bluuebunny/crossref_metadata_2025 huggingface dataset:
Selective Transvenous Embolization for Dural Arteriovenous Fistulas with the Aid of Superselective Venograms of Fistulous Drainages and Involved Sinuses
Authors: Nakamura M. , Nakamura Y. , Fujita A. , Kohmura E.
Published: January 2017

For the treatment of transvenous embolization (TVE) of dural arteriovenous fistulas (DAVFs) the sites of arteriovenous shunts, fistulous drainage, and the pathological changes inside the affected sinuses were explored in detail by means of preoperative arteriograms, superselective arteriograms, and superselective venograms.

Out of 42 adult patients with DAVFs involving a total of 63 sinuses, three distinctive findings were identified as essential for indication of selective TVE for DAVFs. The first is extra-sinus fistulous drainage, which is embolizable fistulous drainage, remote from the major dural sinus, that flows into the sinus lumen. The second is intramural fistulous drainage, which is embolizable fistulous drainage located within the dural leafs of the involved sinus and separate from the major sinus lumen. The third consists of several lumens inside the affected sinuses, which suggests a variety of histological changes in the developmental process of sinus thrombosis and DAVFs. The extra-sinus drainage was occluded in three torcular heroplili fistulas and three transverse sinus fistulas.

The intramural fistulous drainage was eliminated in three superior sagittal sinus fistulas. Several lumens inside the affected sinuses were encountered in 17 posterior fossa fistulas (68%) and 10 cavernous sinus fistulas (34%). These distinctive findings were recognized in 52% of the DAVFs.

Out of various modalities for treatment of DAVFs, TVE has been the method of choice for the treatment of diffuse DAVFs. The TVE of DAVFs do not correspond to simple sinus occlusion, but imply selective occlusion of fistulous drainages and sinus lumens.

The recognition of these three distinctive types of fistulous drainages have clinical impact in that it helps to completely occlude all the fistulous components of fistulas as well as preserve or restore the normal venous outflow through the involved sinus.
Endovascular Treatment of Cerebral Aneurysm with Coils and Onyx
Authors: Ueno J. , Tohma N.
Published: January 2017

We investigated endovascular treatment of cerebral aneurysm by coil and Onyx in vivo experiment in order to promote the advantages of coil embolization,. The aim of this study was to clarify the advantages and problems of coil and Onyx embolization and to evaluate its potentials for application in clinical medicine.

We set experimental aneurysms made of external jugular vein to bilateral carotid arteries of 10 Beagle dogs and embolized aneurysm with coils and Onyx. Two months later, the dogs were sacrificed and took out the experimental aneurysms and examined them histologically.

We have experienced Onyx migration into the vessel at the beginning of our experiment. Technical problems were as follows; Onyx was not easily visible on DSA monitor particularly in tight coil packing. Catheter tip was often stuck to the Onyx in the aneurysm. Protect balloon could not completely protect the Onyx leakage into the vessel. Microscopic examinations were as follows; The aneurysm was filled with Onyx, coils, and inflammatory reactants. The orifice of the aneurysm was packed with augmented fibrous tissue. This method increased contact between the aneurysm wall and coils. Onyx filled the intra-aneurismal space more tightly. Coils prevented Onyx from flowing out into the vessel. In Onyx, intimal layer was more rapidly formed at the neck of the aneurysm than coils only. The most important problems during Onyx embolization is how to prevent Onyx migration into the vessel. We should like to propose the guideline for Onyx embolization.
Strategy for Prevention of Restenosis after PTA
Authors: Yoshimura S. , Kaku Y. , Kokuzawa J. , Hayashi K. , Sakai N.
Published: January 2017

Percutaneous transluminal angioplasty (PTA) has been a useful therapy to treat stenosis of cervical internal carotid artery (ICA) or vertebral artery (VA). Here we show that our clinical results regarding preventive effect of stenting on restenosis after PTA in the ICA and VA origin. We also show our experimental studies with gene transfer techniques aiming reduction of restenosis after balloon-injury in rat carotid artery. It has been reported that drug-eluting stent inhibits restenosis after coronary angioplasty. Further understanding of the mechanism of restenosis and application of these new modalities may lead to better clinical results in angioplasty of the craniocervical arteries.
Development of an Intravascular Laser Treatment with an Infrared Free Electron Laser
Authors: Nakajima Y. , Iwatsuki K. , Ishii K. , Fujinaka T. , Awazu K. , Yoshimine T.
Published: January 2017

We have studied to develop an intravascular device with an infrared free electron laser (FEL) to treat occlusive carotid atherosclerotic lesions. In this study, we irradiated the FEL with a wavelength of 5.75 μm on surgical specimens of human atheromatous carotid plaques. After the irradiation on a cholesterol-ester-accumulated portion of the carotid plaques under proper conditions, a microscope transmission FTIR (Fourier Transform Infrared) spectroscopy showed that the peak of a tissue infrared absorption spectrum corresponding to the molecular vibration of cholesterol ester (5.75 μm) disappeared. Tissue damages associated with the irradiation were not histologically noted. This study demonstrated that irradiation of FEL can selectively remove cholesterol ester from the human atheromatous carotid plaques.
Reperfusion Therapy for Acute Middle Cerebral Artery Trunk Occlusion
Authors: Nakano S. , Wakisaka S. , Yoneyama T. , Kawano H.
Published: January 2017

The purpose of this study was to test the hypothesis that direct percutaneous transluminal angioplasty (PTA) might reduce the incidence of haemorrhagic complications and might improve recanalization rate and clinical outcome as compared with intra-arterial (IA) thrombolysis in patients with acute middle cerebral artery (MCA) trunk occlusion.

A total of 70 patients with acute MCA trunk occlusion were treated with IA reperfusion therapy. Thirty-six patients were treated with IA thrombolysis alone. In the other 34 patients, direct PTA was selected as the first choice of the treatment and subsequent thrombolysis was added if necessary for distal embolization. The modified Rankin scale (mRS) was used to assess clinical outcome at 90 days.

As compared with IA thrombolysis, direct PTA provided significant increase in the rates of partial or complete recanalization (63.9 vs 91.2%, p< 0.01) and decrease in the incidence of large parenchymal hematoma with neurological deterioration (19.4% vs 2.9%, p = 0.03). Despite such favorable effects, direct PTA did not improve the rate of a favorable outcome (mRS score 0 or 1, 41.7% for the IA thrombolysis group vs 52.9% for the PTA group, p= 0.48). However, outcome classified in terms of independence (mRS score ≤ 2) was significantly better in the PTA group (73.5%) than the IA thrombolysis group (50.0%, p = 0.04).

In patients with acute MCA trunk occlusion, as compared with IA thrombolysis, direct PTA improved recanalization rate and reduced serious haemorrhagic complications, resulting in a significant increase in independent patients.
Strategy for the Treatment of Acute Thromboembolic Stroke Involving an Internal Carotid Artery
Authors: Ohmomo T. , Kurata A. , Suzuki S. , Fujii K.
Published: January 2017

With the recent improvement of endovascular techniques, intra-arterial local fibrinolytic therapy has become widely available for treatment of acute embolic stroke and there is some evidence that it could be superior to conventional approaches1–6.

However, because of high mortality and morbidity, strokes involving the internal carotid artery (ICA) and featuring acute thromboembolic occlusion remain problematic7.

We have successfully performed intra-arterial local fibrinolytic therapy via the anterior communicating artery through the contra-lateral ICA in two consecutive cases of thromboembolic occlusion of the ICA, anterior cerebral artery (ACA) and middle cerebral artery (MCA), and obtained satisfactory results. We here present details of this new technique applied for the two cases and discuss the efficacy of this method compared with conventional approaches.
Transvenous Embolization of Dural Arteriovenous Fistula of the Cavernous Sinus
Authors: Takahashi S. , Sakuma I. , Tomura N. , Watarai J. , Mizoi K.
Published: January 2017

We reviewed magnetic resonance (MR) images and digital subtraction angiograms (DSA) from eight patients with dural arteriovenous fistula of the cavernous sinus (DAVFCS) to clarify the fistulous points and to evaluate the venous access routes into the cavernous sinus for transvenous embolization (TVE).

Multiplanar reconstruction of the MR images was achieved using three-dimensional fast spoiled gradient-recalled acquisition in the steady state (3-D fast SPGR) after the intravenous administration of gadopentetate dimeglumine (Gd-DTPA).

TVE was performed using microcoils via the inferior petrosal sinus (IPS) using the transfemoral approach in five patients, via the facial vein and superior ophthalmic vein (SOV) using the transfemoral approach in 1 patient, and by SOV puncture in two patients. Most fistulas were detected in the posterior portion of the cavernous sinus or in the posterior intercavernous sinus in all of the patients. Fistulas identified as hyperintense dots or lines on contrast-enhanced 3-D fast SPGR images and were replaced with the microcoils. Target embolization of the fistulas was feasible in three patients treated via the SOV and in one patient treated via the IPS. Contrast-enhanced 3-D fast SPGR can help to identify the fistulous points of DAVFCS. Precise identification of fistulous points and selection of the adequate access route are mandatory for efficient TVE of DAVFCS.
Treatment Outcome of Carotid Stenting and CEA in the Same Period
Authors: Kobayashi E. , Uchino Y. , Ono J. , Yamaura A.
Published: January 2017

Angioplasty with stent deployment is a promising option for the treatment of carotid stenosis. However, the definite treatment indication is still unknown through lack of scientific evidences in the randomized controlled trial, which is now on going. We compared the short-term outcome, such as periprocedural complication rate, cerebral blood flow, subsequent ischemic events and restenosis, between carotid stenting (CS) and carotid endarterectomy (CEA) in the same period to investigate the justice of our present indication for CS.

Fifty-five patients with carotid stenosis greater than 70% were treated by CS or CEA in a constant indication. Twenty-five times of CEA were indicated in patients who satisfied the inclusion criteria of NASCET without the exclusion criteria, 30 times of CS in patients with the exclusion criteria. No major procedure-related complication was found in either group. One patient (3.3%) in CS group suffered a minor ischemic stroke during the procedure, just after postdilatation. One patient underwent myocardial infarction in CEA group, and one patient congestive heart failure in CS group within one week after the procedure. During a mean follow-up period of 19 months, no further stroke occurred in either group. There was no lesion-related mortality, but one patient in each group was dead of heart disease. As for restenosis, one patient in each group showed recurrent stenosis on angiogram 12 and 24 months after the treatment. Restenosis rate calculated by the person-year method in CEA and CS group was almost same, 2.3% per year.

Stenting seemed to be so safe and effective for cases refractory to CEA that the present indication for CS is thought to be reasonable, though it is necessary to draw a decisive conclusion in randomized trials.
Stenting for Atherosclerotic Stenosis of the Intracranial or Skull Base Cerebral Arteries
Authors: Harakuni T. , Hyodo A. , Shingaki T. , Kugai M. , Kinjyo T. , Kinjyo T. , Tsuchida H. , Sugimoto K. , Yoshii Y. , Matsumaru Y.
Published: January 2017

Since May 1992, we have performed percutaneous transluminal angioplasty (PTA) or stenting 70 times for 65 lesions in 62 patients with atherosclerotic stenosis of the intracranial or skull base cerebral arteries. Stenting was carried out nine times for nine lesions in nine cases. Stenting was performed on patients with an average age of 62. The patients were eight men and one woman. The stenotic lesions involved the internal carotid artery (petrous portion) in four cases, the internal carotid artery (cavernous portion) in two cases, the internal carotid artery (supraclinoid portion) in one case, the middle cerebral artery (M1) in one case, and the vertebral artery (V4) in one case. The degree of stenosis ranged from 70% to 99%, with a mean of 80%. A stent for coronary arteries was used in all cases. After PTA was carried out in four cases, their initial extension was inadequate, and dissection was performed in five cases after PTA. As for the results of the treatment, subarachnoid haemorrhage occurred in one case due to perforation by the guidewire, and a major deficit was accepted. During the operation, asymptomatic cerebral infarction by distal embolism occurred in one case. Although obstruction of the lesion occurred three months after treatment in one case, symptoms did not appear. Stents used for atherosclerotic stenosis of the intracranial or skull base cerebral arteries still do not have sufficient performance. Although the stenting had problems, such as a prolonged patent, in the present condition, it was effective in terms of recovery from complications due to PTA.
Important Things to Master the Neurointerventional Technique and Training Program in Our Department
Authors: Terada T.
Published: January 2017

My personal training experience of neuroendovascular therapy and training program of our department were introduced in this paper.
Nagoya University Training System for Neuroendovascular Therapists
Authors: Miyachi S. , Okamoto T. , Kobayashi N. , Kojima T. , Hattori K.I. , Nakai K. , Suzuki O. , Sahara Y. , Hattori K. , Yoshida J.
Published: January 2017

It is very important to train more neuroendovascular therapists (NETists) in response to Japan's growing social needs. Since the supply of qualified NETists is still insufficient to cover Japanese institutions, therefore some emergency cases with indications for endovascular therapy may be overlooked, untreated or treated by other methods resulting in unfavorable outcomes. Thus, neuroendovascular therapies are situated as one of the important tratment modalities for neurosurgical diseases1,2.

We studied our present states of the endovascular neurosurgery and introduce our training system.
Study of Dural Arteriovenous Fistula Drains into Leptomeningeal Vein without Sinus Interposition
Authors: Kawaguchi T. , Nakatani M. , Kawano T.
Published: January 2017

We evaluated dural arteriovenous fistulas (DAVF) drains into leptomeningeal vein (LMV) without the venous sinus interposition. This type of DAVF contained the extra-sinusal type DAVF and the DAVF with so-called pure leptomeningeal venous drainage (PLMVD). We studied 15 patients with DAVF that flows into LMVD without passing into the sinus. The subjects were 5 patients with DAVF in the anterior cranial fossa, 2 with DAVF in the tentorium cerebelli, and 3 with DAVF in the craniocervical junction as extra-sinusal type DAVF and 3 with DAVF in the transverse sigmoid sinus and 2 with DAVF in the superior sagittal sinus as DAVF with PLMVD.

This type appears to take a very aggressive course. The arterial pressure of the shunt is directly applied to LMV, which causes bending and winding of the vein, eventually varices, inducing intracranial haemorrhage or venous ischemia in the LMV reflux area.

Emergency treatment should be performed as soon as possible. Although it is recognized that interruption of the draining vein is very effective, treatment methods such as TAE, direct surgery, and g knife treatment, or their combinations should be carefully chosen for each case.
A Nonadhesive Liquid Embolic Agent of Ethylene Vinyl Alcohol Copolymer and Ethanol Mixture for Cerebral Arteriovenous Malformations
Authors: Hamada JI , Kai Y. , Mizuno T. , Morioka M. , Kazekawa K. , Iwata H. , Ushio Y.
Published: January 2017

We report our experience using our new nonadhesive liquid embolic agent, an ethylene vinyl alcohol copolymer (EVAL)/Ethanol mixture, to treat human arteriovenous malformations (AVM). Between June 1995 and April 2001, 57 patients with confirmed AVM underwent embolization with the EVAL/Ethanol mixture. Using 87 procedures consisting of one to three stages, we embolized 185 feeding arteries to occlude as much of the AVM as possible. Repeated injections under fluoroscopic control could be performed smoothly without encountering cementing of the catheter in the vessel wall.

Among 87 procedures undertaken in 57 patients, seven (8.0%) procedures in six patients produced new postembolization symptoms. Resolution of these symptoms occurred within hours or days following four of the seven procedures; permanent neurological deficits remained after three embolization procedures (3.4%). Of the 57 patients, three underwent postembolization radiosurgery, 54 were radically treated with microsurgical extirpation.

Histopathological examinations of the 54 specimens disclosed mild inflammation within the embolized lumen without inflammatory reactions in the media or adventitia. Follow-up angiograms obtained three years after they underwent radiosurgery showed that in all three patients the nidus had completely disappeared.

The EVAL/Ethanol mixture is handled easily and appears to be an effective and safe embolic agent for the preoperative embolization of AVM.
Medico-Financial Environment on Treatment for Acutely Ruptured Cerebral Aneurysms
Authors: Koguchi Y. , Kobayashi S. , Tsuru K. , Wada M. , Miyata A. , Yagishita T. , Nakamura H. , Sato A. , Watanabe Y.
Published: January 2017

We have been using the Guglielmi detachable coils (GDC) since 1997 as one choice of cerebral aneurysm treatment. We have, at the present time, two effective radical treatment methods for acutely ruptured cerebral aneurysms, GDC embolization and conventional surgical aneurysmal neck clipping. There ensued questions about the cost and efficacy of the two strategies. Retrospective analysis was done on a GDC group and a clipping group, with each twenty consecutive patients. The features of the GDC group patients were higher age, and poorer Hunt and Kosnik grades than the other group. All MCA aneurysms were treated with surgical neck clipping, while all the posterior circulation aneurysms were embolized with GDC.

Based on the Japanese Medical Insurance and Payment System, 477,890 points (1 point = ¥ 10) as a mean was required with the GDC group, and 456,084 points with the neck clipping group, showing no significant difference between the two groups. In the GDC group, the cost of the implanted medical device seemed to raise the total medical expense.

At present, the GDC embolization is the preferred choice of strategies in acutely ruptured cerebral aneurysms, and its preference increases in the surgically difficult cases, very old, or poor grade patients, and in various complicated cases. And, the GDC embolization seems to be satisfactory from the medico-financial viewpoint.
Computer Simulation of Flow Dynamics in an Intracranial Aneurysm
Authors: Kobayashi N. , Miyachi S. , Okamoto T. , Hattori K. , Kojima T. , Hattori K. , Nakai K. , Qian S. , Takeda H. , Yoshida J.
Published: January 2017

Using a supercomputer, the authors studied the effect of vessel wall pulsation on flow dynamics with a three-dimensional model simulating both a rigid and pulsatile style. The design of the aneurysm models was set with a 5 mm dome diameter and a 1 or 3 mm orifice size to simulate a carotid-ophthalmic aneurysm. Flow dynamics were analyzed according to flow pattern, wall pressure and wall shear stress.

The flow pattern in the aneurysm sac showed the great difference between rigid and pulsatile models particularly in the small-neck aneurysm model. The arterial wall tended to be exposed to a higher pressure peak in the pulsatile model than in the rigid one, especially at its bifurcation and curved regions. Sites of shear stress peak were found on the aneurysmal dome as well as at the distal end of the orifice in both rigid and pulsatile models.

The effects of vessel-wall pulsation should be considered whenever evaluating conditions in and around an aneurysm.
Angiographical Change of Guglielmi Detachable Coils
Authors: Nakai Y. , Sonobe M. , Takigawa T. , Yamazaki T. , Okamoto S. , Sugita K. , Matsumaru Y.
Published: January 2017

Acute angiographical changes for preventing acute rebleeding on GDC treated cerebral aneurysms were evaluated.

From December 2000 to November 2002, 48 total aneurysms in 44 consecutive patients with acute SAH. Acute angiographical evaluations were carried out in 46 aneurysms, including 42 ruptured and 4 unruptured aneurysms. Two cases were excluded because of poor medical condition. In this series, there were no rebleeding cases in acute stage.

In the initial embolization for the 46 aneurysms, CO was achieved in eight aneurysms, NR in 15 aneurysms and BF in 23 aneurysms. Acute angiographical observations showed progressive thrombosis in 17 aneurysms (37%). No changes were observed in remaining 29. No recanalization was observed in this series. Only one case of BF, inside the aneurysm bleb was still observed during follow up. Additional embolization was carried out.

Progressive thrombosis was frequently observed in GDC treated cerebral aneurysms during acute stage. This angiographical finding seems to show prevention of rebleeding, which is considered important for the management of GDC treatment in acutely ruptured cerebral aneurysm.
Retreatment of Cerebral Aneurysms after Guglielmi Detachable Coil Embolization
Authors: Matsumaru Y , Sato H , Takigawa T , Okazaki M , Kamezaki T , Tsukada A , Nose T , Nakai N , Sonobe M
Published: January 2017

Of 175 patients with 181 aneurysms initially treated with Guglielmi Detachable Coils (GDC), 25 were retreated. All retreatments except one were performed on previously ruptured aneurysms. Thirteen aneurysms were retreated because of recurrence, and 12 aneurysms were retreated to complete initial insufficient embolization. Sixteen patients underwent re-embolization and 9 patients were operated upon surgically. No complications related to the retreatment were experienced. We consider that repeat embolization should be attempted before considering surgical treatment in case that additional therapy is required. However, it is difficult to retreat aneurysms having wide necks. In regard to surgical clipping, aneurysms without a coil in the neck are easier to treat with primary clipping, whereas aneurysms with a coil mass in the neck are difficult to surgical clip. We have never used temporary clipping and coil extraction if the distance between the coil and the parent artery was wider than 2 mm. Emerging new embolic agents or devices and technical improvement might decrease the need for retreatment and increase long-term efficacy after endovascular treatment.
Endovascular Treatment for Ruptured VA Dissecting Aneurysm Involving the Origin of PICA
Authors: Kobayashi S. , Karasudani H. , Koguchi Y. , Tsuru K. , Wada M. , Miyata A. , Nakamura H. , Satoh A. , Watanabe Y. , Yagishita T.
Published: January 2017

Ruptured vertebral artery dissecting aneurysms (VADA) re-bleed frequently especially during first 24 hours, which makes the prognosis of the patients with this disease poor. Recently endovascular trapping with detachable platinum coils at an acute stage has been done for preventing re-bleeding. However, for the cases with dissecting aneurysm involving the origin of the posterior inferior cerebellar artery (PICA), these methods are hardly indicated because of the risk of ischemic complication in the PICA territory.

We proposed a simple and effective therapeutic method for these cases. We occluded the affected vertebral artery (VA) near its root intending to introduce collateral blood flow from the deep cervical artery into the VA trunk. The controlled antegrade VA flow and retrograde flow from the contralateral VA make a watershed at the dissecting aneurysm, which promotes thrombosis of pseudolumen with preserving the antegrade blood flow of PICA. We treated two cases with ruptured VADA involving PICA, and in both cases thrombosis of aneurysm was obtained without any ischemic complication.

This method would be considered as a treatment of choice to the cases with VADA involving PICA.
Endovascular Treatment of Vertebral Artery Dissecting Aneurysms Using Stents
Authors: Naito I. , Takatama S. , Shimaguchi H. , Iwai T.
Published: January 2017

We report on five patients who were treated by stent-assisted coil embolization to preserve the patency of the parent artery. Three patients presented with subarachnoid haemorrhage and two with ischemic symptoms. Four patients were treated with stenting and then followed by coil embolization of the aneurysmal dilatation, and the remaining patient with stenting alone because the aneurysmal dilatation was too small to insert coils.

Complete obliteration of the aneurysm was achieved in three patients, but in one patient an aneurysmal rupture occurred during the insertion of the first coil and a parent artery occlusion was therefore performed. In the one patient treated with stenting alone, a small aneurysmal dilatation remained patent, but complete obliteration was confirmed by the follow-up angiography. Subsequent subarachnoid haemorrhage was not observed in any of the patients. Four of them achieved a good recovery, but one patient suffered severe disability due to the aneurysmal rupture during the procedure. Parent artery occlusion remains the treatment of choice. Stent-assisted coil embolization has a higher risk of rupture than does the parent artery occlusion during the procedure. Furthermore, recanalization or subsequent subarachnoid haemorrhage is more likely to occur in a stent-assisted coil embolization after the procedure. However, this procedure, which can maintain the patency of the parent artery, will become an alternative for patients who are at a high risk of developing ischemic symptoms in parent artery occlusions.
Standard Technique of PTA/stenting for Atherosclerotic Intracranial Arterial Stenosis
Authors: Terada T. , Tsuura M. , Matsumoto H. , Masuo O. , Tsumoto T. , Yamaga H. , Itakura T.
Published: January 2017

PTA/stenting for the intracranial arteriosclerotic lesion is effective and novel treatment. Our standard technique to avoid serious complications, such as vessel rupture or acute occlusion was introduced in this paper.
Treatment of Cervical Carotid Artery Stenosis
Authors: Yoshimura S.
Published: January 2017

As treatment for cervical carotid artery stenosis, medical treatment, carotid endarterectomy (CEA), and percutaneous transluminal angioplasty (PTA) with/without stenting are known. In this report, we review the history and current status of these treatments.

Comparison between CEA and PTA/stenting is further discussed based on recent clinical reports and evidence.
Endovascular Surgery as the First-Choice Treatment for Ruptured Cerebral Aneurysms: How Far Has it Come?
Authors: Tone O. , Tomita H. , Tamaki M. , Satoh Y. , Matsuoka Y. , Sampetrean O. , Nakabayashi M. , Katsumi A. , Suzaki S.
Published: January 2017

One hundred and seventy patients with ruptured cerebral aneurysms were treated by coil embolization from September 1997 to December 2002. After January 2000, coil embolization was selected as the first-choice treatment for ruptured aneurysms. During this period, the authors investigated the number of aborted cases, the number of complications, and how many patients could be treated by coil embolization according to the locations of ruptured cerebral aneurysms. One hundred and ninety-five sessions were performed on 170 patients, and 13 sessions (6.7%) were aborted mainly because of the difficulty of the approach and the wide necks of the aneurysms. In four patients, although procedural perforation and haemorrhage occurred, the outcome was good or excellent. Eight poor-grade patients experienced haemorrhage after coil embolization and seven patients died. The volume embolization ratios of small and large aneurysms were 27% and 21%, and the recanalization of small and large aneurysms occurred in 9% and 38% of patients, respectively. From January 2000 to December 2002, 119 (66%) of 180 ruptured cerebral aneurysms were treated by coil embolization. According to the location of aneurysms, 89% vertebrobasilar, 87% anterior cerebral, 65% internal carotid and 24% middle cerebral artery aneurysms could be treated by coil embolization. Because the tight packing of large aneurysms was difficult, the recanalization rate of large aneurysms was high. However, the results of small aneurysms were satisfactory. Almost 90% of vertebrobasilar and anterior cerebral artery aneurysms could be treated by coil embolization.
Embolization of Arteriovenous Malformation
Authors: Nagashima H. , Hongo K. , Kobayashi S. , Takamae T. , Okudera H. , Koyama J.I. , Oya F. , Matsumoto Y.
Published: January 2017

Treatment options for cerebral arteriovenous malformation (AVM) are still controversial due to the recent result of stereotactic radiosurgery and the improved result of microsurgical resection. We investigated previously treated AVM cases and discussed the efficacy and safety of preoperative embolization especially for microsurgical resection of high-grade AVM in the Spetzler-Martin grading.

Efficacy of preoperative embolization was evaluated based on 126 previously treated AVM cases at Shinshu University Hospital during the last 25 years. The safety of embolization was evaluated based on our previously-embolized 58 AVM cases (91 procedures) in the last 11 years after introduction of preoperative embolization for AVM. In all 126 cases, 82 were treated before introduction of embolization and 44 were treated after introduction of embolization. In 82 cases of the pre-embolization era, 63 lesions were removed totally in 63 AVMs (77%), partially resected in 11 (13%) and untreated in eight (10%). In 74 surgically removed cases, 11 (15%) cases showed severe intra/postoperative bleeding. In 44 cases of the embolization era, lesions were removed totally in 29 AVMs (66%), disappeared only with embolization in one (2%), disappeared with radiosurgery in seven (16%) and were untreated in five (11%). In 32 surgically removed cases, only one (2%) case showed severe intra/postoperative bleeding.

In all 58 embolized cases, 44 were surgically removed, six were treated with radiosurgery, one was eliminated with embolization alone and six were partially obliterated and followed up for their location. In 91 procedures for 58 cases, two haemorrhagic and three ischemic complications occurred, three were transient and two remained having neurological deficits.

The introduction of preoperative embolization improved the total removal rate and reduced the intra/postoperative bleeding rate in surgical removal of AVM. The total risk of embolization is low and well-designed preoperative embolization makes surgical resection safer even in high-grade AVM in the Spetzler-Martin grading.
Complications of Embolization for Cerebral Arteriovenous Malformations
Authors: Sugiu K. , Tokunaga K. , Sasahara W. , Watanabe K. , Nishida A. , Ono S. , Nishio S. , Date I. , Rüfenacht D. A.
Published: January 2017

Embolization is recognized as an important adjunct in the treatment of cerebral arteriovenous malformations (AVMs). We reviewed our results of embolizations for AVMs and discussed procedure-related complications. Eleven complications were recorded in 68 consecutive patients (16%). Of these, four were technical problems including a glued catheter, inability to withdraw the catheter, vessel perforation by the microcatheter, and coil migration. Other complications included three cases of ischemic symptoms due to retrograde thrombosis, two cases of asymptomatic cerebral infarction, one case of asymptomatic small haemorrhage due to venous occlusion, and one case of post-embolization haemorrhage of unknown etiology. Our morbidity rate was 7%, mortality rate was 0%, and asymptomatic complication rate was 9%, retorospectively. Further improvements to endovascular techniques and devices are required.
Assessing Prognosis of Areas of Acute Cerebral Ischemia Using Perfusion CT
Authors: Hayakawa M. , Negoro M. , Toyama H. , Irie K. , Imizu S. , Iritani K. , Hayashi J. , Idesawa Y. , Katada K. , Kanno T.
Published: January 2017

Vascular recanalization by the vascular reconstruction method can dramatically improve ischemic symptoms in patients with acute cerebral ischemia. However, this treatment method is frequently associated with haemorrhagic complications. The indications for this therapeutic approach have been described in a number of studies in the literature. The present paper discusses the possibility of assessing the prognosis of ischemic areas using perfusion CT (PCT) by comparing the results obtained before and after thrombolytic therapy.

Twenty-six patients underwent vascular reconstruction at our hospital between July 2002 and March 2004. Of these patients, six who underwent PCT before treatment and showed adequate recanalization following vascular reconstruction were included in the present study. PCT images were obtained using the first-pass bolus-tracking method with a 16-row multislice helical CT scanner. Areas of cerebral ischemia were evaluated by CT before and after vascular reconstruction. A region of interest was placed in the area showing low density in CT images before vascular reconstruction. The mean average CBF (mL/min/100 g), CBV (mL/100 g), and MTT (s) values were calculated in areas with and without cerebral infarction after vascular reconstruction.

The % CBF, % CBV, and % MTT values relative to the normal side were evaluated with reference to the time until recanalization.

Transarterial vascular reconstruction resulted in full recanalization in four patients and partial recanalization in two. The mean time from onset to recanalization was 284.7 ± 63.27 minutes and was not longer than six hours in any patient. The patient prognosis results in terms of GOS were GR in two patients, MD in three patients, and SD in one patient. Based on comparison of the time after examination to recanalization, the % CBF showed a significant positive correlation in the salvaged area (Y = 47.321 + 2.491 × %CBF: R2 = 0.792, p < 0.05). A significant correlation was not observed in % CBV, but % MTT showed a significant negative correlation (Y = 269.45 – 0.356 × % MTT: R2 = 0.794, p < 0.05).

The % CBF and % MTT results obtained by PCT performed before transarterial vascular reconstruction suggest that it may be possible to estimate the time before vascular reconstruction and the relationship with prognosis. These findings are expected to help ensure the appropriate application of vascular reconstruction and to provide useful information for developing optimal therapeutic protocols, thus reducing complications. In addition, because the results are based on the time after examination, the appropriate therapeutic approach can be determined even when the time of onset of ischemia is uncertain.
Basi-Parallel Anatomical Scanning (BPAS) — MRI: A Simple and Useful MRI Technique for Pre-Procedural Evaluation in Cases of Basilar Artery Occlusion
Authors: Nagahata M. , Manabe H. , Hasegawa S. , Tsurutani H.
Published: January 2017

Basi-parallel anatomical scanning (BPAS)-MRI is a simple MRI technique that we designed to reveal the surface appearance of the vertebrobasilar artery within the cistern. Because it requires only 2 cm-thick heavily T2-weighted coronal imaging with gray-scale reversal, we can obtain BPAS-MRI with any MR machine of any company. BPAS-MRI can easily show the outer contour of the vertebrobasilar artery even if occluded. Therefore, BPAS-MRI can also reveal the occluded basilar trunk and the shape of basilar top branching that we cannot see with any other imaging modality before the recanalizing interventional procedure.

To avoid a dangerous blind manipulation of guidewires or micro-catheters, BPAS-MRI should be obtained prior to the interventional procedure in cases of acute basilar artery occlusion.
Complication Analysis of 469 Brain Arteriovenous Malformations Treated with N-Butyl Cyanoacrylate
Authors: Li T. L. , Fang B. , He X. Y. , Duan C. Z. , Wang Q. J. , Zhao Q. P. , Huan Q. Yi Fm
Published: January 2017

We independently assessed the frequency, severity and determinants of neurological deficits after endovascular embolization with NBCA of brain arteriovenous malformations (BAVMs) to have a better basis for making treatment decisions. All the charts of 469 BAVMs patients who underwent embolization with NBCA were reviewed. We analyzed the complications and their relation to angiographic features. The 469 patients were treated with 1108 endovascular procedures. Each met one to eight times, average 2.3 times. Eleven patients showed treatment-related complications, including four haemorrhagic and seven ischemic complications. Of these 11 cases, two died, two had persistent disabling deficits, and another seven suffered transient neurological deficits.

Our finding suggests a low rate of disabling treatment complications for embolization of brain AVMs with NBCA in this center. The management of AVM patients who have high risk of embolization therapy should be treated by special strategy.
Spontaneous Thrombosis of Significant Aneurysm Recanalization in the Long Term Follow-up of Coiled Aneurysms: Observation in Two Cases
Authors: Saatchi I. , Kerimoglu U. , Barbaros C. , Haziroln T. , Cekirge S.
Published: January 2017

Endovascular treatment of cerebral aneurysms with detachable coils has now been proved to be a superior alternative to open microsurgery in terms of survival free of disability at one year according to the recently published large randomized International Subaracnoid Aneurysm Trial (ISAT). However, aneurysm recanalization secondary to coil compaction is still the main problem of this technique observed in the follow-up period but treatment strategies for these regrowths are not yet well established.

We present two interesting cases in which we observed a significant aneurysm recanalization at six month control angiography that was found to be spontaneously thrombosed in the late follow-up angiograms at the second and fifth years consecutively.
Definitive Embolization of Meningiomas
Authors: Bateman B. T. , Lin E. , Pile-Spellman J.
Published: January 2017

This review examines the possible role for definitive embolization as a primary therapy for intracranial meningiomas. Surgery or radiosurgery are currently considered the standard of care for most benign meningiomas. However, each of these carries substantial risks. The perioperative mortality for surgical resection, as reported in large series, is between 3.7–9.4%; these studies report a similarly high rate of new neurological deficits following surgery. The rate of complications from radiosurgery is reported between 2–16% and it may take months to years before improvement in symptoms occurs following this therapy.

There are a few reports of treating meningiomas by embolization without subsequent surgery. While these studies include small numbers of patients and have limited follow-up, the initial results are very promising.

Given the risks and limitations of surgery and radiosurgery, prospective trials are now needed to determine the safety and efficacy of definitive embolization.
Vertebroplasty in the Treatment of Spine Disease
Authors: Ambrosanio G. , Lavanga A. , Vassallo P. , Izzo R. , Diano A.A. , Muto M.
Published: January 2017

We report our experience in the treatment of thoracic and lumbosacral spinal pain due to vertebral bone fractures. This pathology can be related to osteoporosis but also to metastatic disease and less frequently vertebral haemangioma.

From April 2001 through December 2004 we treated 238 patients for a total of 455 vertebral bodies. 175 patients had osteoporosis, 70 had metastasis and 13 had vertebral haemangioma. Sacroplasty was performed in six patients to obtain a cement filling of sacral metastasis.

The procedures were mostly performed under fluoroscopy and only in cases of metastasis or sacroplasty was CT/fluoroscopy guidance preferred for optimal filling of the area of osteolysis.

We evaluated the results at six and 18 months follow-up and analysed the incidence of new vertebral fractures, vascular and disk leakage and the incidence of major and minor complications. Biopsy was performed only in doubtful cases. We obtained different results considering the etiology of the disease. We obtained a 92% success rate at six months follow-up and 89% success at 18 months follow-up in osteoporosis, a 77% and 72% success rate at six and 18 months follow-up in metastastic patients, and no change at six and 18 months follow-up in patients with vertebral haemangioma in which the success rate was of 95%.

We noted extravertebral leakage in 41% of vertebral bodies of which 31% were treated at the level of the vascular space and only 10% at the level of the disk space, and symptomatic in only two cases (acute compressive radiculitis, medically treated and resolved within a month).

Six patients presented new fractures in the adjacent vertebral body and 30% had a partial recovery in the height of the vertebral body with kyphosis curve reduction.

Vertebroplasty is a good technique to obtain spine pain relief and has a low incidence of side effects. Good quality equipment is important to obtain these results.
The Anastomotic Venous Circle of the Base of the Brain
Authors: Cullen S. , Demengie F. , Ozanne A. , Alvarez H. , Mercier Ph. , Brassier G. , Lasjaunias P.
Published: January 2017

Adjacent to the arterial circle of Willis at the base of the brain, there is an anastomotic circle of veins linking the right and left halves of the cerebral deep venous system. This venous circle is formed by anterior and posterior transverse anastomotic channels (the anterior and posterior communicating veins), and paramedian longitudinal vessels (the basal veins of Rosenthal). This collateral venous network has received considerably less attention than its arterial counterpart, but is its functional homologue. Although inconstant, it can be seen readily with current neuroimaging techniques including three-dimensional digital subtraction venographic phase 3D arteriography (3D-DSV) and CT venography (CTV). The venous circle represents a route of contralateral venous drainage that may become important, particularly when segments of the basal vein are absent (with or without complex DVA), or in high flow states including arteriovenous shunts that access the deep venous system. We review the gross anatomy and provide examples of the radiologic imaging of this venous circle.
Pathology of Stented Common Carotid Aneurysm in Dogs
Authors: Liu J.M. , Zhao W.Y. , Zhang X. , Xu Y. , Hong B. , Huang Q.H.
Published: January 2017

To elucidate focal successive histological responses of the neck of wide-necked aneurysm after single stent implantation and stent-assisted coiling, an experimental wide-necked aneurysm model was surgically created in bilateral common carotid arteries of adult dogs. Balloon-expandable porous stents were positioned across the aneurysm necks on both sides. The aneurysm cavity of one side was additionally loosely coiled with Gugliemi detachable coils after stent implantation. The dogs were followed up with ultrasonography and angiography, then sacrificed at two days, one month, and one year and the aneurysm specimen was subjected to macro, micro, and electron microscopic observation. Stent implantation and coiling was successful in eight dogs. This investigation observed that single stent implantation slowed down the blood flow within the aneurysm, but barely induced thrombosis within the aneurysm. There was neointima formation over the stent mesh without thrombus within the aneurysm cavity, but it did not cover the whole aneurysm neck at one year. Aneurysms treated with stent-assisted coiling showed thrombosis within the aneurysms and neointima formation over the whole aneurysm orifice. These results suggest that the neointima could develop over bare stent filament without thrombus within the aneurysm cavity, coils could enhance thrombosis within the aneurysm cavity and facilitate neointima formation over the aneurysm orifice. Stent-assisted coiling may be an alternative option for the treatment of wide-necked aneurysms.
Recurrent or New Symptomatic Cerebral Aneurysm after Previous Treatment
Authors: Rothemeyer S. , Lefeuvre D. , Taylor A.
Published: January 2017

With the establishment of endovascular coiling as a successful treatment for symptomatic cerebral aneurysms, attention is now being directed at the durability of this treatment. If this is to be accurately done it will be important to understand the causes of symptomatic aneurysm presentation after previous treatment. In order to assess this we undertook a retrospective review, covering the four year period from 2000 to 2004, of all patients re-presenting with a symptomatic saccular aneurysm after previous treatment. Seven patients were identified, six presenting with subarachnoid haemorrhage (SAH) and one with a third cranial nerve palsy. Three patients had incomplete clipping of their aneurysms and all presented within months of their initial treatment.

The other four patients presented between five and 20 years after primary treatment and all were felt to have new cerebral aneurysms. Two of these patients had aneurysms develop at the same location as their previously treated lesions, however these were still felt to be new aneurysms rather than re-growth or recurrence because of their morphology. Based on our findings it would appear that development of a new cerebral aneurysm after clipping is more of a risk than aneurysm recurrence from treatment failure. This will need to be considered when evaluating re-presentation after treatment by either coiling or clipping and more importantly, perhaps we should be directing more attention to preventing disease progression rather than treatment failure.
Carotid Blowout Treated by Direct Percutaneous Puncture of Internal Carotid Artery with Temporary Balloon Occlusion
Authors: Chang F.-C. , Lirng J.-F. , Luo C.-B. , Teng M.M.H. , Guo W.-Y. , Chang C.-Y.
Published: January 2017

Direct percutaneous puncture of a cervical carotid pseudoaneurysm for coil placement or acrylic embolization is described for the endovascular management of acute carotid blowout. However, direct puncture of the internal carotid artery (ICA) for the endovascular management of carotid blowout has not been described.

We report a difficult case of acute carotid blowout syndrome in a patient who had radiation-induced occlusion of the right common carotid artery with vasculopathy and pseudoaneurysm in the right cervical ICA. Collaterals from the branches of the controlateral external carotid artery (ECA) anastomosed with branches of right ECA supplied the vasculopathy. We performed direct percutaneous puncture of the bulb of the right ICA using a spinal needle and placed fiber coils to occlude antegrade flow of the artery. During the injection of a mixture of N-butyl cyanoacrylate and lipiodol oil for embolization of the remaining carotid bulb, we transiently inflated an occlusion balloon in the controlateral common carotid artery to further arrest antegrade flow in the ICA. The vasculopathy and pseudoaneurysm of the right cervical ICA were successfully embolized, with preservation of the distal branches of the right ICA.
Abrupt Flow Arrest in the Internal Carotid Artery during Carotid Artery Stenting Using the Parodi Anti-Emboli System
Authors: Oishi H. , Horinaka N. , Arai H.
Published: January 2017

We report a rare complication of carotid artery stenting (CAS) in a patient with severe carotid artery stenosis. CAS with a protection of the Parodi Anti-Emboli System was complicated by an abrupt flow arrest in the internal carotid artery before the guidewire passage through the stenotic site.