Hyperacute Transcapillary Stroke - CTA or MRA Neck

History

Acute change in neurologic status; rule out stroke.

Exam

CTA/MRA/MRV of the neck

Purpose

1 Define sites of any and all arterial thromboses; or flow-limiting high-grade stenosis; or tandem stenoses with lesser degrees of luminal narrowing, but are included within the same arterial circuit.

2 Characterize the features of the stenotic/occluded arterial segment (NASCET, assess length of stenosis/occlusion, intimal dehiscence, atherosclerotic vs inflammatory basis, etc.).

3 Determine whether there is effective collateral around any occluded segment.

4 Assess the presence of effective EC-IC collateral in cases of extradural ICA occlusion.

5 There is evidence of thrombosis of the major neck veins.

6 There is evidence of venous collateral in the neck veins.

Prior Study

Any available

Findings

Low Neck Evaluation (Aorta, Brachiocephalic, Proximal Common Carotid (CCA) & Proximal Vertebral Arteries)

There is evidence of aortic arch dissection or other abnormality. [Yes/No]

There is evidence of occlusion of brachiocephalic arteries. [Yes/No]

There is evidence of stenosis of brachiocephalic arteries. [Yes/No]

There is evidence of occlusion at the origin of a carotid artery. [Yes/No]

There is evidence of stenosis at the origin of a carotid artery. [Yes/No]

Given a CCA is occluded, are the vertebral to occipital branch of the external carotid artery (EAC) collateral arcades functional. [Yes/No]

There is evidence of occlusion in the proximal segment of a vertebral artery. [Yes/No]

There is evidence of stenosis in the proximal segment of either vertebral artery. [Yes/No]

Upper cervical neck & intracranial/extradural evaluation

There is evidence of occlusion at the carotid bifurcation including proximal ICA or ECA or both. [Yes/No]

There is evidence of flow-limiting stenoses within either the high cervical carotid or the vertebral arteries, exceeding 60% or less by NASCET standards. [Yes/No]

There is dissection, pseudoaneurysm, or intimal web or both in the high cervical ICA's or vertebral arteries. [Yes/No]

There is intimal ulceration or intimal dehiscence in the area(s) of carotid plaque. [Yes/No]

There is intraluminal soft clot in the area of carotid plaque or pseudoaneurysm. [Yes/No]

There is large vessel vasculopathy (FMD) of high cervical or intracranial/extradural ICA or vertebral arteries. [Yes/No]

There is focal flow-limiting stenosis/occlusion of the ICA in its intracranial-extradural segment. [Yes/No]

There is focal stenosis or occlusion of the ICA or the vertebral at the dural ring or within the intradural vertebral segment. [Yes/No]

There is evidence of reduced size of the either the high cervical carotid or vertebral arteries related to downstream stenosis [Yes/No]

There is functional EC-IC collateral with enlargement of the internal maxillary or middle meningeal arteries. [Yes/No]

There is increased size of either the ICA or vertebral arteries consistent with exaggerated intracranial flow demand (i.e. collateralization). [Yes/No]

There is is evidence of macrovasculopathy of the proximal intradural ICA with stenoses and or abnormal perforators (both lenticulostriate and/or thalamostriate) representing moyamoya collateralization (disease, syndrome or adult moyamoya forms). [Yes/No]

There is evidence of meningeal arteries connecting with pial arteries representing moyamoya collateralization. [Yes/No]

There is thrombosis of internal jugular or other large neck veins. [Yes/No]

There is thrombosis of the sigmoid, transverse, or torcular sinuses. [Yes/No]