Cerebral and Superior Vena Cava Venography

• 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 is primarily used to rule out thrombus or occlusion.
• During Superior Vena Cava venography, contrast medium is injected through a needle or angiographic catheter in a vein located in the antecubital fossa.
• Images for Superior Vena Cava venography should include the opacified subclavian vein, brachiocephalic vein, superior vena cava, and right atrium.
• The mid-chest area is imaged 1 inch to the right side from the mid-sagittal plane.
• During venography, a low dose of contrast is injected by hand and DSA is performed while the patient lies supine.
• 18g intracaths are often used, with fluoroscopy to guide injection at 2 frames per second.

Cerebro Vascular Accident (CVA or Stroke)

• Risk factors include inherited blood disorders, certain cancers, medications, infections, pregnancy, and birth control, or STUDYING AT DAWSON.
• Symptoms include severe headache (most common), blurred vision, confusion, loss of consciousness and movement control, seizures, and coma.
• A vein rupture can cause venous hemorrhagic stroke.
• Occlusion of the anterior cerebral artery results in contralateral loss of sensation and motor control to the lower body.
• Occlusion of the middle cerebral artery results in contralateral loss of sensation and motor control to the face and upper limbs.
• Occlusion of the posterior cerebral artery results in contralateral loss of vision.
• CVA/stroke is diagnosed with CT or MRI.
• Interventional treatments include Endovascular Thrombectomy, PTA & Stent.
• Endovascular Thrombectomy is performed at the Montreal Neurological Hospital (MNH).

CVA/Stroke Medication Treatments

• Long-term treatment includes blood thinners.
• IV thrombolysis, utilizing tPA (tissue Plasminogen Activator), breaks down blood clots.
• Intravascular Thrombolysis (Fibrinolysis) involves suctioning thrombi into a catheter and fragmenting them with small jets.
• An infusing catheter is placed in the obstructed area to administer streptokinase & urokinase substances.

Interventional CVA/Stroke Treatments

• Thrombectomy is a treatment option.
• Balloon Embolectomy carries a risk of causing Pulmonary Embolism (PE).
• Angiojet rheolytic mechanical thrombectomy is a treatment option.
• PTA & Stent Placement Procedureis done for right Vertebral artery occlusion.

Cerebral Aneurysm

• A true aneurysm affects all three layers of the arterial wall: intima, media, and adventitia.
• A false aneurysm (pseudoaneurysm) involves only the outer layer of the artery (adventitia).
• Aneurysms can be saccular or fusiform in shape.
• Saccular cerebral aneurysms (berry aneurysms) have a 90% occurrence rate.
• Aortic aneurysms are about 94% fusiform.
• Cerebral saccular aneurysms are treated with coil embolization.
• Fusiform Aneurysms most often treated with stents

Risk Factors for Saccular Cerebral Aneurysms

• Risk Factors: advanced age, hypertension, excessive alcohol consumption, cigarette smoking, atherosclerosis of cerebral arteries, trauma to the head, cocaine use, and estrogen deficiency.

Signs and Symptoms of Unruptured Cerebral Aneurysm

• Headache, eye pain, unilateral complete third cranial nerve palsy, ischemic/embolic cerebrovascular disease, seizures, vision loss or hemianopsia.

Arteriovenous Malformation (AVM)

• AVM is an abnormal anastomosis or communication between an artery and a vein.
• During AVM Embolization, the AVM is embolized with coils, plugs, glue, onyx, or absolute alcohol.

Cerebral SinoVenous Thrombosis (CSVT)

• CSVT describes slow thrombi formation in a cerebral vein, which can lead to CVA or stroke.
• It develops over time due to the development of collaterals to bypass the obstruction.
• CSVT is a rare blood clot disorder that prompted the stop of the Johnson & Johnson and AstraZeneca COVID-19 vaccines.
• Risk factors include inherited blood disorders, certain cancers, medications, infections, pregnancy, birth control, and difficult births.
• Symptoms: severe headache (most common), blurred vision, confusion, loss of consciousness and movement control, seizures, coma, and vein ruptured causing venous hemorrhagic stroke.
• CSVT is often misdiagnosed with CT.
• MR Venography is the most effective way to diagnose CSVT.

CSVT Treatment

• Long-term treatment includes blood thinners.
• IV thrombolysis consists of tPA (tissue Plasminogen Activator), which breaks down blood clots.
• Intravascular Thrombolysis (Fibrinolysis) involves suctioning thrombi into a catheter where it is fragmented by small jets.
• An infusing catheter is placed in the obstructed area to administer streptokinase & urokinase substances.
• Thrombectomy, balloon embolectomy (risk of causing PE), and Angiojet rheolytic mechanical thrombectomy are treatment options.