bluuebunny/crossref_metadata_2025 huggingface dataset:
Life-Threatening Arteriovenous Malformation of the Maxillomandibular Region and Treatment Outcomes
Authors: Churojana A. , Khumtong R. , Songsaeng D. , Chongkolwatana C. , Suthipongchai S.
Published: January 2017

We report on cases of life-threatening maxillomandibular arteriovenous malformations (AVM) whereby patients had successful endovascular treatment with good outcomes. Out of a total 93 facial AVMs treated endovascularly between 1991 and 2009, five patients (5.4%) had maxillomandibular AVMs. All presented with uncontrolled dental bleeding. Endovascular procedure was the primary treatment of choice in all cases, either transfemoral approach with arterial feeder embolization or transosseous puncture, depending on the accessible route in each patient. NBCA (glue) was the only embolic agent used. Tooth extraction and dental care were performed after bleeding was controlled.

All five patients (8–18 years) with a mean age of 12.4 years presented with massive dental bleeding following loosening of teeth, dental extraction and/or cheek trauma. The plain films and CT scans of four patients with AVMs of mandibles and one of maxilla, revealed expansile osteolytic lesions. The mean follow-up period was 6.6 years (ranging between one and 19 years). Three cases developed recurrent bleeding between two weeks to three months after first embolization, resulting from residual AVM and infection. Late complications occurred in two patients from chronic localized infection and osteonecrosis, which were successfully eradicated with antibiotic therapy and bony curettage. Complications occurring in two patients which included soft tissue infection, osteomyelitis and osteonecrosis were successfully treated with antibiotics, curettage and bone resection. No patient had a recurrence of bleeding after the disease had cured

Initial glue embolization is recommended as the effective treatment of dental AVMs for emergent bleeding control, with the aim to complete eradicate the intraosseous venous pouches either by means of transarterial superselection or direct transosseous puncture. Patient care by a multidisciplinary team approach is important for sustained treatment results.
Preoperative Embolization of Meningiomas with N-Butyl Cyanoacrylate
Authors: Kominami S. , Watanabe A. , Suzuki M. , Mizunari T. , Kobayashi S. , Teramoto A.
Published: January 2017

Meningiomas are often embolized before their surgical resection to reduce blood loss during surgery. Polyvinyl alcohol (PVA) particles have been the most frequently used material for embolization of meningiomas. We have used n-butyl cyanoacrylate (NBCA) as the first-choice material since 2001. Thirty-one meningiomas were embolized with NBCA. We report the result of embolization of meningiomas with NBCA in comparison with PVA particles.
Spontaneous Healing of Iatrogenic Direct Carotid Cavernous Fistula
Authors: Kwon H-J. , Jin S-C.
Published: January 2017

Direct carotid-cavernous fistula (CCF) by selective navigation using a microcatheter or microwire is a rare complication, and its timing of treatment has not been elucidated. We report two cases of direct CCFs resulting from injury to the cavernous posterior segment of the internal carotid artery during selective navigation. We did not plan to perform emergent endovascular treatment for these direct CCFs because no symptoms related to direct CCFs developed. Follow-up angiography revealed spontaneous healing of both direct CCFs. Close observation rather than emergent treatment may represent another option for direct CCF by selective navigation during the endovascular procedure.
Successful Endovascular Therapy of a Penetrating Zone III Jugular Bulb Injury
Authors: Yamanaka K. , Yamamoto A. , Ishida K. , Matsuzaki J. , Ozaki T. , Ishihara M. , Shimahara Y. , Nakajima S. , Sadamitsu D. , Yamasaki M.
Published: January 2017

Penetrating venous injuries via Zone III of the neck extended over jugular bulb are rare. The optimal strategies for these venous injuries are currently unknown because many of the vital structures in this region are poorly accessible to the surgeon and therefore it is difficult to control bleeding. A 76-year-old man got drunk and fell down onto a paper door. The wooden framework of the paper door was broken and got stuck deep in the right side of his neck. Enhanced computed tomography showed the wood stick had penetrated through the right jugular foramen and injured the jugular bulb. We successfully performed right sigmoid and jugular vein occlusion via an endovascular approach using Guglielmi detachable coils at first and then to draw out the wood stick in order to avoid venous bleeding. To our best knowledge, these venous injuries have reported in only four cases. Only one case was performed by endovascular approach using n-butyl cyanoacrylate (NBCA). Coil embolization is much better than NBCA in the light of reducing complications due to adhesion to the inserted wood stick and embolization of unintended vessels. Venous occlusion using coil embolization is the best way to treat a penetrating jugular bulb injury via zone III because of reducing the hemorrhage and air embolism.
Initial Experience of Intracranial Aneurysm Embolization Using the Balloon Remodeling Technique with Scepter C, a New Double-Lumen Balloon
Authors: Gory B. , Kessler I. , Nakiri G. Seizem , Riva R. , Al-Khawaldeh M. , Mounayer C.
Published: January 2017

The balloon remodeling technique (BRT) was designed for endovascular treatment of wide-necked intracranial aneurysms. To date, the balloon catheters available have had a single lumen and suitable guidewires ranging from 0.010 to 0.012 inches. We describe the first case of aneurysm embolization using the BRT with the new double-lumen balloon catheter, Scepter C®, navigable on a 0.014-inch wire, and discuss the benefit of such a device.
New Insight into Transient Contrast Enhancement on Computed Tomography after Endovascular Treatment of Stroke
Authors: Antonucci M.U. , Mocco J , Bennett J.A.
Published: January 2017

Transient contrast enhancement on computed tomography following endovascular treatment of stroke is a recognized entity that has been previously reported. Technological advances in brain imaging now have the potential to explore and refine its proposed etiology. We describe three patients in whom the location of contrast enhancement correlates with decreased cerebral blood volume on pre-therapeutic CT perfusion studies and with restricted diffusion on MRI. In this regard, contrast enhancement demarcated areas of completed cerebral infarction. The diagnostic and etiological implications are discussed.
Superior Sagittal Sinus Dural Arteriovenous Fistulas Treated by Stent Placement for an Occluded Sinus and Transarterial Embolization
Authors: Ohara N. , Toyota S. , Kobayashi M. , Wakayama A.
Published: January 2017

We describe a case of dural arteriovenous fistulas (DAVFs) involving the superior sagittal sinus (SSS) successfully treated with stent placement for an occluded sinus and transarterial embolization.

A 61-year-old man who had been treated with anticoagulation for a known SSS thrombosis presented with a sudden onset of headache. CT scan revealed an intraventricular hemorrhage and cerebral angiography revealed DAVFs involving the SSS which had severe venous congestion and sinus occlusion. We treated this case with a staged endovascular approach which consisted of stent placement for the occluded sinus and transarterial intravenous embolization resulting in complete eradication of DAVFs.

Recanalization of an occluded sinus by stent placement can reduce venous congestion and transarterial intravenous embolization can obliterate dural arteriovenous shunts. This staged strategy is feasible and should be considered a first option of treatment, especially for DAVFs which presented with intracranial hemorrhage and aggressive venous hypertension.
Delayed Transcutaneous Extrusion of Embolic Coils after Embolization of Facial Artery Pseudoaneurysm
Authors: Hetts S.W. , Mong S. , Sincic R. , English J.D. , Wilson M.W.
Published: January 2017

External carotid artery (ECA) pseudoaneurysm is a known complication of treatment for head and neck cancer. We report a case of facial artery pseudoaneurysm arising after irradiation and salvage surgery for advanced tonsillar cancer, that was treated with endovascular embolization. The case was complicated by delayed transcutaneous extrusion of embolization coils through the skin of the anterior neck. We review the literature for related cases of coil extrusion in the head and neck, and discuss the implications for pseudoaneurysm surveillance.
The Rapid Pull-Back Technique for Navigation across a Wide-Necked Aneurysm
Authors: Oran I. , Çinar C. , Bozkaya H. , Beşir F.H.
Published: January 2017

Embolization of wide-necked and/or giant aneurysms may fail due to the inability to pass across the aneurysm neck. We describe the rapid bull-back technique used in four patients in which a small diameter microcatheter with the aid of a hydrophilic microguidewire was navigated along the inner surface of the aneurysm, making a loop in the dome, exiting the neck to reach distal intracranial vessels. After withdrawal of microguidewire, the microcatheter is pulled back rapidly up to a predetermined length. This maneuver results in elimination of the loop, straightening the microcatheter to allow an exchange procedure for another device to cross the neck distally and continue the embolization procedure.

The rapid pull-back technique is useful during the endovascular treatment of wide-necked and/or giant aneurysms as it helps to achieve reliable access to the distal parent vessel with the microcatheter. This is of increasing importance since an increasing number of aneurysms will be treated in the future with refinements in various intracranial stents.
Effects of Hyper-Early (<12 Hours) Endovascular Treatment of Ruptured Intracranial Aneurysms on Clinical Outcome
Authors: Consoli A. , Grazzini G. , Renieri L. , Rosi A. , De Renzis A. , Vignoli C. , Nappini S. , Ammannati F. , Capaccioli L. , Mangiafico S.
Published: January 2017

Despite the encouraging results obtained with the endovascular treatment of ruptured intracranial aneurysms, few data are available on the effects of the timing of this approach on clinical outcome. The aim of our study was to evaluate the effects of the hyper-early timing of treatment and of pre-treatment and treatment-related variables on the clinical outcome of patients with ruptured intracranial aneurysms.

Five hundred and ten patients (167 M, 343 F; mean age 56.45 years) with 557 ruptured intracranial aneurysms were treated at our institution from 2000 to 2011 immediately after their admission. The total population was divided into three groups: patients treated within 12 hours (hyper-early, group A), between 12–48 hours (early, group B) and after 48 hours (delayed, group C). A statistical analysis was carried out for global population and subgroups.

Two hundred and thirty-four patients (46%) were included in group A, 172 (34%) in group B and 104 (20%) in group C. Pre-treatment variables (Hunt&Hess, Fisher grades, older age) and procedure-related variable (ischaemic/haemorrhagic complications) showed a significant correlation with worse clinical outcomes. The hyper-early treatment showed no correlation with good clinical outcomes. The incidence of intraprocedural complications was not significantly different between the three groups; 1.2% of pre-treatment rebleedings were observed.

The hyper-early endovascular treatment of ruptured intracranial aneurysm does not seem to be statistically correlated with good clinical outcomes although it may reduce the incidence of pre-treatment spontaneous rebleedings without being associated with a higher risk of intraprocedural complications. However, since no significant differences in terms of clinical outcome and pre-treatment rebleeding rate were observed, a hyper-early treatment is not be supported by our data.
Spinal Cord Arteriovenous Malformations in a Pediatric Population Children below 15 Years of Age the Place of Endovascular Management
Authors: Rodesch G. , Pongpech S. , Alvarez H. , Zerah M. , Hurth M. , Sebire G. , Lasjaunias P.
Published: January 2017

Among a global group of 164 spinal arteriovenous shunts, a series of 16 spinal cord arteriovenous malformations (SCAVMs) were diagnosed in a pediatric population below 15 years of age.

The majority of the lesions affected the male population; 6 were located in the cervical spine and 10 at the thoracolumbar level. Hemorrhage was the most frequent symptom encountered (63%). Half of the bleeds occurred only in the subarachnoid spaces. Neurological deficits (acute or progressive) revealed the SCAVM in 31% of patients.

The lesion was an incidental finding in one patient (6%). All the diagnoses (except one) were made by MRI. Selective angiography confirmed the diagnosis and identified the type of the lesion (nidus or fistula) and its angioarchitecture, stressing that the veins and their related features are the key point in the clinical eloquence of SCAVMs.

All the treatments performed were endovascular; no patient was deemed a surgical candidate. Therapeutic abstention was decided in 37% of cases, mainly for anatomical reasons. All the patients in this group improved (50% being normal and 50% presenting slight non-handicapping deficits due to the initial accidents). Embolisation was indicated in 10 patients (63%) and was performed with fluid agents (histoacryl*) except in the first patient who had been treated with particles.

Twelve percent of patients were cured (fistula), the remaining 88% having their lesion controlled to more than 50%. This partial treatment was always targetted towards the angioarchitectural weak points of the lesion.

All patients improved after embolisation, 45% of them being neurologically normal. Follow-up in this group ranges from 1.5 to 13 Years. No complications occurred after embolisation. No bleed, rebleed or clinical worsening has occurred after endovascular treatment.

The results in this series suggest that endovascular treatment (even partial but targetted) represents a safe and stable therapeutic alternative in the management of SCAVMs in this population.
Angio-CT
Authors: Grossi G. , Romanzi F. , MacChia G. , Ruffinengo U. , Calia S.
Published: January 2017

After nine months' experience with helical CT (Elscint Twin), we describe an epicrisis in 13 patients with intracranial aneurysms, 12 of whom were referred to us by the emergency room for suspect subarachnoid hemorrhage. After standard CT scan confirming subarachnoid hemorrhage, patients underwent angio-CT with display of the sac responsible for bleeding in all cases.

All patients subsequently underwent digital angiography which confirmed the angio-CT findings and in three cases disclosed associated malformations. The sensitivity, specificity and diagnostic accuracy of the technique are assessed in relation to the quality of the images obtained (MIP) in such a short time (15 min on average).

The diagnostic information is comparable to that offered by angio-MR with the obvious positive and negative aspects linked to each method.

Digital angiography remains the technique of choice in terms of diagnostic accuracy, but carries some risk to the patient.
Follow-up MR of Intracranial Cavernomas the Relationship between Haemorrhagic Events and Morphology
Authors: Willinsky R. , Harper W. , Wallace M.C. , Kucharczyk W. , Montanera W. , Mikulis D. , terBrugge K.
Published: January 2017

The purpose of this review was to determine whether a classification scheme for cavernomas based on the MR appearance is predictive of the natural history of the lesions with particular reference to the risk of haemorrhage.

We reviewed the clinical and MR findings in 156 patients with intracranial cavernomas. The dominant or symptomatic cavernoma was graded into three groups according to the appearance of the blood products. The presence of haemorrhage, mass effect and oedema was evaluated. Sixty patients had serial MRs with a mean follow-up of 1.9 years.

Subacute haemorrhage with mass effect and oedema was evident on the initial MR in 30 patients (19%). In seven patients follow-up MR showed haemorrhage with mass effect and oedema. Six of these bleeds were in the posterior fossa.

The haemorrhages seen on follow-up MR occurred in all three morphological types. Regression was found on follow-up MR in five of the seven patients who initially showed a bleed. In 35% of patients, the dominant or symptomatic cavernoma changed on serial MR.

Intracranial cavernomas are dynamic lesions with both active and regressive changes seen on follow-up MR. A classification system based on morphology was not found to be useful in predicting future bleeds. Bleeding rates, based on MR follow-up, were 10.9% in the posterior fossa and 1.7% in the supratentorial compartment.
The “Remodelling Technique” in the Treatment of Wide Neck Intracranial Aneurysms
Authors: Moret J. , Cognard C. , Weill A. , Castaings L. , Rey A.
Published: January 2017

The main factor limiting endovascular treatment of intracranial aneurysms is the shape of the aneurysmal sac, particularly the width of the neck.

In this study we present a new technique to occlude wide neck aneurysms that involve the temporary inflation of a non-detachable balloon in front of the aneurysm neck during each coil placement. The aim of the study is to present the feasibility, efficacy and safety of this “remodelling technique” (RT) compared to that of “normal” GDC treatment.

We selected 56 aneurysms in 54 patients for treatment with the RT. Thirty-seven (70%) of the patients presented with subarachnoid haemorrhage. Twenty-five (45%) of the aneurysms were located at the vertebrobasilar artery, 24 (43%) at the internal carotid artery, and seven at the level of smaller arteries.

Treatment was achieved in 52 aneurysms in 50 patients. Two aneurysms which were initially not completely occluded underwent a second treatment using the RT. Final results (i.e. the last follow-up angiography or results at the end of the treatment for the cases that have not yet had follow-up) consisted of total occlusion in 40 cases (77%), subtotal occlusion in nine cases (17%), and incomplete occlusion in three cases (6%). Angiographic evidence of clotting was observed during the procedure in three cases, resulting in one permanent deficit (quadranopia). Rupture of the aneurysmal sac occurred during the procedure in three cases, all of which were asymptomatic in the follow-up. Thus, morbidity due to the technique was 1/52 (1%) and mortality was 0/56 patients.

The remodelling technique allowed the treatment of 52 wide neck or badly shaped aneurysms that were not treatable without this technique. The results of occlusion with the RT seem better than those in our series of normal GDC treatment, and complications related to the technique are fewer.

This technique thereby extends the spectrum of treatable aneurysms without increasing the risk incurred by treatment.
Treatment of a Small Hole Post-Traumatic Carotid-Cavernous Fistula with a Non-Detachable Balloon Catheter
Authors: Kurata A. , Miyasaka Y. , Saegusa H. , Fujii K. , Kan S.
Published: January 2017

Transarterial detachable balloon embolisation has become a well established primary treatment of post-traumatic carotid cavernous fistula (CCF).

However, in some instances due to the complexity of the fistula, the treatment can be difficult or impossibile. A simple and useful technique using a non-detachable balloon catheter to easily navigate the microcatheter into the fistula via the transarterial route is discussed in this paper. The non-detachable balloon catheter allows easy navigation of the microcatheter into the small hole fistula, and complete occlusion of the fistula was obtained using one interlocking detachable coil (IDC) in the draining veins.

The method of using a non-detachable balloon catheter to navigate a microcatheter into a fistula is relatively easy via the transarterial route.
Percutaneous Transluminal Angioplasty for Intracranial Arteriosclerotic Lesions
Authors: Yokote H. , Terada T. , Ryujin K. , Kinoshita Y. , Tsuura M. , Nakai E. , Moriwaki H. , Hayashi S. , Itakura T.
Published: January 2017

Recent developments of the interventional neuroradiological technique made percutaneous transluminal angioplasty (PTA) possible even for intracranial arteries1.

We report our experiences of 17 cases treated by PTA including 9 intracranial internal carotid (ICA), 4 middle cerebral (MCA) and 4 vertebro-basilar arterial (VBA) stenoses and discuss the problems of the procedure.

All patients had cerebral ischemic symptoms and stenoses more than 60% calculated angiographically. Three of them were treated by PTA for residual stenoses after thrombolytic therapy for acute occlusion. We used PTA balloon catheters 2.0 mm to 3.5 mm in diameter (Stealth, Target therapeutics) for all PTA procedures. A PTA balloon was inflated for 1 min at 6 atm as a rule. All were successfully dilated (stenosis less than 50%) except one treated by PTA for residual MCA stenosis after thrombolytic therapy.

The patient died from massive infarction due to MCA re-occlusion caused by MCA dissection. Restenosis appeared in 4 of 16 patients. Repeated PTA was successfuly carried out for the 4 patients.

However, restenosis appeared in one of them but the patient is now on follow-up because of asymptomatic course.

PTA for intracranial arteries is an effective treatment but its indication should be determined strictly because of potential risk such as acute occlusion derived from dissection.
Angioplasty of Acute Occluded Cerebral Arteries
Authors: Nakayama T. , Tanaka K. , Kaneko M.
Published: January 2017

22 cases of stenosed or occluded cerebral arteries were treated by percutaneous transluminal angioplasty (PTA) in acute stage. There were 10 internal carotid lesions, 4 middle cerebral artery lesions, 5 intracranial vertebral artery lesions, and 3 basilar artery lesions. 14 cases were treated for residual stenosis after recanalization using urokinase.

Successful dilatation (over 50%) was achieved in 16 cases (73%). 3 lesions were inaccessible due to atherosclerotic change. There were no major complications. Restenosis was observed in 4 internal carotid lesions and 1 middle cerebral lesion. 7 (50%) cases with internal carotid lesions and 5 (63%) cases with vertebrobasilar lesions returned to their previous life.

The results suggest that PTA in acute stage is feasible for occlusive disease of cerebral arteries.
Endovascular Stenting of the Cervical Internal Carotid Artery
Authors: Hosotani K. , Okamoto S. , Yamashita K.
Published: January 2017

The purpose of this study was to determine the value of stenting in the treatment of occlusive vascular disease involving the cervical internal carotid artery. Clinical and angiographical results of stenting were compared those of conventional angioplasty alone up to 20 months of follow-up.

The Palmaz-Schatz stent was implanted in two patients with acute intimal dissection, whereas conventional angioplasty alone was performed in seven patients with arteriosclerotic stenosis. Initial procedural success was achieved in all the patients, and acute or subacute complications were not encountered at all.

One of the patients (14%) treated with conventional angioplasty alone developed late restenosis at three-month follow-up. The patients treated with stenting revealed satisfactory results clinically and angiographically.

The present results may suggest that stenting is an effective and safe method to treat dissection of cervical internal carotid artery, but larger clinical trials as well as experimental studies would be necessary to define the indications and refine the stents.
Intravascular Ultrasound Image System for Experimental Implantation of Various Stents
Authors: Konishi Y. , Damrinjap G. , Shiota M. , Sato E. , Hara M. , Saito I.
Published: January 2017

This report describes the experiments we have conducted with an ultrasound image system (IVUS) and a three-dimensional intravascular ultrasound image system (3-D IVUS), to examine where and how vascular stents should be applied in the lesion, as a step towards mastering the techniques of this therapeutic approach.

Based on the IVUS findings, it appears to be of importance to select an appropriate type of stent, and the indiscriminate application of stents must be avoided, except in emergency cases.
Cavernous Dural Arteriovenous Fistulas
Authors: Nemoto S. , Mayanagi Y. , Kirino T.
Published: January 2017

In transvenous endovascular treatment of dural arteriovenous fistula (AVE), access to the affected sinus is determined by venous drainage. In cavernous dural AVF, the route to the cavernous sinus is through the inferior petrosal sinus (IPS) or the superior ophthalmic vein. Other venous routes are not practical. Occlusive change of the IPS is a common finding. The transfemoral approach is not always easy because of obliteration of the IPS. In selection of the approach for the transvenous treatment of the cavernous dural AVF, these occlusive changes should be considered.
Classification of the Venous Route of Carotid Cavernous Sinus Fistula
Authors: Usami S. , Abe T. , Hata Y.
Published: January 2017

It is important to investigate the venous routes in and around the carotid cavernous sinus before endovascular interventional treatment to avoid complications such as glaucoma and central retinal vein thrombosis.

This paper classifies the anatomical features of the cavernous sinus and its venous routes and discusses four successfully treated cases.
Intra-Aneurysmal Occlusion of Cerebral Aneurysms Using Detachable Coils: Correlation of Aneurysm Neck Size and Treatment Results
Authors: Irie K. , Taki W. , Nakahara I. , Sakai N. , Isaka F. , Kikuchi H. , Nagao S.
Published: January 2017

The aneurysmal neck size seems to be an import ant factor in the endovascular treatment outcome4,5. The purpose of the present study was to measure aneurysm neck size on angiographic films, and compare the measured value with the extent of intra-aneurysmal occlusion performed with detachable coils.

The subjects were 22 patients with intracranial aneurysms treated using detachable coils. The cases were divided into two groups according to the aneurysmal neck size, 4 mm being the discriminating value for small neck.

The neck of the aneurysm was successfully occluded in 19 of 22 patients. Ten aneurysms had a small neck and 9 aneurysms had a wide neck. Complete aneurysm occlusion was observed in 70% of small neck aneurysms and 25% of wide neck aneurysms.

The results support that the size of the aneurysm neck correlates well with the effectiveness of endovascular treatment.
Long-Term Results of Ruptured Cerebral Aneurysms Embolized in Acute Stage with Interlocking Detachable Coils
Authors: Manabe H. , Fujita S. , Akasaka K. , Suzuki S.
Published: January 2017

We report on a series of eight patients presenting with SAH secondary to ruptured saccular (n=7) or dissecting (n=1) aneurysm, treated in the acute stage (within 14 days) by embolization with interlocking detachable coils (IDCs) who survived at least 3 months following initial hemorrhage.

Embolization resulted in complete occlusion in 2 of 7 cases of saccular aneurysm, 90–95% occlusion was obtained in the remaining 5 cases of saccular aneurysm. Proximal occlusion with intra-aneurysmal coil packing was achieved in 1 case of dissecting aneurysm.

In all 5 cases with partial occlusion, follow-up angiograms taken 2–4 months after the embolization showed partial recanalization due to coil compaction, while no recanalization was recognized in cases with complete occlusion in follow-up angiograms at 5 and 9 months respectively.

Clinical disability, at 9 months after the embolization was rated as none in 4 cases, moderate in 1, and severe in 1.

Two patients died of re-rupture at 4 and 8 months respectively after the embolization. Of the other 3 cases with partial recanalization, 2 were retreated by re-embolization or surgical clipping, one has been followed clinically and angiographically.

Histological findings of the re-ruptured aneurysm showed neither endothelialization of the aneurysmal orifice nor organization of the clot around the coils.

Aneurysmal re-rupture secondary to coil compaction related recanalization remains a critical factor in long-term clinical outcome and prognosis.
Problems in Endovascular Procedures in Acute Ruptured Intracranial Aneurysms
Authors: Shibuya T. , Kushi H. , Kinoshita K. , Saito T. , Hayashi N.
Published: January 2017

Fifteen patients with acute ruptured intracranial aneurysms were treated with interlocking detachable coil (IDC) embolization. All graded poorly, i.e., Hunt & Kosnik grades IV and V. Aneurysm occurred in the anterior circulation in 14 patients and at the basilar tip in one, of these, 13 were small and 2 large. The endovascular procedure was conducted in a transfemoral approach under local anesthesia. Aneurysmal obliteration was examined transitionally after embolization.

Final outcome was evaluated using the Glasgow outcome scale (GOS). Total aneurysmal occlusion was observed immediately after IDC embolization in 11 patients. Two cases of coil migration to the parent artery occurred during endovascular procedure in patients with severe atherosclerosis. Aneurysmal rupture occurred during the endovascular procedure in a small internal carotid artery aneurysm when coil detachment failed.

Follow-up angiography showed coil compaction in 2 patients, one patient experienced deterioration when the aneurysm ruptured. Eleven patients (73.3%) retained total aneurysmal occlusion and had no rebleeding. The overall GOS indicated good recovery in 5 patients, severe disability in 2, persistent vegetative state in 2, and death in 6.

IDC embolization in severe acute ruptured intracranial aneurysm successfully prevented rebleeding, but our series was limited by the very small aneurysm size and the presence of severe atherosclerosis.
3D CT Angiography as a Pre-Embolization Study for Embolization of Cerebral Aneurysms
Authors: Fukasaku K. , Negoro M. , Bundo M. , Kourogi N. , Yamano K. , Sone S.
Published: January 2017

An image guide for aneurysm embolization based on three dimensional CT angiography is reported. Multiplanner reformation (MPR) can measure the neck and dome of the aneurysm accurately enough to select the first coils for aneurysms.

For neck evaluation, cut model and virtual endoscope are helpful because we can observe the neck from inside of dome or parent artery. Proximal arteries are visualized by 3D images and MPR if needed.

Using laser lithography, we can get a real model of aneurysm and parent artery through which we can insert microcatheters and coils. 3D CTA is a dependable modality for embolization of cerebral aneurysms.
Intravascular Neurosurgery for Cerebral Aneurysm Using Interlocking Detachable Coils
Authors: Hyodo A. , Matsumaru Y. , Anno I. , Sato H. , Kato N. , Hashimoto T. , Yoshii Y. , Nose T. , Kamezaki T. , Okazaki M.
Published: January 2017

Instead of the Guglielmi detachable coil (GDC; Target Therapeutics, Fremont, California), the interlocking detachable coil (IDC; Target Therapeutics, Fremont, California) was the only available detachable and retractable coil in Japan until February 1997. From October 1993 to February 1997, endovascular treatment with IDCs were attempted for 25 cases of cerebral aneurysm.

Within 25 trials, 15 cases were treated by intra-aneurysmal coil embolization, 9 cases by parent artery or proximal occlusion using IDCs and one case could not be treated due to anatomical problems of the aneurysm. As for 15 cases of intra-aneurysmal coil packing, 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. Intraoperative bleeding occurred in one case, but no obvious hemorrhage after coil embolization in any case.

From our experiences, treatment for poor-grade ruptured aneurysm is still difficult, but intravascular surgery for cerebral aneurysms using IDC is possible and a useful alternative, especially for surgically difficult aneurysm.
Ion Implantation Modifies the Surface of GDCs: An Experimental Study in Swine Aneurysms
Authors: Murayama Y. , Viñuela F. , Suzuki Y. , Massoud T.F. , Guglielmi G. , Iwaki M. , Kamio M. , Abe T.
Published: January 2017

Ion implantation and protein-coatings were utilized to alter the surface properties (endothelial cellular adhesion) and enhance the thrombogenicity of Guglielmi detachable coils (GDCs) for endovascular treatment of cerebral aneurysms. These modified GDCs were compared with standard GDCs in the treatment of experimental swine aneurysms. Standard GDCs and ion-implanted protein coated GDCs were used to treat 32 aneurysms in 16 swine. GDCs were coated with either proteins, collagen (n = 5), vitronectin (n = 4), fibrinogen (Fn = 3), laminin (n = 2), or fibronectin (n = 2) and underwent Ne+ or He+ implantation with a fluence of 1 × 1014– 1015 ions/cm2 at an energy of 150 keV. Bilateral experimental swine aneurysms were embolized with standard GDCs (n = 16) on one side and with ion-implanted protein-coated GDCs (n = 16; total) on the other side. The necks of aneurysms were evaluated macroscopically and histopathologically at autopsy using day 14 post-treatment specimens.

Greater fibrous coverage of the necks of aneurysms were observed in the ion-implanted coil group.

The results of this experimental study indicate that Ion implantation combined with protein coating of GDCs improved cellular adhesion and proliferation. Future application of this technology may provide early wound healing at the necks of embolized wide-necked cerebral aneurysms.
Endovascular Approach vs Microsurgical Approach for Posterior Circulation Aneurysms
Authors: Nakabayashi K. , Negoro M. , Itou Y. , Ichihara K.
Published: January 2017

We compare the results of detachable coil embolization with those of surgical clipping in patients with posterior circulation aneurysms. Surgical procedure was performed in 31 patients (basilar tip: 13 cases, SCA: 8 cases, basilar trunk: 1 case, VA: 9 cases). Thirty one aneurysms were treated by embolization with Guglielmi detachable coil (GDC) and interlocking detachable coil (IDC) (basilar tip: 14 cases, SCA: 1 case, basilar trunk: 6 cases, VA: 10 cases). In surgical cases, clinical outcome at discharge showed good recovery (GR) in 14 cases, moderate deficits (MD) in 11 cases, severe deficits (SD) in 2 cases, and dead (D) in 4 cases. In embolization cases, clinical outcome at discharge showed GR in 19 cases, MD in 4 cases, SD in 1 case, and D in 1 case.

Embolization with detachable coils is less invasive than surgical clipping in the management of patients with posterior circulation aneurysms. Embolization with detachable coils in ruptured posterior circulation aneurysm cases at an early stage of SAH may improve clinical outcome.
2D-TOF MRA Follow-up Study of Percutaneous Transluminal Angioplasty for Severely Stenotic Cervical Internal Carotid Artery
Authors: Ueda T. , Yoshimura S. , Kaku Y. , Shirakami S. , Andoh T. , Sakai N.
Published: January 2017

Percutaneous transluminal angioplasty (PTA) for severe arteriosclerotic stenosis in the cervical internal carotid artery (ICA) was successfully carried out in 23 cases between December 1994 and August 1996. In order to analyze the condition of the cervical ICA in the early stage after PTA, 12 stenotic lesions of 11 cases were exposed to follow-up study of stenotic cervical ICA after PTA with magnetic resonance angiography (MRA) 1 to 150 days postoperatively. In six lesions, the diameter of the cervical ICA was dilated sequentially.

In another four lesions, the diameter of the cervical ICA was decreased in the first three weeks and dilated over the next three weeks. Angiographically, these lesions had a small intimal flap at the balloon dilated portion, which was speculated to cause the turbulent flow in the first stage. In the remaining 2 lesions, restenotic changes in cervical ICAs were observed within three weeks after PTA.

Follow-up angiography was performed over three months after PTA in five cases of this series and compared with MRA. Consequently, the diameters of the cervical ICA between angiography and MRA were closely correlated.

The evaluation of the lesion after PTA of the cervical ICA demonstrated that MRA is beneficial, but within three weeks after PTA, caution should be paid for underestimation of the small intimal flap on MRA.
Correlation of Continuous EEG Monitoring with [O-15]H2O Positron Emission Tomography Determination of Cerebral Blood Flow during Balloon Test Occlusion of the Internal Carotid Artery
Authors: Murphy K.J. , Payne T. , Jamadar D.A. , Beydoun A. , Frey K.A. , Brunberg J.A.
Published: January 2017

The purpose of this paper was to evaluate the utility of continuous electroencephalography (EEG) during balloon test occlusion (BTO) of the internal carotid artery (ICA). Continuous EEG monitoring and [O-15] H2O PET cerebral blood flow (CBF) studies were completed in 34 patients undergoing BTO of the ICA. CBF determinations were obtained as a baseline without carotid occlusion, and following balloon occlusion, with continuous EEG monitoring. Patients were divided into three groups based on clinical and CBF response to BTO.

Group I had no clinical signs or symptoms and had a CBF decrease less than 10 ml/100 g/min ipsilateral to the occlusion. Group II had no symptoms but CBF fell to 35 to 25 ml/100 g/min on the occluded side. Group III were clinically unable to tolerate occlusion or CBF fell to less than 25 ml/100 g/min on the occluded side.

The results of continuous 21 channel EEG monitoring were assessed at the time of the examination and retrospectively reviewed for changes in the EEG pattern indicative of ischaemia. On the basis of PET CBF, eighteen patients were classified as Group I, four as Group II, and twelve as Group III. EEG evidence of ischaemia was seen in three patients, all members of Group III. Of the three patients, only one patient had clinical signs or symptoms of ischaemia. All four patients in Group II had PET quantitated CBF levels indicating carotid sacrifice should be done with caution or following a presacrifice by-pass procedure, and nine patients in Group III with PET quantitated CBFs below eligibility for carotid sacrifice, were not identified by EEG monitoring.

Even when CBF falls below 25 ml/100 g/minute continuous EEG monitoring is insensitive to reduction in perfusion. Reliance upon EEG for detection of cerebral hypoperfusion in interventionl neuroradiological procedures will significantly underestimate ischaemic risk.
Penetration Difference of n-Butyl 2-Cyanoacrylate into the Nidus in the Embolisation of Brain Arteriovenous Malformation
Authors: Suh Dae Chul , Kim Jun-Hyoung , Lee Moo Song , Park Sangsoo , Kim Sung Tae , Choi Choong Gon , Lee Ho Kyu , Kim Chang Jin , Song Ho-Young
Published: January 2017

Prediction of nidal penetration of the glue is difficult in the embolisation of brain arteriovenous malformations (AVM). We evaluated penetration differences of glue-lipiodol mixtures with and without tungsten powder for embolisation of brain AVM.

Fifty eight injections during embolisation of brain AVM in 15 patients were evaluated. Glue contained lipiodol only (N=25), or lipiodol and tungsten powder (N=33). Glue concentration ranged from 20 to 80%. Injection was done at the pedicle (N=41) or nidus (N=17). Degree of penetration was rated as good, fair, or poor according to penetrated glue amount in the nidus. Penetration difference was compared in each injection at the pedicle or nidus.

When the glue mixtures were injected at the pedicle, the glue-lipiodol mixture (GLM) penetrated into the nidus in eight of 16 injections (50%) and the glue-lipiodol-tungsten mixtures (GLTM) in 23 of 25 (92%). When glue was injected at the nidus, GLM was confined to the nidus in nine of nine injections (100%) and GLTM in seven of eight (88%). Penetration into the vein was noted in two of 25 injections (8%) in GLM and six of 33 (18%) in GLTM. Penetration difference into the nidus between GLM and GLTM was statistically significant (p < 0.05) when the glue mixtures were injected at the pedicle.

GLM and GLTM can be used effectively at the nidus. In contrast to GLM, GLTM can be used effectively at the pedicle. However, the risk of venous penetration seemed to be higher with GLTM than in GLM.
Motor Evoked Potentials Predicting Early Recovery from Paraparesis after Embolisation of a Spinal Dural Arteriovenous Fistula
Authors: Kothbauer K. , Pryor J.C. , Berenstein A. , Setton A. , Deletis V.
Published: January 2017

Spinal dural arteriovenous malformation is an increasingly diagnosed cause of ischaemic myelopathy. Though routine intraoperative monitoring has been demonstrated to be of benefit in the endovascular treatment of these lesions, its predictive value has not been well documented.

We present the case of an elderly woman with progressive spastic paraparesis who demonstrated marked improvement in limb muscle motor evoked potentials of the lower extremities immediately following endovascular occlusion of the lesion.

The patient subsequently showed improvement in strength, sensation and sphincter control.
Basilar Tip Aneurysms and Basilar Tip Anatomy
Authors: Campos C. , Churojana A. , Rodesch G. , Alvarez H. , Lasjaunias P.
Published: January 2017

Five hundred and eighty one cerebral aneurysms seen from 1986–1997 were reviewed. Fifty five basilar tip aneurysms were demonstrated. The analysis of the anatomic disposition of the distal basilar artery in 47 of them showed the prevalence of caudal fusion in 91% of cases. The fusion is either symmetrical or asymmetrical.

The neck of the aneurysm is preferentially implanted on the caudal part of the fusion. Recognition of the distal basilar artery anatomy allows the origin and extent of the perforating branches territory arising from the P1 segment to be predicted in each type of basilar tip disposition. The caudal variant supplies a small ipsilateral territory, whereas the cranial one often provides a bilateral supply.

In the cranial arrangement one can observe interpeduncular anastomoses between the perforators across the midline prior to penetrating the mesencephalo-diencephalic structures. The risks involved in the sacrifice of the P1 segment can then be anticipated.
Spontaneous Resolution of a Ruptured Dissecting PICA Aneurysm
Authors: Piske R.L. , Darwich R. , Campos C.M.S. , Fonseca N.C. , Oliveira E. , Souza A.
Published: January 2017

Spontaneous dissecting aneurysms (SDAs) seldom involve the intradural vertebral artery VA, the posterior cerebral, basilar or postero inferior cerebellar arteries (PICAs), where they produce subarachnoid haemorrhage and/or ischaemia.

These lesions may develop spontaneously or occasionally after minor trauma and occur in young people in whom there is no underlying abnormality to explain the appearance of the dissection in most cases.

Spontaneous dissecting aneurysm of the PICA is rare and its natural history is not well understood. Surgery or endovascular treatment for PICA dissection remain controversial because they suggest vessel occlusion. Only in a few cases is the bypass between the occipital artery and the PICA possible with trapping of the dissected segment. Reinforcement of the arterial wall does not seem efficient and the surgical approach per se with sole exclusion of the aneurysm may be disastrous.

We describe two cases of SDA of PICA that presented with subarachnoid haemorrhage (SAH), treated conservatively, with spontaneous cure of the lesions, angiographically confirmed at mid-time follow-up of five and four months. These favourable spontaneous thromboses, like 11 other similar case reported in the literature, did not show any rebleed. The possibility of a benign clinical course of this lesion exists; clinical and angiographic management of the patient before a decision for a aggressive treatment is proposed.
Influence of Temperature on Embolisation with Cyanoacrylate
Authors: Bracard S. , MacHo-Fernández J.M. , Wang X. , Anxionnat R. , Picard L.
Published: January 2017

We evaluated the influence of temperature on the viscosity of mixtures with different histoacryl/lipiodol concentrations and on injection control, to test the radiological visualization of these mixtures. A viscosimeter was used to measure the viscosity of different histoacryl and lipiodol combinations at various temperatures. After introduction of these blends into the polyethylene tubes, their radiological densities were evaluated by means of CT and DSA. Viscosity was found to be directly proportional to the percentage of lipiodol and inversely proportional to the temperature. By digital subtraction, the mixtures were still visible when the percentage of histoacryl reached 90%. Warming histoacryl and lipiodol mixtures to a temperature that is close to 40° C decreases the mixture's viscosity significantly and makes the injection easier to manage. Tantalum and tungsten powders do not necessarly have to be added to visualize mixtures containing less than 90% histoacryl.
Repositioning of Displaced Guglielmi Detachable Coils after Endosaccular Embolisation Using a Modification of the Neck Plastic Technique
Authors: Chaloupka J.C. , Huddle D.C.
Published: January 2017

After undergoing prior partial surgical clipping of an acutely ruptured internal carotid aneurysm, a 29-year-old woman was referred for endovascular treatment of the gradually enlarging aneurysm remnant. The aneurysm had a somewhat peculiar ellipsoid configuration due to placement of the clip, with the largest dimension measuring less than 4 mm, and the neck measuring approximately 2 mm. Using the conventional endosaccular coil embolisation technique, two small electrolytically detachable coils were carefully folded into the aneurysm sac to produce excellent tight packing. However, immediately after detachment, a loop of the second coil inadvertently herniated out of the aneurysm into the center of the parent artery, exhibiting substantial pulse synchronous displacement. This created a potentially unstable situation for the remaining coils within the embolised aneurysm. To correct this problem we attempted to reposition the loop into the aneurysm using a modification of the previously described neck plastic technique. This technique succeeded without untoward complication.

Although there are theoretical risks and limitations, the modified neck plastic technique may be useful in selective cases of inadvertent coil misplacement during endosaccular coil embolisation of aneurysms with the GDC system.
Stenting of the Extracranial Carotid Artery in a High-Risk Population
Authors: Matsushita K. , Akai F. , Teramoto Y. , Yokoi Y. , Aoki A. , Nakanishi K. , Taneda M.
Published: January 2017

The results of nine patients with carotid stenosis in a high-risk surgical population that were treated by stent supported angioplasty are reported. There were eight males and one female between the ages of 53 to 74. A balloon expandable stent was deployed by a transfemoral approach. Technical success was achieved in all cases. There were no periprocedural complications. The mean % stenosis decreased from 84% to 5.2% after stenting. No arterial dissection was recorded and smooth contour of the vessel was demonstrated in all patients. We have observed long term patency for over 6 months in seven patients. Mean angiographic stenosis was 20% and 21% at 3 and 6 months, respectively (range, 5 to 32%). No further stenosis was recorded. Carotid stenting is an alternative strategy to carotid endoarterectomy (CEA) for high-risk patients, for whom the complications of CEA may exceed the potential benefits.