bluuebunny/crossref_metadata_2025 huggingface dataset:
Type D Traumatic Carotido-Cavernous Fistula Due to Selective Transection of the Inferolateral Trunk(ILT)
Authors: Duncan I.C. , Fourie P.A.
Published: January 2017

A minority of traumatic carotido-cavernous fistulas (CCF) are of the indirect variety, and then usually supplied only by meningeal branches of the ipsilateral external carotid artery (Type C). We describe a case of a Type D CCF due to traumatic injury of the inferolateral trunk (ILT), and describe its angiographic features and endovascular management through both the external and internal carotid arteries following a failed transvenous approach.
Double Internal Carotid Origin of the Ophthalmic Artery with Ruptured Aneurysm of the Posterior Communicating Artery
Authors: Kam C.K. , Alvarez H. , Lasjaunias P.
Published: January 2017

We report a case of double origin of the ophthalmic artery from the carotid siphon. The persistence of the primitive dorsal ophthalmic artery, together with a ventral ophthalmic artery, constitutes the double origin of the ophthalmic artery. Remnant of intraorbital anastomoses formed by these two arteries is demonstrated. This represents a rare configuration of double origin of the arterial blood supply, which is discovered “incidentally” in a patient harboring a ruptured aneurysm of the posterior communicating artery.

The embryology of the ophthalmic artery and a possible association between vascular anomaly and arterial aneurysm can be envisaged.
A Novel Microcatheter-Delivered, Highly-Flexible and Fully-Retrievable Stent, Specifically Designed for Intracranial Use
Authors: Henkes H. , Flesser A. , Brew S. , Miloslavski E. , Doerfler A. , Felber S. , Monstadt H. , Kuehne D.
Published: January 2017

A new microcatheter-delivered, highly-flexible, fully-retrievable intracranial stent has been developed in order to facilitate the endovascular treatment of wide-necked aneurysms, though it might also prove useful for other intracranial pathology.

The nitinol stent has radiopaque proximal and distal markers, is available in a wide range of sizes and is as flexible as a micro-guidewire. It is electrolytically detached, allowing retrieval even after full deployment. The stent is compatible with all currently available embolic agents and does not degrade MR images.
Embolization of Vascular Malformations in Head and Neck Regions
Authors: Churojana A. , Chiewwit P. , Chuangsuwanich A. , Aojanepong C. , Chawalaparit O. , Suthipongchai S.
Published: January 2017

The purpose of this study is to determine the effectiveness of embolization of each type of vascular malformation.

Thirty three patients with a diagnosis of vascular malformations in head and neck regions who were treated by embolization at Siriraj Hospital, Thailand, between 1997–2002 were reviewed retrospectively. There were 19 arterio venous malformations (AVMs), two arteriolar-capillary types, ten venous malformations, one veno-lymphatic malformation and one mixed capillary and venous types. The goal of treatment is to restore function and to prevent bleeding complications with particularly good cosmetic results. The technique and therapeutic agents depended on the types and flow characteristics of each malformation. Transarterial embolization with N-butyl cyanoacrylate were used in AVMs, unless no arterial route approach, then direct puncture was tried. This was carried out in five patients with AVMs. Polyvinyl alcohol was used in two capillary lesions. All venous malformations were treated by absolute alcohol injection, percutaneously. All had good outcome without serious complications. Two patients had further plastic surgery, one was AVM of eyelid and the other was facial venolymphatic malformation. Embolization is considered to be the primary treatment by eradication of those abnormal vessels directly at the target, whereas delayed plastic surgery may be needed later.
Ruptured Intrasellar Superior Hypophyseal Artery Aneurysm Presenting with Pure Subdural Haematoma
Authors: Hornyak M. , Hillard V. , Nwagwu C. , Zablow B. C. , Murali R.
Published: January 2017

Subdural haemorrhage from a ruptured intracranial aneurysm is a well-known entity when associated with subarachnoid haemorrhage. However, haemorrhage confined only to the subdural space is rare because there are limited anatomical sites where extravasation can be purely subdural. We report the rare case of a patient who suffered pure subdural haematoma after the rupture of a left superior hypophyseal artery aneurysm located within the sella turcica. The patient was treated with endovascular coil embolization of the aneurysm. Angiography immediately after treatment and one month later revealed complete obliteration of the aneurysm. Six months after treatment, the patient remained symptom free.
In vitro and in vivo Studies of the Extent of Electrothrombotic Deposition of Blood Elements on the Surface of Electrolytically Detachable Coils
Authors: Henkes H. , Brew S. , Felber S. , Miloslavski E. , Mogilevski G. , Tavrovski I. , Kühne D.
Published: January 2017

Endovascular treatment of intracranial aneurysms with electrolytically detachable coils is often claimed to be based on electrothrombosis, i.e. intra-aneurysmal thrombus formation through applied direct current. Despite the fact that this concept was described more than a century ago, the significance of electrothrombosis in the endovascular treatment of aneurysms remains debatable. Apart from electrothrombosis, mechanical obliteration of the aneurysmal lumen might be one of the many possible mechanisms to explain why and how detachable coils are effective in preventing aneurysms from (re-)rupture. The purpose of this experimental study was to investigate to what extent direct current comparable to that used for coil detachment would influence the adhesion of cellular and liquid blood components to the surface of electrolytically detachable platinum coils.

For the in vitro study, electrolytically detachable platinum coils of various types were exposed to stagnant heparinised blood for a total of 16 h, without or with applied direct current for 30 or 90 s (1 mA, 4–6 V, coil as anode). For the in vivo study, electrolytically detachable platinum coils were exposed to flowing blood for 180 s, without or with applied direct current (2 mA, 4–6 V, coil as either anode or cathode), without anti-coagulation and after intravenous administration of 5000 U Heparin and again after the intravenous administration of 500 mg Aspisol in addition to Heparin. After exposure to blood according to these different experimental protocols, the coils were fixed in formalin solution, gold coated and examined by scanning electron microscopy.

Thrombus formation on the surface of all unfibred coils was thin and highly variable both from coil to coil, and on different areas of any given coil. The application of direct current minimally enhanced thrombus formation in stagnant blood in vitro, but not in vivo. The cellular and fibrin adhesions on the coil surfaces without and with applied current did not effectively increase the diameter or volume of unfibred coils. Coils with attached nylon fibres, however, proved to be highly thrombogenic without or with application of current. In fibred coils, surface adhesions without and with applied current were voluminous enough to effectively increase the diameter of the coil, potentially important for the process of endosaccular aneurysm occlusion.

Electrothrombosis plays no role in the endovascular treatment of intracranial aneurysms with electrolytically detachable coils. This explains why platinum coils with non-electrolytic detachment mechanisms show a similar efficiency and recurrence rate.
Endovascular Treatment of Acute Embolism of the Major Cerebral Arteries
Authors: Ota S. , Ota T. , Goto K. , Inoue I. , Ota T.
Published: January 2017

This study evaluated: 1) the effect of recanalization on changing clinical outcome, 2) the relationship between dose of Urokinase (UK) and incidence of recanalization and intracranial haemorrhage, and 3) the efficacy and feasibility of balloon disruption (BD) in the treatment of acute cerebral embolism.

Sixty-one patients with acute embolism of the major cerebral arteries treated by endovascular approaches over the past nine years were retrospectively evaluated. Among them, 30 cases were treated by BD alone or in conjunction with intra-arterial fibrinolysis in the last five years. The other 31 cases, mostly treated in the first four years, were treated with intra-arterial fibrinolysis alone and were used as controls to evaluate the efficacy of BD. Control angiography was performed just after the reperfusion procedure to evaluate the degree of recanalization. Angiographic responses were graded using modified Thrombolysis in Myocardial Infarction (TIMI) criteria. Clinical outcome was evaluated using modified Rankin Scale (mRS) score at the time of discharge.

Thirty-six of the 61 patients (59.0%) achieved high-grade recanalization (TIMI grade 3). Significantly more patients attained favorable outcome (mRS score 0–1) in the high-grade recanalization group than the low-grade recanalization group (41.7% vs. 16.0%, p< 0.05). Concerning patients treated with BD, significantly more patients attained good recanalization and significantly more patients were ambulatory (mRS score 0–3) than those treated with intra-arterial fibrinolysis alone (76.7% vs. 41.9%, p<0.01; 70.0% vs. 41.9%, p< 0.05, respectively). A significantly lower dose of UK was used, and relatively less intracranial haemorrhage was seen in patients treated with BD than those treated with intra-arterial fibrinolysis (194,000 ± 191,000 units vs. 388,000 ± 231,000 units, p=0.001; 16.7% vs. 38.7%, p = 0.055, respectively). Concerning morbidity and mortality of BD, there was one death caused by dissection of the M2 portion of the middle cerebral artery (MCA) that happened during BD on a distally migrated embolus.

Although no conclusions can be drawn from our study, a favorable outcome for acute embolism of the major cerebral arteries is expected by attaining good recanalization. In addition, BD is an effective technique that can achieve high-grade recanalization alone, or reducing the dose of fibrinolytic agent.
Takayasu Arteritis with Multiple Intracranial Aneurysms
Authors: Sonwalkar H.A. , Gupta A.K. , Purkayastha S. , Bodhey N.K. , Krishnamoorthy T.
Published: January 2017

A rare case of multiple cerebral aneurysms associated with Takayasu aortitis is reported. Only seven cases have been reported so far, all of which are from Japan. This is the first case with this association being reported from India.

A 50-year-old hypertensive woman developed sudden onset severe headache and loss of consciousness. CT scan revealed subarachnoid haemorrhage in the suprasellar cisterns and mild hydrocephalus. The patient on admission had a rebleed producing a massive subarachnoid haemorrhage. Angiogram revealed occlusion of bilateral vertebral arteries and right common carotid artery. The left carotid artery was ectatic with saccular aneurysms in the ophthalmic segment and communicating segment.

Aortogram showed the radiological picture of Takayasu arteritis Type III. Surgical clipping of the aneurysms was performed. However, the patient developed a massive right cerebral infarct in the postoperative period following which she expired. Abnormal haemodynamics in the overloaded cerebral circulation rather than primary arteritic involvement of intracranial vessels appears to be the cause of aneurysm formation.
Spontaneous Thrombosis of a High-Flow Carotid-Cavernous Fistula after Failed Transarterial Balloon Occlusion
Authors: Uchino A. , Takase Y. , Koizumi T. , Kudo S.
Published: January 2017

A 62-year-old man with a traumatic high-flow right carotid-cavernous fistula was treated by transarterial balloon occlusion technique. However, because of the relatively small size of the fistula, the balloon could not enter into the cavernous sinus via the fistula. During the procedure, the shunt flow decreased significantly, and we stopped the procedure. Follow-up angiography performed 14 days after the procedure showed complete occlusion of the fistula with a small residual pseudoaneurysm. One year later, the pseudoaneurysm had decreased in size. Repeated transient decrease and stagnancy of blood flow at the fistula during the balloon procedure may have played an important role in the thrombosis in this patient.
Rupture of a Large Vertebral Artery Aneurysm following Proximal Occlusion
Authors: Iwabuchi S. , Yokouchi T. , Kimura H. , Ueda M. , Samejima H.
Published: January 2017

Proximal occlusion of the vertebral artery is regarded as a safe and effective method of treating aneurysms of the vertebral artery or the vertebrobasilar junction unsuitable for treatment by neck clipping. Complications known to develop after this procedure include ischemic lesions of the perforators and other areas. There are only a limited number of reports on early rupture of aneurysm following proximal occlusion of the vertebral artery for the treatment of unruptured aneurysm. We recently encountered a case of large aneurysm of the vertebral artery identified after detection of brainstem compression. This patient underwent proximal occlusion of the vertebral artery with a coil and developed a fatal rupture of the aneurysm ten days after proximal occlusion.

The patient was a 72-year-old woman who had complained of dysphagia and unsteadiness for several years. An approximately 20 mm diameter aneurysm was detected in her left vertebral artery. She underwent endovascular treatment, that is, her left vertebral artery was occluded with coils at a point proximal to the aneurysm. Her initial post-procedure course was uneventful. However, she suddenly developed right-side hemiparesis nine days after procedure. At that time, CT scan suggested sudden thrombosis of the aneurysm. Right vertebral angiography revealed a small part of the aneurysm. She was treated conservatively. Ten days after the procedure, she suffered massive subarachnoid haemorrhage.

Both the present case and past reports suggest that proximal occlusion of the vertebral artery is effective in treating relatively large aneurysms unsuitable for treatment by neck clipping or trapping. However, when the bifurcation of the posterior inferior cerebellar artery (PICA) is distal to the occluded point in cases where the PICA bifurcates from the aneurysm or the neck region, blood supply to the aneurysm may persist because anterograde blood flow to the PICA may be preserved. Therefore, clinicians must consider the possibility of aneurysm rupture after proximal occlusion in the following cases: 1) when the aneurysm is large or giant, but non-thrombosed; 2) when thrombosis occurs soon after the procedure; 3) when postoperative angiography shows partial filling of the aneurysm with contrast agent through the contralateral vertebral artery of basilar artery or the cervical muscle branches.
Subarachnoid Haemorrhage from a Large Cerebral Aneurysm Visible Only on Repeat Angiography
Authors: Alves J.V. , Andersson T. , Edner G. , Soderman M.
Published: January 2017

We report the case of a 49-year-old woman with a massive subarachnoid haemorrhage in conjunction with trauma. The initial cerebral angiography was normal. Three weeks later she had a second subarachnoid haemorrhage. A repeat angiography demonstrated an eight mm aneurysm of the internal carotid artery bifurcation, a region clearly normal in the previous angiography.
N-Butyl 2-Cyanoacrylate Embolization of Spinal Dural Arteriovenous Fistula
Authors: Kwon B.J. , Kim T.-K. , Seo S.I. , Kyung J.B. , Seol H.Y. , Han M.H.
Published: January 2017

We report an unusual case of spinal dural arteriovenous fistula (SDAVF) presenting with subarachnoid haemorrhage (SAH). Cure was achieved with endovascular treatment with n-butyl 2-cyanoacrylate (NBCA). A review of the literature revealed five cases of cervical SDAVF that presented with SAH. None of these cases were treated with NBCA.
Spontaneous Intracerebral Hemorrhage Caused by an Unusual Association of Developmental Venous Anomaly and Arteriovenous Malformation
Authors: Fok K.F. , Holmin S. , Alvarez H. , Ozanne A. , Krings T. , Lasjaunias P.L.
Published: January 2017

We describe three patients who presented with spontaneous intracerebral hemorrhage resulting from the close association of developmental venous anomaly (DVA) and arteriovenous malformation (AVM). Angioarchitecturally, either the DVA formed the draining pathway for the AVM or they shared a common venous channel. The AVMs were treated by targeted embolization and the DVAs were carefully preserved. It is suggested that the unusual association of an AVM with the less flexible DVA was the cause of hemorrhage.
Bilateral Infraoptic Origin of Anterior Cerebral Arteries: A Rare Anomaly and its Embryological and Clinical Significance
Authors: Chakraborty S. , Fanning N. F. , Lee S. K. , TerBrugge K.G.
Published: January 2017

We describe a case of bilateral infraoptic origin of the anterior cerebral arteries associated with an anterior communicating artery (ACOM) aneurysm. Anatomical variations of the anterior cerebral artery (ACA) are common; however, bilateral infraoptic course of the anterior cerebral artery is extremely rare. Since an infraoptic course of the ACA is associated with ACOM aneurysm formation, an understanding of the cerebrovascular anatomy and embryology is important for appropriate management of the aneurysm.
Efficacy of 3-D Reconstructed Time of Flight MRA Follow-up of the Embolized Cerebral Aneurysms
Authors: Saguchi T. , Murayama Y. , Ishibashi T. , Ebara M. , Irie K. , Takao H. , Abe T.
Published: January 2017

A follow-up of the embolized cerebral aneurysm with Guglielmi Detachable Coils (GDC) were performed mainly using craniograms and digital subtraction angiograms (DSA) so far. Recently, several authors have reported about efficacy of the time of flight (TOF) magnetic resonance angiogram (MRA) as a follow-up for the embolized cerebral aneurysms. In our institution, 3-D reconstructed TOF MRAs have been performed as a follow-up of the embolized cerebral aneurysms. We examined efficacy of 3-D reconstructed TOF MRA.

3-D TOF MRA was performed for a follow-up of the embolized cerebral aneurysms at our outpatient clinic in 35 patients. Morphological examination of the 3-D images between 3-D TOF MRA and 3-D DSA was performed.

Almost similar images of 3-D MRA were obtained after 3-D reconstruction as compared with those of 3-D DSA. In three cases, recanalization was suspected in the 3-D TOF MRA. And recanalization was confirmed in the 3-D DSA actually.

A quality of 3-D TOF MRA for a diagnosis of recanalization was good and practical. However, in two cases, arteries were partially disappeared in the 3-D TOF MRA. These were the artifact due to coil mass and this is a current limitation of 3-D TOF MRA.

The images of 3-D TOF MRA that were reconstructed in the 3-D workstation were very similar to those of 3-D DSA. 3-D reconstructed TOF MRA was very useful for a less-invasive diagnosis of a recanalization of the embolized cerebral aneurysms.
Numerical Simulation of the Intra-Aneurysmal Flow Dynamics
Authors: Shojima M. , Oshima M. , Takagi K. , Hayakawa M. , Katada K. , Morita A. , Kirino T.
Published: January 2017

Intra-aneurysmal flow dynamics is analyzed qualitatively and quantitatively with numerical simulation technique, and presented for the future clinical application in embolizing cerebral aneurysms. From the volumetric data obtained by three-dimensional computed tomographic angiography, patient-specific vessel models were created for 16 middle cerebral artery aneurysms. Intra-aneurysmal flow dynamics was visualized and analyzed qualitatively, and the geometrical parameters of vessels and aneurysms that affect the intra-aneurysmal flow dynamics were determined quantitatively by correlation analysis. The flow velocity was delayed in the aneurysm cavity, especially at its tip where the rupture usually occurs.

The intra-aneurysmal flow dynamics was considerably influenced by the geometrical parameters that are related to the width of the neck and the branching angle of larger branch artery. The intra-aneurysmal flow dynamics is complex, and the numerical flow simulations with patient-specific vascular models seems effective in understanding the flow dynamics and planning the endovascular treatment of cerebral aneurysms.
Flow in a Tube with an Aneurysmal Sac: Effect of Aneurysm and Stent
Authors: Konishi Y. , Fukasaku K. , Kobori T. , Takakura Y. , Arai N. , Yazaki H. , Shiokawa Y.
Published: January 2017

Ruptured saccular aneurysms were severe condition for intracerebral Condition. And the cause for their rupture is not yet clear. In this study (I), since the configurations of aneurysms are considered to be a factor for the rupture of aneurysms, several shapes has been modeled using

Aspect ratio AR and inclination angle of saccular aneurysms. In vitro the parametric study has been conducted on the range of Reynolds Number in human blood flow for aneurismal models of AR=2.1 and 1.3 and q =90° and 70°, As results, it was con firme d that there are characteristic flow patterns with Reynolds Number, And that the aneurismal configuration has effects on the shear stress and pressure losses. II) The object of this paper is to study the effects of STENTS. We made the model of aneurysm and performed in vitro study in range of Reynolds number of human blood flows using three kinds of STENTS. As results, it was confirmed that flow pattern and pressure loss changes with the kinds of STENTS. This study aims the accumulation of data to predict the hazard of aneurysmal rupture by their shapes and STENTS.
Endovascular Coil Embolization for Cerebral Aneurysms Solely Using Ultrasoft Coils
Authors: Tsumoto T. , Terada T. , Yamaga H. , Itakura T.
Published: January 2017

We report a series of coil embolizations for small aneurysms solely using GDC ultrasoft coils and discuss the advantages of this method. Seven small aneurysms (<4.0 mm) were embolized solely with ultrasoft coils. Ultrasoft coils were sequentially inserted into aneurysms. Immediately after embolization, five aneurysms were completely occluded, and two exhibited body filling. All cases were treated successfully without any complications. In conclusion, ultrasoft coils were found efficacious for the treatment of small, irregular-shaped, and ruptured aneurysms; their softness and malleability facilitated their compaction into an aneurysm.
Thromboembolic Events during Endovascular Coil Embolization of Cerebral Aneurysms
Authors: Ishibashi T. , Murayama Y. , Saguchi T. , Ebara M. , Irie K. , Takao H. , Abe T.
Published: January 2017

Thromboembolic events was most important adverse event for coil embolization for intracerebral aneurysm. The present study investigated possible risk factors for thromboembolic events during coil embolization using diffusion-weighted imaging (DWI), comparing unruptured and ruptured lesions.
Diagnosis of Vertebral Artery Dissection by Basi-Parallel Anatomical Scanning (BPAS) MRI
Authors: Takada H. , Hyogo T. , Kataoka T. , Hayase K. , Nakamura H.
Published: January 2017

To diagnose VA dissection, MRA or cerebral angiography, which provides information regarding intra-vascular space, has been performed. We report the acquisition of various information about VA dissection using MRI-BPAS, which is a new diagnostic method.
Treatment of Vertebro-Basilar Dissecting Aneurysms Using Intravascular Stents
Authors: Yamasaki S. , Hashimoto K. , Kawano Y. , Yoshimura M. , Yamamoto T. , Hara M.
Published: January 2017

Endovascular surgery is an established primary therapeutic modality for dissecting aneurysms at vertebro-basilar arteries. Intravascular stents can be used to treat the dissecting aneurysms for which simple obliteration procedures cannot be used. In such cases, stent implantation alone or a combination of stents and coils need to be selected properly by taking into consideration the site and shape of dissections.

In this report, three patterns of stent application are described and their method of selection is discussed.
Dissecting Aneurysm of the Vertebral Artery Developed after Microvascular Decompression for Hemifacial Spasm
Authors: Kudo T. , Iihara K. , Murao K. , Hayashi K. , Ayabe J. , Miyamoto S.
Published: January 2017

We report a rare case of a ruptured de novo dissecting aneurysm induced by ethyl 2-cyanoacrylate. A 39-year-old woman underwent microvascular decompression for left hemifacial spasm. The offending vessel was left posterior inferior cerebellar artery (PICA). Left vertebral artery (VA) was mobilized and affixed to the dura mater with cyanoacrylate to remove pressure of PICA to the root exit zone of the facial nerve. The left VA was found to be intact at the time of the operation.

One year later, the patient sufferd subarachnoid haemorrhage (SAH) caused by rupture of a newly-developed dissecting aneurysm of the left VA. Endovascular occlusion of the dissecting site was performed using Guglielmi detachable coils. We suppose mechanical injury and chemical reaction of ethyl 2-cyanoacrylate induced dissecting aneurysm.
Carotid-Cavernous Fistula Associated with an Intracranial Lesion Caused by Cortical Venous Reflux
Authors: Takahashi S. , Sakuma I. , Otani T. , Yasuda K. , Tomura N. , Watarai J. , Kinouchi H. , Yanagisawa T. , Mizoi K.
Published: January 2017

Digital subtraction angiography (DSA) and magnetic resonance imaging (MRI) findings in 20 patients with carotid-cavernous fistula (CCF; 3 direct CCFs and 17 indirect CCFs) were retrospectively reviewed to evaluate venous drainage patterns that may cause intracerebral haemorrhage or venous congestion of the brain parenchyma.

We evaluated the relationship between cortical venous reflux and abnormal signal intensity of the brain parenchyma on MRI. Cortical venous reflux was identified on DSA in 12 of 20 patients (60.0%) into the superficial middle cerebral vein (SMCV; n=4), the uncal vein (n=2), the petrosal vein (n=2), the lateral mesencephalic vein (LMCV; n=1), the anterior pontomesencephalic vein (APMV; n=1), both the APMV and the petrosal vein (n=1) and both the uncal vein and the SMCV (n=1). Features of venous congestion, such as tortuous and engorged veins, focal staining and delayed appearance of the veins, were demonstrated along the region of cortical venous reflux in the venous phase of internal carotid or vertebral arteriography in six of 20 patients (30.0%). These findings were not observed in the eight CCF patients who did not demonstrate cortical venous reflux. MRI revealed abnormal signal intensity of the brain parenchyma along the region with cortical venous reflux in four of 20 indirect CCF patients (20%). Of these four patients, one presented with putaminal haemorrhage, while the other three presented with hyperintensity of the pons, the middle cerebellar peduncle or both on T2-weighted images, reflecting venous congestion. The venous drainage routes were obliterated except for cortical venous reflux in these four patients and the patients without abnormal signal intensity on MRI had other patent venous outlets in addition to cortical venous reflux.

CCF is commonly associated with cortical venous reflux. The obliteration or stenosis of venous drainage routes causes a converging venous outflow that develops into cortical venous reflux and results in venous congestion of the brain parenchyma or intracerebral haemorrhage. Hyperintensity of brain parenchyma along the region of cortical venous reflux on T2-weighted images reflects venous congestion and is the crucial finding that indicates concentration of venous drainage into cortical venous reflux.
Endovascular GDC Treatment of an Idiopathic Carotid-Cavernous Fistula Caused by Aneurysmal Rupture of the Intra-Cavernous Carotid Artery
Authors: Tatewaki Y. , Nishimura S. , Ezura M. , Nishino A. , Sasaki K. , Utsunomiya A. , Suzuki S. , Uenohara H. , Sakurai Y.
Published: January 2017

Aneurysmal rupture of the intra-cavernous carotid artery may cause idiopathic carotid-cavernous fistula (CCF), and the treatment choice for occluding shunting fistula in this type of CCF is an endovascular approach using detachable balloons. However, little has been reported on treating such lesions with the intra-aneurysmal embolization using Guglielmi detachable coils (GDCs). To our knowledge, ours is the first reported case of successful treatment by selective intra-fistula and intra-aneurysmal embolization with GDCs. A 74-year-old woman exhibited proptosis and chemosis of her left eye over a period of one month. Symptoms of double vision in conversion and pulsatile murmur in her left eye were also noted. Angiography revealed an intra-cavernous aneurysm of the left internal carotid artery (ICA) with a shunting fistula, which drained into the dilated cavernous sinus, superior orbital vein (SOV), superior petrosal sinus, inferior petrosal sinus, and pterygoid plexus. We thought the fistula would occlude by intra-aneurysmal embolization, but we had no confidence of tight packing of the aneurysm since the aneurismal neck was relatively wide. So, we embolized the venous side of the shunting fistula and then the dome of the aneurysm with GDCs. Immediately after the operation, her symptoms and signs were ameliorated, and complete occlusion of the CCF was observed on long-term follow-up. We suggest selective intra-fistula and intra-aneurysmal embolization with GDCs as an alternative method of treatment of idiopathic CCF originating from aneurysmal rupture of the intra-cavernous carotid artery.
A Case of Posterior Fossa Dural Arteriovenous Fistulas Successfully Treated with Transarterial Embolization
Authors: Watanabe K. , Kinkori T. , Takagi T. , Inoue T. , Takayasu M.
Published: January 2017

A 40-year-old man was transferred to our hospital due to sudden headache while swimming in the pool. CT revealed cerebellar haematoma within vermis associated with subarachnoid haemorrhage (SAH). Digital subtraction angiography (DSA) showed dural arteriovenous fistulas (DAVFs) with venous pouch on the surface of cerebellar vermis. Fistulas were on the meningeal surface near the sinus confluence. Draining veins formed venous pouch invaginating into cerebellar vermis.

Transarterial embolization (TAE) was performed under the concept that main feeder should be embolized last to occlude the DAVFs completely. Post-embolization 3D-CT showed the cast of N-butyl –cyanoacrylate (NBCA) in the fistulas as well as in the drainer. The good order of occlusion made the embolization complete.
Cerebral Blood Flow Change before and after Carotid Angioplasty and Stenting (CAS) in Cases with Contralateral Carotid Artery Occlusion
Authors: Kataoka T. , Hyogo T. , Hayase K. , Nakamura H.
Published: January 2017

Contralateral carotid artery occlusion is thought to represent a significant risk factor in carotid endarterectomy (CEA). There is also evidence that intraoperative and postoperative hypotention may cause contralateral hemodynamic ischemia. As such, contralateral carotid artery occlusion is regarded as a risk factor for carotid angioplasty and stenting (CAS). In this paper, we report on five cases of severe ICA stenosis with contralateral carotid artery occlusions. Cerebral blood flow(CBF) and cerebral vasore-activity(CVR) of the contralateral carotid artery occlusions were measured before and after CAS. Additionally, the influence that ipsilateral CAS exerted on the occluded side was examined.

123I-IMP SPECT was performed before and after CAS, both at rest and at the time of acetazoramide administration. The CBF was evaluated quantitatively using the ARG method. The mean CBF of the treated side rose from 30.0 ± 7.1 ml/100g/min to 34.4 ± 8.3 ml/100g/min (p<0.05), and the mean CBF of the occluded side similarly rose from 28.3 ± 6.1 ml/100g/min to 31.7 ± 6.4 ml/100g/min (p<0.05). Correspondingly, the regional CVR (rCVR) increased from 5.9% ± 16.3% to 35.0% ± 16.4%(p<0.05) on the treated side, and from 3.7% ± 14.7% to 10.7% ± 16.9% (p<0.05) on the occluded side.

This demonstrates that ipsilateral CAS seems to improve both CBF and CVR on the contralateral occluded side. The fact that some cases developed cross flow from the anterior communicating artery was both remarkable and significant. Where there was poor cross flow from the anterior communicating artery, improvement in cerebral vaso reactivity was limited.
Risk Factors of Postprocedural Hypotension following Carotid Artery Stenting
Authors: Nonaka T. , Oka S. , Miyata S. , Baba T. , Mikami T. , Houkin K.
Published: January 2017

This study is performed to investigate risk factors of hypotension in response to elective carotid stenting. Forty-four lesions of 40 consecutive patients (mean age 70.4 ± 8.2 years) were retrospectively analyzed. Easy Wall stent was applied in 15 lesions and SMART stent in 29 lesions. We investigated correlations between the occurrence rate of postoperative hypotension below 90 mmHg and persisting over three hours and findings of preoperative angiograms, ultrasonograms and clinical characteristics. Postprocedural hypotension occurred in 19 patients (47.5%) and medical treatment (intravenous administration of catecholamines) was required in eleven patients (27.5%). Although there was no permanent neurological deficits related with postprocedural hypotension, transient neurological deficits were found in three patients. Risk factors of prolonged postprocedural hypotension were statistically analyzed. On angiographic characteristics; 1) distance between the carotid bifurcation and the lesion with maximum stenosis (≦10 mm vs. >10 mm: p = 0.031), 2) type of stenosis (eccentric vs. concentric: p = 0.014) On ultrasonographic characteristics; 1) calcifications at the carotid bifurcation (present vs. absent: p<0.001). Other variables, including age and degree of stenosis, were not associated with postprocedural hypotension after carotid stenting. These angiographic and ultrasonographic variables can be used to identify patients at risk for postprocedural hypotension after carotid stenting. Such identification may help in selection of patients who will benefit from appropriate pharmacological treatment.
Endovascular Treatment of Multiple Severe Atherosclerotic Stenoses with Cerebral Hypoperfusion
Authors: Uchiyama N. , Okada Y. , Higashi S.
Published: January 2017

A 60-year-old man presented with syncope and transient left-sided motor weakness. Cerebral angiography revealed multiple severe atherosclerotic stenoses of bilateral internal carotid arteries, bilateral intracranial vertebral artery (VA), and left VA origin. A SPECT study showed poor cerebral perfusion and vascular reserve in the right cerebral hemisphere and the posterior circulation. We performed angioplasty and stentings for the VA stenoses first by using balloon-expandable stents.

The patient had shown no syncope attack ever since, which might be due to an increased vascular reserve in the posterior circulation. The following bilateral carotid angioplasty and stentings could be performed safely. Angioplasty and stenting is feasible, and can improve cerebral perfusion even in a patient with multiple severe atherosclerotic stenoses by pre-operative appropriate haemodynamic assessment.
Balloon Test Occlusion with Perfusion CT Imaging Utilizing Intraarterial Contrast Injection
Authors: Ebara M. , Murayama Y. , Saguchi T. , Ishibashi T. , Irie K. , Takao H. , Sadaoka S. , Klotz E. , Abe T.
Published: January 2017

Balloon Test Occlusion (BTO) is performed to evaluate the collateral flow when a permanent therapeutic occlusion of unilateral carotid artery is planned. BTO with neurological evaluation alone, however, has a rather high false negative rate. In order to improve the sensitivity, several adjunctive procedures such as induced hypotension or cerebral blood flow (CBF) measurement with various modalities have been combined. Perfusion CT (PCT) is another imaging modality that is mainly used for the diagnosis of acute stroke. In this study, we evaluate the efficacy and the safety of BTO combined with PCT in the same procedure utilizing intraarterial contrast injection from the catheter.

Seven patients underwent BTO with PCT in our institution. All the procedures were performed in the angio/CT combination suite. BTO was performed in the usual fashion and when the patient passed the 30 minutes' BTO clinically, PCT was performed subsequently. Contrast material was injected from a Pig Tail catheter placed in the ascending aorta. The obtained data were transferred to a workstation and perfusion maps of CBF, cerebral blood volume (CBV), and time to peak (TTP) were generated using software. In three patients, single photon emission CT (SPECT) was also obtained with administering 99mTc-ethyl cysteinate dimer (99mTc-ECD) intravenously during BTO.

Although all the patients had passed the BTO clinically, the CBF maps of three patients revealed significant decrease in the occluded hemisphere. There was no procedure-related morbidity. PCT using intraarterial contrast injection during BTO was performed successfully and safely. Intraarterial injection allowed us to obtain excellent time-attenuation curves by utilizing less contrast material and less radiation doze.
Pitfalls during the Embolization and Evaluation after the Embolization for the Skull Base Meningiomas
Authors: Nishio A. , Ohata K. , Tsuyuguchi N. , Gotoh T. , Ishiguro T. , Kawakami T. , Hara M.
Published: January 2017

Pitfall during the embolization and evaluation after the embolization for skull base meningiomas supplied by meningeal arteries of internal carotid artery (ICA) are reported. This study includes 15 cases of skull base meningiomas (two males and 13 females) that supplied by meningeal branches of internal carotid artery. The preoperative embolization was performed by these feeders. MRI findings and serum levels of C-reactive protein (CRP) after the embolization were examined. In ten patients among 15 patients the meningeal branches of ICA were dominant feeders. In ten patients out of 15 patients, the embolization from the meningeal branches of ICA was possible. Eight patients out of these ten patients were suffered from high fever and increase of serum level of CRP after the embolization. During the embolization for skull base meningiomas, the existence of collateral pathways between the ICA system and external carotid artery system were identified. The increase of serum levels of CRP might be recognized in the patients that effective embolization were performed.
Intracranial Stenting in the Treatment of Wide-Necked Aneurysms
Authors: Leonardi M. , Dall'olio M. , Cenni P. , Raffi L. , Simonetti L.
Published: January 2017

We positioned the following self-expanding stents certified for intracranial application: 16 Neuroform (Boston Scientific), three INX (Medtronic), one Leo (Balt). 6F calibre femoral introducers and guiding catheters were used for stent placement changing to 5F calibre introducers and guiding catheters (Envoy, Cordis) for the Neuroform 2 and 3 stents. All procedures were carried out under general anaesthesia and heparinization. Our pharmacological protocol consisted of adjunctive treatment with anti-aggregants during the interventional procedure and for the following six months, without premedication. From November 2000 to August 2006 we treated 28 patients (27 F/1M) with giant wide-necked aneurysms and one dissecting basilar artery aneurysm requiring the placement of 29 stents.

We successfully positioned 20 stents: 11 stents combined with coils (8 immediate; 3 late) with complete exclusion of the aneurysm from the circulation in seven cases and subtotal exclusion in four; nine stents not followed by embolization with complete exclusion of the aneurysm from the circulation in six cases and subtotal exclusion in three.

Stenting was not possible in nine cases due to extreme vessel tortuosity and the poor flexibility of release systems for the first stents. No late stent occlusion or subarachnoid haemorrhage were encountered after treatment.
Early Experiences of Neuroform Stent-Assisted Coiling in Ruptured Intracranial Aneurysms
Authors: Kim Young-Joon
Published: January 2017

Endovascular treatment of ruptured intracranial aneurysms with detachable coils has proven a favorable alternative to surgical clipping. However, coiling has limitations in the treatment of complex or broad neck aneurysms because of possible coil prolapse or coil migration into the parent vessel and long-term angiographic recurrences. To achieve reconstruction of intracranial vessels with preservation of the parent artery, the use of stents has the greatest potential for assisted coil embolization. Three-dimensional coils and reconstructive techniques such as balloon-assisted remodeling may overcome these problems. But these methods had some drawbacks.

The Neuroform stent is the most recently developed endovascular stent with self-expandable and micro-delivery properties that are specially designed for the treatment of unruptured intracranial broad neck aneurysms.

Aim of the following working is to report a single center experience of stent-assisted coiling on ruptured intracranial aneurysms with assessment of its efficacy and safety, and follow-up findings.
A New Hemostasis Valve for Neuroendovascular Procedures
Authors: Namba K. , Song J.K. , Niimi Y. , Heran N.S. , Berenstein A.
Published: January 2017

A hemostasis valve is routinely used in neuroendovascular procedures to decrease the risk of thromboembolism 1,2. Recently, a new hemostasis valve that is designed to minimize blood loss has been introduced. We report our initial experience in using this new hemostasis valve.

In neuroendovascular procedures, a hemostasis valve is commonly used for continuous irrigation of guide and microcatheters to decrease the risk of thromboembolism 1,2,3. A conventional hemostasis valve has a rotating seal at the end, which is turned open or closed each time a wire or microcatheter/guidewire is introduced or extracted. Often this results in significant back bleeding. When a rotating seal is adjusted suboptimally during a wire or microcatheter manipulation, leakage of pressurized saline from the end of a hemostasis valve results in stagnation of blood within a guiding catheter, which becomes a potential source of emboli during a procedure.

The Guardian Haemostasis Valve (Zerusa Limited, Galway, Ireland) is a new hemostasis valve that is designed to minimize blood loss during interventional procedures by minimizing the opening time of the valve during wire or microcatheter insertion.

A continuous sealing mechanism during wire or microcatheter positioning minimizes blood loss and stagnation of blood within the guide catheter. We report our initial experience with the Guardian hemostasis valve.
Cerebrofacial Venous Metameric Syndrome 2 Plus 3: Facial and Cerebral Manifestations
Authors: Agid R. , TerBrugge K.G.
Published: January 2017

A unique case of Cerebrofacial Venous Metameric Syndrome (CVMS) in a 25- year-old women is described with venous malformations involving simultaneously the brain and the face. This case represents CVMS 2 plus 3 according to the classification described by Lasjaunias et Al. The metameric distribution of the cerebrofacial venous syndromes is well illustrated in this case. The extracranial and intracranial involvement is described and the appearance on MRI imaging is detailed. In our opinion this case demonstrates that cerebrofacial venous metameric syndromes include a wide spectrum of possible phenotypes including Sturge Weber syndrome and cases such as we describe here.
In Vivo Thrombogenicity of Embolic Protection Systems for Angioplasty and Stenting
Authors: Raymond J. , Guilbert F. , Metcalfe A. , Salazkin I. , Gevry G. , Leblanc P. , Weill A. , Roy D.
Published: January 2017

Despite the increasing use of embolic protection systems (EPS) for carotid stenting, their intrinsic in vivo thrombogenicity remains unknown. We studied three different types of EPS (n = 24) deployed in the carotid arteries of pigs in which pools of platelets and fibrinogen were labelled with 111In and 125I. The amount of clot deposition seen on photography was also scored using a qualitative scale.

EPS made of fabric nets under normal flow conditions were 5–6 and 15–16 times more thrombogenic (for both platelet (P=.04) and fibrin (P=.007)) than Nitinol mesh nets. Clot deposition on Nitinol mesh nets was more abundant under flow arrest than under normal flow conditions (P=.018).

EPS differ in intrinsic thrombogenicity, a characteristic of the material that could be investigated in pre-clinical studies designed to optimize devices.
Surgical Management of Parkinson's Disease: Update and Review
Authors: Chao Y. , Gang L. , Na Z.L. , Ming W.Y. , Zhong W.S. , Mian W.S.
Published: January 2017

Although medical therapy is still the mainstay of treatment for Parkinson's disease, the development of surgical precision and decreased morbidity have made stereotatic lesioning and deep brain stimulation more popular. Neurosurgical ablations include pallidotomy, thalamotomy, and, more recently, subthalamotomy. Because of concern over the high risk of side-effects resulting from bilateral ablative procedure, alternative approaches have been explored. With improved deep brain stimulation (DBS) technology, DBS has been successfully applied in the internal globus pallidus, ventral intermediate nucleus and subthalamic nucleus for Parkinson's disease.

In addition, recent surgical approaches including biological neurorestorative technologies — surgical therapies with transplantation, gene therapy, and growth factor are all being discussed in this review. Although a great deal of work remains to be done for researchers, advances in surgical therapies for the treatment of Parkinson's disease are moving forward at an unprecedented pace, and, not surprisingly, would give PD patients more choices and hope.
Dissecting Aneurysm of the Basilar Arterial Trunk Presenting with Pontine Infarction
Authors: Jang Y.-G. , Ryu C.W. , Kim J.S. , Cha E.Y. , Pyun H.W. , Kim D.Y. , Choi J.W. , Suh D.C.
Published: January 2017

Dissecting basilar aneurysms have rarely been reported but are associated with high morbidity and mortality. Therefore, controversy exists as to the proper management of such lesions because their natural course is not well understood. We describe a 50-year-old man with a dissecting aneurysm involving the lower basilar trunk who presented with pontine infarction corresponding to the aneurysmal sac location. We obliterated the dissecting basilar aneurysm by coil embolization of the aneurysmal sac as well as the diseased segment of the basilar trunk after confirmation of collateral filling of the basilar artery through the posterior communicating artery. The patient recovered without any procedural complication. Eight month follow-up revealed complete disappearance of the aneurysm without symptom recurrence together with preservation of collateral flow in the distal basilar artery. Obliteration of the parent artery as well as the aneurysmal sac with coils could be considered in a lower basilar aneurysm of a dissecting nature.
Terminal Triplication of the Left Vertebral Artery: A Unique Variation
Authors: Dissanayake P.H. , Bhattacharya J.J. , Teasdale E.V.
Published: January 2017

This report describes a unique case of triplication of the terminal left vertebral artery, forming the basilar artery in a 75-year-old male. CT angiography of cranio-cervical vessels also demonstrated the right vertebral artery originating from the right common carotid and an aberrant right subclavian artery. To the best of our knowledge this is the first report of a variation of this nature. The embryology and the clinical importance are discussed.
Treatment of Vasospasm Secondary to Subarachnoid Hemorrhage Using Intra-Arterial Nimodipine in Low Dosage
Authors: Bandeira A. , Ribeiro C. , Reis J.
Published: January 2017

There are currently no consensus criteria to define the dosage of intra-arterial Nimodipine to be used to obtain permanent remission of vasospasm secondary to subarachnoid haemorrhage.

The purpose of this paper is to establish a mathematical relation between the number of vessels affected by this kind of vasospasm and the Nimodipine dose that must be used for intra-arterial angioplasty to obtain permanent remission of the vasospasm.