bluuebunny/crossref_metadata_2025 huggingface dataset:
Basilar Artery Fenestration Aneurysms Treated with Guglielmi Detachable Coils
Authors: Nakstad P.H. , Bakke S.J. , Dale L.G. , Moen G.
Published: January 2017

Four patients with basilar artery fenestration aneurysms at the vertebro basilar junction were admitted after subarachnoid haemorrhage. In two of them attempted surgery failed. Subsequently, all four were embolised with Guglielmi Detachable Coils (GDC), three of them in the acute phase. In one case the initial embolisation was incomplete, but follow-up angiography demonstrated spontaneous total occlusion.

In another, partial reopening was treated with further embolisation. Three patients recovered completely after treatment. One patient still has deficits related to surgery of an accompanying aneurysm at the middle cerebral artery. He is clinically improving but still not back at work.

In two cases the fenestration was combined with a hypoplastic upper vertebral artery on one side. A hypoplastic veretebral artery on one side may frequently be part of the developmental anomaly of basilar fenestration aneurysms. The anatomical configuration and location of these aneurysms is such that their true nature is sometimes difficult to disclose at cerebral angiography and is only realised during embolisation. Treatment with GDC coils seems superior to surgery in basilar artery fenestration aneurysms.
Origin of the Perforating Arteries of the Interpeduncular Fossa in Relation to the Termination of the Basilar Artery
Authors: Brassier G. , Morandi X. , Fournier D. , Velut S. , Mercier P.
Published: January 2017

We studied the perforating arteries of the interpeduncular fossa in 100 human brains which had previously been embalmed and injected with coloured intravascular neoprene latex. Three groups of perforating arteries were observed: the short interpeduncular arteries, a group of very fine arteries which can originate on every artery in the interpeduncular fossa and are destined to the cerebral peduncles and the oculomotor nerves (III); the diencephalic arteries, larger in diameter, most of which supply the mamillary bodies; only a few of them (one or two) penetrate the diencephalic floor and reach the posterior limb of the internal capsule and the anterior and medial thalamus; the diencephalic arteries are either individual branches of the P1 segment of the posterior cerebral arteries (PCA) or stem from the same segment of the PCA via a trunk common to the mesencephalic arteries; the latter supply the mesencephalic area medial to the pars reticularis of the black substance.

Our study focusses on where the diencephalic and mesencephalic arteries originate, based on how both anterior longitudinal neural arteries merged into a basilar artery in the embryo. When merging was symmetrical, whether in the early stages or later, the origins are more or less equally distributed; however, when merging was asymmetrical, the great majority of the perforating diencephalic and mesencephalic arteries stem from the P1 segment on the side that merged earliest (cranially).
Multiple Spinal Perimedullary Arteriovenous Fistulae Associated with the Parkes-Weber Syndrome
Authors: Niimi Y. , Ito U. , Tone O. , Yoshida K. , Sato S. , Berenstein A.
Published: January 2017

We present a rare case of multiple spinal perimedullary arteriovenous fistulae associated with the Parkes-Weber (PW) syndrome.

A 31-year-old male known to have the PW syndrome involving the left leg since birth, presented with a 7-month-history of progressive myelopathy of the lower extremities and dysfunction of the bladder and bowel. Myelography demonstrated dilated intradural vessels. Angiography demonstrated two distinct single hole perimedullary arteriovenous fistulae near the conus at two different metameres. They were supplied by the left posterior spinal artery.

The patient was treated by transarterial embolisation using polyvinyl alcohol particles, which resulted in venous side occlusion of the fistulae. After the treatment, the patient developed transient worsening of the spasticity of the lower extremities, and was treated by heparinization. After heparinization, the patient partially recovered from the pre-embolisation status of his myelopathy.

The follow-up angiogram one year after the embolisation demonstrated persistent obliteration of both fistulae. At long-term follow-up, the patient can ambulate without assistance and work as a farmer.
Foramen Magnum Dural Arteriovenous Fistulae with Repeated Subarachnoid Haemorrhage
Authors: Kai Y. , Hamada J. , Morioka M. , Ushio Y. , Fujioka S.
Published: January 2017

We report a patient who had dural arteriovenous fistulae in the region of the foramen magnum with repeated subarachnoid haemorrhage. Magnetic resonance imaging revealed abnormal vascular structures on the right side of the medulla oblongata in an extra-axial portion.

Angiographic findings showed that the lesion was supplied from the meningeal arteries and drained directly into the subarachnoid vein. There was venous dilatation. Embolisation was performed via the transarterial approach using a micro coil and liquid material.

Three years after treatment, the patients' condition is good and follow-up angiograms confirmed the stability of the treatment outcome. While dural arteriovenous fistulae of the foramen magnum are rare, this malformation results in a high rate of bleeding and requires treatment.
Multiple Intracranial Arterial Aneurysms: A Congenital Metameric Disease?
Authors: Campos C. , Churojana A. , Rodesch G. , Alvarez H. , Lasjaunias P.
Published: January 2017

We reviewed the angiographic study and clinical charts of 398 consecutive cases of intracranial arterial aneurysms, involving adults and children in the last 11 years (1986–1997). Giant aneurysms, dissecting aneurysms, mycotic aneurysms, and fusiform aneurysm were excluded. From the 341 patients presenting so-called berry aneurysm disease, attention was paid to multiple aneurysm sub group. One hundred and thirteen cases were analysed and compared with a group of single AA (228 cases) from the same material.

Three longitudinal embryological territories giving rise to cranial endothelial cells and media were used to regroup the aneurysm sites. Eighty four cases presented aneurysms in the rostral region (74%), 20 cases with aneurysms involving rostral and middle territories (18%), 1 case presented aneurysm involving the middle and caudal territories (0.9%), 5 cases had aneurysms in the rostral and caudal territories (4.4%) and three cases presented aneurysm involving rostral, medial and caudal territories at the same time (2.7%). No multiple group was located in the middle or caudal territories alone. When several arterial territories were concerned they were adjacent in 95.6% of cases.

Multiple AA could therefore result from mesodermal/neural crest stem cell or focal endothelial cell defect within one or two (usually consecutive) embryonic segments. Mirror lesions would correspond to bilateral symmetrical impairment in the same territory or involvement of a group of cells with bilateral distribution. AA may result from a constitutional vasculopathy, later expressed with focal overproduction of the arterial wall without remodelling correction. Secondary mutations and triggers are likely to be needed to lead to such AA production.
Endovascular Embolisation of a Cerebral Arteriovenous Fistula with Hereditary Haemorrhagic Telangiectasia
Authors: Kobayashi E. , Shimazaki K. , Shimoeda N. , Yamakami I. , Yamaura A.
Published: January 2017

We report a case of cerebral arteriovenous fistula (AVF) associated with hereditary haemorrhagic telangiectasia (HHT). Although the patient had no symptoms from the cerebral AVF, the AVF was successfully embolised using a two-staged double provocative test. We reviewed the literature of HHT and have concluded that there are two types of cerebral arteriovenous communication in patients with HHT and endovascular embolisation is the most reasonable therapy for the fistula type from the standpoint of its angioarchitecture.
Balloon Migration into a Giant Carotid Aneurysm after Parent Artery Occlusion Using Detachable Balloons
Authors: Uchino A. , Maurer P.K. , Brara H.S. , Numaguchi Y.
Published: January 2017

We treated a 70-year-old man with a giant paraophthalmic region aneurysm of the right internal carotid artery using the parent artery occlusion technique with three detachable balloons. Initially, the patient did well, but migration of the distal balloon into the aneurysm was detected seven months later. This report suggests that initial parent artery occlusion using balloons will not always induce permanent thrombosis of a large aneurysm, because the occlusion and thrombosis is strictly dependant on the position of the balloons that are used, and adjunct use of coils may be indicated.
Thrombolytic Therapy for Cerebral Embolism
Authors: Hyogo T. , Kataoka T. , Hayase K. , Nakagawara J. , Takeda R. , Nakamura H. , Nakamura J.
Published: January 2017

We summarized our clinical experience of thrombolytic therapy for cerebral embolism to evaluate the relation between the prognosis and the occlusion site, and the role of pre-treatment CBF measurement for supratentorial cerebral embolism.

56 cases of thrombolysis were analyzed and results were compaired with conservative medical therapy group. For ICA embolism, we stopped thrombolysis in the early period because of its poor collateral circulation. MCA embolism seemed to be a good candidate for this treatment and results were significantly better than the conservative medical therapy group in good recovery rate, severe disablity rate and large size infarction rate. In basilar artery embolism, thrombolysis seemed to be the most effective treatment in spite of the high mortality rate.

Pre-treatment CBF measurement was important and useful to estimate the severity of ischemia, and it could make it possible to avoid severe hemorrhagic complications.
Intravascular Ultrasound with Percutaneous Transluminal Angioplasty for Supra-Aortic Arteries
Authors: Uno J. , Kawashima M. , Miyazono M. , Nakamura T. , Gi H.
Published: January 2017

One of the major complications during or after percutaneous transluminal angioplasty (PTA) is distal embolism.

We performed intravascular ultrasound (IVUS) to assess the morphological characteristics of atheromatous plaques which caused stenosis of arteries. In 7 cases of ICA stenosis, IVUS demonstrated hyperechoic plaques which were considered to be fibrous. Mixed type of plaque was observed in one case of ICA stenosis and another one case of ICA stenosis had plaque which was hyperechoic with acoustic shadowing. In all cases of SCA stenosis, plaques were hypoechoic, indicating fatty plaque. Distal embolism occurred after PTA in the case of ICA stenosis which had a mixed type of plaque.

It is important to evaluate plaque morphology to prevent distal embolism. PTA is considered to he contraindicated in cases of ICA stenosis having hypoechoic plaques or ulceration.
PTA for Internal Carotid Artery Stenosis
Authors: Ezura M. , Takahashi A. , Fukuchi M. , Yoshimoto T.
Published: January 2017

Thirty-one lesions of internal carotid artery (ICA) stenosis were treated by percutaneous transluminal angioplasty (PTA). All the patients were males except two. There were 18 extracranial ICA stenosis and 13 intracranial ICA stenosis. Four patients were treated in acute stage and 27 were in chronic stage. In 27 patients in the chronic stage, clinical presentation was transient ischemic attack or reversible ischemic neurological deficits or minor completed stroke. Dilatation of any degree was observed in all patients except one in the chronic group. Good dilatation (stenosis ratio after PTA is less than 50%) was observed in 11 out of 13 intracranial lesions and in 10 out of 14 extracranial lesions. Restenosis was two out of 11 intracranial good dilated lesions and 6 out of 10 good dilated extracranial lesions. No patients but one have experienced recurrent symptoms. Symptomatic complications occurred in only one patient who encountered arterial dissection during PTA resulting in severe hemiparesis.

In four patients in the acute stage, dilatation of any degree was observed in two and good dilatation was seen in two. In conclusion, PTA for chronic ICA stenosis is an effective and safe technique. However, extracranial lesions tend to develop restenosis. Self-expandable stent will be one of the solutions for extracranial lesions. Major complications of PTA are distal embolism and arterial dissection. PTA for acute ICA stenosis is a challenging technique.
Treatment of Restenosis after PTA for Internal Carotid Stenosis
Authors: Terada T. , Yokote H. , Kinoshita Y. , Tsuura M. , Masuo O. , Matsumoto H. , Nakai K. , Itakura T.
Published: January 2017

Thirteen cases of restenosis occurred after percutaneous transluminal angioplasty (PTA) in 63 cases of internal carotid stenoses. They were treated by PTA or carotid endarterectomy. The patients were sufficiently informed of each treatment. Seven of them were initially treated by repeated PTA. The stenosis ratio improved from 82% to 30% after repeated PTA on average. However, one case in the PTA treated group resulted in restenosis and then carotid endarterectomy was performed. The other case also caused restenosis and was treated by PTA. Six cases were initially treated by carotid endarterectomy and all cases were successfully treated without difficulty. The success rate of the PTA was 2/7 (29%) in restenosis cases. One case causing re-restenosis had severe calcification in the arterial wall. PTA was thought to be effective for the restenosis cases after initial PTA if the arterial calcification was not severe.
Follow-up Study after Percutaneous Transluminal Cerebral Angioplasty
Authors: Kazita K. , Mori T. , Fukuoka M. , Mori K.
Published: January 2017

The purpose of this study was to assess the safety and efficacy of percutaneous transluminal cerebral balloon angioplasty (PTCBA) of extra- and intra-cranial arteries by investigating procedural outcome. Eighty haemodynamically significant extra- and intra-cranial lesions (% diameter stenosis >70) in 74 clinically symptomatic patients were treated by elective and initial PTCBA between March 1991 and February 1996 and followed thereafter.

Death, stroke including transient ischemia, surgery, or repeated angioplasty of restenosis or new lesions were regarded as cerebral events after the initial PTCBA. Crescendo ischaemic symptoms disappeared completely after clinically successful dilatation. The clinical success rate was 81% (65/80). Angiographic restenosis rate at 3 months was 22% (14/65).

By life-table method, the death/stroke risk was 16% and death/stroke/surgery/repeated PTCBA risk was 49 % at 2 years following PTCBA, respectively.

In conclusion, PTCBA successfully, decreased recurrent neurological symptoms and produced a favourable short-term outcome, whereas restenosis limited long-term benefit.
Percutaneous Transluminal Angioplasty for Intracranial Atherosclerotic Stenosis
Authors: Mandai S. , Matsushita H. , Akamatsu S. , Maeda Y. , Gohda Y. , Sakurai M. , Matsumoto Y.
Published: January 2017

Eleven patients with symptomatic intracranial atherosclerotic stenotic lesions underwent percutaneous transluminal angioplasty (PTA). Seven patients had stenosis in M1 segment of the middle cerebral artery (MCA), two in the cavernous internal carotid artery, one in M2 segment of the MCA and one in the P2 segment of the posterior cerebral artery. Initial successful dilatation (less than 50% residual stenosis) was obtained in nine patients (81.8%). Permanent neurological deficit related to PTA was seen in one patient and transient symptoms were observed in two. Re-stenosis was revealed in two cases (18.2%) in the early follow-up period. All patients with successful dilatation and without re-stenosis never had TIA or stroke after PTA. Intracranial PTA is an effective procedure, but several problems remain to be solved.
Intra-Aneurysmal Embolization for the Treatment of Cerebral Aneurysms Using Detachable Coils
Authors: Hyodo A. , Kato N. , Anno I. , Sato H. , Nose T. , Okazaki M. , Kamezaki T. , Ito M.
Published: January 2017

From October 1993 to February 1998, intraaneurysmal embolization by endovascular treatment with detachable coils was performed for 41 cases of cerebral aneurysm. As a detachable coil, interlocking detachable coils (IDC) were used in the initial 15 cases and Guglielmi detachable coils (GDC) were used in the subsequent 26 cases.

As for 15 cases treated with IDC, complete occlusion was performed in 9 cases, subtotal occlusion in 4 cases and partial occlusion in 2 cases. In one of the partial occluded cases, a coil compaction occurred 6 months after embolization. Distal emboli were recognized on CT after embolization in 3 cases, however, only one case was symptomatic. Intra-operative bleeding occurred in one case, but no obvious hemorrhage after coil embolization in any case.

As for 26 cases treated with GDC, complete occlusion was performed in 18 cases, subtotal occlusion in 8 cases. In one case of basilar-tip aneurysm, a mild coil compaction occurred 6 months after embolization. Distal emboli were recognized on CT after embolization in 3 cases, however, only one case was symptomatic (minor stroke). No intra-operative bleeding and no obvious hemorrhage after coil embolization occurred in any case.

From our experiences, treatment for poor-grade ruptured aneurysm is still difficult, but intra-aneurysmal embolization for cerebral aneurysms using detachable coils is possible and a useful alternative, especially for surgically difficult aneurysms. The results of treatment of aneurysm with GDC are much better than those with IDC, so the indications for intra-aneurysmal embolization with GDC might increase in the future.
Clinical Results and Problems in Embolization for Intracranial Aneurysms Using Electrically Detachable Coils
Authors: Tsuura M. , Terada T. , Yokote H. , Kinoshita Y. , Nakai K. , Itakura T. , Ryujin Y. , Hyoutani G. , Moriwaki H.
Published: January 2017

Nineteen patients with intracranial aneurysm were treated using electrically detachable coils (GDC or IEDC) and angiographic results and complications were assessed. In 18 aneurysms treated by endosaccular occlusion, 11 (61%), 3 (17%) and 4 (22%) resulted in complete occlusion, neck remnant and dome filling, respectively. Neither haemorrhagic nor thromboembolic complications occurred in 19 patients. Embolization using electrically detachable coils seemed to be a safe and useful procedure without complications, but we should give attention to avoiding complications and incomplete occlusion in particular in a case of 1) wide-necked, 2) small (> 3 mm) or 3) complex-shaped aneurysms.
Coil Embolization for Intracranial Aneurysm by Direct Puncture of the Carotid Artery in Elderly Patients
Authors: Takata H. , Iida T. , Akai T. , Kumano K. , Iizuka H. , Kadoya S.
Published: January 2017

Seven aneurysms in elderly patients (average 78 year-old) were treated by intra-aneurysmal coil embolization. The 19 gage elastic needle or 4.0Fr. sheath introducer was placed into the carotid artery, and 3.0Fr. microcatheter was advanced into the aneurysm.

An operative difficulty to approach to the aneurysm due to arteriosclerosis was ameliorated by this method. Mobility related to this procedure was a local hematoma at the puncture site in one case.
A Case of Partially Thrombosed Giant Basilar Aneurysm Successfully Treated by Coil Embolization Followed by Proximal Clipping
Authors: Manabe H. , Fujita S. , Kimura M. , Hatayama T. , Suzuki S.
Published: January 2017

A case of unclippable partially thrombosed giant basilar artery (BA) aneurysm was treated successfully by intra-aneurysmal GDC embolization followed by proximal BA occlusion.

Balloon occlusion test of the BA showed a good opacification of the aneurysm angiographically through plentiful collateral flow from anterior circulation.

This combination may prevent coil compaction and will promote intra-aneurysmal thrombosis.
The Strategy of Dural Arteriovenous Fistula with Isolated Sinus
Authors: Masuo O. , Terada T. , Tsuura M. , Kinoshita Y. , Yokote H. , Itakura T. , Yamaga H. , Maeshima S. , Ozaki F. , Moriwaki H. , Oobayashi S. , Kuwata T. , Hyoutani G. , Nishiguchi T.
Published: January 2017

We treated 7 cases of dural arteriovenous fistulas (dAVF) with isolated sinus by transvenous direct embolization.

The fistulas located in the transverse-sigmoid sinus in 5 cases, superior sagittal sinus in 1 case and transverse-sigmoid and superior sagittal sinus in 1 case.

The initial symptoms were generalized convulsion in 2 cases, disturbed consciousness in 1 case, tinnitus in 2 cases and transient ischemic attack in 2 cases. We performed sinus packing with coils in all cases following transarterial embolization.

All patients improved neurologically after the treatments and AVFs completely disappeared in all cases.
Embolization of Posterior Circulation Aneurysms with Detachable Coils
Authors: Kazekawa K. , Fukushima T. , Tomonaga M. , Kawano T. , Kawaguchi T. , Kaneko Y. , Koizumi T. , Dosaka A. , Ooigawa H. , Hosoda H. , Gondo G. , Ideguchi H. , Ono A.
Published: January 2017

We evaluated the usefulness of endovascular treatment of posterior circulation aneurysms with GDCs and IDCs, Five cases were treated with IDCs, and 15 cases were treated with GDCs.

In this study, 8 aneurysms were identified at the basilar bifurcation, 3 at the P1 segment of the pasterior cerebral artery, 1 at the origin of the superior cerebellar artery, 2 at the vertebrobasilar junction, 1 at the origin of the posterior inferior cerebellar artery, 1 at the distal anterior inferior cerebellar artery, and 4 dissecting aneurysms at the vertebral artery.

Thirteen of the aneurysms were small (< 12 mm), 5 were large (13–24 mm), and 2 were giant (> 25 mm). Of the 20 patients, 14 patients returned to their previous occupation. Patients with permanent deficits included 2 patients with infarction caused by thromboembolic complications during the embolization procedure, and 2 with infarction caused by vasospasm. There were 2 deaths. The outcomes of the patients seemed favorable. However, long-term follow-up is necessary to determine the usefulness of detachable coils.
Intravascular Treatment for Cerebral Aneurysms
Authors: Negoro M. , Okamoto T. , Miyachi S. , Takahashi I. , Fukui K. , Nakabayashi K. , Hattori T. , Iwakoshi T. , Bundou M. , Fukasaku K. , Handa T. , Yoshida J.
Published: January 2017

We have treated 142 aneurysms with intrasaccular or parent artery occlusions. Selective intrasaccular occlusions were attempted on 109 cases. Total or subtotal saccular occlusion was achieved in 93 of 96 cases. Intrasaccular occlusion could not be achieved in 13 cases because of various reasons such as wide neck, branching from aneurysmal dome, difficult to catheterize, and aneurysm too small. Parent artery occlusion was attempted on 33 cases. Twenty-five patients had giant aneurysms of the internal carotid artery (ICA) at the cavernous portion. The rest of this group had dissecting or fusiform aneurysms of the vertebral artery. Parent artery occlusion was achieved in 30 cases with six ischemic symptoms. High percentage of occlusion rate and low morbidity and mortality for metallic coil embolization prove the efficacy of this endovascular treatment.
Surgical Management of Cerebral Aneurysms in Comparison with Endovascular Treatment
Authors: Ohnishi H. , Kosimae N.
Published: January 2017

We report our surgical results of 92 intrabasal (below the ophthalmic segment) carotid aneurysms and 16 basilar aneurysms after the era of skull base surgery.

These lesions were the most difficult location for neck clipping of aneurysms. Mortality, surgery associated mortality and morbidity of intrabasal carotid aneurysm surgery were 2.2%, 0% and 9.7% respectively. Mortality and morbidity of basilar ameurysm surgery were 0% and 6.2% respectively.

Although endovascular treatment of cerebral aneurysms with detachable coils is premising treatment due to its convenience and less invasiveness, results of this treatment must be superior to the results of microsurgery for it to become a widely accepted therapy.
An in Vitro Study to Define the Term “Dense Packing” of Aneurysms with Detachable Coils, Liquid Embolic Material and Their Combination
Authors: Mandai S. , Rüfenacht D.A. , Kinugasa K. , Ohmoto T.
Published: January 2017

The purpose of this study was to define the terms minimal and maximal “dense packing” of a given cavity with platinum coils and liquid material (cellulose acetate polymer; CAP) using precise in vitro volumetric methods. Tests were performed using a simple in vitro aneurysm model, precisely measured in volume and thereafter filled with platinum coils and/or CAP.

The volume of the aneurysmal cavity was measured with a very precise special micropump. The volume of each platinum coil (GDC) was also calculated. Minimal dense packing was defined as the point where there was angiographic evidence of complete filling of the cavity and exclusion from the parent lumen of the aneurysm. Maximal dense packing was defined as the point where introduction of additional coils resulted in their protrusion into the parent artery.

At minimal dense packing the ratio of aneurysm volume to coil volume ranged from 25.97% to 32.50%. At maximal dense packing the ratio ranged from 29.55% to 36.16%. The volumetric ratio of minimal and maximal dense packing obtained was lower than we had expected. The volumetric ratio with CAP was 106.08% and 126.08% and the ratio obtained by the combined use of coils and CAP ranged from 103.78% to 140.2%.

When the volumetric ratio of the packing is much lower than the ratio of dense packing by rough estimate, we should expect coil compaction and careful follow-up should be done. Liquid material filled the lumen more densely and the additional use of liquid may be useful to prevent coil compaction.
Percutaneous Transluminal Angioplasty (PTA) with Wallstent for Internal Carotid Artery Stenosis
Authors: Nishizaki J. , Arakawa Y. , Ishii A. , Morimoto M. , Yoshizumi H. , Goto Y. , Yamagata S.S. , Mitsudo K.
Published: January 2017

A 67 year-old male who had suffered from myocardial infarction, was admitted to our clinic to examine his internal carotid artery stenosis revealed by preoperative study for heart surgery.

Although he had no neurological symptoms, the angiograms showed severe stenosis of his right internal carotid artery. To improve stenotic internal carotid artery, PTA was performed employing a self-expanding stent. The stenotic right internal carotid artery was improved from 75% to 11% immediately after the stenting though restenosis mildly occurred up to 16% three months later. No complication occurred during this stenting procedure. Afterwards the patient uneventfully received coronary artery bypass grafting (CABG) surgery.
Spinal Dural AVF Two Cases with MRI Follow-up
Authors: Nishi S. , Hashimoto N. , Nakahara I. , Iwama T. , Sawada M. , Kojima A. , Nagata I. , Ishikawa M.
Published: January 2017

Spinal dural arteriovenous fistula (d-AVF) is one of the arteriovenous malformations that are treatable by surgery or embolization. We present two cases treated by embolization and stress the necessity of early diagnosis and treatment, and the usefulness of T2WI on MRI for follow-up after embolization.

One was a 51-year-old man who presented with gait disturbance and sphincter dysfunction. MRI revealed diffuse swelling on T1WI, and intramedullary high signal intensity on T2WI. A spinal d-AVF was found through tiny radicullomeningeal arteries via the right Th12 intercostal artery that drained into engorged retromedullary veins. The spinal d-AVF was embolized with 50% NBCA. Six months after the embolization, he was able to go back to his job, T2WI showed disappearance of the high signal intensity, which was confirmed at angiography one year after the embolization.

The other case was a 62-year-old man who presented with sensory disturbance and gait disturbance, MRI showed the same findings, without the flow voids on them in case 1. The high signal area in the central spinal cord was thought to be syringomyelia, in which a syrinx-subarachnoid shunt was tried in vain. On the surface of the spinal cord, abnormally engorged and tortuous vessels were found. The syrinx was not confirmed.

An angiogram showed a spinal d-AVF fed by the radicullomeningeal artery through a common trunk of the Th11/12 intercostal arteries with drainage into the retromedullary vein. The spinal d-AVF was embolized. Six months after the embolization, T2WI showed a decrease of high intensity areas. Early diagnosis and treatment are important for the prognosis of spinal d-AVF, T2WI may be the best way to check for recurrence.
Treatment of a Giant Aneurysm of the Right Middle Cerebral Artery with GDCs after Extracranial to Intracranial Bypass
Authors: Castro E. , Fortea F. , Villoria F. , Muñoz L. , Benito C , Morales F.
Published: January 2017

A case of a giant aneurysm of the right middle cerebral artery treated with Guglielmi detachable coils is reported. Extracranial to intracranial bypass had previously been performed and surgical trapping had been attempted.

During the endovascular procedure, balloon test occlusion of the middle cerebral artery was performed in order to demonstrate clinical and angiographic tolerance to parent vessel occlusion. A previous occlusion test in the right common carotid artery did not show sufficient flow through the bypass to perform safe parent vessel occlusion.

Diagnostic imaging, the endovascular procedure, and haemodynamic aspects in cases in which parent vessel occlusion is required after extracranial-intracranial bypass are described and the literature is reviewed.
Spontaneous Vertebrovertebral Arteriovenous Fistulae Clinical Features, Angioarchitecture and Management of Twelve Patients
Authors: Goyal M. , Willinsky R. , Montanera W. , terBrugge K.
Published: January 2017

Spontaneous vertebrovertebral arteriovenous fistula (SWAVF) is a rare condition which often presents as a bruit. We reviewed the clinical and imaging records of 12 patients with 13 SVVAVF fistulae who were managed at our institution over the last 14 years. Two patients had predisposing conditions, neurofibromatosis in one and Ehlers-Danlos syndrome in the other. Nine of the patients presented with a bruit; one patient presented with a myelopathy and one with congestive cardiac failure. Six of the 13 fistulae were at C1 and five of these six were children. In seven of the fistulae there was retrograde flow in the distal vertebral artery. Eight patients underwent endovascular treatment. Six required both contralateral and ipsilateral vertebral artery approaches. Coils (two patients), balloons (three patients), or a combination of agents including liquid adhesives (three patients) were used. Preservation of the vertebral artery was possible in three of the eight patients. Angiographic obliteration was obtained in all eight patients. There were no significant procedure-related complications. Embolisation is the primary treatment of SVVAVF and can be performed successfully with low morbidity. Preservation of the vertebral artery, although desired, is often not possible.
Acute Histologic and Ultrastructural Study in One Case of Human Basilar Tip Aneurysm Embolised with Guglielmi Detachable Coils
Authors: Padolecchia R. , Puglioli M. , Collavoli P.L. , Castagna M. , Nardini V. , Zucchi V. , Narducci P.
Published: January 2017

Histologic findings after Guglielmi detachable coils endovascular embolisation have been studied in experimental aneurysms. Few reports describe histopathologic reactions to platinum coils in humans. In this report we describe gross, light microscopic pathology and scanning electron microscopy study of a ruptured basilar tip artery aneurysm in a patient who died 16 hours following coiling.
Endovascular Treatment for Internal Carotid Stenoses
Authors: Terada T. , Tsuura M. , Yokote H. , Matsumoto H. , Masuo O. , Nakai K. , Itakura T. , Yamaga H. , Moriwaki H. , Hyotani G. , Kamei I.
Published: January 2017

Seventy four cases of internal carotid stenoses greater than 60% were treated by PTA and/or stenting 86 times. Sixty one cases of cervical ICA stenosis were treated 71 times. 11 cases of high cervical - intracranial ICA stenosis were treated 13 times. Two cases of ICA dissection were treated by stent deployment.

Stenotic ratio reduced from 79% to 29% in cervical ICA stenosis and 71 % to 32% in high cervical to intracranial ICA stenosis in average. Morbidity related to PTA and/or stenting was 2/74 (2.7%) and mortality was 0%. One was an ischemic complication and the other was a hemorrhagic complication due to hyperperfusion. Restenosis (stenosis greater than 70%) rate was 32%. Asymptomatic cerebral embolism were found in three cases (4.2%) on angiogram immediately after PTA and/or stenting. The complication rate related to PTA and/stenting was low but asymptomatic emboli were found in three cases.

Considering these results, the indication for PTA and/stenting should be restricted to patients with high risk group, such as cases with high medical risks or difficult CEA cases, if appropriate protective systems for cerebral emboli were not available.
Endovascular Treatment Using Detachable Coils for Non-Ruptured Intracranial Aneurysm
Authors: Satoh K. , Satomi J. , Nakajima N. , Nagahiro S.
Published: January 2017

Detachable coil embolization was performed on 34 non-ruptured cerebral aneurysms in 33 patients. Patients consisted of 28 females and five males, with an age range of 26 to 77 years.

Angiographic examination after coil embolization revealed complete or near-complete occlusion in 24 aneurysms (70.5%) and partial occlusion in three (8.8%). Detachable coil embolization was attempted unsuccessfully in seven aneurysms (20.5%).

Transient ischemic attack occurred in one case with coil migration. The combined mortality/morbidity rate was 0%.
Endovascular Treatment of Incidental Cerebral Aneurysms
Authors: Murayama Y. , Viñuela F. , Duckwiler G.R. , Gobin Y.P. , Guglielmi G.
Published: January 2017

One hundred and fifteen patients with 120 intracranial incidental aneurysms were embodied using the GDC endovascular technique at UCLA Medical Center.

Angiographic results showed complete or near complete aneurysm occlusion in 109 aneurysms (91%) and an incomplete occlusion in five aneurysms (4%). An unsuccessful GDC embolization was attempted in six aneurysms (5%).

One hundred and nine patients (94.8%) remained neurologically intact or unchanged from initial clinical status. Five patients (43%) deteriorated due to immediate procedural complications. All these complications occurred in the first 50 patients. No clinical complications were observed in the last 65 patients. In Groups 1 and 3, the average length of hospitalization was 3.3 days.

The technical evolution of the GDC technology has proved to be safe for the treatment of incidental aneurysms (0% morbidity in the last 65 patients). The topography of the aneurysm/s and the clinical condition of the patient did not influence final anatomical or clinical outcomes. GDC technology also brings a positive economical impact by decreasing hospitalization time and eliminating postembolization ICU care.
Interventional Neuroangiography in Neonates
Authors: Komiyama M. , Nakajima H. , Nishikawa M. , Kitano S. , Sakamoto H.
Published: January 2017

Two neonates with either vein of Galen aneurysmal malformation or dural sinus malformation (congenital dural arteriovenous fistula at the torcular herophili) are reported. In neonatal interventional neuroangiography, special attention should be paid to body temperature, contrast material, infusion fluid, heparin, and angio-equipment. In the neonatal period, the umbilical approach provides unique access routes to both arterial and venous sides of the cerebral circulation. Among them, transumbilical venous, transcardiac approach through the foramen ovale allows transarterial intervention from the venous side.
Indication of Thrombolysis for Middle Cerebral Artery Occlusion Using MR Diffusion - Weighted Image
Authors: Inagaki T. , Saito K. , Okuyama T. , Hirano A. , Takahashi A. , Irie S. , Inamura S.
Published: January 2017

We have evaluated the usefulness of diffusion-weighted MRI (DWI) for determining an indication of emergent thrombolytic revascularization therapy in patients with acute occlusive cerebrovascular disease. Out of twenty-nine patients with acute occlusion of the middle cerebral artery within six hours after the onset, nine patients performed thrombolytic therapy. In results, seven patients of them obtained revascularization and good outcome. DWI findings on admission were correlated to the cerebral blood flow measured by SPECT and classified into four types; Type 1: no high intensity, Type 2: high intensity only in the perforator's territory, Type 3: limited high intensity in the cortical branches' territory, Type 4: extended high intensity. As presented cases, the high intensity area seen on DWI became obvious infarction regardless of implementation of revascularization therapy. However, thrombolytic therapy could rescue the area of low CBF on SPECT and could improve clinical symptoms. We considered that the area of low CBF without high intensity on DWI was “ischemic penumbra” and classification of DWI findings could be a valuable indicator in determining an indication of thrombolytic therapy.
Angiographic Classification of Cerebral Embolism
Authors: Otsuka Y. , Waki R. , Fukazawa S. , Kitajima H. , Shimizu K.
Published: January 2017

Since 1994, we have treated 62 cases with hyperacute cerebral embolism with local intraarterial thrombolysis (LIT), but not all cases showed recanalization. We tried to classify these cases by angiographic results. Angiographically they could be classified into four types; tapering type, fading type, stump type, and edge type. The tapering and fading type had a significantly higher tendency to recanalize than the stump and edge type.

We think these classifications indicate the dissolubility of the cerebral emboli; the former two types dissoluble, the latter two types indissoluble. The tapering and fading type are the good indicators for LIT, but the stump and edge type may not be.
The Selection and Result of AVM treatment
Authors: Negoro M. , Miyachi S. , Hattori T. , Okamoto T. , Fukui K. , Fukasaku KA. , Iwakoshi T. , Yoshida J.
Published: January 2017

The treatment selection for cerebral arteriovenous malformation (AVM) still is in controversy. In order to find out the best way to treat AVM, we summarized the treatment result of AVM patients in our hospital. Sixty-three AVM patients who had been treated at Nagoya University Hospital since 1988 to 1997 were studied. The patient characteristics were nearly the same as other reported series. The treatment modalities include surgery, embolization and radiosurgery.

Rate of nidus disappearance was assessed in each treatment. Highest rate was observed in surgery or surgery with embolization. But new neurological deficits were seen in 37% of the patients of same group.

Nidus occlusion rate was not high in radiosurgery with embolization, but low in complication rate. The result showed the importance of embolization procedure in the treatment selection of AVM. The value of functional MRI as pre-therapeutic study is high in those patients whose AVM adjacent to eloquent area.
The Role of Intravascular Embolization Prior to Radiosurgery of Cerebral Arteriovenous Malformations
Authors: Inoue H.K. , Nagaseki Y. , Naitou I. , Negishi M. , Hirato M. , Shibazaki T. , Ohye C. , Andou Y.
Published: January 2017

The role of intravascular embolization prior to radiosurgery of cerebral arteriovenous malformations was evaluated based on the basis of the results of gamma knife radiosurgery in relation to hemorrhage and early obliteration after treatment. Nine of 213 patients experienced hemorrhage 4 to 42 months after radiosurgery.

All AVMs in these patients had dilated feeding arteries, and the flow of the AVM was rapid and/or high. An intranidal aneurysm was seen in one patient. Drainage of all AVMs consisted of a single and/or deep draining veins, and venous obstruction was found in six. Sixty-three of 87 patients followed for more than four years after radiosurgery were examined angiographically, and total obliteration of AVM was observed in 52 of them (82.5%). Early obliteration was found in 19 of the 34 patients examined within 12 months. The obliteration rate was significantly higher in slow- and low-flow AVMs (73.9%) than in rapid- and/or high-flow AVMs (18.2%). It is concluded that the role of intravascular embolization prior to radiosurgery is not only decreasing the size of the AVM but decreasing the risk of hemorrhage and shortening the latency period by decreasing their flow rate and flow volume.
Hemodynamic Perturbations in Cerebral Arteriovenous Malformations and Management Implications
Authors: Hacein-Bey L. , Young W.L.
Published: January 2017

Cerebral AVMs have high flow, low resistance shunts that induce regional hemodynamic disturbances and possibly neural derangements. A better understanding of these mechanisms may help treatment planning and the management of complications after endovascular or surgical treatment.

Although the precise mechanisms of hemodynamic perturbation are still relatively unclear, the presence of chronic cerebral hypoperfusion is central and widely believed to be associated with both neurological deficits at presentation (‘steal‘) and ‘hyperemic’ complications following shunt obliteration. The ‘normal perfusion pressure breakthrough‘ (NPPB) theory states that chronic hypoperfusion around AVMs induces the loss of autoregulatory capability; following AVM shunt obliteration, perfusion pressure elevation induces an increase in flow, due to ‘vasomotor paralysis’, which can cause hemorrhage. The ‘dissociative vasoparalysis' theory suggests that vasodilation is preserved but not vasoconstriction. However, pharmacologic exploration of cerebral autoregulation with induced vasoconstriction (phenylephrine) and vasodilatation (acetazolamide) helps identify 3 patterns of autoregulatory behavior. The vast majority of AVM patients appear to retain autoregulatory capability, despite low arterial feeding pressures, consistent with a “shift to the left” of the autoregulation curve. Pronounced hypotension may “exhaust” cerebrovascular reserve in some patients, predisposing to hemorrhagic complications in the post-operative period. Lastly, “vasoparalysis” may coexist with a combination of vascular insult and marked hypotension.

Clinical presentation, AVM angioarchitecture and peri-operative physiologic data (especially feeding artery and venous outflow pressures) may assist patient management. Patients can be identified in whom staged treatment is recommended initially. Following AVM obliteration, the patient's hemodynamic response, which may range from a minimal increase in A-V pressure gradient to significant CBF increase may be predicted, and blood pressure, fluid and ICP management adjusted accordingly, as the monitoring of post-operative cerebral hemodynamics remains difficult. Extreme attention to endovascular and operative technique must be exercised, as technical problems can be devastating.

Although incompletely understood, hemodynamic derangements associated with cerebral AVMs increasingly appear to be associated with intact cerebral autoregulation in most patients. As cerebral hemodynamics monitoring remains challenging, clinical, angiographic and physiologic data from interventional/operative monitoring must be used to guide patient management.
Intra-aneurysmal GDC Embolization for Ruptured Aneurysm in the Acute Stage
Authors: Ezura M. , Takahashi A. , Yoshimoto T.
Published: January 2017

This study focused on our experiences in intra-aneurysmal embolization for ruptured aneurysm in the acute stage. Clinical materials of this study consist of 37 patients who were treated with intra-aneurysmal GDC embolization within 72 hours after the onset of subarachnoid hemorrhage from December 1995 to July 1998. Patients with cerebral aneurysms are always examined as possible candidates for neurosurgical clipping. If the patient had any difficulties and/or problems on neurosurgical clipping (high age 22, poor grade 15, surgically difficult location 9, systemic disease 3), the patient was treated by intra-aneurysmal GDC embolization. GDCs were inserted as tight as possible. Then, spinal drainage was set in patients with thick subarachnoid hemorrhage. Tissue plasminogen activator was administered via the drainage in patients with thicker subarachnoid hemorrhage.

One patient experienced rerupture during peritherapeutic period. Symptomatic vasospasm was observed in three patients (8.1%). Good outcome was obtained in 26 out of 30 surviving patients. Symptomatic complication caused by distal embolism occurred in two patients.

In conclusion, intra-aneurysmal GDC embolization is thought to be sufficient regarding prevention of rerupture, incidence of vasospasm, and clinical outcome.
Comparison of Clinical Results between GDC Treatment and Direct Surgery for Ruptured Cerebral Aneurysms
Authors: Fukui K. , Miyazaki M. , Hattori K. , Osawa H. , Miyachi S. , Negoro M. , Yoshida J.
Published: January 2017

We present a comparison of clinical results between GDC treatment and direct surgery for ruptured cerebral aneurysms. From May 97 to April 98, 32 aneurysms were treated by direct surgery (DS) or GDC treatment. Treatments were selected depending on the clinical grade, degree of hematoma and anatomical aspect of the aneurysms. There were 13 GDC treated cases and 19 direct surgery cases. In GDC cases, there were acute stage embolization for ruptured basilar aneurysm, recurrence of case after clipping for BA-SCA aneurysm, advanced age cases, and systemic complication cases.

Glasgow outcome scale (GOS) in GDC cases were 8 GR, 2 MD and 3 SD. GOS in direct surgery cases were 7 GR, 4 MD, 4 SD and 4 deaths. Cases of severe subarachnoid hemorrhage with hematoma influenced the high death rate in direct surgery group. There were three complications associated with the procedure in the GDC group, however, the rate improved after advancement of the procedure. In conclusion, GDC treatment for ruptured cerebral aneurysm was satisfactorily acceptable compared to the results of direct surgery, however, more cases will be needed for precise comparison.
Development of Biologically Active GDC for the Treatment of Cerebral Aneurysms
Authors: Murayama Y. , Viñuela F. , Suzuki Y. , Akiba Y. , Duckwiler G.R. , Gobin Y.P. , Kaibara M. , Kurotobi K. , Iwaki M. , Abe T.
Published: January 2017

In Vitro Study: The surface of polystyrene dishes were treated either by: 1) collagen coating without ion implantation, or 2) collagen coaling with ion implantation. Ne+implantation was performed on area 2 with fluences of 1 times 1015at an energy of 150 keV. Bovine endothelial cells were cultured on the dishes and the resistance to detachment of cells was evalated with trypsin treatment.

Experimental Aneurysm Study: GDCs were coated with either type 1 collagen, fibronectin, vitronectin, laminin or fibrinogen. Ion implantation was then performed on these protein-coated GDCs. 56 experimental aneurysms were constructed microsurgically in the bilateral common carotid arteries of 28 swine. The aneurysms were embolized with standard GDCs or with ion-implanted protein-coated GDCs. The animals were sacrificed at day 14 after coil placement. The aneurysmal orifice was observed microscopically.

In vitro study showed that endothelial cell proliferation and strength of cell attachment were accerelated by ion implantation. On specimens examined 14 days post-embolization, greater fibrous tissue coverage at the neck of the aneurysm was observed macroscopically and microscopically with ion implanted GDCs, whereas only a fibrin-like thin layer covered the standard GDC surfaces.

These in vitro and in vivo studied indicate that ion implantation combined with protein coating of GDCs improves cellular adhesion/proliferation. This technology may provide an improvement in clinical outcome of cerebral aneurysms.