bluuebunny/crossref_metadata_2025 huggingface dataset:
Posttraumatic Intradural Internal Carotid Artery-Cavernous Sinus Fistula Associated with Ipsilateral Carotid Dissection
Authors: Oran I. , Parildar M. , Memis A. , Dalbasti T.
Published: January 2017

We describe a relatively unusual case of traumatic direct carotid-cavernous fistula in association with a giant intradural venous pouch and ipsilateral carotid dissection, related to carotid artery fistula located in the supraclinoid segment just below the origin of posterior communicating artery. Endovascular therapy could be accomplished by use of detachable coils transarterially. Awareness of an unusual intradural origin of a carotid-cavernous sinus fistula and the possibility of an embolization should be kept in mind.
Relevance of Occlusion Test in Endovascular Coiling of Posterior Cerebral Artery (P2 Segment) Aneurysms
Authors: Jayakumar P. N. , Desai S. , Srikanth S. G. , Ravishankar S. , Kovoor J. M. E.
Published: January 2017

P2 segment aneurysms are located on the posterior cerebral artery (PCA) between the junction of the posterior communicating artery with the PCA and the quadrigeminal cisternal part of the PCA. We reviewed our experience with endovascular coiling in such aneurysms. Clinical and pre-procedural data from four patients, referred for endovascular treatment of P2 segment aneurysms, were retrospectively studied for factors influencing post-interventional neurological deficits caused by ischemia of the PCA distal territory. Balloon occlusion was done in three patients and patient tolerance was assessed using clinical and anatomic criteria. Embryologic and anatomic features of the PCA were reviewed. Balloon occlusion test and endovascular coiling of aneurysms was possible in three patients. Control angiogram after embolization showed elimination of aneurysms from the circulation and the distal PCA filled through leptomeningeal anastomoses. One patient deteriorated due to aneurysmal rupture soon after the balloon occlusion test and coiling could not be done.

In the other three patients post-intervention CT and MRI images showed PCA territory infarcts in spite of demonstration of good collateral circulation distal to the occluded PCA. In conclusion, P2 aneurysms can be effectively treated by endovascular coiling without a balloon occlusion test. While the balloon occlusion test does not contribute to clinical decision-making it may be associated with potential morbidity and mortality.
Emergency Extracranial-to-Intracranial Bypass after Thromboembolic Occlusion of the Middle Cerebral Artery following GDC Embolization of a Ruptured ACoA Aneurysm
Authors: Standhardt H. , Gruber A. , Ferraz-Leite H. , Bavinzski G.
Published: January 2017

We report a case of thromboembolic occlusion of the middle cerebral artery after endovascular treatment of a ruptured anterior communicating artery aneurysm. When fibrinolytic therapy failed to recanalize the occluded vessel, an emergency extracranial-to-intracranial bypass was performed. This intervention rescued our patient from cerebral infarction. This case demonstrates the importance of the offering this procedure at neurointerventional centers.
Metachronous Multiplicity of Spinal Cord Arteriovenous Fistula and Spinal Dural AVF in a Patient with Hereditary Haemorrhagic Telangiectasia
Authors: Ling J.C.M. , Agid R. , Nakano S. , Souza M.P.S. , Reintamm G. , terBrugge K.G. , Kim Taik-Kun
Published: January 2017

HHT (Hereditary Haemorrhagic Telangiectasia or Rendu Osler Weber disease) is a known autosomal dominant dysplasia. The first clinical presentation of HHT in a child may be a cerebral or spinal AVM. We present the case of a young boy with HHT who had a previous spinal cord AVF treated by surgical obliteration and then presented with a spinal dural AVF nine months later.

This patient had surgical obliteration of a spinal cord perimedullary AVF and subsequently developed a new spinal dural AVF at a different level. The diagnosis was made by spinal MR imaging and spinal angiography
Initial Clinical Experience with a New Complex-Shaped Detachable Platinum Coil System for the Treatment of Intracranial Cerebral Aneurysms
Authors: Higashida R.T. , Cognard C. , Bracard S.
Published: January 2017

Endovascular coil occlusion of cerebral aneurysms is increasing as a viable treatment for both ruptured and unruptured aneurysms. The purpose of this study was to evaluate the safety and performance of a newer generation of complex-shaped, geometrically conformable, platinum coils, the TRUFILL DCS Detachable Coil System. From September 2000 to December 2002, 112 patients with 116 aneurysms, either ruptured or unruptured, deemed by an attending neuro-in-terventionalist to be acceptable candidates for endovascular coil embolization, were recruited into an open-label, prospective, multi-center, international registry study from 23 centers in Europe. Information on relevant clinical characteristics, device and procedure performance, and angiographic occlusion data were collected for all patients. An Independent Medical Monitor collected and reviewed information on all device- and procedure-related complications resulting in serious adverse events. Angiographic evaluation immediately following treatment of 116 aneurysms showed a mean ± SD percent of aneurysm occlusion of 93.5% ± 14.2, with 90.2% of aneurysms occluded at least 90%. The desired occlusion was achieved in 94.9% of aneurysms. Success was defined as the ability to obtain ≥ 90% aneurysm occlusion. The proportion achieving greater than 90% occlusion was statistically equivalent (at least as good) to the 80% registry standard. Complication rates were 6.9% device-related and 2.6% procedure-related. Only two complications were categorized as serious adverse events. The TRUFILL DCS coil system provided good to excellent complete occlusion of the aneurysm at initial treatment, as compared to other published studies, and proved effective and safe to use in treating both ruptured and unruptured cerebral aneurysms.
Traumatic Bilateral Common Carotid Artery Dissection Due to Strangulation
Authors: Chokyu I. , Tsumoto T. , Miyamoto T. , Yamaga H. , Terada T. , Itakura T.
Published: January 2017

We report a case of bilateral common carotid artery dissection due to strangulation successfully treated by stent placement, with a review of the literature. A 61-year-old woman was strangled by an apron strap. She was admitted to our hospital with tetraparesis, because of spinal cord injury. On the next day, her left hemiparesis aggravated and left facial palsy newly appeared. Diffusion weighted magnetic resonance imaging (MRI) showed new ischemic lesions in the right cerebral hemisphere. Aortography revealed bilateral common carotid artery dissection. Moreover, thrombus or intimal flap was recognized in the right common carotid artery. The right common carotid dissection was fixed with deployment of self expanding stents to prevent the aggravation of ischemic stroke at that time.

The contralateral lesion was also treated ten days later because small ischemic lesions were newly recognized in the left hemisphere on MRI. No new neurological deficit appeared after bilateral carotid artery stenting. Her paraparesis completely improved two months after the spinal cord injury. Carotid artery stenting using self expanding stents was especially effective as the treatment for bilateral carotid artery dissection.
A Case of Carotid Rete Mirabile Associated with Basilar Tip Aneurysm
Authors: Herwadkar A.
Published: January 2017

Carotid rete mirabile (CRM) is a rare condition consisting of a physiological network between the external and internal carotid arteries in lower vertebrates. Only a few cases have been reported in humans presenting as hemorrhagic or ischemic cerebrovascular disorder. We present a case of CRM presenting as an aneurysmal subarachnoid hemorrhage and discuss the embryologic, anatomic, hemodynamic and clinical significance of this rare entity.
Pathological Result of Basilar Artery Stenosis Rapidly Progressed and Ruptured with Stent-Assisted Angioplasty
Authors: Nagashima H. , Naito K. , Oya F. , Koyama J.
Published: January 2017

Intracranial artery angioplasty utilizing coronary stent is now widely tried as an effective alternative for treating intracranial artery stenosis, and several successful result of stent-assisted angioplasty for intracranial artery were reported.

Authors experienced a case of the basilar artery stenosis, in which re-stenosis progressed rapidly after simple balloon angioplasty and resulted in vessel rupture during stent-assisted angioplasty. Pathological result achieved by autopsy showed vessel wall disruption at the stent and multiple interruptions and defect of elastic laminar.
Endovascular Treatment of Urgent Carotid Occlusion
Authors: Tsumura K. , Kuwayama N. , Iwai R. , Kanbayashi T. , Satoh H. , Kubo M. , Endo S.
Published: January 2017

Emergency revascularization of acute carotid artery occlusion is still controversial. We treated 15 patients (13 men and two women, mean age of 67.3 years) with acute atherosclerotic carotid occlusion by endovascular procedures and evaluated the usefulness of this treatment. All of the patients were evaluated with emergency MRI and MRA before treatment. Intracranial tandem arterial occlusion due to distal embolism was observed in nine patients, and contralateral carotid stenosis (>70%) was observed in seven. The mean NIHSS score of the patients was 15.4±7.4 (mean±SD) before treatment. Treatment modality included local intraarterial fibrinolysis (LIF), percutaneous transluminal angioplasty (PTA), and carotid artery stenting (CAS). A protective balloon was successfully placed in the distal carotid artery through the plaque before recanalization in seven patients. Three patients were treated with LIF+PTA, five with PTA+CAS, six with LIF+PTA+CAS, and one with PTA only. Successful recanalization of the carotid artery was obtained in 14 of the 15 patients, and distal tandem middle cerebral artery occlusion was also successfully recanalized in eight of the nine patients. GOS was four or five in eight patients (good outcome group) and 1–3 in seven patients (poor outcome group). Mean NIHSS score of the 15 patients was (6.9 ± 7.4) after treatment. Preoperative NIHSS score (10.3 ± 7.4) in the good outcome group was significantly lower than that (21.3 ± 5.4) in the poor outcome group.

The protective balloon technique, PTA with stenting, seems to be useful for acute revascularization of urgent carotid occlusion. Simultaneous treatment of the intracranial tandem occlusive lesion is essential to achieve good clini-cal results. Patients with acute carotid occlusion with NIHSS scores of less than 16 could be good candidates for this advanced treatment.
Transvenous Removal of Glue from Obstructed Straight Sinus during Transarterial Embolization
Authors: Krajina A. , Lojik M. , Nahlovsky J.
Published: January 2017

Inadvertent embolization of the veins that drain arteriovenous intracranial shunts is likely to precipitate passive hyperemia with subsequent hemorrhage and brain edema. The mainstay of therapy for this complication is to decrease the flow through the shunt as much as possible and maintain the patient's blood pressure below baseline. We herein report our successful attempts at glue removal from partially obstructed straight sinus in two cases using a microsnare. This complication occurred during intracranial arteriovenous shunt embolization.
Giant Serpentine Internal Carotid Artery Aneurysm: Endovascular Parent Artery Occlusion
Authors: Prochazka V. , Chmelova J. , Cizek V. , Skoloudik D. , Hrbac T.
Published: January 2017

We report on a case of a 14-year-old boy with a giant serpentine aneurysm of the left internal carotid artery cavernous segment with symptoms of acute mass-effect cranial nerve dysfunction. After a balloon occlusion test of the collateral circulation, the patient underwent parent artery occlusion with platinum Guglielmi detachable coils and fibered coils. An optimal angiographic result and successful clinical outcome were achieved with resolution of IIIrd, IVth and VIth cranial nerve ischemic symptoms. CT angiography and 3D-XRA rotational angiography reconstructions gave sufficient inclusion information on the giant serpentine aneurysm angioarchitechture.
Giant Serpentine Aneurysm in a Patient with Multiple Endocrine Neoplasia Type 1 Syndrome
Authors: Zampakis P. , Papanastasiou V. , Devine J. , Bhattacharya J.
Published: January 2017

Giant serpentine aneurysms (GSA) are a rare, distinct group of giant intracerebral aneurysms. Multiple endocrine neoplasia type 1 (MEN 1) syndrome is characterised by tumours of the parathyroid glands, pancreatic islets and the pituitary.

We report a case of a GSA in a diabetic patient diagnosed with MEN 1 syndrome.
Restenosis after Carotid Endarterectomy: Incidence and Endovascular Management
Authors: Oszkinis G. , Pukacki F. , Juszkat R. , Weigele J.B. , Gabriel M. , Krasinski Z. , Zieliński M. , Krejza J.
Published: January 2017

Surgical procedures designed to restore vascular patency for a recurrent stenosis following carotid endarterectomy (CEA) are burdened with technical difficulties as well as with the possibility of serious neurological complications. An endovascular approach employing transluminal percutaneous angioplasty and stenting (PTAS) is a promising solution to these problems.

We aimed to evaluate the incidence of carotid artery restenosis following CEA, and to evaluate the safety and efficacy of treating post-CEA restenosis with an endovascular technique (PTAS).

One hundred and two patients who underwent CEA for symptomatic and asymptomatic stenosis were included in the analysis. Clinical and sonographic follow-up examinations identified carotid artery restenosis in 16 patients, who fulfilled our criteria for endovascular treatment. Carotid PTAS was performed on symptomatic patients with a stenosis over 60% of the artery lumen (n=7) and in asymptomatic patients with a stenosis over 80% (n=9). The post-PTAS patients were evaluated by duplex sonography every three months over a 24 month follow-up period for evidence of restenosis.

The cumulative incidence of post-CEA carotid restenosis qualifying for PTAS was 9.3% during an average 12-month follow-up interval. The average time from CEA to carotid PTAS was 11 months. All 16 endovascular procedures were technically successful. All of the carotid arteries were widely patent following PTAS. There were no immediate perioperative complications. One patient died two days after carotid PTAS from a cerebral hemorrhage. Thirteen of the 16 patients remained asymptomatic and had no sonographic evidence of significant restenosis during the 24-month post-PTAS follow-up period. One patient developed a symptomatic 80% restenosis proximal to the stent six months after carotid PTAS. Another patient developed an asymptomatic 60% restenosis proximal to the stent at 24 months. One patient was lost to follow-up.

Following CEA, there is a significant risk of developing a symptomatic or high-grade carotid artery restenosis requiring correction. Endovascular treatment (PTAS) of a recurrent stenosis after CEA is a safe and effective alternative to repeat carotid surgery.
Comparing the Accuracy of Digital Subtraction Angiography, CT Angiography and MR Angiography at Estimating the Volume of Cerebral Aneurysms
Authors: Hanley M. , Zenzen W.J. , Brown M.D. , Gaughen J.R. , Evans A.J.
Published: January 2017

While there are many studies that compare imaging modalities in the detection of cerebral aneurysms there are no existing studies that compare two dimensional digital subtraction angiography (DSA), CT angiography (CTA) and MR angiography (MRA) in calculating the volume of cerebral aneurysms. This study will compare these imaging modalities on seven in-vitro models of known volume.

Seven silicone models of cerebral aneurysms were chosen representing slight variations in geometric shape and size. The volume of each model was measured by weighing the amount of water required to fill the aneurysm to the parent artery. Contrast enhanced images of the models were taken with DSA, CTA and MRA. The images were interpreted by four independent readers and the volumes were calculated. The measured volumes from the water weight analysis were compared to the volumes calculated from the interpreter's measurements. The accuracy of DSA, CTA and MRA were compared using the percent of absolute and true variance from the measured volume.

The average percent absolute variance for DSA was 14.3%, CTA was 16.8% and MRA was 18.6%. While these differences were minimal, comparing the percent of true variance demonstrated an average variance of −1.9% for DSA, 16.1% for CTA and −15.9% for MRA.

Calculating the volume of cerebral aneurysms, while increasingly important, is difficult and error prone. It is important to understand the limitations and inherent errors before relying on calculated volumes in clinical decision-making. Regardless of imaging modality, one should consider error rates of 14–19% for calculating volume while keeping in mind the tendency for CTA to overestimate volume, MRA to underestimate volume and DSA to both under and overestimate equally.
Relationship between Focal Inflammation and Symptom Exacerbation after Endovascular Coil Embolization for Symptomatic Intracranial Aneurysms
Authors: Suzuki S. , Kurata A. , Iwamoto K. , Yamada M. , Niki J. , Miyazaki T. , Oka H. , Fujii K. , Kan S.
Published: January 2017

As endovascular surgery (EVS) of symptomatic unruptured aneurysms can result in symptom exacerbation due to intra-aneurysmal thrombosis or lump formation by coils, this treatment remains controversial.

We present five women ranging in age from 58 to 76 years (mean 65.6 years) who suffered post-EVS symptom exacerbation attributable to local inflammation.

The aneurysms measured from 8 to 25 mm (mean 19 mm) and were located at the cavernous portion in four patients and at the origin of the ophthalmic artery in one. All underwent endosaccular embolization under local anesthesia. Immediately after embolization, 24 h anticoagulation therapy was started via the continuous injection of heparin; they also received anti-platelet therapy.

At one to three days post-EVS, all five patients manifested worsening of their cranial nerve symptoms.

In three other patients the symptoms were improved after EVS. We posit that inflammation induced by coil embolization may worsen cranial nerve symptoms transiently.

Our findings suggest that post-EVS follow-up is necessary and that patients exhibiting an inflammatory reaction be treated with anti-inflammatory drugs.
ICONE: An International Consortium of Neuro Endovascular Centres
Authors: Raymond J. , White P. , Kallmes D.F. , Spears J. , Marotta T. , Roy D. , Guilbert F. , Weill A. , Nguyen T. , Molyneux A.J. , Cloft H. , Cekirge S. , Saatci I. , Bracard S. , Meder J.-F. , Moret J. , Cognard C. , Qureshi A.I. , Turk A.S. , Berenstein A.
Published: January 2017

The proliferation of new endovascular devices and therapeutic strategies calls for a prudent and rational evaluation of their clinical benefit. This evaluation must be done in an effective manner and in collaboration with industry. Such research initiative requires organisational and methodological support to survive and thrive in a competitive environment.

We propose the formation of an international consortium, an academic alliance committed to the pursuit of effective neurovascular therapies. Such a consortium would be dedicated to the design and execution of basic science, device development and clinical trials. The Consortium is owned and operated by its members. Members are international leaders in neurointerventional research and clinical practice. The Consortium brings competency, knowledge, and expertise to industry as well as to its membership across a spectrum of research initiatives such as: expedited review of clinical trials, protocol development, surveys and systematic reviews; laboratory expertise and support for research design and grant applications to public agencies. Once objectives and protocols are approved, the Consortium provides a stable network of centers capable of timely realization of clinical trials or preclinical investigations in an optimal environment.

The Consortium is a non-profit organization. The potential revenue generated from client-sponsored financial agreements will be re-directed to the academic and research objectives of the organization. The Consortium wishes to work in concert with industry, to support emerging trends in neurovascular therapeutic development. The Consortium is a realistic endeavour optimally structured to promote excellence through scientific appraisal of our treatments, and to accelerate technical progress while maximizing patients' safety and welfare.
Endovascular Treatment of Aneurysmal Subarachnoid Hemorrhage Associated with Bilateral Common Carotid Artery Occlusion
Authors: Meguro T. , Tanabe T. , Muraoka K. , Terada K. , Hirotsune N. , Nishino S.
Published: January 2017

Cases of aneurysm associated with the occlusion of both common carotid arteries are very rare. We present a case of ruptured aneurysms of the basilar bifurcation and posterior cerebral artery coexisting with bilateral common carotid artery occlusion, successfully treated by endovascular coil embolization with a double-balloon remodeling technique. Finally, we review the literature. A 62-year-old woman presented with severe headache; a computed tomography scan demonstrated subarachnoid hemorrhage. Angiography revealed that the bilateral common carotid arteries were occluded.

The muscle branches of the vertebral arteries had anastomosed to the bilateral external carotid arteries. Bilateral posterior communicating arteries had developed and supplied the bilateral internal carotid arteries. Two aneurysms (a saccular aneurysm of the P1 portion of the left posterior cerebral artery and a wide-necked aneurysm of the basilar bifurcation) were also observed. Endovascular embolization of the aneurysms was successfully performed using a double-balloon remodeling technique.

The patient made a full recovery after treatment, and the aneurysms remained obliterated 12 months after embolization. We believe that this is the first report of ruptured aneurysms associated with bilateral common carotid artery occlusion successfully treated by endovascular coiling. The double-balloon remodeling technique was useful for treatment of wide-necked basilar bifurcation aneurysm.
Novel Use of the “Buddy” Wire
Authors: O'Hare A. , Brennan P. , Thornton J.
Published: January 2017

During interventional procedures the tortuosity of the vasculature hampers catheter stability. The buddy wire may be used to aid and maintain vascular access. We describe a case of acute subarachnoid haemorrhage secondary to dissecting aneurysm of the vertebral artery. We discuss the value of the buddy wire during balloon occlusion of the vertebral artery not as it is typically used, but to actually prevent the balloon repeatedly entering the posterior inferior cerebellar artery during the procedure.
How Intracranial Aneurysm Rupture Damages the Brain
Authors: Trojanowski T.
Published: January 2017

Intracranial aneurysm rupture causes arterial bleeding into the subarachnoid space (SAH). In the acute stage lasting around 5 minutes intracranial pressure (ICP) rises rapidly up to the level between systolic and diastolic blood pressures, which slows down the outflow of blood, facilitates clot formation in the site of rupture and leads to arrest of bleeding. Increased ICP lowers cerebral perfusion pressure, causing brain ischemia, which is unevenly distributed throughout the brain as a result of interhemispheric pressure gradients, arterial spasms and other factors. No-reflow phenomenon in the capillaries following temporary arrest or considerable slowing of circulation produces areas of hypoperfusion and reduced capacity of blood flow autoregulation scattered irregularly in the brain in the subacute stage up to 30 minutes following haemorrhage. Disturbed regional cerebral blood flow is accompanied by spots of damaged blood brain barrier resulting in brain oedema. After SAH the brain remains vulnerable to reduction of blood flow and hypoxaemia, which explains greater brain damage after secondary haemorrhage, and in some cases persistent neurological deficits or global brain dysfunction.
Modern Approach to SAH in Intensive Care Unit (ICU)
Authors: Bruder N. , Velly L. , Codaccioni J.-L.
Published: January 2017

SAH is still a severe pathology carrying a high risk of death or severe neurological morbidity. New diagnostic, monitoring and therapeutic methods are available for the detection and treatment of vasospasm. This includes transcranial Doppler, CT or MRI perfusion scan, protein S100B dosage, cerebral blood flow monitoring at the bedside. Medical treatment of vasospasm relies on increased blood pressure and dobutamine.

Emergency balloon angioplasty or arterial vasodilator infusion is mandatory in case of vasospam-induced ischemic deficit.

Despite several medical advances in the treatment of subarachnoid haemorrhage (SAH) due to aneurysm rupture, particularly interventional neuroradiology, it remains a potentially devastating illness with a high mortality rate. The most important determinant of outcome is neurologic state on arrival in the hospital, assessed with the World Federation of Neurological Surgeons (WFNS) scale (table 1) 1. Delayed cerebral ischemia due to cerebral vasospasm and medical complications due to SAH have both a major impact on outcome.

The cooperative aneurysm study, including 457 patients with SAH, showed that the proportion of deaths from medical complications (23%) was comparable with the proportion of deaths attributed to the direct effects of the initial hemorrhage (19%), rebleeding (22%), and vasospasm (23%) after aneurysmal rupture (2). Thus, the aim of ICU management is to prevent or to limit the consequences of vasospasm and to treat medical complications that can have an adverse effect on the brain.
Management of Posterior Fossa Dissecting Aneurysms
Authors: Chong W. K. Winston
Published: January 2017

Treatment and prognosis of 14 patients of posterior fossa arterial dissections (AD) and dissecting aneurysms (DA) in one institution was reviewed. Internal trapping of aneurysm was performed for six patients presenting with SAH (three Vertebral, one posterior cerebral, one posterior inferior cerebellar, one anterior inferior cerebellar DA). The patency of the parent arteries was preserved in four DA patients with SAH (two Vertebral, two Basilar DA), 1 incidental vertebral DA, and one DA patient with brainstem infarction using stents and coils (four patients) or coils only (two patient). Proximal occlusion of parent artery was performed in a vertebral DA with SAH. One patient with a superior cerebellar DA presented with a midbrain infarct developed SAH with spontaneous occlusion of the aneurysm two weeks later. Of the 14 cases, ten were angiographically stable or cured during a follow up period of four to 70 months. one spontaneously resolved and two recurred. There was one death.
Repeat Percutaneous Vertebroplasty at Cemented Vertebra with Fluid Sign and Recurrent Pain
Authors: Lin Chao-Chun , Chen Ing-Ho , Yen Pao-Sheng , Chen Der-Cherng , Hsu Shih-Hsiang , Kwong Sai-Tung , Chiu Cheng-Hui
Published: January 2017

Six patients (three females and three males) were referred from their clinicians for evaluation with complaints of recurrent pain. A follow-up MRI showed fluid at the cemented vertebral bodies. Repeat percutaneous vertebroplasty (PV) was performed in these six patients at the cemented vertebrae. Pain scores, mobility scores, and spine MRIs before the 1st P V, prior to the repeat PV, and 1 and 3 months after the repeat PV were obtained. One month after the repeat P V, the six patients had a mean pain score reduction of 6.2 points and a mean postoperative pain level reduction of 2.8 points. Four of the six patients demonstrated an improvement in mobility with a 1.7 point mean decrease one month after the repeat PV. There was decreased fluid and bone marrow edema in four of the six patients on the follow-up MRIs one and three months after the repeat PV. Repeat PV at cemented vertebrae with fluid signs may offer therapeutic benefits for recurrent pain.
Covered Stent Implantation for the Treatment of Direct Carotid-Cavernous Fistula and its Mid-Term Follow-up
Authors: Briganti F. , Tortora F. , Marseglia M. , Napoli M. , Cirillo L.
Published: January 2017

Carotid-cavernous fistulas are abnormal arteriovenous communications either directly between the internal carotid artery and the cavernous sinus or between the dural branches of the internal and external carotid arteries. These fistulas predominantly present with ocular manifestations and they are treated mainly by endovascular techniques in most cases. A detailed review of the literature allowed us to make a complete analysis of the information available on the topic. We describe a case of a direct carotid-cavernous fistula occluded by endovascular implantation of a covered stent, showing the persistence of results after three years.
Endovascular Treatment of ACom Intracranial Aneurysms
Authors: Finitsis S. , Anxionnat R. , Lebedinsky A. , Albuquerque P.C. , Clayton M.F. , Picard L. , Bracard S.
Published: January 2017

The immediate and long-term outcomes, complications, recurrences and the need for retreatment were analyzed in a series of 280 consecutive patients with anterior communicating artery aneurysms treated with the endovascular technique. From October 1992 to October 2001 280 patients with 282 anterior communicating artery aneurysms were addressed to our center. For the analysis, the population was divided into two major groups: group 1, comprising 239 (85%) patients with ruptured aneurysms and group 2 comprising of 42 (15%) patients with unruptured aneurysms. In group 1, 185 (77.4%) patients had a good initial pre-treatment Hunt and Hess grade of I-III. Aneurysm size was divided into three categories according to the larger diameter: less than 4 mm, between 4 and 10 mm and larger than 10 mm. The sizes of aneurysms in groups 1 and 2 were identical but a less favorable neck to depth ratio of 0.5 was more frequent in group 2.

Endovascular treatment was finally performed in 234 patients in group 1 and 34 patients in group 2. Complete obliteration was more frequently obtained in group 2 unlike a residual neck or opacification of the sac that were more frequently seen in group 1. No peri-treatment complications were recorded in group 2. In group 1 the peri-treatment mortality and overall peri-treatment morbidity were 5.1% and 8.1% respectively. Eight patients (3.4%) in group 1 presented early post treatment rebleeding with a mortality of 88%. The mean time to follow-up was 3.09 years. In group 1, 51 (21.7%) recurrences occurred of which 14 were minor and 37 major. In group 2, eight (23.5%) recurrences occurred, five minor and three major. Two patients (0.8%) presented late rebleeding in group 1.

Twenty-seven second endovascular retreatments were performed, 24 (10.2%) in group 1 and three (8.8%) in group 2, seven third endovascular retreatments and two surgical clippings in group 1 only. There was no additional morbidity related to retreatments.

Endovascular treatment is an effective method for the treatment of anterior communicating artery aneurysms allowing late rebleeding prevention. Peri-treatment rebleeding warrants caution in anticoagulation management. This is a single center experience and the follow-up period is limited. Patients should be followed-up in the long-term as recurrences may occur and warrant additional treatment.
Balloon-Assisted Superselective Intra-Arterial Cerebral Infusion of Bevacizumab for Malignant Brainstem Glioma
Authors: Riina H.A. , Knopman J. , Greenfield J.P. , Fralin S. , Gobin Y. P. , Tsiouris A.J. , Souweidane M.M. , Boockvar J.A.
Published: January 2017

Malignant brainstem gliomas (BSG) are rare tumors in adults, associated with a grim prognosis and limited treatment options. Currently, radiotherapy represents the mainstay of treatment, although new studies suggest an increased role for certain chemotherapeutic agents. Intravenous (IV) administration of bevacizumab (Avastin, Genentech Pharmaceuticals) has been shown to be active in the treatment of some enhancing malignant brainstem gliomas. The IV route of administration, however, carries a risk of systemic side effects such as bowel perforation, wound disrepair and pulmonary embolism. In addition, the percentage of IV drug that reaches the tumor site is restricted by the blood brain barrier (BBB).

This technical report describes our protocol in performing superselective intra-arterial cerebral infusion (SIACI) of bevacizumab using endovascular balloon-assistance in the top of the basilar artery in a patient with a recurrent malignant brainstem glioma. It represents the first time such a technique has been performed for this disease.

This method of drug delivery may have important implications in the treatment of both adult and pediatric brainstem gliomas.
Bare, Bio-Active and Hydrogel-Coated Coils for Endovascular Treatment of Experimentally Induced Aneurysms
Authors: Reinges M.H.T. , Krings T. , Drexler A.Y. , Ludolph A. , Sellhaus B. , Bovi M. , Geibprasert S. , Agid R. , Scherer K. , Hans F.J.
Published: January 2017

Endovascular treatments of cerebral aneurysms with bare platinum coils have a higher rate of recurrence compared to surgical clipping. This may be related to failed vessel wall reconstruction since histological and scanning electron microscopy results following embolization failed to demonstrate neoendothelialization over the aneurysm neck. The present study tried to elucidate whether the use of modified coils resulted in a better rate of reconstructing the vessel wall over the aneurysm neck in experimental aneurysms.

Aneurysms were created in 20 rabbits by intraluminal elastase incubation of the common carotid artery. Five animals each were assigned to the following groups: untreated, bare platinum coils, bioactive coils with polyglycolic/polylactic acid coating, and hydrogel-coated platinum coils. After 12 months, angiography, histology and scanning electron microscopy was performed.

No neoendothelial layer was visualized in the bioactive and bare coil groups with a tendency to an increased layering of fibroblasts along the bioactive coils at the aneurysm fundus. However, at the aneurysm neck perfused clefts were present and although a thin fibrinous layer was present over some coils, no bridging neointimal or neoendothial layer was noted over different coils. Following loose Hydrogel coiling, a complete obliteration of the aneurysm was present with neoendothelialization present over different coil loops.

The study demonstrates that with surface coil modifications complete and stable aneurysm obliteration may become possible. A smooth and dense surface over the aneurysm neck may be necessary for endothelial cells to bridge the aneurysm neck and to lead to vessel wall reconstruction.
Bilateral Frontal Sinus Pericranii with an Intratabular Course
Authors: Schenk B. , Brouwer P.A.
Published: January 2017

Sinus pericranii is a rare venous anomaly, representing a transosseous connection between the intracranial venous system and the epicranial venous system. We present an unusual case of bilateral frontal sinus pericranii in a 12-year-old boy, with associated lacrimation. Instead of the usual short bridging vein between the intra- and extracranial venous circulation, in our case the veins connecting the superior sagittal sinus and the left superior ophthalmic/orbital vein coursed intratabularly over a distance of several centimeters. To our knowledge, such a course has not previously been reported in literature.
An Atypical Case of Foster Kennedy Syndrome
Authors: Liang F. , Ozanne A. , Offret H. , Ducreux D. , Labetoulle M.
Published: January 2017

Foster-Kennedy syndrome was described in 1911 as an ophthalmologic manifestation of compression by a solid tumor in the frontal area with intracranial hypertension (ICHT). We describe a peculiar case of Foster-Kennedy syndrome associated with an arteriovenous malformation in which neither optic nerve compression nor ICHT was obvious. We discuss the different pathogenic mechanisms to explain this case, for which a chronic venous hypertension was the most probabile etiology.
Successful Endosaccular Coiling after a Balloon Occlusion Test of the Caudal Channel of a Double Origin of the Posterior Inferior Cerebellar Artery Originating from the Aneurysm Neck
Authors: Lee S.H. , Koh J.S. , Ryu C.W. , Lee C.Y. , Lee S.J.
Published: January 2017

Therapeutic strategies for unruptured aneurysms in elective procedures must be carefully planned with respect to safety. We describe the case of a patient who presented with an unruptured aneurysm associated with a double origin of the posterior inferior cerebellar artery (DOPICA), a rare variant of aberrant origin. A three-dimensional rotational angiogram clearly showed that the aneurysm incorporated the origin of the DOPICA caudal channel, which was more dominant than the cranial one. The aneurysm was completely obliterated using detachable coils after a balloon occlusion test (BOT) of the caudal channel was conducted to confirm the tolerance of the patient following sudden interruption of the more prominent flow coming from the caudal channel of the DOPICA. This report affirms the need to suspect anomalies associated with a DOPICA that predispose to intracranial aneurysms and highlights the potential role of a BOT in pretreatment hemodynamic evaluations of unusual aneurysms accompanying a particular developmental anomaly.
Cavernous Redirection of Venous Drainage after Partial Transvenous Coil Occlusion of a Sigmoid Sinus dAVF: Coil Mass Retrieval with Flexible Cysto-Urethroscopy Grasping Forceps
Authors: Pérez M. Aguilar , Kühn A. , Miloslavski E. , Henkes H.
Published: January 2017

We describe the case of a patient who presented with ocular symptoms (chemosis, proptosis, increased intra-ocular pressure, impaired visual acuity) eight months after the transvenous coil occlusion of an ipsilateral sigmoid sinus dural arteriovenous fistula (dAVF).

Digital substraction angiography revealed a partial occlusion of the left sigmoid sinus with coils. Since the connection from the sigmoid sinus to the internal jugular vein was obliterated by coils without interrupting the arteriovenous shunt, the venous drainage was redirected into the inferior petrosal sinus, the cavernous sinus and the superior ophthalmic vein.

The transjugular access to the inferior petrosal sinus was obstructed by a large coil mass in the jugular bulb. Several attempts to remove these coils with an Alligator retrieval device and a goose neck snare failed.

The coil mass was withdrawn via a direct access to the internal jugular vein using flexible cysto-urethroscopy grasping forceps, an urological device designed for the removal of kidney stones. After establishing anterograde drainage, the now accessible inferior petrosal sinus was occluded with fibered coils and the dAVF was completely obliterated. The ocular symptoms resolved within ten days.
Intercavernous Sinus Dural Arteriovenous Fistula Successfully Treated with Transvenous Embolization
Authors: Loumiotis I. , Cloft H. J. , Lanzino G.
Published: January 2017

The venous sinuses commonly found in the margins of the diaphragm and sella are venous interconnections between the bilateral cavernous dural sinuses and are termed intercavernous communications or intercavernous sinuses. They form a venous ring, a single “circular sinus” that extends throughout the skull base. We report the first case to our knowledge of an intercavernous sinus fistula. We emphasize the importance of thorough knowledge of lesion characteristics before considering any interventional procedure.

An 84-year-old woman presented with alarming progressive orbital symptoms for one month affecting her left eye. A cerebral angiogram showed an intercavernous sinus fistula supplied by internal and external carotid arterial branches.

Transvenous embolization through retrograde catheterization of the right inferior petrosal sinus allowed complete coil occlusion of the lesion. Cerebral angiography confirmed the absence of residual blood flow through the fistula.

This report represents the first case of an intercavernous sinus dural arteriovenous fistula successfully treated with transvenous embolization. A detailed awareness of the regional anatomy is essential for treatment approach and favorable outcomes.
Endovascular Treatment of Paraclinoid Aneurysms
Authors: Sun Y. , Li Y. , Li A-M.
Published: January 2017

The anatomical complexity of the paraclinoid region has made surgical treatment of intracranial ophthalmic segment aneurysms (OSAs) difficult. This study evaluated the safety and efficacy of endovascular treatment of paraclinoid aneurysms. We conducted a retrospective study of 28 patients with 30 aneurysms of the paraclinoid in whom treatment with endovascular techniques was attempted. Patient age, sex, presence of subarachnoid hemorrhage, aneurysm type, size of aneurismal sac and treatment modality were reviewed. Clinical evaluation and control angiography were performed between one and 43 months. Overall, complete occlusion was obtained in 26 aneurysms (86.6%), nearly complete (>90%) occlusion in two aneurysms (6.7%) and incomplete occlusion was observed in two aneurysms (6.7%). All endovascular techniques were successful. Procedure-related complications were observed in two patients (7.1%). Patients underwent follow-up for a mean of 14.8 months (range 1–43 months). Repeated coil treatment was performed in one patient. One patient died of massive brain infarction six days postoperatively and thus no follow-up data were available for this case. In 27 patients with follow-up studies, aneurysm closure was complete in 22 (81.5%) and incomplete in five (18.5%). Endovascular treatment is a safe and efficient alternative approach for paraclinoid aneurysms.
Intravascular Ultrasound and Virtual Histology of Basilar Artery Atherosclerotic Lesion
Authors: López-Rueda A. , García A. González , Pérez M. Aguilar , Jarrín I. Gutiérrez , Deyá A. Mayol
Published: January 2017

To our knowledge, this paper presents the first intravascular ultrasound and virtual histology (IVUS-VH) study in the basilar artery. IVUS-VH serves to characterize and determine the extension of the plaque and we also to check stent placement.
The Sacral Hiatus Approach for Drainage of Anterior Lumbo-Sacral Epidural Abscesses
Authors: Mathews M.S. , Ospina J. , Suzuki S.
Published: January 2017

Lumbosacral epidural abscesses are managed either conservatively with IV antibiotics or with open surgery, particularly in the presence of acute neurological symptoms. Their location makes it difficult for image-guided interventional approaches either for biopsy or evacuation. We report the sacral hiatus and canal as a corridor for image-guided minimally invasive abscess of lumbosacral epidural abscess for aspiration. A 56-year-old man presented to the emergency department complaining of six weeks of worsening low back pain. MRI of the patient's lumbosacral spine showed osteomyelitis involving his L5, S1 vertebrae, L5-S1 discitis, as well as an anterior epidural abscess extending from L4–5 disc space to the S2 vertebral level. Blood cultures grew out gram-positive cocci. For drainage, a 5-French micropuncture kit was utilized to access the hiatus. Under fluoroscopic guidance a microwire was then advanced along the sacral canal. An 18-gauge needle curved to approximate the contours of the sacral canal was then advanced over the guidewire. Once anatomic access was established 2 ml of thick purulent material was aspirated. The patient tolerated the procedure well, and no focal nerve root symptoms were noted following the procedure. Image-guided aspiration of lumbosacral epidural abscesses can thus be carried out in a safe and effective manner using a sacral hiatus approach.
Stent-Assisted Coil Embolization of Complex Wide-Necked Bifurcation Cerebral Aneurysms Using the “Waffle Cone” Technique
Authors: Liu W. , Kung D.K. , Policeni B. , Rossen J.D. , Jabbour P.M. , Hasan D.M.
Published: January 2017

Endovascular treatment of complex, wide-necked bifurcation cerebral aneurysms is challenging. Intra/extra-aneurysmal stent placement, the “waffle cone” technique, has the advantage of using a single stent to prevent coil herniation without the need to deliver the stent to the efferent vessel. The published data on the use of this technique is limited. We present our initial and follow-up experience with the waffle cone stent-assisted coiling (SAC) of aneurysms to evaluate the durability of the technique. We retrospectively identified ten consecutive patients who underwent SAC of an aneurysm using the waffle cone technique from July 2009 to March 2011. Clinical and angiographic outcomes after initial treatment and follow-up were evaluated.

Raymond Class I or II occlusion of the aneurysm was achieved in all cases with the waffle cone technique. No intraoperative aneurysm rupture was noted. The parent arteries were patent at procedure completion. Clinical follow-up in nine patients (median 12.9 months) revealed no aneurysm rupture. Two patients had a transient embolic ischemic attack at 18 hours and three months after treatment, respectively. Catheter angiography or MRA at six-month follow-up demonstrated persistent occlusions of aneurysms in seven out of eight patients. Another patient had stable aneurysm occlusion at three-month follow-up study. Our experience in the small series suggests the waffle cone technique could be performed on complex, wide-necked aneurysms with relative safety, and it allowed satisfactory occlusions of the aneurysms at six months in most cases.
Angioarchitecture and Treatment Modalities in Posttraumatic Carotid Cavernous Fistulae
Authors: Malan J. , Lefeuvre D. , Mngomezulu V. , Taylor A.
Published: January 2017

Posttraumatic carotid cavernous fistulae are abnormal direct hole communications between the intracavernous carotid artery and the cavernous sinus that can result from both blunt and penetrating trauma. They can be challenging lesions to treat and a variety of modalities and approaches have been proposed since endovascular treatment has become the standard treatment.

An analysis of the angioarchitecture of 32 consecutive patients treated in our service demonstrated that seven could be classified as small hole, eight medium and 17 large. Different size fistulae required varying endovascular tools. Small fistulae were best treated using coils and large and medium lesions with balloons. Large lesions were more likely to require multiple tools in order to achieve closure and had a lower chance of ipsilateral carotid preservation. All patients in the series were cured with a carotid preservation rate of 66%. There was no permanent morbidity associated with endovascular treatment.