bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment and Short-Term Follow-up of Symptomatic Atherosclerotic Intracranial Artery Stenosis by Stent-Assisted Angioplasty
Authors: Feng Miao Zhongrong Ling , Shengmao Li , Fengshui Zhu , Yang Hua , Moli Wang
Published: January 2017

Atherosclerotic intracranial artery stenosis can cause hypoperfusion of brain tissues and embolus formation, causing stroke. Conservative medical treatment seemed to have little effect on the natural history and prevent the stroke attack caused by artery stenosis. The purpose of stent-assisted angioplasty is to reconstruct the damaged vessels: the indications, feasibility, effectiveness, complications and follow-up for this new treatment method are discussed.

A series of 32 cases with symptomatic intracranial artery stenosis were accepted from 1998 to 2002. The mean age was 42 yrs (31∼76 yr), male/female ratio=23/9. All patients were refractory to optimal medical therapy. Lesions included 12 middle cerebral arteries (37.5%), six basilar arteries (18.75%), three distal ICAs (9.38%) and 12 intracranial Vas (37.5%). All patients were treated by methods of transluminal stent-assisted angioplasty under general anesthesia. Patients were premedicated with Aspirin (300mg/per day) and Ticlopidine (250mg/per day), this was continued for six weeks after the procedure. Medical history, anamnesis, and treatment protocol were reviewed and evaluated retrospectively, short-term follow-up (2mths ∼ 1 yr) was also obtained.

Primary clinical presentations were TIAs (21/32, 65.63%), minor stroke (8/32, 25%) and severe stroke (3/32, 9.38%). 31 cases (96.86%) were successfully implanted with coronary stents within the stenosed vessels; technical success rate was 96.86%. Instant angiographic results showed the stenosed extent had decreased from 72.36%±5.69 to 10.16%±6.94. One vessel ruptured during the procedure, the patient recovered after surgical repair of the ruptured vessel. Clinical follow-up demonstrated symptoms resolved in most patients (30/32, 93.75%) within the follow-up period, two cases with MCA stenosis had TIAs within two months after the procedure. 12 cases accepted angiographic follow-up. Velocities of stented vessels of five cases (5/21, 23.81%) increased compared to instant results, suggesting restenosis, three of them were confirmed by angiography which included two cases with MCA stenosis (figure 3) and one with distal VA, one of the five cases had recurred TIAs.

With the newer generation of coronary stent, this technique seemed safe, feasible and effective to prevent stroke attack, but the indication is very important for the technical success. Restenosis remains a common problem as with coronary stenting. Long-term follow-up will be needed.
Non-Aneurysmal Perimesencephalic Subarachnoid Haemorrhage with Associated Pontine Haemorrhagic Infarction
Authors: Duncan I.C. , Terblanche J.M. , Fourie P.A.
Published: January 2017

Non-aneurysmal perimesencephalic subarachnoid saemorrhage is characterized by an accumulation of blood in the perimesencephalic and prepontine cisterns identified on sectional imaging together with persistently negative cerebral angiography. Magnetic resonance imaging usually contributes no further information on the possible cause of the bleed but may occasionally show further features including associated parenchymal infarcts such as the pontine haemorrhagic infarct seen in the case described here.
GDC Embolization of Intracranial Aneurysms with SAH and Mass Effect by Subdural Haematoma
Authors: Kim J.-K. , Kim Y.-J.
Published: January 2017

A 43-year -old woman was brought to the emergency room due to the sudden onset of severe headache and stuporous consciousness. She had no history of head injury. Computerized tomography scan revealed subarachnoid haemorrhage and left SDH with midline shift of about 10 mm. Cerebral angiography demonstrated anterior communicating artery and right middle cerebral artery bifurcation aneurysms. Her family refused operation due to her religion never to permit blood transfusion. So just aneurysm coiling and medical ICP control was planned.

Guglielmi detachable coil (GDCs) embolization of the two aneurysms was successfully performed. She made a neurological recovery after embolization without evacuation of the SDH. She was discharged from hospital with no neurological deficit on day 21. We report our experience of successful GDC embolization on multiple aneurysms without craniotomy even in the selected case of mass effect.
Dural Arteriovenous Fistula within the Hypoglossal Canal Successfully Treated by Transvenous Embolization
Authors: Arai Y. , Ishii H. , Handa Y. , Ueda Y. , Shirasaki N. , Nozaki J. , Kubota T.
Published: January 2017

We report a case of dural arterio venous fistula (DAVF) within the left hypoglossal canal in a 64-year-old man who presented with tinnitus and ocular symptoms. Angiography revealed DAVF with the fistulous pouch medial to the left jugular bulb. The fistula was feeded by meningeal branches of the bilateral ascending pharyngeal arteries and the branches from the left vertebral artery. The fistula shunted into the left jugular bulb, with reflux into the left inferior petrosal (IPS) and cavernous sinuses (Cses), left superior ophthalmic vein (SO V) and cortical veins over the cerebral convexity. We performed transvenous coil embolization to occlude the fistula resulting in complete resolution of symptoms and signs.
Cavernous Sinus Dural Fistula Treated by Transvenous Facial Vein Approach
Authors: Prochazka V. , Cizek V. , Kacirova R.
Published: January 2017

We report on the endovascular treatment of the spontaneous indirect dural carotid cavernous sinus type D fistula in a 60-year-old woman, in whom ipsilateral facial, angular and superior ophthalmic veins catheterization was performed to get access to the fistula site for embolization treatment. Approach via the facial vein is helpful after inferior petrosal sinus treatment failure. Although this technique requires caution in the angular vein region it allows a safe and effective treatment of these lesions. 3D rotational digital angiography can obtain more information of the angioarchitecture of the cavernous plexus and venous outflow for the catheter navigation.
Simultaneous Bilateral Carotid Stenting under the Circumstance of Neuroprotection Device
Authors: Lee Y.H. , Kim T.-K. , Suh S.-I. , Kwon B.J. , Lee T.H. , Kwon O-Ki , Han M.H. , Lee N.J. , Kim J.H. , Seol H.Y.
Published: January 2017

In this study, in order to evaluate the feasibility and outcomes of simultaneous bilateral carotid artery stenting (CAS) with the use of neuroprotection in symptomatic patients, we conducted a retrospective analysis of 27 patients (19 men, eight women; median age, 69.2 years), all of whom had been scheduled to undergo bilateral CAS in a single setting. All patients presented with severe atherosclerotic bilateral carotid stenosis (>50% for symptomatic side, >80% for asymptomatic side), exhibiting symptoms of either a cerebrovascular accident or of a transient ischemic attack on at least one side. 48 arteries were treated with self-expandable stents. Neuroprotection devices were utilized for bilateral CAS in 11 patients, and in 16 unilateral CAS patients. We did not perform the second procedure in six patients, in cases in which a patient exhibited (a) hemodynamic instability, (b) a new neurological impairment, or (c) restlessness after a prolonged time for the first CAS. The second procedure was postponed in a staged manner.

We achieved a mean residual stenosis of 8.1 ± 5.0 % in the treated lesions. The mean procedural time for bilateral CAS was three hours and 18 minutes. 17 patients (63%) developed transient bradycardia during the balloon dilatation of one or both of the relevant arteries. Three patients (11%) exhibited persistent bradycardia and hypotension, which required the administration of intravenous vasopressors for several days (2!7 days). None of the patients ultimately required pacemakers, or any further therapy. Two of the patients (7%) developed transient ischemic attack during the periprocedural period, but recovered completely. One patient developed a new minor stroke after the first procedure, and the second procedure was delayed in a staged manner. We observed no periprocedural deaths, major strokes, or myocardial infarctions, nor did we detect any cases of hyperperfusion syndrome within 30 days.

In summary, simultaneous bilateral CAS with neuroprotection can be performed in a single setting without increased concerns with regard to hyperperfusion syndrome, hemodynamic instability, thrombo-embolism, or procedure time, when the first CAS has been safely completed with no evidence of complications in a well-managed procedure time.
Method to Quantify Flow Reduction in Aneurysmal Cavities of Lateral Wall Aneurysms Produced by Stent Implants Used for Flow Diversion
Authors: Fujimura N. , Ohta M. , Abdo G. , Ylmaz H. , Lovblad K.-O , Rüfenacht D.A.
Published: January 2017

Stent implants placed across the neck of cerebral aneurysms are capable of reducing aneurysmal flow when coils are not used for filling the aneurysms. It is important to evaluate the effects of flow reduction caused by stent implants used for the treatment of cerebral aneurysms. Subtracted vortex centers path line method (SVC method) is one of the image post processing methods employed for quantitative flow measurement. We developed a modified SVC method by employing Cinematic Angiography (25 frames/s) and digital video recording (30 frames/s) with a commercial digital camera. We successfully compared the flow effectiveness using a tubular silicon model with a sidewall aneurysm.

The result suggests that our modified SVC method is useful for a comparative examination of the effect of aneurysmal flow reduction caused by stent implants.
Arteriovenous Fistula of the Mandible Simulating an Odontogenic Cyst
Authors: Granata F. , De Ponte F. , Pandolfo I. , Pitrone A. , Vinci S. , Blandino A. , Longo M.
Published: January 2017

We describe a rare case of mandibular high-flow arteriovenous malformation (AVM) mimicking an odontogenic cyst in a young man.

The diagnosis of mandibular AVM was made by CT angiography and confirmed by digital subtraction angiography. CT scan showed the extent of mandibular bone alteration and a double enlarged mandibular canal on the same side. An AVM containing a large aneurysm was demonstrated by CT angiography. The mandibular AVM was successfully treated by endovascular therapy with Guglielmi detachable coils.

On panoramic radiogram, mandibular AVMs can appear as cystic lesions without pathognomonic features. Several benign and malignant tumours of this anatomical region must be considered in the differential diagnosis. We emphasize the radiological sign of double enlarged mandibular canal and the diagnostic role of CT, particularly CT angiography, to discriminate a mandibular AVM from neoplastic entities of this region, sparing the risks of a needle biopsy.
Delayed Thrombosis of the Basilar Artery after Stenting for a Basilar Trunk Dissection Aneurysm
Authors: Liu L. , Jiang C. , He H. , Li Y. , Wu Z.
Published: January 2017

A 30-year-old man was referred in our department for treatment of a midbasilar trunk aneurysm. His presenting symptoms included headache and dizziness. A CT scan at another hospital showed no significant findings whereas a digital subtraction angiogram disclosed a dissecting aneurysm in the midbasilar trunk, and there was severe stenosis in the basilar artery. After discussion, we planned to use stent-assisted-coil embolization technique. During the procedure, a LEO stent (Balt, Montmorency, France) was implanted into the basilar artery across the aneurysm neck, but fearing acute basilar artery occlusion because of stent collapse or thrombus we did not fill coils into the aneurysm.

After the procedure, the completion angiography demonstrated considerably decreased flow into the aneurysm, with stasis persisting into the venous phase of angiography. The patient awoke from general anaesthesia after the procedure and had no additional neurological symptoms, he was discharged three days later and used clopidogrel and aspirin for antiplatelet therapy. Six months later when he was admitted for a recheck, a DSA showed the basilar artery was occluded completely and the aneurysm had disappeared even though the patient remained neurologically normal.
Traumatic Persistent Trigeminal Artery - Cavernous Sinus Fistula Treated by Transcatheter Arterial Embolization
Authors: Asai K. , Hasuo K. , Hara T. , Miyagishima T. , Terano N.
Published: January 2017

We describe a rare case of traumatic persistent trigeminal artery (PTA) - cavernous sinus fistula. Cerebral angiography showed direct communication between the right PTA and the cavernous sinus which was treated by transcathether arterial embolization. Although previous reports have indicated the use of more coils to treat this condition, we successfully treated the patient with only two coils placed near the orifice of the fistula after sufficient anatomical evaluation.
Secondary Clinical Deterioration after Successful Embolization of a Spinal Dural Arteriovenous Fistula: A Plea for Prophylactic Anticoagulation
Authors: Knopman J. , Zink W. , Patsalides A. , Riina H.A. , Gobin Y.P.
Published: January 2017

We present a case of delayed aggravation of initially-resolved symptoms in a patient after successful embolization of a T5 spinal dural arteriovenous (AV) fistula with N-butyl cyanoacrylate. The symptoms were attributed to venous thrombosis and resolved with systemic anticoagulation after five days of treatment. Although the most adequate treatment for preventing venous thrombosis after spinal dural AV fistula is not known, we describe this patient as a case for more aggressive prophylactic anticoagulation measures in the immediate post-embolization time period.
A Versatile Method for Treating Intracranial Wide-Neck Aneurysms: Catheter-Assisted Technique of Three Variations
Authors: Lai Y-J. , Yen C-H. , Hsieh L-C. , Kuo K-H. , Lin C-J.
Published: January 2017

Successful management of aneurysms of complex morphology depends primarily on adjunct use of balloons or stents. However, these two methods are technically demanding and have higher complication rates. As an alternative to these two techniques, we have used a catheter-assisted technique with a number of cases. It is simple, versatile, and less demanding technically. This technique should be considered as an alternative strategy in cases of wide-necked aneurysms.
Direct Carotid-Cavernous Fistula following Intracavernous Carotid Aneurysm Treatment with a Flow-Diverter Stent
Authors: Mustafa W. , Kadziolka K. , Anxionnat R. , Pierot L.
Published: January 2017

A 39-year-old woman presented with a right intra-cavernous carotid aneurysm measuring 1.76 cm×1.33 cm. The aneurysm was treated with a self-expandable flow-diverter stent. Follow-up MRI showed normal flow in the internal carotid artery with partial thrombosis of the aneurysmal sac. Two weeks later, the patient developed a right direct carotid-cavernous fistula. The fistula was treated by transvenous route. We concluded that rupture of a previously unruptured aneurysm can occur after treatment with a flowdiverter stent.
Endovascular Treatment of Traumatic Pericallosal Artery Aneurysms
Authors: Van Rooij W.J. , Van Rooij S.B.T.
Published: January 2017

Traumatic pericallosal artery aneurysms are rare complications of blunt head trauma. The pericallosal artery is torn under the sharp edge of the rigid falx. CT shows a typical hematoma in the corpus callosum. Endovascular treatment with occlusion of the aneurysm including the parent vessel with coils or glue is the best treatment option.
A Mechanical Coil Insertion System for Endovascular Coil Embolization of Intracranial Aneurysms
Authors: Haraguchi K. , Miyachi S. , Matsubara N. , Nagano Y. , Yamada H. , Marui N. , Sano A. , Fujimoto H. , Izumi T. , Yamanouchi T. , Asai T. , Wakabayashi T.
Published: January 2017

Like other fields of medicine, robotics and mechanization might be introduced into endovascular coil embolization of intracranial aneurysms for effective treatment. We have already reported that coil insertion force could be smaller and more stable when the coil delivery wire is driven mechanically at a constant speed. Another background is the difficulty in synchronizing operators' minds and hands when two operators control the microcatheter and the coil respectively. We have therefore developed a mechanical coil insertion system enabling a single operator to insert coils at a fixed speed while controlling the microcatheter.

Using our new system, the operator manipulated the microcatheter with both hands and drove the coil using foot switches simultaneously. A delivery wire force sensor previously reported was used concurrently, allowing the operator to detect excessive stress on the wire. In vitro coil embolization was performed using three methods: simple mechanical advance of the coil; simple mechanical advance of the coil with microcatheter control; and driving (forward and backward) of the coil using foot switches in addition to microcatheter control.

The system worked without any problems, and did not interfere with any procedures. In experimental coil embolization, delivery wire control using the foot switches as well as microcatheter manipulation helped to achieve successful insertion of coils. This system could offer the possibility of developing safer and more efficient coil embolization. Although we aim at total mechanization and automation of procedures in the future, microcatheter manipulation and synchronized delivery wire control are still indispensable using this system.
Role of 3D Display MR Angiography in the Study of Intracranial Aneurysms
Authors: Dumas J.-L. , Abdennebi A. , Belin C. , Sellier N. , Moret J. , Goldlust D.
Published: January 2017

This paper determines the usefulness of three-dimensional (3D) phase-contrast (PC) magnetic resonance (MR) angiography with 3D display in characterizing large intracranial saccular aneurysms.

Eight patients referred for non invasive confirmation of unruptured aneurysm (n=9) detected by conventional CT and/or MR imaging were studied by 3D PC (VENC of 20 cm/s, 3 axes) in axial acquisition localised on the circle of Willis using a 0.5 T unit (Vectra, GE). We used 3D display images to assess the feasibility of selective treatment. Results were correlated with catheter angiograms in 3 patients.

In two thirds of the cases, location and size of the orifice, size of the sac, and clarification of parent artery were clearly provided allowing prediction of therapeutic management. In the remaining cases results remained doubful because of lack of spatial resolution. The benefit of the method was coupled with the clinical status of the patients to influence the final decision.

3D PC MR angiography with 3D display has emerged as an improvement in predicting therapeutic management, and is especially useful in large unruptured aneurysms in elderly or ill patients.
The Arithmetics of Risk
Authors: Mansmann U.
Published: January 2017

In the following note the basic principles of event data analysis and censored data will be explained.

The concept of risk will be defined. The interaction of estimation and confidence interval will be discussed. We explain the estimator of risk and show how to use it for the calculation of probability statements.

An example is given to make the formal statements more explicit. We define the Kaplan-Meier estimator and compare it to the risk concept. Two common fallacies in risk assessment are discussed.
Expansion of a Haematoma after Urokinase Thrombolysis of Superior Sagittal Sinus Thrombosis
Authors: Moran C.J. , Cross D.-W.T. , Derdeyn C.P. , Dromerick A.W. , Dacey R.G.
Published: January 2017

Thrombosis of the superior sagittal sinus may result in significant morbidity and recently up to 20% mortality. Primary treatment has consisted of anticoagulation and methods for controlling increased intracranial pressure. The development of interventional neuroradiologic techniques has enabled infusion of thrombolytics at the clot.

We describe a woman with a cerebral haemorrhage due to a thrombosed superior sagittal sinus.

Her decreased level of consciousness and increasing hemiparesis prompted direct thrombolytic therapy (urokinase). Flow was restored in the occluded sinus, but an acute expansion of the haematoma an hour after conclusion of the infusion resulted in temporary worsening of her neurologic deficits.

Although the ultimate outcome was satisfactory, the possibility of further intracranial bleeding must be balanced against the risk of death with conservative therapy.
Embolisation of Spinal Cord Arteriovenous Malformations with Glue through the Anterior Spinal Axis
Authors: Rodesch G. , Hurth M. , Alvarez H. , Lasjaunias P.
Published: January 2017

We reviewed the clinical and morphological results of spinal cord arteriovenous malformations (SCAVMs) embolised with acrylic glue through the anterior spinal axis (ASA), and assessed the anatomical guidelines that should be followed to safely embolise the ASA.

Twenty consecutive SCAVMS seen between 1982 and 1996 were reviewed. There were 15 lesions in the thoracolumbar cord and 5 in the cervical cord. Haemorrhage was the revealing symptom in 13 patients (65%). Embolisation through the ASA was done in 19 SCAVMs (2 with PVA particles in our early experience and 17 with Histoacryl*). One patient was not embolised because of a spastic reaction of the ASA that led to secondary subtotal thrombosis of the SCAVM without neurological deficit.

The ASA was chosen as arterial approach to the AVM because it was the only feeder to the lesion (1 case) and/or because it was one of the accessible pedicles harbouring particular angioarchitectural weakness points. Vascular occlusion was always indicated and performed following precise anatomical analysis of the lesion and of the regional vascular disposition. In all cases embolisation of the ASA feeders to a SCAVM was performed under general anaesthesia, without any evoked potentials or provocative tests. However, 3/19 (16%) patients presented transient worsening of their clinical condition. Permanent morbidity occurred in 2/19 patients (11%): one patient cured from a cervical intramedullary AVM presents mainly a deltoid palsy, the other with a thoracic intramedullary AVM has worsened his paraparesis. At follow-up, 6/19 patients (32%) are neurologically normal and 10/19 (53%) have improved their neurological conditions and deficits. One patient embolised recently is currently stable but is expected to improve. No embolised patient bled or rebled during follow-up. Neurological symptoms recurred in one patient who had been stable for one year after his first embolisation.

For an experienced interventional neuroradiology team, embolisation of SCAVMs through the ASA is feasible with acrylic glue with good clinical results. Proper analysis of the vascular architecture is mandatory to select the cases that can benefit from such approach.
Determining the Optimal Fluoroscopic View during Aneurysmal Embolization with Rotation DSA
Authors: Bundo M. , Negoro M. , Fukasaku K. , Miyachi S. , Yoshida J.
Published: January 2017

To prevent coil protrusion into the parent artery, the fluoroscopic view during coil packing is quite important. However it is not always easy to find out the optimal fluoroscopic view.

We applied a rotation DSA to predict the optimal fluoroscopic view for the endovascular treatment of 4 cases with a cerebral aneurysm.

Since the trajectory of the C-arm is restricted within 60 degrees only around the patient's head and the number of DSA shots are limited rather than conventional DSA, we employed three dimensional CT angiography (3D-CT angiography) to focus the range of C-arm rotation.

Rotation DSA proved quite useful to determine the optimal fluoroscopic view, when combined with pre-estimation by 3D-CT angiography.
Direct PTA for Acute Ischemic Stroke
Authors: Uno J.
Published: January 2017

We have performed direct PTA for 23 patients with acute ischemic stroke. Occlusion was identified at extracranial internal carotid artery (ICA) in 6 patients, at extracranial vertebral artery (VA) in 1, at intracranial ICA in 3, at middle cerebral artery (MCA) in 12, and at basilar artery (BA) in 1.

Stenosis was identified at extracranial VA in 1 patient. In 4 of 6 patients of extracranial ICA, 1 of 1 patient of extracranial VA, 1 of 3 patients of intracranial ICA, 7 of 12 patients of MCA and 1 of 1 patient of BA, recanalization was observed. Fourteen of 22 occluded arteries (64%) were recanalized.

The recanalization rate approximated that of local intraarterial fibrinolytic therapy. We have not experienced complications with this procedure. Direct PTA is promising and might be a novel recanalization technique.
Intra-Arterial Thrombolytic Therapy for Acute Vertebrobasilar Artery Occlusion
Authors: Kinoshita Y. , Terada T. , Nakai E. , Nakai K. , Itakura T. , Naka Y. , Kido T. , Kuwata T. , Matumoto H. , Moriwaki H.
Published: January 2017

We report on the results of intra-arterial thrombolysis in 11 patients with vertebrobasilar artery occlusion treated within 6 hours after onset of symptoms. Urokinase (5 patients) or recombinant tissue plasminogen activator (t-PA) (6 patients) was injected through a microcatheter conducted to the thrombus.

Eight patients showed recanalization of the thrombus. The outcome was excellent in 5 patients, good in 2 patients, and poor in one patient. Recanalization could not be achieved in 3 of the 11 procedures; all patients in whom recanalization failed died.

There were no hemorrhagic complications after thrombolysis. Two patients with residual stenosis after thrombolysis underwent successful percutaneous transluminal angioplasty (PTA) to prevent re-occlusion. Intra-arterial thrombolysis for vertebrobasilar artery occlusion is a safe and effective treatment if it is performed within 6 hours.
Reperfusion Therapy for Acute Vertebrobasilar Occlusion
Authors: Ohta H. , Nakano S. , Yano T. , Ohnishi T. , Miyahara D. , Yokogami K. , Goya T. , Wakisaka S.
Published: January 2017

We reviewed retrospectively our experience in treating 10 patients with acute vertebrobasilar occlusion.

Nine patients were treated with interventional reperfusion therapy and the remaining one patient with top of the basilar embolism was treated conservatively because of deep coma and decerebrate rigidity with severely reduced cerebral blood flow (CBF) in the brain stem.

Among 9 patients with reperfusion therapy, 8 patients underwent intra-arterial thrombolytic therapy and the other one patient had direct percutaneous transluminal angioplasty (PTA). Eight patients had basilar artery occlusion, 1 patient treated with direct PTA had bilateral intracranial vertebral artery occlusion and the other patient had left posterior cerebral artery occlusion presumably preceding top of the basilar embolism. In 4 of 10 patients, residual CBF was evaluated by single photon emission computed tomograpy (SPECT).

Successful recanalization with clinical improvement was achieved in 6 of 9 patients (66.7%) treated with reperfusion therapy. In patients with progression or fluctuation of incomplete brain stem syndrome, SPECT revealed preserved residual CBF and successful recanalization with clinical improvement was achieved by interventional reperfusion therapy.

On the other hand, in patients with persistent deep coma and decerebrate rigidity, SPECT revealed marked reduction of residual CBF in the brain stem and recanalization could not improve clinical outcome.

Preoperative SPECT may be useful to make a decision whether reperfusion therapy should be performed or not in case of vertebrobasilar occlusion.
Endovascular Treatment for Tandem Internal Carotid Stenosis
Authors: Terada T. , Yokote H. , Kinoshita Y. , Tsuura M. , Masuo O. , Nakai K. , Itakura T.
Published: January 2017

Three patients with tandem internal carotid stenoses were treated in one operation including carotid endarterectomy (CEA) for the proximal stenosis and percutaneous transluminal angioplasty (PTA) for the distal stenosis. We devised a Y-shaped shunt tube which we used for CEA, while a PTA balloon catheter was introduced via the tube to perform PTA guided by portable digital subtraction angiography (DSA). No cerebrovascular events occurred during follow-up. Our approach avoids the risk of a second procedure while effectively treating tandem stenoses.
Surgery of a Large Paraclinoid Aneurysm with the Support of Coil Embolization
Authors: Nakazawa T. , Nakajima M. , Matsuda M. , Handa J.
Published: January 2017

An attempt was made to clip the neck of a large paraclinoid aneurysm with the support of a balloon catheter, using a trapping-evacuation technique. The clip applied to the neck slipped off because of blood pressure through the posterior communicating artery which arose from the dome of the aneurysm.

Therefore, using portable digital subtraction angiography (DSA) equipment, we placed interlocking detachable coils (IDCs) in the aneurysm for the purpose of reducing the intraaneurysmal pressure.

Although the aneurysm was eventually trapped with two clips, this case indicates the supportive role of intravascular intervention in aneurysmal surgery when clipping an aneurysm or immediately after clip failure.
Embolization of Cerebral Arteriovenous Malformations with Cellulose Acetate Polymer
Authors: Tokunaga K. , Kinugasa K. , Meguro T. , Kawada S. , Sugiu K. , Nakashima H. , Furuta T. , Taguchi K. , Kamata I. , Mandai S. , Hirotsune N. , Ohmoto T.
Published: January 2017

To test the usefulness of a cellulose acetate polymer(CAP) solution for brain arteriovenous malformations (AVMs), we analyzed the clinical and histological results of patients with AVMs embolized using CAP solution.

We reviewed the cases of six patients with cerebral AVMs treated by embolization prior to surgical resection. We used two types of CAP solutions, CAP-M and CAP-L, which are mixtures of 250 mg of solid CAP and 1800 or 2250 mg of bismuth trioxide dissolved in 5.5 or 7.0 ml of dimethyl sulfoxide, respectively. All patients underwent surgical resection 1 to 37 days after the embolization procedure. Resected specimens were fixed in formalin and stained for light microscopic examination.

Eighteen feeding vessels were embolized. The reduction rate of the nidus volume was between 20% and nearly 100%. Mild ischemic deficits occurred in one patients but there were no hemorrhagic complications related to the embolization procedures. All AVMs were completely resected by surgery. Direct inspection at surgery revealed that there was no apparent swelling or hematomas in the normal brain areas adjacent to the nidus, and the AVMs were soft enough to be easily retracted. The histological examinations disclosed no or mild inflammatory reactions within two weeks after embolization. The internal elastic lamina was preserved in every case. Recanalization of embolized vessels was not observed until 37 days after embolization.

CAP solution is a safe and useful embolic agent for brain AVMs. Further study is needed to resolve the issue of recanalization.
The Efficacy of Endovascular Surgery for Treatment of Giant Aneurysms with Special Reference to Coil Embolization for Endosaccular Occlusion
Authors: Morishima H. , Kurata A. , Ohmomo T. , Miyasaka Y. , Fujii K. , Kan S. , Kitahara T. , Suzuki R.
Published: January 2017

We assessed the long-term follow-up results of platinum coil embolization and aneurysmography (ARG) with endovascular surgery for giant aneurysms. 24 cases of giant aneurysms were treated over a period of seven years. In the present study, the 16 of these for which surgical dipping was impossible so that only endovascular surgery was employed were investigated in detail. In 10 cases the cavernous sinus area was involved, in two each the tip of the basilar artery, and the bifurcation of the ophthalmic artery, and in one each the extracranial internal carotid and the vertebral artery.

Since conventional angiography did not allow the position and size of the neck of 10 cavernous sinus aneurysms to be identified, making treatment decisions difficult, we applied the ARG developed by the senior author. Prior to treatment, balloon test occlusion of the parent arteries was performed. In all 10 cavernous sinus cases, ARG successfully revealed the morphology of the aneurysm. A small neck was diagnosed for seven of the aneurysms of the cavernous sinus and all those located at the basilar and ophthalmic arteries, making a total of 11, and for these endosaccular embolization was carried out. In the other 5 cases, proximal occlusion using Gold valve balloons was performed.

Under ARG, embolization of the aneurysms could be safely accomplished with platinum coils, without dislocation of the coils into the parent arteries in all cases. In four out of 10 cases, re-opening of the aneurysms occurred after 2 months or longer, so that re-embolization was required. Regarding complications, transient monoparesis of the upper extremity was encountered in one case. After angiographic and MRA follow-up of 1–36 months (average, 13.8 months), 4 of 10 cases demonstrated complete occlusion, and 5 displayed an 80–90% reduction in blood flow. In only one case, involving a basilar tip aneurysm, was the treatment unsuccessful in preventing eventual rupture and death.

In cases where the morphology of the aneurysm is unclear, ARG can be considered indispensable for determining the treatment modality and safe performance of localized embolization of the neck by endovascular surgery. However, since coils used for embolization of giant aneurysms may move or become compacted, re-opening can occur so that applications may be limited, especially with terminal type lesions with intraluminal thrombus, and the necessity for long-term follow-up must be emphasized.
A Case of Sigmoid Sinus Dural Arteriovenous Fistula after Treated Cavernous Dural Arteriovenous Fistula
Authors: Makiuchi T. , Takasaki K. , Yamagami M. , Oda H. , Todoroki K. , Atsuchi M. , Kadota K.
Published: January 2017

Transvenous embolization has been recommended recently as the primary treatment for symptomatic cavernous dural arteriovenous fistula(dural AVF). We present a case of sigmoid sinus dural AVF which developed after transvenous embolization of cavernous dural AVF

A 43-year-old man was admitted to our hospital because of left conjunctival chemosis, exophthalmus and abducens nerve palsy. Cerebral angiograms showed left cavernous dural AVF fed by the bilateral internal and external carotid arteries and draining into the enlarged left superior ophthalmic vein. Transfemoral approach in the cavernous sinus via inferior petrosal sinus (IPS) was difficult because of the occlusive change of IPS.

Then, direct canulation of the left superior ophthalmic vein and transvenous embolization using interlocking detachable coils (IDC) were performed. Dural AVF and clinical symptoms were disappeard rapidly after embolization.

Six months later, follow-up cerebral angiograms showed development of a dural AVF in the left sigmoid sinus. The pathogenesis of dural AVF remains unclear.

We suggest that injury to the sinus wall during endovascular procedures may have provoked the development of dural AVF in our case. Clinical and angiographical follow-up are important.
Multifocal and Metameric Spinal Cord Arteriovenous Malformations
Authors: Matsumaru Y. , Pongpech S. , Laothamas J. , Alvarez H. , Rodesch G. , Lasjaunias P.
Published: January 2017

We describe 19 (16.0%) multiple vascular malformations (AVMs) in 119 spinal cord arteriovenous malformations (SCAVMs).

The associated lesions were eight vertebral vascular malformations, two cutaneous, four limbs, four radicular AVMs, three bifocal SCAVMs; one patient had a bifocal cord lesion associated with vertebral and limb localisations. Various syndromic associations were seen: nine Cobb, two Klippel-Trenaunay-Weber, one Parkes Weber. An additional subgroup of unclassified associations is constituted by seven cases with bifocal intradural uni or multimetamerk lesions.

In our SCAVMs series, the incidence of multiple vascular lesions is high, in particular multifocal intradural malformations. Metameric distribution is the most frequent type of multiplicity. Identification of the myelomeric level involved in SCAVM allows segmental link between various lesions of mesodermal or neural crest origin to be discussed.
Improvement of Functional Magnetic Resonance Imaging by a Novel Fibre-Optic Device and 3D Software
Authors: Hoell T. , Oltmanns F. , Schilling A. , Stockhausen H.M. , Wolf K.J. , Brock M.
Published: January 2017

This report describes three years of clinical experience with a new set of devices aimed at improving functional MRI of speech areas. They provide a valuable tool for pre-operative definition of hemispheric localization and spatial extension of these areas, especially in left-handed persons.

The fibre-optic device described here transmits stimuli for cognitive tasks to patients undergoing MR investigations. Cognitive tasks elicit a defined brain activity lasting for several minutes. The resultant metabolic changes are detectable by functional MRI. The software (FIT ware) applied to process raw data allows semi-automated segmentation of the brain so as to obtain 3D images. Furthermore it allows the superposition of functional data. The effectiveness of the equipment was assessed on the basis of data from 140 fMRI studies. Intra-operative verification in eight patients with tumours located in the speech areas showed that the new set-up identified the speech-dominant side in each case and located speech areas in accordance with electrophysiological procedures.
Carotid Angioplasty
Authors: Duckwiler G. , Gobin Y.P. , Viñuela F.
Published: January 2017

Although no consensus yet exists on the ideal patient characteristics, materials, and indications for carotid angioplasty, it is clear that this procedure which is increasing in popularity will continue to do so. Until such time as the procedure is routinely approved (there are still barriers to insurance coverage for these procedures in the United States), we are highly selective in our application of carotid angioplasty. So far our experience is limited to approximately 40 patients with no major complications and no strokes. However, patient characteristics, operator experience, and patient selection play large roles in the outcomes of these procedures.

The current status of carotid angioplasty and stenting wilt be discussed as well as the potential complications and their treatment.
Follow-up Study on Intra-Aneurysmal Embolization for Unruptured Cerebral Aneurysms
Authors: Kaku Y. , Yoshimura S. , Hayashi K. , Ueda T. , Sakai N.
Published: January 2017

We describe follow-up clinical and angiographical results in patients with unruptured cerebral aneurysms treated with IDC or GDC. In 28 patients who underwent intra-aneurysmal occlusion for unruptured aneurysms, there were no permanent neurological deficits in the periprocedural period, while three transient neurological deficits were observed.

On the angiograms obtained immediately after the procedure, complete aneurysmal occlusion was achieved in three patients (10.7%), a small neck remnant was detected in two cases (7.1%), a body filling in 12 cases (42.9%) and both of them were detected in 11 patients (39.3%). On the follow up angiograms (median angiographical follow-up period 15.6 months), 46.4% of incompletely obliterated aneurysms showed aneurysmal recanalization, and a incompletely embolized aneurysm ruptured 15 months after initial embolization.

Detachable platinum coil embolization is a safe treatment for unruptured aneurysms with a lower incidence of peri-procedural morbidity, wheareas follow-up results are less satisfactory in cases involving incompletely obliterated lesions. With this limitation in mind, patients need to be very carefully chosen for GDC embolization and strict follow-up angiography is mandatory when a complete embolization is not achieved.
Vaccination with Plasmids Encoding the Leishmania Major GP63 Glycoprotein and CD40L Results in a Partial Suppression of the Inflammatory Reaction after Experimental Infection
Authors: Tsagozis P. , Tseveleki V. , Probert L. , Dotsika E. , Karagouni E.
Published: January 2017

The development of an effective vaccine against leishmaniasis is the aim of an intensive research effort, to bring relief to thousands of people worldwide. DNA vaccination is a promising approach in this direction, since it is able to generate a strong cellular immune response. We tested whether the co-administration of a plasmid encoding a truncated gp63 gene, that allows extracellular secretion of the encoded protein, and a plasmid encoding for CD40L could induce a protective response in genetically susceptible BALB/c mice and reduce the local inflammatory swelling after infection with Leishmania major. We document that vaccination with the combination of plasmids for gp63 and CD40L reduced inflammatory swelling, while vaccination with the truncated gp63-encoding plasmid resulted in an exacerbation of the local inflammatory reaction. These preliminary data indicate that the CD40L expression plasmid is consequently an efficient adjuvant for the induction of protective responses in the context of a DNA vaccination against leishmaniasis.
Allergic Subjects Have More Numerous Respiratory Infections and Severe Gastrointestinal Infections Than Non-Allergic Subjects: Preliminary Results
Authors: Ciprandi G. , Cirillo I. , Troisi R.M. , Marseglia G.L.
Published: January 2017

Allergic disorders are characterized by Th2-polarization, thus physiological Th1-dependent mechanisms for fighting infectious diseases (ID) may be defective. This study aims at evaluating the number and duration of respiratory (RI) and gastrointestinal diseases (GI) in allergic and non-allergic subjects in a particular community: the crew of an operative warship consisting of 189 persons (171 males and 18 females). The study period lasted for 5 months during an operative mission. The number and duration (days) of RI and GI were evaluated. Allergic subjects experienced more numerous RI (p=0.0029) and more severe GI (p=0.0001) than non-allergic subjects. This preliminary study provides evidence that allergic subjects may have more numerous RI and prolonged GI than non-allergic subjects.
Intermittent and Persistent Allergic Rhinitis and Association with Asthma in Children
Authors: Ciprandi G. , Cadario G. , Di Gioacchino M. , Tosca M.A. , Bernardini R. , Marseglia G.L. , Gangemi S. , Isola S. , Marengo F. , Minelli M. , Ricciardi L. , Ridolo E. , Valle C. , Verini M. , Borrelli P. , Varin E. , Sambugaro R. , Puccinelli P. , Incorvaia C. , Russello M. , Milioni M. , Boccardo R. , Piergentili E. , Di Rienzo A. , Frati F.
Published: January 2017

The natural history of allergic rhinitis (AR) is commonly characterized by worsening of symptom severity, frequent comorbidity with asthma, and polysensitization to aeroallergens. The polysensitization phenomenon starts in early childhood. AR classification has been recently revised, and some studies investigated the new types: intermittent (IAR) and persistent (PER) AR. However, no study has been carried out on children regarding this issue. This preliminary study was performed on a large cohort of children with allergic rhinitis to evaluate the type and severity of rhinitis and its possible association with asthma, including severity grade. One hundred and thirty-nine children (86 males, 53 females, mean age 11.8 years, range 3.5–17.7 years) with allergic rhinitis were prospectively and consecutively evaluated. Seventy-one children had rhinitis alone and 68 had rhinitis associated with asthma. Forty children had IAR, 30 of whom with moderate-severe grade. Ninety-nine children had PER, 65 of whom had moderate-severe grade. The severity of AR was not associated with asthma presence (Fisher χ2 = 0.5765; Prob.=0.9018). Regarding asthma severity, 30 children had the intermittent form, whereas 38 had the persistent form: 15 mild, 22 moderate, and 1 severe. This study provides the first evidence concerning the ARIA classification in children, partially confirming findings obtained in adulthood.
Investigation of Anti-Inflammatory, Analgesic and Antipyretic Properties of Madhuca Indica Gmel
Authors: Shekhawat N. , Vijayvergia R.
Published: January 2017

The crude methanolic extract of Madhuca indica (Sapotaceae) at 50,100 and 200 mg/kg body weight was evaluated for anti-inflammatory, analgesic and antipyretic activities in male wistar rats. Anti-inflammatory activity was studied by using carrageenan-induced oedema right hind paw volume while the analgesic effect was evaluated using acetic acid-induced abdominal pains, i.e. nociception response and the brewer's yeast-induced pyrexia model was used for antipyretic investigation. Phytochemical screening of the alcoholic extract revealed the presence of cardiac glycosides, flavonoids, saponins, steroids, tannins and terpenes. All the doses of the plant methanolic extract and the indomethacin significantly inhibited carrageenan-induced inflammation that was not dose-dependent. The plant extract reduced the acetic acid-induced pain licking. The plant extract reduced the brewer's yeast-provoked elevated body temperature in rats after 60 mins for 50 and 100 mg/kg dose range and 30 mins for 200 mg/kg dose range. The results suggest a potential benefit of M indica methanolic extract in treating conditions associated with fever, inflammation and pain. These properties might be adduced to the presence of the phytoconstituents.
Epidemiological Study and Classification of ICU Infections, Using the Carrier State Criterion
Authors: Trikaliotis C. , Soulountsi V. , Tsorlini H. , Katsifa H. , Chatzidimitriou D. , Trikaliotis K. , Kalaitzopoulou P. , Bitziani M. , Chatzopoulou F. , Arvanitidou M.
Published: January 2017

This work aims at the better comprehension of epidemiology of ICU infections, using a classification based on the carrier state of the patient. This classification distinguishes the infections in primary endogenous (PE), secondary endogenous (SE) and exogenous (EX) infections. The material used was derived from ICU patients who were admitted to the ICU without being transferred from another ward of the same hospital or another hospital. Culture swabs were obtained from the pharynx and perineum of the patients at ICU admission and from then onwards every 3 days during their hospitalization. At the same time, cultures of clinical samples were carried out, on suspicion of infection. Ninety-six ICU patients were studied. In 31 of these, a total of 78 infections were developed. According to the proposed classification, 26 of the infections were PE (rate 33.3%), 34 SE (rate 43.6%) and 18 EX (rate 23.1%). Using the carrier state criterion, there were 11 fewer infections characterized as nosocomial (rate 14.1%), contrary to the 48-hour criterion. Based on this new taxonomy of infections, we are able to know in advance the source of the causative microorganisms and reduce the prevalence of ICU infections, by applying appropriate prevention and treatment strategies.