bluuebunny/crossref_metadata_2025 huggingface dataset:
Preoperative Embolization of Brain Tumor with Pial Artery or Dural Branch of Internal Carotid Artery as Feeding Artery
Authors: Hirohata M , Abe T , Fujimura N , Takeuchi Y , Shigemori M
Published: January 2017

This study evaluated the clinical usefulness of preoperative embolization of the pial artery or dural branch of the internal carotid artery (ICA) for brain tumor. Subjects comprised 17 patients with large hypervascular brain tumors who underwent preoperative selective embolization. Micro-catheters (2- or 1.7-F) and shapeable hydrophilic micro-guide wires were used for pial artery (branching from the posterior or anterior cerebral artery) or ICA dural branch embolization.

Embolization was performed under digital subtraction fluoroscopy with Polyvinyl alcohol (PVA) particles (150–250 mm) and/or liquid coil. Tumor resection was performed immediately or the day after embolization. Digital subtraction angiography (DSA) before and after endovascular devascularization, blood loss during tumor resection, and clinical outcome were evaluated. All endovascular procedures were technically successful. Post-embolization DSA revealed either a disappearance or a marked decrease of the tumor stain in all cases. Control of intraoperative bleeding was easily accomplished, and intraoperative blood loss was low. Preoperative particle embolization of the feeding artery from the cortical artery or ICA dural branch is safe and effective as adjuvant therapy before tumor resection.
Transvenous Embolization for Dural Arteriovenous Shunt of the Cavernous Sinus
Authors: Kato S. , Ishihara H. , Nakayama H. , Fujii M. , Fujisawa H. , Kajiwara K. , Nomura S. , Sadanaga H. , Suzuki M.
Published: January 2017

We describe the treatment and follow-up clinical symptoms and angiographic results in patients with dural arteriovenous fistula of the cavernous sinus treated by transvenous embolization (TVE). We have treated eight cases of dural arteriovenous fistula of the cavernous sinus by multi-staged TVE in two cases and TVE with sinus packing in six and three of six cases were treated with a combination of transarterial embolization. Multi-staged TVE was performed by occlusion from dangerous drainage veins to the cavernous sinus on several occasions.

Angiographical results showed disappearance or reduction of the arteriovenous shunt in all cases. Six patients presented with ophthalmic symptoms and two had tinnitus. Six cases had complete disappearance of clinical symptoms after treatment. There was a deterioration of ocular movement in one patient treated by TVE with sinus packing. Multi-staged TVE was performed to reduce the coil volume for the packing of the cavernous sinus in two cases without cranial nerve palsy. Embolization, especially multi-staged TVE, was considered a good treatment to occlude arteriovenous shunts at the cavernous sinus without cranial nerve complications.
Target Embolization of AVMs: Identification of Sites and Results of Treatment
Authors: Le Feuvre D. , Taylor A.
Published: January 2017

Although cure of cerebral arteriovenous malformations (AVMs) is the ideal goal it is often only possible with smaller sized lesions. This is certainly true if surgery or radiotherapy is used as the treatment strategy. Endovascular treatment, however, allows the possibility of partial treatment directed at specific areas of AVM architecture. With this in mind we retrospectively reviewed our cohort of AVMs to establish which morphological areas we had identified as targets and how the treatment of the AVM influenced the clinical picture.

Over a 36-month period 42 AVMs were treated. In 22 of the patients who presented with a hemorrhage an intranidal aneurysm was identified as a target and treated in nine patients.

Other patients presented with headaches (2), neurological deficit (4) and seizures (16) with two patients having their AVM picked up coincidentally. Targets identified included high flow fistulas (12), decreasing venous flow (17) and cure of the AVM (8).

Results of targeted treatment showed a lower rehemorrhage rate than anticipated by the natural history. Patients cured did best and targeted embolization improved seizures in nine patients, neurological deficit in four patients and headache in 20 patients.

Until safer methods exist to cure large AVMs the use of targeted embolization is acceptable as it protects patients against rehemorrhage and translates into an improvement in their clinical picture.
Spanish Registry for Embolization of Small Intracranial Aneurysms with Cerecyte Coils (SPAREC) Study
Authors: Castro E. , Villoria F. , Castaño C. , Romance A. , Mendez J.C. , Barrena R. , Fortea F.
Published: January 2017

This study aimed to report the results obtained in treating small ruptured and unruptured intracranial aneurysms using Cerecyte coils. A prospective, non-randomized multicenter registry operating in Spain with a reporting period between May 2005 and September 2007. We present clinical and angiographic results for 48 small aneurysms (26 ruptured, five with III cranial nerve paresis, and 17 incidental) that had undergone six months' follow-up. The volumetric percentage occlusion (VPO) achieved and percentage bioactive coils (PBC) used were assessed.

No episodes of bleeding occurred during the follow-up period. The technical complication rate was 10.4% (five cases): four thromboembolic complications resolved with medication (8.3%) and one asymptomatic protrusion of a coil into the parent vessel. The clinical complication rate for the procedure was 2.1% (occlusion of the anterior choroidal artery in a ruptured anterior choroidal anaeurysm). Mean VPO was 25.2%. Balloon-assisted technique (BAT) was used in 60.4% of cases. The VPO was higher in the BAT-treated cases (P<0.05). The overall six-month recanalization rate was 16.7% (12.5% minor and 4.2% major recanalizations). Neck size and VPO were unrelated to the recanalization rate. The PBC was higher in cases with progressive Deployment of the device is safe from the standpoint of periprocedural technical and clinical complications. No episodes of hemorrhage were recorded during follow-up. The six-month recanalization and retreatment rates compared favorably with most endovascular platinum and bioactive coil series.
Rate of Recanalization and Safety of Endovascular Embolization of Intracranial Saccular Aneurysms Framed with GDC 360 Coils
Authors: Ortiz R. , Song J. , Niimi Y. , Berenstein A.
Published: January 2017

Coil compaction and recanalization of cerebral aneurysms treated with coil embolization continue to be of great concern, especially in patients that presented with subarachnoid hemorrhage. The incidence of recanalization reported by previous studies ranges from 12 to 40 percent in experienced centers. We reviewed the incidence of recanalization requiring retreatment in patients treated with GDC 360 framing coils.

A retrospective review of every patient who underwent coil embolization with GDC 360 coils for saccular aneurysms at our institution from December 2004 to March 2008 was performed. We studied the patients' demographics, clinical presentation, aneurysm size and configuration, type of coils used to embolize the aneurysm, the percentage of coils that were GDC 360 in any given aneurysm, the need for remodeling techniques like stent and/or balloon for embolization, immediate complications, cases in which we were unable to frame with the GDC 360 coil, and rate of recanalization on follow-up.

A total of 110 patients (33 men, 77 women) and 114 aneurysms were treated with GDC 360 coils. Ninety-eight aneurysms were framed with the GDC 360 coils. There were two patients in whom the initial GDC 360 coil intended for framing had to be pulled out and exchanged for another type of coil. There were five procedure related complications (4.4%). Four patients required intra-arterial abciximab due to thrombus formation. One patient that presented with a grade III subarachnoid hemorrhage had aneurysm rupture while the coil was being advanced. A total of 50 patients (15 men and 35 women) underwent follow-up femoral cerebral angiograms at least six months after coiling (mean follow-up was 15 months). Forty-four of the patients with follow-up had the GDC 360 coil used as a framing coil. Three patients (6%) required retreatment due to recanalization. Every patient with recanalization requiring treatment had aneurysms of the anterior communicating complex that presented with subarachnoid hemorrhage.

The rate of recanalization of cerebral aneurysms embolized with GDC 360 framing coils was lower in our case series compared to the existing literature reports. Patients with aneurysms of the anterior communicating artery were at increased incidence of recanalization in our patient cohort.
Percutaneous Transvenous Embolization of Intracranial Dural Arteriovenous Fistulas with Detachable Coils and/or in Combination with Onyx
Authors: Lv Xianli , Jiang Chuhan , Li Youxiang , Yang Xinjian , Wu Zhongxue
Published: January 2017

This study evaluated angiographic and clinical results in patients with a dural arteriovenous fistula (DAVF) who underwent percutaneous transvenous embolization.

Retrospective chart analysis and radiographic studies were performed in 23 patients (aged 11–70 yrs) with a DAVF treated with percutaneous transvenous embolization in the past five years. Lesions were located in the anterior cranial fossa, cerebellar tentorium, transverse-sigmoid sinus and cavernous sinus. All procedures were analyzed with regard to presentation, delivery, angiographical and clinical outcome.

Data for 23 patients (age range, 11–70 yrs, mean age 49.5 yrs) with DAVFs (cavernous sinus[CS], n=17; transverse-sigmoid sinus, n=3; anterior cranial fossa, n=2; cerebellar tentorium, n=1) were retrospectively reviewed. The DAVFs were treated with coils or a combination with Onyx via different transvenous approaches, in 28 procedures. Cerebral angiography was performed to confirm the treatment.

The mean clinical follow-up period was 22.1 months.

Transvenous treatment of intracranial DAVFs can be safe and effective if various transvenous approaches are attempted. Percutaneous transvenous embolization with detachable platinum coils or a combination with Onyx is effective in the treatment of DAVFs.
Fenestrated Anterior Cerebral Artery with Associated Arterial Anomalies
Authors: Dimmick S.J. , Faulder K.C.
Published: January 2017

Fenestration of the A2 segment is extremely rare. Cerebrovascular fenestration may be associated with an increased incidence of cerebral aneurysm and other vascular anomalies. Two case reports are presented which identify a fenestration of the A2 segment and other normal variations of the intra-cerebral circulation.

A review of the literature has been undertaken to determine the prevalence and embryology of anterior cerebral artery fenestrations, their clinical significance and the association with aneurysm formation and other intracranial vascular anomalies.
Focal Cement Accumulation in Lytic Metastatic Lesions: A New Sign in Vertebroplasty?
Authors: Debnam J.M. , Schellingerhout D.
Published: January 2017

We describe a unique imaging appearance of focal cement accumulation inside lytic metastatic lesions in four patients with pathologic vertebral fractures undergoing vertebroplasty. This appearance differs from the normal, trabecular appearance of cement distribution in osteoporotic vertebrae.

Two patients, in whom the lytic metastasis was completely filled with cement, had a complete pain response, and two patients, in whom the lytic metastasis could only be partially filled, had an incomplete response. Focal cement accumulation in a lytic lesion may be a predictor of favorable patient outcome in patients with lytic metastasis.
Transcutaneous Puncture of the Superior Ophthalmic Vein for Embolization of Dural Carotid-Ophthalmic Fistula
Authors: Chen Wen-Hsien , Tsai I-Chen , Huang Hou-Chi , Lin Chun-Han , Hung Hao-Chun , Wu Chen-Hao , Chen Clayton Chi-Chang
Published: January 2017

Carotid-ophthalmic fistula is a rare disease, which can be treated by transvenous endovascular embolization. Here, we report a unique case with draining vein thrombosed, making a transvenous approach impossible. An old but valuable technique, direct transcutaneous puncture of the superior ophthalmic vein, was used to save the patient's right eye. The old technique, direct puncture of the superior ophthalmic vein, retains its irreplaceable usefulness in this special situation. Thus, interventional neuroradiologists should equip themselves with this essential technique.
Endovascular Covered Stent Reconstruction Improved the Outcomes of Acute Carotid Blowout Syndrome
Authors: Chen Yao-Liang , Wong Ho-Fai , Ku Yi-Kang , Wong Alex Mun-Ching , Wai Yau-Yau , Ng Shu-Hang
Published: January 2017

Carotid blowout is a devastating complication in patients with head and neck cancer, commonly encountered as a delayed complication of radiation therapy. The clinical outcomes in patients with carotid blowout are discouraging; even transarterial embolization has been performed to control the acute massive bleeding. In recent years, covered stents have been reported as an alternative treatment producing favorable results.

In this study, 13 consecutive patients with acute carotid blowout syndrome were treated at our institute by covered-stent reconstruction between December 2005 and December 2007. The median posthemorrhagic survival period after reconstruction (187 days) was more than that reported in patients treated only with transarterial embolization (26 days). Though the estimated mortality was about 54%, those who survived showed favorable outcomes, and only one transit complication of acute in-stent thrombosis occurred. Thus, endovascular covered-stent reconstruction is a safe and effective approach to manage acute carotid blowout syndrome.
“Waffle Cone” Technique for Intra/Extra-Aneurysmal Stent Placement for the Treatment of Complex and Wide-Necked Bifurcation Aneurysm
Authors: Yang Tzu-Hsien , Wong Ho-Fai , Yang Ming-Shiang , Ou Chang-Hsien , Ho Tzu-Lung
Published: January 2017

Endovascular treatment of intracranial aneurysms by coiling has become an accepted alternative to surgical clipping 1. In cases of wide-necked and sidewall aneurysms, selective embolization is difficult because of the risk of coil protrusion into the parent vessel. The use of three-dimensional coils, stents 2, and balloon remodeling have all aided the attempt to adequately manage such lesions. However, compared with sidewall aneurysms, bifurcation aneurysms are more challenging from an endovascular standpoint. Because of their specific anatomy and hemodynamics, the tendency to recur and rerupture is higher. Several authors have reported successful treatment of these complex and wide-necked bifurcation aneurysms by using Y-configured dual stent-assisted coil embolization 3,4, the double microcatheter technique 5, a more compliant balloon remodeling technique6, the TriSpan neck-bridge device7, or the waffle cone technique8. We describe two cases of wide-necked bifurcation aneurysms in which the waffle cone technique was used for coil embolization. The waffle cone technique was first described in 2006; however, the small number of published cases and the lack of follow-up prevent one from assessing this technique's durability and the probability of recanalization. We report the cases of two patients harboring unruptured wide-necked bifurcation aneurysms that were treated and followed-up for six months.
Meta-Analysis on Diagnostic Accuracy of MR Angiography in the Follow-up of Residual Intracranial Aneurysms Treated with Guglielmi Detachable Coils
Authors: Weng Hsu-Huei , Jao Shaner-Yeun , Yang Chun-Yuh , Tsai Yuan-Hsiung
Published: January 2017

Patients with intracranial aneurysm after coiling with Guglielmi detachable coils (GDC) require imaging follow-up. The accuracy of noninvasive magnetic resonance angiography (MRA) techniques including time-of-flight (TOF) and contrast-enhancement (CE) have been compared with the gold standard digital subtraction angiography (DSA). We systematically reviewed the diagnostic accuracy of these imaging methods in follow-up study of patients with residual intracranial aneurysms after GDC treatment. The authors used MEDLINE, bibliographies, review articles, textbooks, and expert opinion to retrieve English- and non-English-language articles published from 1966 to December 2007. Sixteen suitable MRA original articles (14 TOF-MRA and six CE-MRA) with comparison to DSA have met the inclusion criteria. TOF-MRA had a pooled sensitivity of 90% (95% CI, 79% to 95%), a specificity of 95% (95% CI, 88% to 98%), and a diagnostic odds ratio (DOR) of 168.4 (95% CI, 60.3 to 470.3). CE-MRA had an overall sensitivity of 92% (95% CI, 79% to 97%), a specificity of 96% (95% CI, 91% to 98%), and a DOR of 280.4 (95% CI, 64.8 to 1212.6). The areas under two summary ROC curves of TOF-MRA and CE-MRA were 0.97 (95% CI, 0.96 to 0.99) and 0.98 (95% CI, 0.96 to 0.99), respectively. Compared with DS angiography, both TOF-MRA and CE-MRA can accurately depict the residual aneurysm. The diagnostic accuracy of TOF-MRA and CE-MRA tests offer comparable and equal results and may obviate the invasive DS angiography
Embolization of a Cavernous Sinus Dural Arteriovenous Fistula with Onyx via Direct Puncture of the Cavernous Sinus through the Superior Orbital Fissure
Authors: Amiridze N. , Zoarski G. , Darwish R. , Obuchowski A. , Soloveychic N.
Published: January 2017

Treatment of cavernous sinus dural arteriovenous fistula (CSDAVF) may be challenging. We describe a patient who had presented with progressive ocular symptoms due to CSDAVF requiring urgent interventional therapy. Initial attempts to embolize the fistula utilizing a transvenous approach through the inferior petrosal sinus failed because of difficult anatomy. Successful occlusion of the fistula was subsequently achieved with injection of ethylene vinyl alcohol copolymer, Onyx (EV3 Neurovascular, Irvine, CA, USA), via direct percutaneous puncture of the cavernous sinus through the superior orbital fissure. A brief period of asystole during the initial injection of Onyx may be the result of the trigeminocardiac reflex.
Treatment of a Traumatic Carotid-Cavernous Fistula with a Covered Stent: Some Considerations
Authors: Meijer F.J.A. , Van Der Vliet A.M.
Published: January 2017

This article discusses some considerations concerning covered stent placement in a patient with a traumatic direct carotid-cavernous fistula. Our case supports recent reports in the literature that covered stent placement can be an acceptable alternative when detachable balloon occlusion or coil occlusion of a direct carotid-cavernous fistula fails or cannot be done. Positioning of a covered stent in the internal carotid artery can be technically challenging. No specific covered stents for neurovascular use have been designed or registered. Because of limited experience with covered stent placement in the carotid artery the optimal preventive and therapeutic strategies for thromboembolic complications are not known.
Stenting of Vertebral Artery Origin with the Buddy Wire Technique in Tortuous Subclavian Artery
Authors: Uysal E. , Caliskan C. , Caymaz İ , Orken D.N. , Basak M.
Published: January 2017

Tortuous vasculature is a common reason for failure to stabilize a guiding catheter in an appropiate position and is associated with a higher incidence of vascular complications. In such a case, the guiding catheter often buckles into the aorta during an attempt to place the balloon or stent. In this report, we used the buddy wire technique to support the guiding catheter, and we passed through the vertebral artery origin stenosis with the help of a microcatheter-microguidewire combination which enabled stent deployment. We kept the buddy wire through the guiding catheter throughout the procedure and the 6F guiding catheter allowed passages of both buddy wire and stent system.
Endovascular Treatment of Sigmoid Sinus Aneurysm Presenting as Devastating Pulsatile Tinnitus
Authors: Mehanna R. , Shaltoni H. , Morsi H. , Mawad M.
Published: January 2017

Pulsatile tinnitus is a rare yet potentially disabling symptom that can have either vascular or nonvascular etiologies. A recently described vascular cause is an aneurysm of dural venous sinuses. To our knowledge, eight of such cases have been published, five of which were treated surgically and three by endovascular approach. We describe one additional case treated successfully by endovascular coiling and review the current data on this subject.
Deliberate Parent Artery Occlusion for Non-Saccular Posterior Cerebral Artery Aneurysms
Authors: Liu L. , He H. , Jiang C. , Lv X. , Li Y. , Wu Zhongxue
Published: January 2017

Posterior cerebral aneurysms are rare vascular lesions and usually present as non-saccular or dissecting in nature. We present a retrospective review of our experience in the deliberate parent artery occlusion of posterior cerebral artery (PCA) aneurysms.

From June 2006 to June 2010, 12 patients (seven men, five women) with posterior cerebral artery non-saccular aneurysms presented to our department and were treated by parent artery occlusion. There were eight (66.7%) aneurysms located at the P2 segment, two (16.7%) at the P2–3 junction, one (8.3%) at the P1–2 junction and one (8.3%) at the P3 segment. Ten of the 12 patients were treated by aneurysm together with parent artery occlusion and two were treated by proximal occlusion.

The procedure was technically successful in all cases. Angiography was performed immediately after the procedure in all patients and showed occlusion of the parent vessel with no filling of the aneurysm. Only one patient (8.3%) developed procedure-related transient hemianopsia and recovered within one month. The other 11 patients showed no additional neurological symptoms after procedure.

Deliberate parent artery occlusion by detachable coils appears to be well tolerated for P2 or distal segment of PCA in our limited case series. We propose that this technique could be a good treatment option in treating non-saccular aneurysms in this location.
Outcomes after Endovascular Treatment of Symptomatic Patients with Takayasu's Arteritis
Authors: Kim H.J. , Lee C-S. , Kim J.S. , Kwon S.U. , Kim J.L. , Park J.W. , Hyun D.H. , Suh D.C.
Published: January 2017

We report our experience with endovascular treatment of supra-aortic arteries and follow-up results in patients with Takayasu's arteritis (TA) presenting with neurological symptoms. Of the 20 patients with TA who underwent cerebral angiography for neurological manifestations between May 2002 and May 2009, 12 (11 females, one male; mean age, 39 years; range 31–56 years) underwent endovascular treatment and evaluated outcome for 21 lesions, including nine common carotid arteries, four vertebral arteries, four subclavian arteries, two internal carotid arteries, and one brachiocephalic artery. Eight patients underwent multiple endovascular procedures for different lesions in single or multiple stages. Mean angiographic and clinical follow-up durations were 34 months (range, 11–79 months) and 39 months (range 11–91 months), respectively.

Technical success was achieved for 20 procedures in 11 patients. One procedure failed, with 50% residual stenosis after stenting due to dense calcification of vessel walls. There were no procedure-related complications. Restenosis occurred at two lesions in two patients were treated by re-stenting. Asymptomatic occlusion occurred at two lesions in one patient. Ten patients remained in 0–1 on the modified Rankin scale (mRs) during mean 39 months. One patient, however, had a score of 3 on mRs due to a traumatic contusion during follow-up. One patient died from cardiac failure 36 months after successful angioplasty.

Our data suggest that endovascular treatment of symptomatic supra-aortic lesions of TA is effective and durable in selected patients with neurologic symptoms.
Endovascular Mechanical Thrombectomy for the Treatment of Acute Ischemic Stroke Due to Arterial Dissection
Authors: Fields J.D. , Lutsep H.L. , Rymer M.R. , Budzik R.F. , Devlin T.G. , Baxter B.W. , Malek R. , Padidar A.M. , Barnwell S.L. , Smith W.S.
Published: January 2017

Arterial dissections account for 2% of strokes in all age groups, and up to 25% in patients aged 45 years or younger. The safety of endovascular intervention in this patient population is not well characterized.

We identified all patients in the Merci registry — a prospective, multi-center post-market database enrolling patients treated with the Merci Retriever thrombectomy device — with arterial dissection as the most likely stroke etiology. Stroke presentation and procedural details were obtained prospectively; data regarding procedural complications, intracerebral hemorrhage (ICH), and the use of stenting of the dissected artery were obtained retrospectively.

Of 980 patients in the registry, ten were identified with arterial dissection (8/10 ICA; 2/10 vertebrobasilar). The median age was 48 years with a baseline NIH stroke scale score of 16 and median time to treatment of 4.9 h. The procedure resulted in thrombolysis in cerebral ischemia (TICI) scores of 2a or better in eight out of ten and TICI 2b or better in six out of ten patients. Stenting of the dissection was performed in four of nine (44%). The single complication (1/9; 11%) — extension of a dissected carotid artery — was treated effectively with stenting. No symptomatic ICH or stroke in a previously unaffected territory occurred. A favorable functional outcome was observed in eight out of ten patients.

Despite severe strokes on presentation, high rates of recanalization (8/10) and favorable functional outcomes (8/10) were observed. These results suggest that mechanical thrombectomy in patients with acute stroke resulting from arterial dissection is feasible, safe, and may be associated with favorable functional outcomes.
A Minimally Invasive Treatment for Lumbar Disc Herniation: DiscoGel® Chemonucleolysis in Patients Unresponsive to Chemonucleolysis with Oxygen-Ozone
Authors: Stagni S. , De Santis F. , Cirillo L. , Dall'Olio M. , Princiotta C. , Simonetti L. , Stafa A. , Leonardi M.
Published: January 2017

A multitude of therapies is available to treat disc herniation, ranging from conservative methods (medication and physical therapy) to minimally invasive (percutaneous) treatments and surgery. O2-O3 chemonucleolysis (O2-O3 therapy) is one of the minimally invasive treatments with the best cost/benefit ratio and lowest complication rate. Another substance recently made available exploiting the chemical properties of pure ethanol is DiscoGel®, a radiopaque gelified ethanol more viscous than absolute alcohol 8,9. The present study aimed to assess the therapeutic outcome of DiscoGel® chemonucleolysis in patients with lumbar disc herniation unresponsive to O2-O3 therapy.

Thirty-two patients aged between 20 and 79 years were treated by DiscoGel® chemonucleolysis between December 2008 and January 2010. The treatment was successful (improvement in pain) in 24 out of 32 patients.

DiscoGel® is safe and easy to handle and there were no complications related to product diffusivity outside the treatment site.

The therapeutic success rate of DiscoGel® chemonucleolysis in patients unresponsive to O2-O3 therapy was satisfactory. Among other methods used to treat lumbar disc herniation, DiscoGel® chemonucleolysis can be deemed an intermediate procedure bridging conservative medical treatments and surgery.
Cerebrofacial Venous Anomalies, Sinus Pericranii, Ocular Abnormalities and Developmental Delay
Authors: MacIt B. , Burrows P.E. , Yilmaz S. , Orbach D. B. , Mulliken J.B. , Alomari A.I.
Published: January 2017

The clinical implications of venous cerebrovascular maldevelopment remain poorly understood. We report on the association of cerebrofacial venous anomalies (including sinus pericranii), ocular abnormalities and mild developmental delay in two children. In addition, one child had a seizure disorder. Complex cerebrofacial slow-flow vascular anomalies may herald an underlying developmental aberration affecting the cerebrofacial and orbital regions.
Treatment of a Transorbital Penetrating Injury: A Particular Endovascular Approach
Authors: Natrella M. , Duc L. , Lunardi G. , Cristoferi M. , Fanelli G. , Meloni T.
Published: January 2017

The management of craniocerebral penetrating injury currently represents a challenge for neurosurgeons and neuroradiologists and requires innovative planning. This report describes the case of a worker admitted to hospital with an intracranial piece of concrete-cutting saw stuck through the right eye. At the time of admission the patient was conscious and this fact influenced the choice of a particular approach. This patient escaped without neurological deficit or complications, except for the inevitable removal of an eye.
Symptomatic Middle Cerebral Artery Stenosis Treated by Percutaneous Transluminal Angioplasty: Improvement of Cerebrovascular Reserves
Authors: Abe A. , Ueda T. , Ueda M. , Nogoshi S. , Nishiyama Y. , Katayama Y.
Published: January 2017

This study evaluated the recoveries of cerebrovascular reserves (CVR) after applying percutaneous transluminal angioplasty (PTA) to patients with symptomatic middle cerebral artery (MCA) stenosis of varying severity. The patients were submitted to single photon emission computed tomography (SPECT) to obtain their regional cerebral blood flows at resting stage (rCBFrest) and acetazolamide-challenged CBF in five regions of interest (ROIs), including the MCA, on the ipsilateral and contralateral sides of the hemisphere. rCVR values were then calculated from these CBF data to evaluate the CVR recoveries after PTA treatment. When the PTA effects were statistically analyzed of the patients dichotomized into more severe (n=9) and less severe (n=5) groups, distinctly significant ROI-specific PTA effectiveness was observed for CVR rather than CBF values in the patients of the severer group.
The Cost of Materials for Intra-Arterial Thrombectomy
Authors: Bing F. , Jacquin G. , Poppe A. , Roy D. , Raymond J. , Weill A.
Published: January 2017

This paper reports the cost of endovascular materials used for the treatment of large-vessel ischemic stroke in the anterior circulation according to the angiographic score and clinical results at three months. From November 2009 to July 2011, 57 ischemic patients (mean age, 64.6 ±13.8 years) with anterior large vessel occlusion were included. Mean National Institutes of Health Stroke Scale (NIHSS) on admission was 18.4 ± 4.9. Mean duration of symptoms until the arterial puncture was 207±67 minutes. Recanalization was assessed using the Thrombolysis In Myocardial Infarction (TIMI) score. Patient selection was performed on a non-enhanced CT scanner. According to the TIMI final angiographic score and the modified Rankin score (mRS) at three months, we determined the cost of the material used. Complete (n=12, TIMI grade 3) or partial perfusion (n=35, TIMI grade 2) was achieved in 47 (82.5%) lesions. At three months, 33.3% (n=19) had a mRS score ≤ 2. The mean cost of the material used in the operative room was 5018±2402 euro.

Intra-arterial thrombolysis presents a substantial initial cost and the long-term economic impact has to be evaluated. Our health system has to take the price of these new technologies into account for future medical choices and urgently evaluate them in randomized controlled trials.
Disappeared Pulsatile Tinnitus Related to Petrous Segment Stenosis of the ICA after Relief of the Stenosis by Stenting
Authors: Ihn Y.K. , Jung W.S. , Kim B-S.
Published: January 2017

Pulsatile tinnitus may result from turbulent flow within the internal carotid artery (ICA). Atherosclerotic carotid stenosis is a rare but well-known cause of pulsatile tinnitus. The classical treatment was endarterectomy or ligation for proximal ICA disease or stenting for distal ICA lesions. Endovascular techniques offer new ways to treat atherosclerotic vascular stenosis lesions. We describe two cases of pulsatile tinnitus caused by stenosis within the petrous segment of the ICA and treated by stent-assisted angioplasty.
‘Progressive-Onset’ versus Injury-Associated Discogenic Low Back Pain: Features of Disc Internal Derangement in Patients Studied with Provocation Lumbar Discography
Authors: Bartynski W.S. , Dejohn L.M. , Rothfus W.E. , Gerszten P.C.
Published: January 2017

Chronic low back pain (LBP) can be ‘progressive onset’ or injury-related. This study compares the patient-reported cause of chronic LBP to features of disc internal derangement at painful concordant discs evaluated by provocation lumbar discography.

Concordant LBP was identified in 114 patients with chronic LBP studied by provocation discography. LBP cause, discogram pain response and discogram/post-discogram CT features of internal derangement were retrospectively reviewed.

‘Progressive-onset’ LBP was reported in 32 (28%) patients, injury-related LBP in 75 (66%) with LBP equated to non-specific causes in seven.

Injury-related LBP was more commonly identified in men (52 of 63 [83%]) with women reporting near-equal frequency of ‘progressive-onset’ (23 of 44 [52%]) and injury-related (21 of 44 [48%]) LBP (p=0.002).

In 172 concordant painful discs, near-equal frequency of severely degenerative (Dallas grade-3: 82 of 172 [47.3%]) and full-thickness radial fissure discs (Dallas grade-3: 90 of 172 [52.7%]) were identified.

Women with ‘progressive-onset’ LBP demonstrated more frequent severely degenerative discs (24 of 37 [65%]); women with injury-related LBP demonstrated more frequent radial-defect discs (21 of 31 [68%]; p=0.01).

In men with injury-related LBP, severe degeneration-only (44 of 89 [49%]) and radial defect discs (45 of 89 [51%] were seen with equal frequency. In men with ‘progressive-onset’ LBP, radial defects are more common (11 of 15 [73%]).

‘Progressive-onset’ and injury-related chronic LBP subgroups are definable. Gender-related differences in incidence and internal derangement features at concordant discs are identified at discogram/post-discogram CT. These differences may have implications related to LBP origin/treatment-response.
Quantified Partial Embolisation in a Vein of Galen Malformation with Congestive Cardiac Failure
Authors: Moersdorf M. , Lasjaunias P.
Published: January 2017

The aim of the study was to quantify embolisation in a vein of Galen malformation by intraluminal measurements of flow velocities in the feeding vessels and to test a new 0.014-inch Doppler guide wire in the paediatric population.

The examination was performed in a seven month old boy who presented with a vein of Galen malformation combined with congestive cardiac failure from birth.

The measurements showed a decrease of the systolic and diastolic velocities and an increase in the effective downstream vascular resistance after closure of the high flow fistula.

The decrease of the diastolic velocities after embolisation was more prominent because of the reduction of the sump effect responsible for the high diastolic velocity before embolisation.

The reduction of about 40% of the vein of Galen malformation estimated with morphological criteria was associated with a decrease of the diastolic velocity in the basilar artery of about 50%.

The clinical improvement led to the discontinuance of most of the cardiac treatment over a few days.

These measurements seem to offer the possibility to assess the necessary reduction of the shunt to relieve CCF in a vein of Galen malformation.
Transarterial Embolisation of Cerebral Arteriovenous Malformations
Authors: Wikholm G. , Lundqvist C. , Svendsen P.
Published: January 2017

Arteriovenous malformations of the brain are rare disorders. Embolisation has emerged as an effective treatment with an acceptable, low complication rate.

Previously presented results are completed with results from 1994 to 1996. Ninety-six percent of the patients were treated with no or very minor sequelae resulting in total obliteration in 32% and supplementary stereotactic radiation in 49%.

Ninety percent of all patients are in excellent or good health at follow up. These results may be jeopardised by the ongoing proliferation of endovascular treatment for AVMs.
Interventional Neuroradiology in Hemifacial Spasm
Authors: Yamashita K. , Okamoto S. , Hosotani K. , Nakatsu S. , Hojo M. , Miyamoto K. , Matsumoto R.
Published: January 2017

There have never been functional studies in the diagnosis of hemifacial spasm caused by neurovascular compression. We used neurointerventional techniques to conduct a functional investigation of the artery responsible for hemifacial spasm in seven patients.

A microcatheter was inserted into the various arteries of the posterior circulation under systemic heparinization, and its effect on the spasm was evaluated clinically and electromyographically. In six patients who underwent microvascular decompression surgery, the vessels compressing the root exit zone of the facial nerve were surgically determined, and compared with the result of the procedure.

The catheter was inserted into twelve arteries. The spasms were stopped immediately and completely by the insertion of the catheter into seven arteries. Six of them were surgically proven to compress the root exit zone of the facial nerve. The spasm was changed in frequency or in type by the insertion into two arteries. These arteries were also compressing the root exit zone. One artery was located at a more peripheral part of it and the other was running over another artery compressing the root exit zone. The spasms were not affected at all by the insertion into three arteries.

These arteries were not observed in the operative field and had no contact with the nerve. Superselective ‘angiograms showedpositional qnd configurational changes of the arteries. There was no arterial spasm and tight catheterization leading to stasis of contrast material within the arteries. There were no complications related to the procedures.

Functional relationship between the artery and the spasms was established in all the patients, and one patient refused surgery because the frequency of the spasm was reduced by the procedure.

The result of this study may suggest that a functional investigation of hemifacial spasm is feasible and seems useful for selecting good candidates for microvascular decompression surgery.
Stenting for Extracranial Stenotic Lesions of Carotid and Vertebral Arteries
Authors: Matsushita K. , Akai F. , Taneda M. , Yokoi Y.
Published: January 2017

We evaluated the feasibility of stenting in four patients. Two cases were vertebral osteal stenosis and the others were carotid stenosis at high position with ulcers. We placed balloon expandable coronary stents by a bared stent technique. The mean preprocedural stenosis (86.58%) was reduced to 13.05%. Patients were examined clinically and angiographically at 1, 3 and 6 months after stenting. There was no minor nor major stroke during and after the procedures. Asymptomatic restenosis occurred in the cases of proximal vertebral arteries. One of these patients needed to repeat balloon dilatation. There were no angiographic restenoses in the location of stenting in the carotid artery.

In the treatment for atherosclerotic stenoses, stent placement is a feasible and safe method. However restenosis in a vertebral osteal lesion should be carefully followed after stent placement.
Carotid and Vertebral Stenting: Preliminary Report
Authors: Mori T. , Kazita K. , Fukuoka M. , Mori K.
Published: January 2017

We report our initial experience of carotid and vertebral stenting. Three haemodynamically significant extra-cranial lesions (% diameter stenosis >70) in 3 clinically symptomatic patients were treated by stenting between March 1996 and September 1996.

Two lesions of the internal carotid arteries were ostial and in one case a subtotal stenosis and ostial lesion of the vertebral artery were observed.

All lesions looked more widely and smoothly dilated by stenting than by ordinary standard balloon angioplasty.
The Evaluation of Preoperative Embolization of Meningioma
Authors: Sato H. , Hyodo A. , Matsumaru Y. , Anno I. , Kato T. , Nose T. , Kamezaki T. , Kobayashi E. , Tsukada A.
Published: January 2017

To evaluate the efficacy of preoperative embolization of meningioma, we examined the correlation between the angiographic disappearance of the tumor blush after the embolization and the volume of blood loss and transfusion intraoperatively.

Preoperative embolization of meningioma with intravascular neurosurgery was attempted for 42 trials, 41 cases from July 1989 to December 1995. There were no major complications attributed to the embolization procedure. As a subjective assessment in 23 cases the information from the surgeon following the operation was obtained. The angiographic disappearance of the tumor blush and reducing of the bleeding from tumor could be considered to be statiscally significant (p<0.05). As an objective assessment in 37 cases following operation, the volume of both intraoperative blood loss and blood transfusion was examined. The angiographic disappearance of the tumor blush and reduced intraoperative blood transfusion could be also considered to be statiscally significant (p<0.05), otherwise reduced intraoperative blood loss failed to reach the significance level.

In this study the efficacy of preoperative embolization of meningioma has been especially shown to reduce intraoperative blood transfusion significantly, therefore it is very useful to increase the chance of complete tumor removal with more safely and less invasively.
IDC Embolization of Aneurysms
Authors: Kanaoka N. , Akashi K. , Kato Y. , Sano H. , Kanno T. , Ogura Y. , Takeshita G. , Katada K.
Published: January 2017

Embolization using IDC was carried out for 33 aneurysm cases in the last 3 years.

The indication for the embolization was that the direct surgery was considered to be difficult, because of 1) technically impossible to do clipping, 2) aneurysm of the posterior fossa, 3) reject of patients.

Regarding the location of aneurysm, 27 cases were seen in the anterior circulation, and 6 cases in the posterior circulation. Count of 33 cases, 11 cases were ruptured and 22 cases were non-ruptured.

The procedure of embolization of aneurysms are generalized as compared to direct surgery, but there remain some technical problems.

33 cases in our series had no significant complication, except for one which had ruptured again. We emphasize that the weak point of IDC which was so hard, had no variations, especially if it happens to migrate during locking procedure. These complications can be prevented, if we use GDC5,6,7 instead of IDC.
Results and Problems on Direct Embolization of Cerebral Aneurysms Using Interlocking Detachable Coils
Authors: Yoshimura S. , Ueda T. , Kaku Y. , Nishimura Y. , Andoh T. , Sakai N.
Published: January 2017

The clinical results of direct embolization of cerebral aneurysms using interlocking detachable coils (IDCs) were analysed. In 27 patients who underwent direct embolization of the aneurysm, 19 patients (70%) were treated uneventfully. In the other 8 patients, symptomatic or asymptomatic complications occurred; parent artery occlusion in 3 patients, rupture of the aneurysm in 2 patients, distal embolism in 2 patients, and neurological deterioration due to enlargement of the aneurysm after embolization in 1 patient. In 5 of 8 patients in whom complications occurred, neurological deficits disappeared after additional embolizations or thrombolysis therapies. Permanent deficits were observed in 3 of all patients (11%). These deficits were caused by the parent artery occlusion due to protrusion of the detached coil in wide neck aneurysms.

These results suggest that indication of direct embolization of the cerebral aneurysm should be decided according to neck size. Balloon-assisted coil placement in wide-necked aneurysms was useful but unable to prevent protrusion or migration of the coils after balloon withdrawal. Development of a new device, such as a stent for intracranial use, may make it possible.
Clinical Results and Complications of Endovascular Treatment for Intracranial Aneurysms
Authors: Tsuura M. , Terada T. , Nakamura Y. , Kinoshita Y. , Yokote H. , Nishiguchi T. , Nakai K. , Itakura T.
Published: January 2017

Thirty-two patients with intracranial aneurysm were treated via the endovascular approach and clinical results and complications were accessed. The aneurysms were on the anterior circulation, posterior circulation and feeding artery of AVM in 17, 12 and three patients respectively. In 17 (anterior circulation aneurysm), 12 patients underwent parent artery occlusion.

There were two complications: cerebral embolism due to premature detachment of balloons and cerebral infarct due to parent artery occlusion. In 12 (posterior circuration aneurysm), four patients had complications: three infarcts due to parent artery occlusion and one aneurysmal bleeding at the interventional procedure. Coil compactions occurred in four cases. There were no complications in cases associated with AVM.

Use of detachable balloons for intra-aneurysmal occlusion and intra-aneurysmal embolisation for partially thrombosed giant aneurysm tends to result in ischemic lesions where patient outcome is poor. We must pay attention to avoid these complications even though intra-aneurysmal embolisation using microcoils is currently performed safely.
The Nature of Early Intraluminal Thrombosis in Terminal Aneurysms Occluded with Guglielmi Detachable Coils
Authors: Reul J. , Spetzger U. , Weis J. , Von Buelow S. , Ince A. , Thron A.
Published: January 2017

To investigate the early intraluminal thrombotic events after endovascular treatment of terminal aneurysms with detachable coils, and to assess the biological changes over the first three weeks, terminal arterial bifurcation aneurysms were produced microsurgically in 20 rabbits.

After a healing period of three weeks, transfemoral angiography was performed and all aneurysms were occluded with Guglielmi Detachable Coils (GDC). Complete (i.e. 100%) occlusion was achieved in ten aneurysms. About 95% occlusion (only a small neck remnant) was seen in eight cases. In two cases, occlusion was about 70–80%. Half of the animals were treated by anticoagulation during and continuously two days after occlusion therapy. Angiographic studies and histological analysis were done for four aneurysms (two without and two with anticoagulation) after 24 – 48 hours, 3 – 4 days, 6 – 7 days, 14 days, and 21 days after the treatment. On macroscopic examination, complete occlusion of the aneurysms by early thrombus formation was found in all cases during the first two days. After three to seven days, recanalization and fibrinolysis were observed, leading to a reopening of the neck, and part of the dome. After three weeks recanalization was found in six out of eight aneurysms, regardless of whether the animal was under anticoagulation.

In nine cases, the degree of occlusion was overestimated by angiography compared to the pathological findings. During the early phase after occlusion of an aneurysm with platinum coils, extensive clot formation is induced. Over time due to the natural fibrinolysis, continuous recanalization beginning at the neck takes place.

These findings can explain the clinical phenomenon of early thromboembolic complications, and the reopening and regrowth of aneurysms occluded with metallic coils observed at later stages.
Aneurysm on a Persisting Primitive Trigeminal Artery Occluded with Guglielmi Detachable Coils
Authors: Nepper-Rasmussen J. , Bjerre P. , Andersen P.
Published: January 2017

A persisting primitive trigeminal artery (PPTA) is present in 0.2 – 0.6% of all cerebral angiographies. 27 cases of PPTA aneurysms have been reported.

We present a case with sixth cranial nerve palsy due to a non ruptured aneurysm on a persisting primitive trigeminal artery. The aneurysm was successfully occluded with Guglielmi Detachable Coils with preservation of the parent artery. The cranial nerve palsy resolved and recovery was uneventful.