INTERVENTIONAL NEURORADIOLOGY
HETTS VOL 176 BOARD PREP 150
DETAILED CORRECT ANSWERS WITH
RATIONALES CORRECT VERIFIED
ANSWERS UNIQUE GRADE A+ STUDY
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Interventional Neuroradiology (Handbook of Clinical
Neurology Vol. 176) – Hetts: Questions 1–150
1. According to Hetts in the Handbook of Clinical
Neurology, which imaging modality is currently
considered the gold standard for pre-procedural planning
of cerebral arteriovenous malformation (AVM)
embolization due to its superior temporal and spatial
resolution? A. Time-resolved MRA with parallel imaging
acceleration B. Multiphase CTA with automated bolus
tracking C. Digital subtraction angiography (DSA)
with superselective catheterization D. High-
resolution vessel wall MRI at 7 Tesla The rationale for
selecting DSA is that despite advances in non-invasive
imaging, it remains the only modality capable of
providing real-time hemodynamic flow dynamics,
precise nidus architecture definition, and identification of
high-risk aneurysms or venous outflow restrictions
necessary for safe embolization planning as emphasized
in Vol. 176.
2. In the context of acute ischemic stroke mechanical
thrombectomy described in this volume, what is the
primary advantage of using a stent retriever combined
, with aspiration (SWIM technique) over stent retriever
alone? A. It significantly reduces the cost per procedure by
eliminating device redundancy B. It eliminates the risk of
distal embolization entirely in all cases C. It increases
first-pass recanalization rates and overall
successful reperfusion by preventing distal
fragment migration during retrieval D. It allows for
treatment of patients beyond the standard 24-hour time
window without perfusion imaging The correct answer
reflects evidence cited by Hetts that the combination
technique creates a synergistic effect where aspiration
captures fragments liberated by the stent retriever,
leading to higher TICI 2b/3 scores on the first attempt
compared to either technique used in isolation.
3. When evaluating a patient with a suspected dural
arteriovenous fistula (dAVF), which angiographic feature
identified in Hetts’ text is most predictive of aggressive
clinical behavior and hemorrhage risk? A. Single arterial
feeder from the middle meningeal artery B. Slow venous
drainage into the sigmoid sinus C. Cortical venous
drainage (CVD) with venous ectasia or stenosis D.
Presence of multiple small dural feeders without cortical
reflux The rationale is that cortical venous drainage
represents retrograde flow into pial veins not designed
for high-pressure arterial flow; Vol. 176 highlights that
CVD, especially when accompanied by venous
hypertension markers like ectasia, correlates strongly
with hemorrhagic presentation and mandates urgent
intervention.
4. Regarding the use of liquid embolic agents for AVM nidus
penetration, which agent characteristic does Hetts
emphasize as critical for achieving deep nidus penetration
while minimizing premature proximal occlusion? A. High
viscosity to prevent reflux into feeding arteries B.
, Radiopacity independent of tantalum powder suspension
C. Low viscosity and appropriate polymerization
time matched to nidus transit time D. Adhesive
properties that bond immediately upon contact with blood
The correct answer is based on the principle that low-
viscosity agents like diluted nBCA or specific Onyx/LAVA
formulations can penetrate the interstices of the nidus
before solidifying; high viscosity or rapid polymerization
leads to proximal pedicle occlusion without treating the
pathological core.
5. In the management of intracranial aneurysms, what is the
primary indication for flow diversion over traditional
coiling or clipping as outlined in the Handbook’s
endovascular therapy chapters? A. Small saccular
aneurysms <3mm in diameter B. Acute ruptured
aneurysms requiring immediate hemostasis C. Large,
giant, or fusiform aneurysms with wide necks
involving branch vessels where reconstruction is
difficult D. Distal mycotic aneurysms associated with
infective endocarditis The rationale is that flow diverters
reconstruct the parent artery lumen and promote
endothelialization across the neck, making them ideal for
complex morphologies where coils would herniate or fail
to achieve durable occlusion, whereas they are generally
contraindicated in acute rupture due to required dual
antiplatelet therapy.
6. Which complication of carotid artery stenting (CAS) is
specifically highlighted in Hetts’ discussion as being more
frequent in elderly patients (>80 years) compared to
younger cohorts? A. Access site hematoma requiring
transfusion B. Contrast-induced nephropathy C. Peri-
procedural stroke due to embolic debris from
calcified or ulcerated plaque D. Hyperperfusion
syndrome leading to seizures The correct answer reflects
, data showing that age-related vascular tortuosity and
plaque instability increase embolic risk during CAS
navigation; Vol. 176 notes this has led to stricter patient
selection criteria favoring CEA in octogenarians unless
anatomical contraindications exist.
7. When performing balloon test occlusion (BTO) prior to
permanent parent vessel sacrifice, what adjunctive
measure does Hetts recommend to improve sensitivity for
detecting inadequate collateral circulation? A. Increasing
balloon inflation pressure above systolic levels B.
Performing the test under general anesthesia to eliminate
pain artifacts C. Hypotensive challenge reducing
mean arterial pressure by 20-30% during
occlusion D. Simultaneous administration of
vasodilators to maximize collateral flow The rationale is
that normotensive BTO may miss patients with marginal
collaterals who decompensate only under stress; adding
hypotension unmasks hemodynamic insufficiency that
would lead to delayed ischemia after permanent
occlusion, improving predictive value for stroke risk.
8. In pediatric interventional neuroradiology, which
condition is uniquely emphasized in Hetts’ volume as
requiring specialized microcatheter techniques due to
vessel fragility and size constraints? A. Adult-type berry
aneurysms B. Degenerative cervical spine disease C. Vein
of Galen aneurysmal malformation (VGAM) in
neonates and infants D. Chronic subdural hematoma
evacuation The correct answer identifies VGAM as the
quintessential pediatric neurointerventional pathology
where transarterial or transvenous embolization must
balance cure against catastrophic complications in tiny,
fragile vessels; Vol. 176 details staged approaches
tailored to cardiac status and developmental stage.
HETTS VOL 176 BOARD PREP 150
DETAILED CORRECT ANSWERS WITH
RATIONALES CORRECT VERIFIED
ANSWERS UNIQUE GRADE A+ STUDY
GUIDE | INSTANT DOWNLOAD | 100%
PASS GUARANTEE
Interventional Neuroradiology (Handbook of Clinical
Neurology Vol. 176) – Hetts: Questions 1–150
1. According to Hetts in the Handbook of Clinical
Neurology, which imaging modality is currently
considered the gold standard for pre-procedural planning
of cerebral arteriovenous malformation (AVM)
embolization due to its superior temporal and spatial
resolution? A. Time-resolved MRA with parallel imaging
acceleration B. Multiphase CTA with automated bolus
tracking C. Digital subtraction angiography (DSA)
with superselective catheterization D. High-
resolution vessel wall MRI at 7 Tesla The rationale for
selecting DSA is that despite advances in non-invasive
imaging, it remains the only modality capable of
providing real-time hemodynamic flow dynamics,
precise nidus architecture definition, and identification of
high-risk aneurysms or venous outflow restrictions
necessary for safe embolization planning as emphasized
in Vol. 176.
2. In the context of acute ischemic stroke mechanical
thrombectomy described in this volume, what is the
primary advantage of using a stent retriever combined
, with aspiration (SWIM technique) over stent retriever
alone? A. It significantly reduces the cost per procedure by
eliminating device redundancy B. It eliminates the risk of
distal embolization entirely in all cases C. It increases
first-pass recanalization rates and overall
successful reperfusion by preventing distal
fragment migration during retrieval D. It allows for
treatment of patients beyond the standard 24-hour time
window without perfusion imaging The correct answer
reflects evidence cited by Hetts that the combination
technique creates a synergistic effect where aspiration
captures fragments liberated by the stent retriever,
leading to higher TICI 2b/3 scores on the first attempt
compared to either technique used in isolation.
3. When evaluating a patient with a suspected dural
arteriovenous fistula (dAVF), which angiographic feature
identified in Hetts’ text is most predictive of aggressive
clinical behavior and hemorrhage risk? A. Single arterial
feeder from the middle meningeal artery B. Slow venous
drainage into the sigmoid sinus C. Cortical venous
drainage (CVD) with venous ectasia or stenosis D.
Presence of multiple small dural feeders without cortical
reflux The rationale is that cortical venous drainage
represents retrograde flow into pial veins not designed
for high-pressure arterial flow; Vol. 176 highlights that
CVD, especially when accompanied by venous
hypertension markers like ectasia, correlates strongly
with hemorrhagic presentation and mandates urgent
intervention.
4. Regarding the use of liquid embolic agents for AVM nidus
penetration, which agent characteristic does Hetts
emphasize as critical for achieving deep nidus penetration
while minimizing premature proximal occlusion? A. High
viscosity to prevent reflux into feeding arteries B.
, Radiopacity independent of tantalum powder suspension
C. Low viscosity and appropriate polymerization
time matched to nidus transit time D. Adhesive
properties that bond immediately upon contact with blood
The correct answer is based on the principle that low-
viscosity agents like diluted nBCA or specific Onyx/LAVA
formulations can penetrate the interstices of the nidus
before solidifying; high viscosity or rapid polymerization
leads to proximal pedicle occlusion without treating the
pathological core.
5. In the management of intracranial aneurysms, what is the
primary indication for flow diversion over traditional
coiling or clipping as outlined in the Handbook’s
endovascular therapy chapters? A. Small saccular
aneurysms <3mm in diameter B. Acute ruptured
aneurysms requiring immediate hemostasis C. Large,
giant, or fusiform aneurysms with wide necks
involving branch vessels where reconstruction is
difficult D. Distal mycotic aneurysms associated with
infective endocarditis The rationale is that flow diverters
reconstruct the parent artery lumen and promote
endothelialization across the neck, making them ideal for
complex morphologies where coils would herniate or fail
to achieve durable occlusion, whereas they are generally
contraindicated in acute rupture due to required dual
antiplatelet therapy.
6. Which complication of carotid artery stenting (CAS) is
specifically highlighted in Hetts’ discussion as being more
frequent in elderly patients (>80 years) compared to
younger cohorts? A. Access site hematoma requiring
transfusion B. Contrast-induced nephropathy C. Peri-
procedural stroke due to embolic debris from
calcified or ulcerated plaque D. Hyperperfusion
syndrome leading to seizures The correct answer reflects
, data showing that age-related vascular tortuosity and
plaque instability increase embolic risk during CAS
navigation; Vol. 176 notes this has led to stricter patient
selection criteria favoring CEA in octogenarians unless
anatomical contraindications exist.
7. When performing balloon test occlusion (BTO) prior to
permanent parent vessel sacrifice, what adjunctive
measure does Hetts recommend to improve sensitivity for
detecting inadequate collateral circulation? A. Increasing
balloon inflation pressure above systolic levels B.
Performing the test under general anesthesia to eliminate
pain artifacts C. Hypotensive challenge reducing
mean arterial pressure by 20-30% during
occlusion D. Simultaneous administration of
vasodilators to maximize collateral flow The rationale is
that normotensive BTO may miss patients with marginal
collaterals who decompensate only under stress; adding
hypotension unmasks hemodynamic insufficiency that
would lead to delayed ischemia after permanent
occlusion, improving predictive value for stroke risk.
8. In pediatric interventional neuroradiology, which
condition is uniquely emphasized in Hetts’ volume as
requiring specialized microcatheter techniques due to
vessel fragility and size constraints? A. Adult-type berry
aneurysms B. Degenerative cervical spine disease C. Vein
of Galen aneurysmal malformation (VGAM) in
neonates and infants D. Chronic subdural hematoma
evacuation The correct answer identifies VGAM as the
quintessential pediatric neurointerventional pathology
where transarterial or transvenous embolization must
balance cure against catastrophic complications in tiny,
fragile vessels; Vol. 176 details staged approaches
tailored to cardiac status and developmental stage.
