Viva · Specialty
Interventional Radiology Viva Questions
Oral-exam style questions and answers on interventional radiology for MD, DNB and super-specialty practical examinations. Each answer links back to the playbook or Library entry it was written from.
- What does ARUBA stand for?
- A Randomized Trial of Unruptured Brain Arteriovenous Malformations.
- What was the design of ARUBA?
- It was an international, multicentre, open-label, parallel-group randomised controlled trial comparing medical management alone with medical management plus interventional therapy.
- Which patients were studied in ARUBA?
- Adults with an unruptured brain AVM, no previous interventional treatment, and a lesion considered suitable for eradication by the participating centre.
- What treatments constituted the ARUBA interventional arm?
- Neurosurgery, embolisation or stereotactic radiotherapy, used alone or in any combination, sequence or number, together with medical management.
- What was the primary endpoint in ARUBA?
- Time to death from any cause or symptomatic stroke.
- What was the primary 2014 result of ARUBA?
- At a mean 33.3 months, death or symptomatic stroke occurred in 10.1% with medical management versus 30.7% with intervention; the hazard ratio was 0.27 in favour of medical management.
- Did the ARUBA result persist on final follow-up?
- Yes. At a mean 50.4 months, death or symptomatic stroke remained less frequent with medical management, with a hazard ratio of 0.31.
- What is the central management implication of ARUBA?
- In patients resembling the trial population, routine prophylactic intervention should not be presumed beneficial; conservative medical management should be the reference strategy during the first several years.
- What is the main interpretive limitation of ARUBA for an interventional radiologist?
- It pooled embolisation, surgery and stereotactic radiotherapy into one heterogeneous arm and was not powered to judge any individual technique or carefully selected subgroup.
- Does ARUBA prove that no unruptured brain AVM should ever be treated?
- No. It supports medical management in the studied population over the observed period, but it does not resolve modality-specific benefit, selected low-risk lesions or lifetime haemorrhage risk.
- What is the ASITN/SIR collateral grading system?
- It is a five-grade DSA scale, from 0 to 4, that assesses the speed and completeness of collateral filling of an ischaemic vascular territory.
- Enumerate the ASITN/SIR collateral grades in one line.
- Grade 0 is absent flow, grade 1 slow-incomplete, grade 2 rapid-incomplete, grade 3 slow-complete and grade 4 rapid-complete collateral filling.
- How do grades 1 and 2 differ?
- Both are incomplete. Grade 1 shows slow filling to the periphery, whereas grade 2 shows rapid peripheral filling but supplies only part of the ischaemic territory.
- How do grades 3 and 4 differ?
- Both completely fill the ischaemic bed. Grade 3 is delayed and becomes complete by the late venous phase, whereas grade 4 is rapid and complete.
- Which ASITN/SIR grades are generally considered good collaterals?
- Grades 3 and 4 are commonly considered good because collateral filling is complete. However, dichotomisation varies between studies, so the full grade should be reported.
- What is the main pitfall when interpreting an ASITN/SIR collateral grade?
- The scale requires adequate angiographic coverage and sufficiently late acquisitions. Missing contributing arterial injections or the late venous phase can underestimate collateral completeness.
- How does ASITN/SIR collateral grading differ from eTICI grading?
- ASITN/SIR grades collateral supply to the threatened vascular bed, while eTICI grades the extent of antegrade reperfusion achieved in the target territory after thrombectomy.
- Should the ASITN/SIR grade alone determine eligibility for thrombectomy?
- No. Collateral status provides prognostic and physiological information but must be integrated with vessel occlusion, infarct core, clinical deficit, time window and current treatment guidelines.
- What does the Barrow classification describe?
- It is an anatomical–angiographic classification of carotid–cavernous fistulas based on whether the shunt is direct or dural and on the carotid arterial system supplying it.
- Enumerate the four Barrow types.
- Type A is a direct ICA-to-cavernous sinus fistula. Type B is supplied by ICA meningeal branches, type C by ECA meningeal branches and type D by meningeal branches of both the ICA and ECA.
- Which Barrow type represents a direct carotid–cavernous fistula?
- Type A, consisting of a direct connection between the intracavernous internal carotid artery and the cavernous sinus.
- How do Barrow types B and C differ?
- Both are indirect dural fistulas. Type B is supplied by meningeal branches of the internal carotid artery, whereas type C is supplied by meningeal branches of the external carotid artery.
- What is a Barrow type D fistula?
- It is an indirect dural carotid–cavernous fistula supplied by meningeal branches of both the internal and external carotid arteries.
- What is the reference-standard investigation for classifying a carotid–cavernous fistula?
- Digital subtraction angiography, because it defines the arterial feeders, fistulous connection and venous drainage required for treatment planning.
- What is a common pitfall when applying the Barrow classification?
- Assigning the type purely from flow rate or presumed traumatic aetiology. The definitive Barrow type depends on the anatomical arterial connection.
- What does CEAP stand for?
- CEAP stands for Clinical, Etiological, Anatomical and Pathophysiological classification of chronic venous disorders.
- Enumerate the clinical classes from C0 to C6.
- C0 is no visible or palpable disease, C1 telangiectasias or reticular veins, C2 varicose veins, C3 oedema, C4 venous skin or subcutaneous changes, C5 healed venous ulcer and C6 active venous ulcer.
- How is the C4 clinical class subdivided?
- C4a denotes pigmentation or eczema, C4b denotes lipodermatosclerosis or atrophie blanche, and C4c denotes corona phlebectatica.
- Which recurrent-disease modifiers were introduced in the 2020 CEAP revision?
- C2r denotes recurrent varicose veins and C6r denotes a recurrent active venous ulcer.
- What do the S and A modifiers mean in the clinical component?
- S indicates symptoms attributable to venous disease, whereas A indicates the absence of attributable venous symptoms.
- What are the anatomical categories in CEAP?
- As denotes superficial veins, Ad deep veins, Ap perforating veins and An no identified venous anatomical location.
- How is venous pathophysiology coded in CEAP?
- Pr indicates reflux, Po obstruction, Pr,o combined reflux and obstruction, and Pn no identifiable venous pathophysiology.
- Is CEAP a severity score or treatment algorithm?
- No. CEAP is a descriptive classification of each limb at a particular time; it does not directly measure longitudinal severity or prescribe treatment.
- What does the Cho–Do classification describe?
- It is an angiographic classification of arteriovenous malformations based on the morphology of the fistulae, nidus and venous outflow, with implications for embolisation strategy.
- Enumerate the original Cho–Do AVM types.
- Type I is arteriovenous fistulous, Type II is arteriolovenous with a dominant venous component, Type IIIa is arteriolovenulous with non-dilated fistulae, and Type IIIb is arteriolovenulous with dilated fistulae.
- What is the defining angiographic feature of a Type I AVM?
- There are three or fewer feeding arteries communicating through focal fistulae with a single draining vein, without an intervening nidus.
- What distinguishes Type II from Type III AVMs?
- Type II has multiple arterial feeders converging on a dominant outflow vein or venous sac. Type III has multiple arteriolovenulous fistulae distributed through a vascular network.
- How does Type IIIa differ from Type IIIb?
- Type IIIa contains numerous non-dilated, fine, blush-like fistulae, whereas Type IIIb contains visibly enlarged fistulous channels within a complex vascular network.
- Why is recognising a Type II uterine or pelvic AVM important?
- The dominant venous sac or outflow vein is the key therapeutic target. A transvenous or direct-puncture approach may achieve more complete exclusion than embolising multiple arterial feeders alone.
- Which Cho–Do type is generally the most difficult to eradicate by embolisation?
- Type IIIa, because its innumerable fine microfistulae form a diffuse blush-like nidus that is difficult to penetrate and completely occlude.
- What is the common nomenclature trap regarding the Cho classification in uterine embolisation?
- The Cho–Do system classifies AVM angioarchitecture, not uterine artery origin or branching anatomy. It should also not be confused with classifications of ovarian artery–uterine artery anastomoses.
- Why are image-guided procedures assigned a bleeding-risk category?
- The category helps plan haemostatic laboratory assessment and periprocedural antithrombotic management. It must be considered together with the patient's bleeding and thrombotic risks.
- What are the CIRSE procedure-associated bleeding-risk categories?
- CIRSE uses three categories: low, moderate and high bleeding risk.
- What categories are used in the current SIR scheme?
- The 2019 SIR update uses two categories: low and high bleeding risk. It replaced the previous low, moderate and high scheme.
- Why should the CIRSE and SIR categories not be merged?
- They use different numbers of tiers and do not assign every procedure identically. The society and edition must therefore be stated whenever a category is quoted.
- How is transjugular liver biopsy categorised by CIRSE and SIR?
- It is moderate bleeding risk in the CIRSE table but low bleeding risk in the 2019 SIR table.
- Name procedures classified as high bleeding risk in both frameworks.
- Examples include thermal ablation, nephrostomy and transjugular intrahepatic portosystemic shunt creation.
- What features make a procedure high bleeding risk in the SIR framework?
- High-risk procedures may have a greater expected haemorrhage risk, occur where bleeding is difficult to detect or control, or take place where even limited bleeding can have severe consequences.
- Can the procedure category alone determine antithrombotic management?
- No. Patient comorbidity, the specific antithrombotic drug, thrombotic risk and anticipated technical complexity must also be assessed, using the current society or institutional protocol.
- What was the principal finding of the DAWN trial?
- In selected patients with intracranial ICA or proximal M1 occlusion and clinical-core mismatch, thrombectomy 6–24 hours after last known well improved 90-day disability and functional independence compared with standard medical care alone.
- What was the design of the DAWN trial?
- It was a multicentre, prospective, randomised, open-label controlled trial with blinded outcome assessment and a Bayesian adaptive-enrichment design.
- Which occlusion sites and treatment window were studied in DAWN?
- The trial studied intracranial internal carotid artery or proximal M1 middle cerebral artery occlusion treated 6–24 hours after the patient was last known well.
- What were the DAWN clinical-core mismatch thresholds?
- For patients aged 80 years or older, NIHSS was at least 10 with core volume below 21 mL. For patients younger than 80 years, NIHSS was at least 10 with core below 31 mL, or NIHSS was at least 20 with core from 31 mL to below 51 mL.
- What were the co-primary efficacy endpoints in DAWN?
- The co-primary endpoints were mean utility-weighted modified Rankin Scale score and functional independence, defined as mRS 0–2, both assessed at 90 days.
- What were the main efficacy results of DAWN?
- Mean utility-weighted mRS was 5.5 versus 3.4, and functional independence was 49% versus 13%, both favouring thrombectomy.
- Did thrombectomy significantly increase symptomatic intracranial haemorrhage or mortality in DAWN?
- No. Symptomatic intracranial haemorrhage was 6% versus 3%, and 90-day mortality was 19% versus 18%; neither difference was statistically significant.
- What is the major pitfall when interpreting DAWN?
- DAWN did not establish thrombectomy for every stroke presenting within 24 hours. Benefit was demonstrated only in a highly selected population with intracranial ICA or proximal M1 occlusion and strict age-adjusted clinical-core mismatch criteria.
- What is the full form of DEFUSE 3?
- DEFUSE 3 stands for Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3.
- What was the design of DEFUSE 3?
- It was a multicentre, randomised, open-label trial with blinded 90-day outcome assessment, comparing thrombectomy plus medical therapy with medical therapy alone at 38 US centres.
- Which vascular occlusions were eligible for DEFUSE 3?
- CTA or MRA had to demonstrate cervical or intracranial internal carotid artery occlusion or proximal M1 middle cerebral artery occlusion.
- What was the DEFUSE 3 target-mismatch profile?
- The ischaemic core had to be below 70 mL, the mismatch ratio at least 1.8 and the mismatch volume at least 15 mL on automated CT perfusion or MR diffusion-perfusion analysis.
- What was the primary endpoint and result of DEFUSE 3?
- The primary endpoint was the ordinal 90-day modified Rankin Scale distribution. It favoured thrombectomy with a common odds ratio of 2.77 and P<0.001.
- What was the functional-independence result in DEFUSE 3?
- At 90 days, modified Rankin Scale 0–2 was achieved in 45% with thrombectomy versus 17% with medical therapy alone.
- What were the major safety results of DEFUSE 3?
- Ninety-day mortality was 14% versus 26%, while symptomatic intracranial haemorrhage was 7% versus 4% and was not significantly different.
- How should DEFUSE 3 be distinguished from DAWN?
- DEFUSE 3 selected patients within 6–16 hours using a tissue–core perfusion mismatch, whereas DAWN extended selection to 24 hours and used an age-adjusted clinical–core mismatch.
- What is an endoleak?
- An endoleak is persistent blood flow outside the endograft lumen but within the treated aneurysm sac or adjacent excluded vascular segment after endovascular aortic repair.
- Enumerate the five types of endoleak.
- Type I is attachment-site seal failure, Type II is retrograde branch-vessel flow, Type III is structural endograft failure, Type IV is graft porosity and Type V is sac expansion without a visible leak, termed endotension.
- What are the subtypes of a Type I endoleak?
- Type IA arises at the proximal attachment site, Type IB at the distal attachment site and Type IC around an iliac occluder.
- What are the usual sources of a Type II endoleak?
- It usually results from retrograde flow through patent lumbar arteries or the inferior mesenteric artery; other collateral branches may also contribute.
- Differentiate Type IIIA from Type IIIB endoleak.
- Type IIIA is caused by separation or inadequate overlap of modular endograft components, whereas Type IIIB results from disruption or tearing of the graft fabric.
- Which endoleak types generally require prompt treatment?
- Types I and III generally require prompt correction because they provide direct systemic-pressure communication with the aneurysm sac and increase the risk of sac expansion and rupture.
- What is a Type V endoleak?
- Type V endoleak, or endotension, is progressive aneurysm-sac expansion without a demonstrable endoleak on available imaging. It is a diagnosis of exclusion after searching for an occult Type I, II or III leak.
- What is the major imaging pitfall when diagnosing a Type II endoleak?
- A low-flow Type I or III endoleak may mimic or coexist with a Type II leak. The seal zones and component junctions must therefore be assessed carefully, particularly when the aneurysm sac is enlarging.
- What does the expanded TICI scale assess?
- It assesses the proportion of the original downstream target territory that has been reperfused on angiography after endovascular stroke treatment.
- Enumerate the expanded TICI grades.
- The grades are 0, 1, 2a, 2b50, 2b67, 2c and 3.
- How are eTICI 0 and eTICI 1 differentiated?
- Both have no distal tissue reperfusion. Grade 0 indicates no reperfusion, whereas grade 1 indicates some thrombus reduction or limited passage beyond the original occlusion without reperfusion of distal arteries.
- What percentage of territorial reperfusion defines eTICI 2a?
- eTICI 2a represents reperfusion of 1–49% of the original target territory.
- How are eTICI 2b50 and 2b67 differentiated?
- eTICI 2b50 represents 50–66% reperfusion, while eTICI 2b67 represents 67–89% reperfusion.
- What is the difference between eTICI 2c and eTICI 3?
- eTICI 2c is near-complete reperfusion of 90–99% of the target territory. eTICI 3 requires complete, 100% territorial reperfusion.
- Why was the expanded TICI scale introduced?
- The conventional mTICI 2b category covered a wide range of reperfusion. eTICI subdivides this range into 2b50, 2b67 and 2c, allowing more precise angiographic and outcome assessment.
- What is the common pitfall when assigning eTICI 3?
- Reopening the proximal target artery is not sufficient. Any residual distal territorial perfusion defect means that complete eTICI 3 reperfusion has not been achieved.
- Does flow-diverter implantation mean the aneurysm is immediately occluded?
- No. Occlusion typically develops through thrombosis and healing over time.
- What is the principal job of an Atlas-type coil-assist stent?
- Support the coil mass across a suitable aneurysm neck.
- Can a surface-treated flow diverter automatically be used without antiplatelets?
- No. Follow the exact device label and clinical protocol.
- Are all flow diverters nitinol devices?
- No. Pipeline uses cobalt-chromium and platinum-alloy braid construction.
- What activates the lubricity of a hydrophilic guidewire?
- Hydration with the specified aqueous flush.
- Is a PTFE-coated Rosen wire hydrophilic?
- No. PTFE is a hydrophobic coating.
- Can one wire have both coating types?
- Yes. V-18 has a hydrophilic distal segment and a PTFE-coated proximal segment.
- A hydrophilic wire crosses effortlessly. Does this prove safe intraluminal passage?
- No. Confirm its course and distal position under imaging.
- What clinical question did ISAT address?
- ISAT asked whether endovascular coiling or neurosurgical clipping produced better outcomes after aneurysmal subarachnoid haemorrhage when the ruptured aneurysm was considered suitable for either treatment.
- What was the design and sample size of ISAT?
- It was an international multicentre randomised controlled trial of 2,143 participants: 1,073 allocated to coiling and 1,070 to clipping.
- What was the primary endpoint of ISAT?
- The primary endpoint was death or dependence at one year, defined as a modified Rankin Scale score of 3–6.
- What was the complete one-year ISAT result?
- Death or dependence occurred in 23.5% after allocation to coiling versus 30.9% after allocation to clipping, an absolute risk reduction of 7.4 percentage points.
- Why do the 2002 and 2005 one-year figures differ slightly?
- The 2002 paper reported the prespecified cohort eligible for one-year assessment at the interim analysis; the 2005 report provided nearly complete one-year follow-up for the randomised cohort.
- What did long-term ISAT follow-up show?
- At 10 years, coiling retained an advantage for being alive and independent, but late rebleeding from the treated aneurysm was more frequent after coiling and remained uncommon overall.
- What is the major generalisability limitation of ISAT?
- Only aneurysms judged suitable for both techniques were randomised, and the cohort mainly contained good-grade patients with small anterior-circulation aneurysms; the result cannot be applied to every ruptured aneurysm.
- How should ISAT influence present-day treatment selection?
- When a good-grade anterior-circulation ruptured aneurysm is equally suitable for coiling and clipping, coiling is generally preferred for better one-year functional outcome, while final selection remains multidisciplinary and anatomy-specific.
- What are the major categories in the 2025 ISSVA classification?
- Vascular anomalies are divided into vascular tumours, vascular malformations and potentially unique vascular anomalies, termed PUVA.
- What is the fundamental distinction between a vascular tumour and a vascular malformation?
- A vascular tumour represents a proliferative vascular neoplasm, whereas a vascular malformation is a structural developmental abnormality of vascular channels.
- How are vascular tumours classified by ISSVA?
- They are classified according to biological behaviour as benign, borderline or malignant.
- How are vascular malformations broadly classified according to flow?
- They are classified as slow-flow malformations, fast-flow malformations or developmental anomalies of named vessels.
- What are the principal slow-flow vascular malformation groups?
- The principal groups are capillary, lymphatic, venous and combined vascular malformations.
- What are the main fast-flow vascular malformations?
- The principal fast-flow lesions are arteriovenous malformations and congenital arteriovenous fistulas, occurring as isolated, multifocal or syndromic abnormalities.
- What does PUVA mean in the 2025 ISSVA classification?
- PUVA means potentially unique vascular anomaly. It is a provisional category for lesions that cannot yet be confidently assigned to either vascular tumours or vascular malformations.
- What is the commonest terminology error when describing vascular anomalies?
- The common error is calling every vascular lesion a haemangioma. Venous, lymphatic and arteriovenous malformations are distinct malformations and should be named accordingly.
- What is the purpose of the modified CIRSE complication classification?
- It standardises reporting of complications after image-guided procedures using procedural completion, additional treatment, hospitalisation, permanent sequelae and death.
- Which grades were subdivided in the modified CIRSE classification?
- Grades 1 and 3 were subdivided. Grade 1 became 1a and 1b, while Grade 3 became 3a and 3b.
- How do Grades 1a and 1b differ?
- In both, the complication is resolved during the same session without additional post-procedural treatment or sequelae. The intended procedure is completed in Grade 1a but not completed in Grade 1b.
- What constitutes a Grade 2 complication?
- Grade 2 requires prolonged observation, including an unplanned overnight stay of less than 48 hours, without additional post-procedural treatment or sequelae.
- How are Grades 3a and 3b distinguished?
- Both may require additional treatment and have no permanent sequelae. Grade 3a involves hospitalisation for more than 48 hours but less than 2 weeks, whereas Grade 3b involves hospitalisation for more than 2 weeks.
- How do Grades 4, 5 and 6 differ?
- Grade 4 causes permanent mild sequelae compatible with independent living and return to work. Grade 5 causes permanent severe sequelae requiring ongoing assistance or long-term treatment, and Grade 6 is death.
- An intraprocedural complication is controlled, but the planned treatment is abandoned. What is the grade?
- This is Grade 1b because the complication was resolved during the same session but prevented completion of the intended procedure.
- What separates Rutherford acute category IIa from IIb?
- Both are salvageable and neither has audible pedal arterial Doppler signals. IIa has minimal sensory loss limited to the toes or none, with no muscle weakness. IIb has sensory loss extending beyond the toes with persistent ischaemic rest pain, and mild to moderate muscle weakness. Any motor loss puts the limb into IIb.
- Why was category II subdivided in the 1997 revision?
- Because of catheter-directed thrombolysis. The original three-category scheme could not identify the subgroup with absent pedal signals but only mild or evanescent sensory loss in whom limb salvage was achievable with a more time-consuming lytic approach. IIa allows time for angiography and lysis under close surveillance; IIb requires immediate revascularisation.
- How does the acute category change your interventional strategy?
- Category I allows deliberate evaluation and even non-operative management with anticoagulation, with elective revascularisation. Category IIa permits catheter-directed thrombolysis or endovascular thrombectomy but promptly. Category IIb needs immediate flow restoration, so surgical embolectomy, mechanical or aspiration thrombectomy, or a hybrid approach with adjunctive lysis is preferred. Category III is not revascularised for salvage.
- What findings define Rutherford acute category III?
- Profound anaesthetic sensory loss and paralysis with muscle rigor, absent distal capillary skin flow, sometimes skin marbling, and inaudible arterial and venous Doppler signals over the pedal vessels. Major amputation or permanent neuromuscular damage is inevitable regardless of therapy, and reperfusion risks rhabdomyolysis and hyperkalaemia.
- Why does the acute scale contain no time criterion?
- The 1997 standards deliberately excluded temporal criteria such as 6 to 12 hours because the extent of tissue damage also depends on the site of occlusion, existing collateral circulation and other factors, so a fixed duration does not reliably predict viability.
- Which chronic Rutherford categories constitute chronic limb-threatening ischaemia?
- Grades II and III, that is categories 4, 5 and 6 - ischaemic rest pain, minor tissue loss with non-healing ulcer or focal gangrene and diffuse pedal ischaemia, and major tissue loss above the transmetatarsal level. Categories 1 to 3 are claudication. The term was chronic critical ischaemia in 1997 and is now chronic limb-threatening ischaemia.
- Why are the pressure thresholds higher for tissue loss than for rest pain?
- Rest pain uses an ankle pressure below 40 mmHg and toe pressure below 30 mmHg, whereas tissue loss uses an ankle pressure below 60 mmHg and toe pressure below 40 mmHg. Healing an ulcer or a distal amputation, particularly with secondary infection, requires more perfusion pressure than merely preserving intact tissue.
- Why did Rutherford use absolute ankle pressures rather than the ABI to define advanced chronic ischaemia?
- Because actual perfusion pressure is what matters. A single ABI value can correspond to a wide range of ankle pressures depending on systemic blood pressure, so two patients with the same ABI may differ substantially in whether they have ischaemic pain. Pressure indices such as the ABI remain better for comparing groups and following an individual over time.
- How does Rutherford relate to WIfI, TASC II and GLASS?
- Rutherford grades clinical severity only. WIfI stages limb threat by wound, ischaemia and foot infection; TASC II and GLASS describe anatomical lesion complexity to guide revascularisation strategy. They are complementary and should not be used interchangeably.
- What was the clinical question addressed by SAMMPRIS?
- It tested whether intracranial angioplasty and Wingspan stenting plus aggressive medical management was superior to aggressive medical management alone for preventing recurrent stroke in recently symptomatic severe intracranial atherosclerotic stenosis.
- Which patients were enrolled in SAMMPRIS?
- Patients aged 30–80 years with a TIA or non-disabling stroke within 30 days, attributable to catheter-angiographically confirmed 70–99% stenosis of a major intracranial artery.
- What did aggressive medical management in SAMMPRIS include?
- It included aspirin 325 mg daily, clopidogrel 75 mg daily for 90 days, intensive blood-pressure and LDL-cholesterol control, management of other vascular risk factors and structured lifestyle modification.
- Which intracranial stent system was evaluated in SAMMPRIS?
- The Wingspan self-expanding intracranial stent was deployed after angioplasty with the Gateway balloon.
- What was the primary endpoint of SAMMPRIS?
- It combined stroke or death within 30 days, later ischaemic stroke in the qualifying-artery territory, and stroke or death within 30 days of any subsequent revascularisation of that lesion.
- What was the decisive 30-day SAMMPRIS result?
- Stroke or death occurred in 14.7% with PTAS versus 5.8% with aggressive medical management, showing significant early harm from stenting.
- Did longer follow-up reveal a delayed benefit from intracranial stenting?
- No. Primary-endpoint events remained more frequent with PTAS at final follow-up, and similar post-30-day event rates did not compensate for the initial procedural hazard.
- What is the principal management implication of SAMMPRIS?
- Aggressive medical management is the preferred initial strategy for recently symptomatic 70–99% intracranial atherosclerotic stenosis; routine Wingspan PTAS should not replace it.
- What is an important limitation when applying SAMMPRIS to current endovascular practice?
- The trial evaluated a specific device and recently symptomatic population, so its procedural event rates should not be indiscriminately extrapolated to different devices, delayed treatment or more selectively chosen patients.
- What is the basis of the SIR adverse-event severity classification?
- It grades an adverse event primarily according to its clinical consequence and the degree of escalation in care required.
- Enumerate the five SIR adverse-event grades.
- Grade 1 is mild, Grade 2 moderate, Grade 3 severe, Grade 4 life-threatening or disabling, and Grade 5 is death.
- What distinguishes Grade 2 from Grade 3?
- Grade 2 requires substantial treatment or moderate escalation. Grade 3 requires marked escalation, such as atypical admission beyond 24 hours, intensive-care transfer or a complex intervention under general anaesthesia in a previously non-intubated patient.
- How is blood-product administration classified?
- Blood-product administration is generally a Grade 2 moderate adverse event unless associated consequences independently satisfy a higher grade.
- What does the M modifier indicate?
- M indicates multiple adverse events. Each event should be counted and graded separately whenever possible.
- What is assessed in Part B of the SIR system?
- Part B separately analyses causality, patient and procedural risk modifiers, preventability and the management of the adverse event.
- Which adverse events should be included in SIR reporting?
- All adverse events occurring within 30 days of the procedure should be included, irrespective of whether they are ultimately considered procedure-related.
- Does a high SIR severity grade establish operator error?
- No. Severity grading describes the event's consequence and escalation of care; causality, preventability and management are assessed separately.
- What is the purpose of the thoracic aortic landing-zone classification?
- It standardises the description of the proximal and distal positions of a thoracic aortic endograft in relation to the supra-aortic branches and descending thoracic aorta.
- Which landing zone involves the brachiocephalic trunk origin?
- Zone 0, extending from the sinotubular junction to the distal margin of the brachiocephalic trunk.
- Which supra-aortic branch is involved by a zone 1 landing?
- The left common carotid artery origin is involved by a zone 1 landing.
- Which supra-aortic branch is involved by a zone 2 landing?
- The left subclavian artery origin is involved by a zone 2 landing.
- How are zones 3 and 4 distinguished?
- Zone 3 is the first approximately 2 cm of the descending thoracic aorta beyond the left subclavian artery. Zone 4 begins more than 2 cm distal to the left subclavian artery and extends to approximately the midpoint of the descending thoracic aorta.
- What is the common error when assigning a thoracic aortic landing zone?
- The common error is assigning the zone from the lesion location rather than from the position of the covered end of the endograft.
- What is the Spetzler–Ponce classification?
- It is a three-tier simplification of the Spetzler–Martin system that groups brain AVMs into Classes A, B and C to predict microsurgical outcome and guide broad treatment selection.
- How are Spetzler–Martin grades mapped to Spetzler–Ponce classes?
- Spetzler–Martin Grades I and II form Class A, Grade III forms Class B, and Grades IV and V form Class C.
- What is the usual management approach for a Spetzler–Ponce Class A AVM?
- Microsurgical resection is generally favoured when the patient and lesion are otherwise suitable because Class A represents low-grade AVMs with the most favourable operative risk.
- Why is Spetzler–Ponce Class B clinically challenging?
- It corresponds to the heterogeneous Spetzler–Martin Grade III group. Management must therefore be individualised and may involve microsurgery, radiosurgery, embolisation, combined treatment or observation.
- What is the usual approach to a Spetzler–Ponce Class C AVM?
- Observation is generally favoured because attempted cure may carry substantial neurological morbidity. Intervention may be considered selectively, including in exceptional cases with recurrent haemorrhage or progressive neurological deficit.
- What is the major pitfall when applying the Spetzler–Ponce classification?
- It should not be used as an automatic treatment rule or as a predictor of spontaneous haemorrhage. Clinical presentation, patient factors, detailed angioarchitecture and modality-specific risks remain essential.
ARUBA (2014): Medical Management versus Intervention for Unruptured Brain AVMs
ARUBA (2014): Medical Management versus Intervention for Unruptured Brain AVMs
ARUBA (2014): Medical Management versus Intervention for Unruptured Brain AVMs
ARUBA (2014): Medical Management versus Intervention for Unruptured Brain AVMs
ARUBA (2014): Medical Management versus Intervention for Unruptured Brain AVMs
ARUBA (2014): Medical Management versus Intervention for Unruptured Brain AVMs
ARUBA (2014): Medical Management versus Intervention for Unruptured Brain AVMs
ARUBA (2014): Medical Management versus Intervention for Unruptured Brain AVMs
ARUBA (2014): Medical Management versus Intervention for Unruptured Brain AVMs
ARUBA (2014): Medical Management versus Intervention for Unruptured Brain AVMs
Cho–Do Angiographic Classification of Arteriovenous Malformations
Cho–Do Angiographic Classification of Arteriovenous Malformations
Cho–Do Angiographic Classification of Arteriovenous Malformations
Cho–Do Angiographic Classification of Arteriovenous Malformations
Cho–Do Angiographic Classification of Arteriovenous Malformations
Cho–Do Angiographic Classification of Arteriovenous Malformations
Cho–Do Angiographic Classification of Arteriovenous Malformations
Cho–Do Angiographic Classification of Arteriovenous Malformations
CIRSE and SIR Bleeding-Risk Categories for Image-Guided Procedures
CIRSE and SIR Bleeding-Risk Categories for Image-Guided Procedures
CIRSE and SIR Bleeding-Risk Categories for Image-Guided Procedures
CIRSE and SIR Bleeding-Risk Categories for Image-Guided Procedures
CIRSE and SIR Bleeding-Risk Categories for Image-Guided Procedures
CIRSE and SIR Bleeding-Risk Categories for Image-Guided Procedures
CIRSE and SIR Bleeding-Risk Categories for Image-Guided Procedures
CIRSE and SIR Bleeding-Risk Categories for Image-Guided Procedures
DEFUSE 3 (2018): Perfusion-Selected Thrombectomy at 6–16 Hours
DEFUSE 3 (2018): Perfusion-Selected Thrombectomy at 6–16 Hours
DEFUSE 3 (2018): Perfusion-Selected Thrombectomy at 6–16 Hours
DEFUSE 3 (2018): Perfusion-Selected Thrombectomy at 6–16 Hours
DEFUSE 3 (2018): Perfusion-Selected Thrombectomy at 6–16 Hours
DEFUSE 3 (2018): Perfusion-Selected Thrombectomy at 6–16 Hours
DEFUSE 3 (2018): Perfusion-Selected Thrombectomy at 6–16 Hours
DEFUSE 3 (2018): Perfusion-Selected Thrombectomy at 6–16 Hours
ISAT (2002): Endovascular Coiling versus Neurosurgical Clipping for Ruptured Intracranial Aneurysms
ISAT (2002): Endovascular Coiling versus Neurosurgical Clipping for Ruptured Intracranial Aneurysms
ISAT (2002): Endovascular Coiling versus Neurosurgical Clipping for Ruptured Intracranial Aneurysms
ISAT (2002): Endovascular Coiling versus Neurosurgical Clipping for Ruptured Intracranial Aneurysms
ISAT (2002): Endovascular Coiling versus Neurosurgical Clipping for Ruptured Intracranial Aneurysms
ISAT (2002): Endovascular Coiling versus Neurosurgical Clipping for Ruptured Intracranial Aneurysms
ISAT (2002): Endovascular Coiling versus Neurosurgical Clipping for Ruptured Intracranial Aneurysms
ISAT (2002): Endovascular Coiling versus Neurosurgical Clipping for Ruptured Intracranial Aneurysms
Rutherford classification: acute and chronic limb ischaemia categories
Rutherford classification: acute and chronic limb ischaemia categories
Rutherford classification: acute and chronic limb ischaemia categories
Rutherford classification: acute and chronic limb ischaemia categories
Rutherford classification: acute and chronic limb ischaemia categories
Rutherford classification: acute and chronic limb ischaemia categories
Rutherford classification: acute and chronic limb ischaemia categories
Rutherford classification: acute and chronic limb ischaemia categories
Rutherford classification: acute and chronic limb ischaemia categories
SAMMPRIS (2011): Intracranial Stenting versus Aggressive Medical Management
SAMMPRIS (2011): Intracranial Stenting versus Aggressive Medical Management
SAMMPRIS (2011): Intracranial Stenting versus Aggressive Medical Management
SAMMPRIS (2011): Intracranial Stenting versus Aggressive Medical Management
SAMMPRIS (2011): Intracranial Stenting versus Aggressive Medical Management
SAMMPRIS (2011): Intracranial Stenting versus Aggressive Medical Management
SAMMPRIS (2011): Intracranial Stenting versus Aggressive Medical Management
SAMMPRIS (2011): Intracranial Stenting versus Aggressive Medical Management
SAMMPRIS (2011): Intracranial Stenting versus Aggressive Medical Management
Spetzler–Ponce Classification of Brain Arteriovenous Malformations
Spetzler–Ponce Classification of Brain Arteriovenous Malformations
Spetzler–Ponce Classification of Brain Arteriovenous Malformations
Spetzler–Ponce Classification of Brain Arteriovenous Malformations
Spetzler–Ponce Classification of Brain Arteriovenous Malformations
Spetzler–Ponce Classification of Brain Arteriovenous Malformations