerebral Artery Occlusion Symptoms
Signup and view all the flashcards
Medication Treatments for CVA
Medication Treatments for CVA
Signup and view all the flashcards
Study Notes
- Cerebral venography is indicated for AVM, thrombus, tumor evaluation, trauma, pre/post surgical assessment, and inferior petrosal venous sampling for ACTH levels.
- ACTH stands for AdrenoCorticoTropic Hormone
Superior Vena Cava Venography
- Primarily used to rule out thrombus or occlusion
- Contrast media is injected through a needle or angiographic catheter in a vein of the antecubital fossa
- Images taken should include the opacified subclavian vein, brachiocephalic vein, superior vena cava, and right atrium
- The mid-chest area imaged should be 1 inch to the right side from the mid-sagittal plane
- Typical exposure settings include using a low-dose hand injection with DSA in the supine position
- 2 frames per second is a typical rate
- Image quality can be improved through collimation, adjusting SID, focal spot size, and OID
Venous Sinuses & Cerebro Vascular Accident (CVA or Stroke)
- Risk factors for CVA include inherited blood disorders, certain cancers, medications, infections, pregnancy, and birth control.
- Symptoms of CVA include severe headache (most common), blurred vision, confusion, loss of consciousness/movement control, seizures, coma
- A vein rupture can cause a venous hemorrhagic stroke
- Symptoms of Occlusion of the anterior cerebral artery include contralateral loss of sensation and motor control to the lower body
- Symptoms of Occlusion of the middle cerebral artery include contralateral loss of sensation and motor control to the face and upper limbs
- Symptoms of Occlusion of the posterior cerebral artery include contralateral loss of vision
- CVA is diagnosed with CT or MRI
- Interventional treatment includes endovascular thrombectomy, PTA, and stent placement.
- Endovascular Thrombectomy is performed at the Montreal Neurological Hospital (MNH)
CVA Medication Treatments
- Blood thinners are used for long-term treatment
- IV thrombolysis uses tissue Plasminogen Activator (tPA), a protein that breaks down blood clots
- Intravascular Thrombolysis (Fibrinolysis) is an interventional procedure where thrombi is suctioned into a catheter and fragmented by small jets
- A catheter is placed in the obstructed area to infuse streptokinase and urokinase substances
CVA Interventional Treatments
- Thrombectomy
- Balloon Embolectomy carries a risk of causing PE (pulmonary embolism)
- Angiojet rheolytic mechanical thrombectomy
Cerebral Aneurysm
- A true aneurysm affects all 3 layers of the arterial wall: intima, media, & adventitia
- A false aneurysm (pseudoaneurysm) involves only the outer layer of the artery (adventitia)
- Aneurysms can be saccular or fusiform depending on their shape
- Saccular cerebral aneurysms (berry aneurysms) have a 90% occurrence
- Aortic aneurysms are about 94% fusiform
- Cerebral saccular aneurysms are treated with coil embolization
- Fusiform Aneurysms are most often treated with stents
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Cerebral venography helps evaluate AVM, thrombus and tumors. Superior Vena Cava venography rules out thrombus or occlusion. Contrast is injected into the antecubital fossa to image the subclavian, brachiocephalic veins and right atrium.
