Basilar Artery Stent - Threading the Needle in a Complex Case

Patient History:

A patient with a basilar artery stent develops a subdural hematoma and is taken off Plavix.

What is NOVA's role?

NOVA allows close monitoring of the basilar artery flow status during this critical phase of the patient’s treatment.

Venous Sinus Stenting

Patient History:

Grade 1 dural arteriovenous fistula associated with severe right transverse sinus stenosis.

What is NOVA's role?

NOVA quantifies the improvement in cerebral venous blood flow after angioplasty and stenting.

Baseline QMRA after treatment of a carotid aneurysm with flow diversion

Patient History:

A flow diverting stent did not open fully on deployment.

What is NOVA's role?

NOVA QMRA documents preservation of flow after stenting and provides a baseline for non-invasive follow up.

in-stent stenosis following stent assisted coiling of a right middle cerebral artery aneurysm

Patient History:

The patient presented with a new stroke 10 months post coiling.

What is NOVA's role?

NOVA is used to evaluate the hemodynamic significance of the in stent stenosis now seen on angiography

Internal carotid artery stenosis with impending occlusion

Patient History:

A 65 year old, right handed woman had an episode of unusual gait and fell to her knees. Her symptoms resolved within 5 minutes. She was seen in the ER and diagnosed with a TIA.

What is NOVA's role?

NOVA quantified the amount of blood flow the patient would lose if the carotid were to occlude.

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AVM Management

Patient History:

A 28 year old woman with a left parietooccipital AVM was found unresponsive.

What is NOVA's role?

NOVA provides quantitative measurement of the blood flow leading to and from the AVM, helping her physicians to determine the effectiveness of treatment.

Cerebrovascular Reserve Testing

Patient History:

A 55 year old male referred by his primary care physician for a left internal carotid artery occlusion with recurring symptoms.

What is NOVA's role?

NOVA was performed with and without diamox to evaluate cerebrovascular reserve.

Embolic or Hemodynamic Stroke

Patient History:

A 79 year old woman develops stroke symptoms on post-operative Day 1.

What is NOVA's role?

NOVA rules out a hemodynamic cause and supports the decision to administer heparin to treat embolic stroke.

Carotid Stenting - NOVA qMRA pre and post intervention

Patient History:

A 58 year old man presents with asymptomatic carotid restenosis two years post CEA.

What is NOVA's role?

Quantifies and documents the improvement in carotid artery blood flow after angioplasty and stenting.

Aysmptomatic Bilateral Carotid Stenosis

Patient History:

A 68 year old man with bilateral carotid stenosis is being considered for carotid endarterectomy. He is reported to have a > 90% LICA stenosis on ultrasound.

What is NOVA's role?

Quantitative vessel flow measurements refute the ultrasound findings and confirm normal cerebral blood flow. An incidental finding is vertebral steal.

Basilar Artery Dissection

Patient History:

A 41 year old woman presents with an intracranial bleed and is found to have a dissection of the basilar artery.

What is NOVA's role?

NOVA shows that blood flow in the posterior circulation is adequate and supports a decision to defer a high-risk intervention.

Transient monocular vision loss

Patient History:

46 year-old Indian woman with amaurosis fugax on the left.

What is NOVA's role?

In the presense of a LICA occlusion, NOVA and vascular reserve testing both show good collateral compensation.

71 year old woman with possible limb-shaking TIAs

Patient History:

71 year-old woman with a 2 episodes of right hand jerking thought to be possible limb-shaking transient ischemic attacks; left carotid endarterectomy on asymptomatic basis 3 years prior.

What is NOVA's role?

Based on the NOVA result and vascular reserve testing, her perfusion was likely adequately compensated and no intervention was offered. She is medically treated and has not had any recurrent ischemic symptoms in more than 2 years.

40 year old with Mid-Basilar Stenosis

Patient History:

A 40 year-old Caucasian man with acute onset of dysarthria, left sensorimotor loss and imbalance.

What is NOVA's role?

NOVA demonstrated that large vessel posterior circulation flows are not likely to be associated with the patient’s symptoms.

Peri-operative Evaluation of Vertebral Artery Stenting

Patient History:

65-year-old man; Status post-stroke involving posterior circulation territory;High grade left vertebral stenosis just proximal to the vertebrobasilar junction.

What is NOVA's role?

NOVA provides early, non-invasive indication of restenosis.

35 Year-old Female with Bilateral Carotid Occlusion

Patient History:

35 year-old right-handed woman presented with a one-week history of left leg weakness and difficulty walking.

What is NOVA's role?

NOVA QMRA demonstrated that the intracranial circulation (anterior) was preserved despite the presence of bilateral ICA occlusions.

Global reduction in CBF during episode of atrial fibrillation

Patient History:

69 year old female with carotid artery stenosis and an ophthalmic artey aneurysm.

What is NOVA's role?

A comparison of two NOVA studies done at 3 months interval shows the overall cerebral blood flow during normal sinus rhythm and the reduction of flow during an episode of atrial fibrillation.

Pre-occlusive MCA waveform an early warning of impending stroke

Patient History:

58-year-old male presents with right-sided TIA.

What is NOVA's role?

The MCA waveform morphology and right/left sided asymmetry in MCA flow signified an impending stroke.

Anterior Circulation Hemispheric Hemodynamic Ischemia in the setting of Occult Subclavian Steal

Patient History:

57 year-old right-handed gentlement. Presented with transient right hemispheric symptoms which included left hemianesthesia and dysarthria.

What is NOVA's role?

NOVA guided the interventional treatment strategy and confirmed restoration of right hemispheric blood flow.

Symptomatic Vertebral Disease

Patient History:

56 year old male; VBI, symptoms resolved. The angiogram shows long segmen BA stenosis & RICA occlusion.

What is NOVA's role?

NOVA provides quantitative measurement of Pcom collateral and shows that flow in the posterior cerebal arteries is maintained within the normal range.

Symptomatic Vertebral Occlusion

Patient History:

61 year old male with two episodes of vertebral basilar insufficiency; one transient locked-in event precipitated by aggressive treatment hypertension.

What is NOVA's role?

NOVA guides a less invasive treatment strategy utilizing carotid endarterectomy.