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Abstract 397: Reversible cerebral vasoconstriction syndrome: Objective assessment of arterial improvement and the potential use of computed tomography angiography for non‐invasive approach
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Abstract 397: Reversible cerebral vasoconstriction syndrome: Objective assessment of arterial improvement and the potential use of computed tomography angiography for non‐invasive approach

A Gudino, E Sagues, C Dier, A Brake, M Cabarique and E Samaniego
Stroke: vascular and interventional neurology, Vol.4(S1)
11/01/2024
DOI: 10.1161/SVIN.04.suppl_1.397
PMCID: PMC12774220
url
https://doi.org/10.1161/SVIN.04.suppl_1.397View
Published (Version of record) Open Access

Abstract

Introduction/PurposeReversible cerebral vasoconstriction syndrome (RCVS) pathophysiology understanding is limited. Subjective assessment of reversibility in digital subtraction angiography (DSA) after intraarterial (IA) verapamil is routinely performed. However, this can carry potential procedural complications and undiagnosed cases. We propose an objective measurement of arterial improvement in DSA, and the use of computed tomography angiography (CTA) for non‐invasive diagnosis of RCVS.Materials and methods:Patients with RCVS diagnosis on last clinic follow‐up were included. DSA images were analyzed using PACS for area determination (image 1) and CTA images were assessed using 3D Slicer for volume extraction (image 2) before and after verapamil administration. Proximal and distal arterial segments were analyzed. Proximal segments were defined as follows: M1‐M2, A1‐A2, P1‐P2. Distal portions involved: M3‐M4, A3‐A4, P3‐P4. Mann‐Whitney U test was used to assess differences in area and volume between different segments.ResultsTwenty‐six patients with RCVS were included. Distal arterial segments had the highest luminal improvement in DSA area compared with proximal sections (18.91%, IQR: 15.09 vs 13.41%, IQR: 12.79, p 0.02). Similarly, distal arterial segments have the most volumetric improvement compared with proximal portions in CTA (49.87%, IQR: 48.91 vs 15.69, IQR: 21.07, p<0.001).ConclusionDistal arterial segments of RCVS patients have the highest luminal and volumetric improvement after verapamil administration. CTA imaging is a potential non‐invasive tool to evaluate RCVS.Figure 1: DSA studies before (A) and after (D) intraarterial (IA) verapamil were analyzed. Diameter of the most stenotic segment is recognized, and area is measured three millimeters proximally and distally away from it.Figure 2: CTA imaging before (A) and after (D) administration of oral verapamil were included. Similar pipeline was used for vessel boundaries. 3D segmentation of the corresponding vessel segment is generated, and the volume is extracted.
 Medical Imaging Tomography

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