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Background Endoscopic third ventriculostomy (ETV) has become a well-established method for the treatment of noncommunicating hydrocephalus with a high success rate and a relatively low morbidity rate. However, vessel injury has been repeatedly reported, often with a fatal outcome. Vessel injury is considered to be the most threatening complication. The use of indocyanine green (ICG) angiography has become an established tool in vascular microneurosurgery. Objective We report our initial experience with endoscopic ICG angiography in ETV for intraoperative visualization of the basilar artery and its perforators to reduce the risk of vascular injury. Methods Eleven patients with noncommunicating hydrocephalus underwent ETV. Before opening of the third ventricular floor, ICG angiography was performed using a prototype neuroendoscope for intraoperative visualization of ICG fluorescence. Results In 10 patients, ETV and ICG angiography were successfully performed. In 1 case, ICG angiography failed. Even in the presence of an opaque floor of the third ventricle (n = 5), ICG angiography clearly demonstrated the course of the basilar artery and its major branches and was considered useful. Conclusion ICG angiography has the potential to become a useful adjunct in ETV for better visualization of vessel structures, especially in the presence of aberrant vasculature, a nontranslucent floor of the third ventricle, or in case of reoperations.

La maladie de Moya Moya est une maladie angiogénique, caractérisée par un rétrécissement de l'artère carotide interne distale qui s'étend aux segments proximaux des artères cérébrales moyennes et antérieures, induisant la formation de vaisseaux de suppléance. Ces derniers proviennent des collatérales parenchymateuses, perforantes, leptoméningées et autres anastomoses transdurales. Ces vaisseaux collatéraux ont un aspect caractéristique à l'angiographie formant un nuage de fumée : réseau Moya Moya. Son étiologie reste encore mal élucidée et représente 10 à 15% des causes d'accidents vasculaires cérébraux (AVC), avec 2 pics d'âge où l'atteinte est plus fréquente: les enfants autour de 5 ans et les adultes autour de 40 ans. Son évolution peut être lente avec des symptômes intermittents ou être fulminante avec un déclin neurologique rapide. Les données actuelles montrent l'importance du traitement chirurgical comme méthode de référence pour la prise en charge du syndrome de Moya en particulier chez les patients avec des symptômes progressifs et récidivants.Mots clés: Moya, vascularite, AVC, angioscanner, angio-IRM, angiographieEnglish Title: Moya moya disease: a rare cause of ischemic stroke in children: about a caseEnglish AbstractMoya moya disease is an angiogenic disease characterized by the narrowing of the distal internal carotid artery extending to the proximal segments of the middle and anterior cerebral arteries, inducing collateral vessels formation. These vessels come from the collateral parenchymal vessels, the perforating vessels, leptomeningeal vessels and other transdural anastomoses. These collateral vessels have a characteristic appearance on angiography, forming a cloud of smoke: net-like moyamoya. Its etiology is still poorly understood. Moyamoya disease accounts for 10-15% of the causes of stroke, with 2 age peaks at which its occurrence is more frequent: children around 5 years old and adults around 40 years old. Its evolution can be slow with intermittent symptoms or fulminant with fast neurological deterioration. The current data show the role of surgery as the gold standard for the treatment of moyamoya syndrome, in particular in patients with progressive and recurrent symptoms.Keywords: Moya, vasculitis, stroke, angioscanner, angio-MRI, angiography

To evaluate the hemodynamic effect of percutaneous transluminal intervention (PTI) on stenosis of the superficial femoral (SFA) and popliteal arteries (PA) using time-density curves (TDCs) derived from digital subtraction angiography (DSA) series in correlation with ultrasound peak systolic velocity ratio (PSVR) and ankle brachial index (ABI). DSA series of SFA or PA of patients with symptomatic peripheral arterial occlusive disease was obtained with a flat-panel angiography system with intention-to-treat. In DSA series acquired before and after PTI, TDCs were analyzed proximal and distal of each stenosis using parametric color coding (PCC). For correlation, ABI and PSVR measurements pre- and post-PTI were recorded for all patients. In total, 25 stenoses of the SFA or PA were treated by PTI in 22 patients (17 male, 5 female, mean age 68 years). After treatment, peak-to-peak (PTP) times between TDCs proximal and distal to the treated vessel segment decreased statistically significantly (p = 0.01) on average from PTP = 1.9 +/- A 1.7 s to mean PTP = 1 +/- A 1 s. ABI and PSVR also changed statistically significantly after treatment (pretreatment ABI = 0.7 +/- A 0.2, PSVR = 4.2 +/- A 1.9; post-ABI = 0.9 +/- A 0.2, PSVR = 1.3 +/- A 0.4, both p < 0.05). Correlation parameters did not show a strong correlation between change in TDC and clinical parameters ABI and PSVR. Using PCC for analyzing contrast medium dynamics in DSA series is clinically useful for evaluating stenoses of the SFA and PA and for immediate treatment control after PTA.

International audience; PURPOSE. To evaluate the association between retinal microvasculature (vascular density) on optical coherence tomography-angiography (OCT-A) and the cardiovascular profile of patients hospitalized for acute coronary syndrome (ACS). METHODS. EYE-Myocardial Infarction (EYE-MI) study is a prospective cross-sectional study in the Cardiology Intensive Care Unit of Dijon University Hospital. Retinal OCT-A was performed for each patient within 2 days after admission. Superficial retinal capillary plexus (SCP) vascular density was measured. The population was divided into tertiles according to OCT-A data. RESULTS. Overall, 237 cases were retained for analysis. Patients in the tertile with the lowest retinal vascular density (RVD) were older, and more frequently had systemic hypertension and diabetes. Moreover, American Heart Association (AHA) risk and Global Registry of Acute Coronary Events (GRACE) scores were higher and left ventricular ejection fraction (LVEF) was lower in these patients. In multivariate analysis, the AHA risk score (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.04–1.09; P < 0.001) and LVEF (OR, 0.95; 95% CI, 0.93–0.98; P ¼ 0.001) were significantly associated with the lowest tertile of RVD. The association between RVD and a high-risk cardiovascular profile was confirmed by a moderate correlation with the GRACE scores (Spearman r ¼ _0.33, P < 0.001). CONCLUSIONS. SCP density measured on OCT-A was associated with the cardiovascular risk profile and with impaired LVEF in patients with a high-risk cardiovascular status. In the future, quantitative retinal microvascular data could be considered a good surrogate of the cardiovascular risk profile and could improve cardiovascular risk assessments.

Nous rapportons un cas d'anévrysme post-traumatique de l'artère carotide interne chez un enfant de 11 ans, ayant présenté une ophtalmoplégie droite. Un faux anévrisme de la carotide interne droite a été diagnostiqué par angiographie cérébrale. Le malade a bénéficié d'un traitement endovasculaire et l'évolution fut favorable. Malgré leur rareté, le diagnostic des anévrysmes post traumatiques devrait être évoqué chez tout traumatisé crânien en cas d'aggravation clinique secondaire, afin de réaliser une exploration angiographique avant d'envisager un traitement radical soit chirurgical soit par voie endovasculaire.

Summary Background There is a lack of Tunisian data on the frequency and clinical significance of different coronary artery anomalies. Methods All patients who underwent coronary angiography from March 1996 to December 2006 were considered. Only patients with congenital anomalous aortic origin of the coronary artery were included. Results Among 7330 adult patients who underwent diagnostic coronary angiography, 20 (0.27%) patients (13 men; mean age 53.3 years) had anomalies of the coronary artery origin. The right coronary artery was the vessel involved most frequently ( n = 10); it originated separately from the left sinus of Valsalva (SV) in three patients and from the posterior sinus of Valsalva in one patient. In the other patients, it arose from the left main coronary artery or its branches in a single coronary artery originating from the left sinus of Valsalva. Isolated anomalous left circumflex artery was the second most frequent anomaly ( n = 6). Isolated anomalous left anterior descending artery was seen in one patient. A single coronary artery arising from the right SV was seen in three patients. Atheroslerotic lesions were seen in eight cases. Four patients underwent coronary revascularization; the remainder received medical management. All 20 patients are alive and had an uneventful follow-up (mean 34.2 months). Conclusions In Tunisia, the incidence of congenital anomalous aortic origin of the coronary artery in adults is 0.27%. The right coronary artery is involved most frequently. Medical management seems promising.

International audience; OBJECTIVE: Intravascular ultrasound (IVUS) is a cornerstone tool for the diagnosis of plaque rupture (PR) but is usually used secondary to the suspicion of PR on angiography; the true incidence of PR may therefore be overestimated. We sought to evaluate predictors of angiographic diagnosis of PR using a non-angiographically driven IVUS examination. METHODS AND RESULTS: Diagnosis of PR on IVUS required agreement between two operators blinded to the results of angiography. Any irregular lesion with ulceration, flap or aneurysm on a qualitative angiogram was considered suspicious for PR. IVUS-detected PR and non-PR lesions were compared with the corresponding angiograms. A total of 224 distinct (ruptured or non-ruptured) lesions were detected by IVUS in 65 patients; 49 of the 105 IVUS-detected non-culprit PRs were suspected on angiography. The positive and negative predictive values for correct angiographic diagnosis of PR were 96% and 61%, respectively. Proximal coronary location, wide cavity, and counterflow rupture were strong predictors of correct angiographic diagnosis, enabling four specific angiographic patterns to be identified using three-dimensional IVUS PR reconstruction. CONCLUSION: Against IVUS as the gold standard, angiographic diagnosis of PR showed good specificity but low sensitivity. However, better angiographic diagnosis should enable medical treatment to be optimized, especially with respect to statin therapy.

Wert der MR-angiographischen Technik für die Dignitätsbeurteilung von Ovarialraumforderungen Ziel der Studie war die Überprüfung der Wertigkeit der kontrastmittelunterstützten MRT und der Aussagekraft der arteriellen und venösen Phase in der Charakterisierung ovarieller Raumforderungen. 51 Patientinnen (97 Ovarien) mit ovariellen Raumforderungen in der klinischen und sonographischen Kontrolle wurden in einem 1,5 Tesla MRT mit einer Body-phased-array-Spule untersucht. Dabei kamen T1- und T2-gewichtete Sequenzen zur Anwendung (axiale, sagittale und coronare). Zusätzlich wurde eine MR-Angiographie mit Aufnahmen in der arteriellen und venösen Phase durchgeführt. Als Kontrastmittel kam Gadolinium-DTPA zur Anwendung. 43 Patientinnen wurden operiert, die übrigen Patientinnen mit als gutartig gewerteten Tumoren im Verlauf von 13 bis 23 Monaten klinisch kontrolliert. Die Histologische Untersuchung zeigte 21 bösartige (einschließlich 4 Borderline-Tumoren) und 43 gutartige Tumoren. Die Sensitivität, Spezifität und Treffsicherheit wurde mit Hilfe der folgenden Kriterien berechnet: Größe der Tumoren, Wand- und Septendicke, Vorhandensein solider Anteile und die Kontrastmittelanreicherung in der arteriellen und venösen Phase. Zusätzlich wurde die Aussagekraft der Substraktionsangiographie sowie der maximum intensity projections (MIP) überprüft. Die MRT war korrekt bei 17 von 21 malignen Tumoren und 73 von 76 benignen Tumoren bzw. unauffälligen Ovarien und hat somit eine Sensitivität von 81%, eine Spezifität von 96% und eine Treffsicherheit von 93%. Die Treffsicherheit der Kriterien für Malignität liegt bei 85% für die Kontrastmittelanreicherung in der arteriellen Phase, bei 86% für die soliden Anteile, bei 78% für die Wanddicke und bei 69% für die Septendicke. Die Ergebnisse zeigen, dass die kontrastmittelanreichernde MRT einen nützlichen zusätzlichen Faktor darstellt, um die Spezifität der MRT in der Charakterisierung gutartiger und bösartigen Tumoren zu erhöhen., Role of MR Angiography in the Characterization of Ovarian Lesions The aim was to investigate the role of contrast-enhanced magnetic resonance (MR) angiography and the arterial and venous contrast medium enhancement for lesion characterization. Fifty-one patients (97 ovarian) with ovarian masses identified in the clinical examination and by endovaginal ultrasound underwent MR imaging on a 1.5-T scanner using a body phased-array coil. Images were acquired with T1- and T2-weighted sequences (axial, sagittal and coronal). An MR angiography sequence was performed before and after intravenous injection of Gd-DTPA during the arterial and venous phase after determination of the transit time of the contrast medium bolus. Forty-three patients were operated on; the remaining patients with benign lesions were followed up clinically for 13 to 23 months. Histology demonstrated 21 malignant lesions (including 4 borderline tumors) and 43 benign lesions. The sensitivity, specificity and diagnostic accuracy were calculated for the following criteria: size of ovarian mass, thickness of walls and septae, solid portions, and arterial and venous contrast medium enhancement. In addition, the diagnostic benefit of maximum intensity projections (MIP) and thin slices acquired with the MR angiography technique was evaluated. MRI correctly identified 17 of the 21 malignant tumors and 73 of the 76 benign findings (benign lesions or normal ovaries) and had a sensitivity of 81%, a specificity of 96%, and a diagnostic accuracy of 93%.The accuracies of the different malignancy criteria were 85% for arterial contrast medium, 86% for the solid portions, 78% for the wall thickness and 69% for septal thickness. The results presented show that arterial contrast medium enhancement is a useful criterion to improve the specificity of MRI in characterizing ovarian lesions.

Our goal was to study the arterial supply to the sheep uterus to compare its similarity with that of women and to evaluate the interest of this animal model for training in uterine artery embolization.Ten nonpregnant sheep underwent aortography and selective study of the ovarian, internal iliac, uterine, and vaginal arteries.The uterus was supplied mainly by the uterine arteries in all sheep. The ovarian artery, which was identified in five sheep, had a thin anastomosis with the ipsilateral uterine artery at the tubal junction. The vaginal artery provided blood flow to the inferior part of the cervix and anastomosed with the ipsilateral uterine artery.Because uterine vascularization of nonpregnant sheep is similar to that of women, the sheep represents an appropriate model for experimental uterine artery embolization. This model should be used for interventional radiologists in training not familiar with endovascular navigation inside pelvic arteries.