title: Moderately elevated intracranial pressure produces greater cross-filling of the anterior communicating artery.
abstract: This study aimed to investigate whether moderately elevated intracranial pressure is associated with greater cross-filling of the anterior communicating artery on diagnostic cerebral angiography. A retrospective study of 12 patients with subarachnoid hemorrhage was performed. Data on sequential cerebral angiograms and clinical data were used to indirectly estimate intracranial pressure (ICP). Cross-filling of the anterior communicating artery (ACom) was recorded according to our scoring system. Our study included 12 patients with mean age 43 ± 11 yrs. Six patients demonstrated greater ICP associated with greater cross-filling of the ACom on initial angiogram. One patient had greater ICP with greater cross-filling on follow-up angiogram secondary to infarction and midline shift. Two patients had lower ICP yet greater cross-filling on follow-up angiogram due to higher injection rate and volume. One patient with no change in ICP demonstrated the same degree of cross-filling. A markedly elevated ICP is traditionally associated with no cross-filling across the ACom. We propose a counter-intuitive model in which moderately elevated ICP produces greater cross-filling of the ACom. This diagnostic angiographic finding should make the angiographer consider that the patient has moderately elevated ICP, and facilitate more timely clinical management.
authors.affiliation: Department of Radiology, St Luke's-Roosevelt Hospital; New York, NY, USA - Radiology Department of the St. Luke's-Roosevelt Hospital Center; New York, NY, USA - yiczhang@chpnet.org.
authors.forename: Yi C
authors.initials: YC
authors.lastname: Zhang
authors.affiliation: New York Presbyterian Hospital / Weill Cornell Medical College, Department of Radiology, Memorial Sloan Kettering Cancer Center; New York, NY, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Young
authors.affiliation: Clarion Diagnostics LLC; Ponte Vedra Beach, FL, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Jones
authors.affiliation: Verona Veins at Access Care Physicians; New York, NY, USA.
authors.forename: Elsie
authors.initials: E
authors.lastname: Koh
authors.affiliation: Winthrop University Hospital; New York, NY, USA.
authors.forename: Ruby J
authors.initials: RJ
authors.lastname: Lien
authors.affiliation: Department of Radiology, St Luke's-Roosevelt Hospital; New York, NY, USA.
authors.forename: Nolan J
authors.initials: NJ
authors.lastname: Kagetsu
mesh_terms: D000328:Adult; D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging*; D019586:Intracranial Hypertension / Q000000981:diagnostic imaging*; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging*
keywords: cerebral angiography; cross-filling; intracranial pressure