bluuebunny/crossref_metadata_2025 huggingface dataset:
Patterns of the Cranial Venous System from the Comparative Anatomy in Vertebrates
Authors: Aurboonyawat T. , Pereira V. , Krings T. , Toulgoat F. , Chiewvit P. , Lasjaunias P.
Published: January 2017

Ontogenetically, the ventricular venous system may develop in order to drain the gray matter (cells of the mantle layer of the neural tube) which migrates dorsally. On primitive brain vesicles of submammals especially fish, amphibian and reptile, the ventricular venous system is the major venous collector located on the mid-dorsal surface, in between the meningeal layers comparable to the subarachnoid space in mammals. The ventricular venous system functions as a major drainage system for the brain vesicles in these submammals but its role decreases when the other two venous systems develop.

Concerning the route of venous exit from the brain vesicles, we found that it resembles the spinal cord but could not be found all the way along the brain vesicles.
Efficacy of Selective Transarterial Chemotherapy Using a Port System for Angiosarcomas of the Face and Scalp
Authors: Iwamoto K. , Suzuki S. , Kurata A. , Sato K. , Niki J. , Miyazaki T. , Utsuki S. , Oka H. , Fujii K. , Kan S. , Masuzawa M.
Published: January 2017

Angiosarcoma is a rare, highly malignant tumor with a poor clinical outcome. From January 2004 to September 2005, we advocated transarterial chemotherapy using a port system for four patients with angiosarcomas of the face and scalp. A heparin coated ANTHRON P-U catheter was introduced into the feeding artery. The proximal part of the P-U catheter was connected to the port system and buried in subcutaneous tissue. The amount of chemotherapeutic drug applied using the port system was almost the same as the conventional intravenous dose. Paclitaxel was the standard agent, at 50–100mg/diluted in 15–30 ml of physiological saline fluid slowly injected over 0.5–1 hour. For immunotherapy where appropriate, r-IL2 was mainly used at a dose of 70.000U/diluted in 5ml of physiological saline fluid injected into the port system over 30 seconds. This was continued for two to three weeks (five days/week) until recognition of a disappearance of the tumor. Macroscopic size reduction of the tumor was achieved in three out of the four cases. One case could not be evaluated because of eruptions induced by immunotherapy. Unfortunately two patients died after placement of port system, but the other two are still alive and are enjoying useful lives. Transarterial infusion chemotherapy using such a port system may be particularly effective for angiosarcoma in the early stages because small lesions with limited invasion mean a small territory of blood supply to be covered, and useful life was possible because the port system embedded in subcutaneous tissue allows treatment in an out-patient clinic.
Carotid Stenting without Angioplasty and without Protection
Authors: Leonardi M. , Dall'Olio M. , Raffi L. , Cenni P. , Simonetti L. , Marasco R. , Giagnorio F.
Published: January 2017

Endovascular stenting is a consolidated alternative to thrombendarterectomy in the treatment of extracranial carotid artery atheromasic stenosis.

The most common complication of stenting is a distal embolism causing clinically silent or symptomatic cerebral ischaemia. To prevent this complication distal embolism protection devices are often used but their effectiveness remains unsettled. In addition, there is some evidence that distal embolism may actually be triggered by the protection systems due to clot formation at their distal surface or in the intimal lesions these systems cause. Another rarer complication is hyperperfusion syndrome arising during both stenting and thrombendarterectomy but more common in endovascular procedures. To avoid these complications the Neuroradiology Service at Bellaria Hospital (Bologna Local Health Trust) has devised a mini-invasive carotid stenting technique that does not require either distal embolism protection or angioplasty.

The technique uses only the radial force exerted by the self-expanding stent to widen the atherosclerotic stenosis slowly and gradually. The goal of treatment has also changed from a prompt restoration of the atheromasic vessel's original calibre to slow transformation of the hemodynamic significance of the stenosis. The technique's success lies mainly in selecting the stenosis to treat using CT angiography to analyse plaque morphology and structure. We used the technique to treat 83 stenotic lesions in 75 patients. The study aims to describe and discuss our experience.
Treatment of Arteriovenous Malformations with Hydrocoils in a Swine Model
Authors: Amiridze N.S. , Darwish R. , Griffith G.M. , Zoarskia G.H.
Published: January 2017

Arteriovenous malformations (AVM) of the brain are the most common symptomatic congenital vascular malformation of the central nervous system, with significant associated morbidity and mortality. This study compared the feasibility and efficacy of treating AVMs by embolization with hydrocoils with similar treatment with bare platinum coils, using the swine rete mirabile as a model. A right carotid-jugular fistula was created in ten swine. A microcatheter was positioned into the rete mirabile, which was unilaterally (contralateral to the fistula) embolized with hydrocoils in six and bare platinum coils in four swine. Angiograms were evaluated during and immediately after embolization. Embolization with complete cessation of blood flow in the unilateral rete mirabile was achieved in all animals treated with hydrocoils. The number of coils needed varied from four to seven (diameter 2–4 mm; mean coil length 22.3 cm). Embolization with platinum coils of similar number (seven) and slightly longer length (mean 37.75 cm) had a minimal effect on blood flow, resulting in occlusion of only small compartments. No immediate complications were noted with either coil. Hydrocoils are more effective in achieving embolization than bare platinum coils. Expansion of the hydrocoil over only a few minutes allows precise placement and stabilization of the coil before detachment. Hydrocoils can be safely placed into small vessels. This approach may be particularly useful to decrease the flow rate, as a first stage of AVM embolization in high flow AVMs that contain arteriovenous fistulae.
Direct Ascending Pharyngeal Artery to Jugular Vein Arteriovenous Fistula
Authors: Tomsick S.D. , Tomsick T.A.
Published: January 2017

A 32-year-old female developed a bruit, determined to arise from a rare direct arteriovenous (AV) fistula from the ascending pharyngeal artery to the internal jugular vein.

The fistula was treated by transarterial silicone balloon occlusion, with occlusion of fistulous flow, ablation of symptoms, and excellent long-term result.
The Prevention of Hemorrhagic Stroke
Authors: Raymond J. , Mohr JP ,   The Team-Aruba Collaborative Groups
Published: January 2017

There is currently no evidence that preventive treatment of unruptured aneurysms or AVMs is beneficial and randomized trials have been proposed to address this clinical uncertainty. Participation in a trial may necessitate a shift of point of view compared to a certain habitual clinical mentality. A review of the ethical and rational principles governing the design and realization of a trial may help integrate clinical research into expert clinical practices.

The treatment of unruptured aneurysms and AVMs remains controversial, and data from observational studies cannot provide a normative basis for clinical decisions. Prevention targets healthy individuals and hence has an obligation of results. There is no opposition between the search for objective facts using scientific methods and the ethics of medical practice since a good practice cannot forbid physicians the means to define what could be beneficial to patients. Perhaps the most difficult task is to recognize the uncertainty that is crucial to allow resorting to trial methodology. The reasoning that is used in research and analysis differs from the casuistic methods typical of clinical work, but clinical judgement remains the dominant factor that decides both who enters the trial and to whom the results of the trial will apply. Randomization is still perceived as a difficult and strange method to integrate into normal practice, but in the face of uncertainty it assures the best chances for the best outcome to each participant. Some tension exists between scientific methods and normal practice, but they need to coexist if we are to progress at the same time we care for patients.
The Hydrodynamic Effect of Bare Platinum Coils versus Hydrogel-Coated Platinum Coils
Authors: Sorteberg A. , Bakke S.J.
Published: January 2017

HydroCoils (HES) were designed to obtain a better initial aneurysm occlusion and increased durability of endovascular treatment. We compared the immediate hydrodynamic effects of HES versus bare platinum coils (Guglielmi detachable coils, GDC). Intra-aneurysmal pressure and flow were measured with a 0.014 inch guide-wire mounted transducer in silicone aneurysms mounted onto a pulsatile flow phantom before and after consecutively coiling with GDC and HES. We evaluated flow using the thermodilution technique along with changes in steady pressure and sudden increases in pressure. We also considered the effect of the coils on the transmission of pressure from the parent artery to the dome of the aneurysm.

Intra-aneurysmal pressure remained unchanged after maximal packing with either GDC or HES. Sudden increases in pressure were less attenuated within the aneurysm after coiling with HES. In spite of HES obtaining a much higher percentage filling volume in the aneurysms, GDC equivalently virtually abolished intra-aneurysmal flow apart from in one instance where there was significant persistent flow after coiling with GDC. The effects of HES in terms of pressure and flow attenuation within the aneurysm could hence not be proven superior to GDC.
Treatment of Carotid Siphon Aneurysms with a Microcell Stent
Authors: Leonardi M. , Dall'Olio M. , Princiotta C. , Simonetti L.
Published: January 2017

The treatment of giant, large, multiple or wide-necked carotid siphon aneurysms has always represented a challenge for neurosurgeons and neuroradiologists. Very recently the use of stents with tiny holes has been proposed by two companies: Balt Silk Stent in Europe and Pipeline in America. We have used the Silk stent on a few patients and describe our first case who now has an eleven month follow-up. The carotid siphon presented three converging aneurysms sharing a very large common neck. The Silk stent (Balt Extrusion, Montmorency, France) was deployed through a 4F Balt introducer. The procedure was uneventful and very quick. As soon as the stent was positioned contrast medium stagnation was displayed within the aneurysm. The patient's post-operative course was normal and she was discharged three days later in good health.
Intracranial Pseudoaneurysms, Fusiform Aneurysms and Carotid-Cavernous Fistulas
Authors: Lv Xianli , Jiang Chuhan , Li Youxiang , Lv Ming , Zhang Jingbo , Wu Zhongxue
Published: January 2017

The study assessed the effectiveness and safety of endovascular covered stents in the management of intracranial pseudoaneurysms, fusiform aneurysms and direct carotid-cavernous fistulas.

Fourteen endovascular covered stents were used to repair three pseudoaneurysms, six fusiform aneurysms and six direct carotid-cavernous fistulas. Aneurysms were in the carotid artery in seven cases, in the vertebral artery two cases. It was not possible to treat two additional cases transcutaneously for technical reasons 2/15.

Percutaneous closure of the lesions with an endovascular covered stent was successful in 13 of 15 cases. Initial follow-up showed good stent patency. No complications were observed after stent implantation. During follow-up, stent thromboses were detected in two of nine patients with follow-up digital subtracted angiography. One carotid-cavernous fistula of Barrow Type A transformed into Barrow Type D at nine month follow-up study was cured with a procudure of Onyx-18 injection.

Endovascular covered stents may be an option for percutaneous closure of intracranial pseudoaneurysms, fusiform aneurysms and direct carotid-cavernous fistulas. Endoluminal vascular repair with covered stents offers an alternative therapeutic approach to conventional modalities.
Direct Fluoroscopic Drainage of Symptomatic Post-Traumatic Syringomyelia
Authors: Sudheendra D. , Bartynski W.S.
Published: January 2017

First described in 1928, percutaneous aspiration of syringomyelia is infrequently performed to aid in diagnosis and surgical management. We describe a case of post traumatic syringomyelia successfully treated with direct fluoroscopic drainage with substantial resolution of syrinx-related neurologic symptoms.

The patient is a 36-year-old man involved in a motorcycle accident who sustained multiple vertebral fractures resulting in dense paraplegia below T4, ultimately treated with multilevel laminectomy and pedicle screw fixation. The patient began to experience phantom leg paresthesias and muscle spasm felt to be related to an extensive spinal cord syrinx extending to the conus.

Syrinx drainage was accomplished fluoroscopically at the level of the conus by percuntaneous needle drainage after cord localization with intrathecal myelographic contrast. Clear spinal fluid was drained from the syrinx cavity without complication. Immediately during and after drainage, the patient recognized a decrease in phantom pelvic and lower extremity paresthesias with significantly reduced spasticity. Syrinx collapse was documented with post-drainage CT imaging. Sustained relief of paresthesias and muscle spasms was achieved with gradual syrinx and symptom return requiring subsequent drainages performed at nine, 22 and 37 months following the initial drainage.

In addition to confirming the symptomatic nature of syringomyelia in those with atypical symptoms, fluoroscopically guided drainage of syrinx can in select instances provide sustained relief.

This modality may have additional advantages including serving as an adjunctive maneuver to improve operative access to the subarachnoid space by collapsing the cord, and serving as a temporizing measure for those patients who are poor surgical candidates. Maneuvers such as fluoroscopic table angulation provide an additional benefit in both the localization and drainage of syringomyelia and thus may be preferred over other minimally invasive procedures such as CT-guided drainage.
The Aneurysmal Wall
Authors: Krings T. , Lasjaunias P.L. , Geibprasert S. , Pereira V. , Hans F.J.
Published: January 2017

The pathogenesis of intracranial arterial aneurysms (AA) has been debated for many years and still remains unclear, although these entities might pose life-threatening risks to the patient and understanding the disease is of utmost importance for choosing treatment concepts. Apart from the “classical” berry-type aneurysm, there are different other types of intracranial AA such as infectious, dissecting or giant, partially thrombosed aneurysms. From the clinician's perspective, the hypothesis that some of these intracranial aneurysms might be due to abluminal factors has been put forward for many years. Alterations of the vessel wall, either due to luminal or abluminal factors may be employed for an etiological classification of aneurysmal vasculopathies as will be discussed in this article. Moreover, regarding certain aneurysmal vasculopathies as an abluminal disease might alter current therapeutic strategies since therapy should not only aim at the intraluminal repair of the artery but may also target the vessel wall.
Transarterial Embolization of Direct Carotid Cavernous Fistulas with the Double-Balloon Technique
Authors: Tsai Yuan-Hsiung , Wong Ho-Fai , Chen Yao-Liang , Weng Hsu-Huei
Published: January 2017

Treatment of direct carotid cavernous fistulas (CCF) has progressed from surgical ligation to surgical trapping to endovascular techniques. Endovascular therapies are advantageous as they allow for occlusion of the fistula whilst preserving flow in the parent carotid artery. However, technical difficulties are not uncommon and occur when the fistulous orifice is too small or when the inflated balloon in the cavernous sinus retracts to the carotid artery. Both circumstances may lead to technical failure or an unplanned sacrifice of the parent internal carotid artery (ICA).

Here we describe a double-balloon technique used in the embolization of CCF in four patients that were successfully treated with complete immediate occlusion whilst preserving the parent ICA.
Percutaneous Direct Puncture Embolization for Superficial Craniofacial Arteriovenous Malformation
Authors: Ou Chang-Hsien , Wong Ho-Fai , Yang Ming-Shiang , Yang Tzu-Hsien , Ho Tzu-Lung
Published: January 2017

Endovascular embolization for craniofacial arteriovenous malformation has been used as preoperative adjuvant devascularization or as definitive therapy. However, because the vascular network is complex, embolization via arterial access may be ineffective, risky, incomplete or technically difficult.

The purpose of this report is to describe our experience of percutaneous direct venous pouch puncture embolization. Four patients with craniofacial AVMs were treated with direct puncture embolization via injection of NBCA. After the selective transarterial angiogram, the lesions were directly punctured in the venous pouch under a road map angiogram. A glue mixture was injected, and post-embolization angiograms revealed that in all patients, the lesions had been completely obliterated without complication. Percutaneous direct puncture embolization is an effective, time saving and safe technique for the superficial craniofacial AVM with prominent venous pouch.
Complications of Carotid Blowout Syndrome in Patients with Head and Neck Cancers Treated by Covered Stents
Authors: Chang Feng-Chi , Luo Chao-Bao , Lirng Jiing-Feng , Guo Wan-Yuo , Wu Hsiu-Mei , Teng Michael Mu Huo , Chang Cheng-Yen
Published: January 2017

The purpose of this study was to improve clinical assessment of carotid-blowout syndrome (CBS) in patients with head-and-neck cancers and with covered stents by evaluating immediate and delayed complications of reconstructive management. Eleven such patients were treated with self-expandable covered stents. We evaluated immediate and delayed complications by assessing clinical and imaging findings. Technical success and immediate hemostasis were achieved in all patients. Immediate complications were noted in four patients (36.4%), including thromboembolism in three patients and, in one patient, dissection of the carotid artery and type III endoleak by the overlapped self-expandable stent causing rebleeding. Delayed complications were noted in eight patients (72.7%), including six episodes of rebleeding in five patients, distal marginal stenosis in five patients, and delayed carotid thrombosis in three patients (one with brain abscess formation). We suggest close follow-up of the patients and aggressive re-intervention of their complications to improve outcomes.
Treatment of Intracranial Aneurysm with Bare Stent Only
Authors: Teng Michael Mu Huo , Luo Chao-Bao , Chang Feng-Chi , Harsan Harsan
Published: January 2017

Typical treatment of intracranial aneurysm includes: surgical clipping, intrasacular packing, and parent artery occlusion. The treatment of a fusiform aneurysm is often parent artery occlusion, and keeping patency of the parent artery is difficult. We report our experience in the treatment of 3 cases of intracranial fusiform aneurysm with stent placement inside the parent artery only, without coil packing of the aneurysm lumen. All 3 patients had a non-hemorrhagic dissecting aneurysm in the vertebral artery. They were treated with 2 Helistents, 3 Neuroform stents, and 2 Neuroform stents, respectively. These aneurysms disappeared after treatment at their follow-up angiograms. Treatment with a bare stent may induce obliteration or reduction in the size of some aneurysms. This technique is useful in the treatment of non-hemorrhagic fusiform-shaped aneurysms or non-hemorrhagic dissecting aneurysms to preserve the patency of these parent arteries.
Are Non-Contrast MR Images Enough for Detection of Fracture Levels Prior to Percutaneous Vertebroplasty in Patients with Osteoporosis?
Authors: Yuan Wei-Hsin , Teng Michael Mu-Huo , Hsu Hui-Chen , Sun Ying — Chou , Chang Cheng-Yen
Published: January 2017

We evaluated the detectability of painful vertebral compression fractures (VCFs) on different MRI protocols in 40 osteoporotic patients with thoraco-lumbar osteoporotic vertebral fractures. Five hundred and ten thoracic and lumbar vertebrae in 40 patients were evaluated. All patients underwent percutaneous vertebroplasty. Vertebral fractures were found in 126 (24.7%) of 510 vertebrae. Healed vertebral fractures were found in 33 (26.2%) of 126 vertebral fractures. Painful osteoporotic VCFs was found in 93 (73.8%) of 126 fractures. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of contrast-enhanced MR images, and the non-contrasted combined protocol (including T1-weighted, T2-weighted and STIR images) for the detection of painful osteoporotic VCFs were all more than 90%. Therefore, the non-contrasted combined protocol can be used for detection of painful osteoporotic VCFs prior to percutaneous vertebroplasty, unless there are conditions where contrast-enhanced MR is needed to rule out other causes of VCFs.
Urgent Intracranial Angioplasty after Combined Systemic and Intra-Arterial Thrombolysis in Acute Stroke
Authors: Sadikin Cindy , Iskandar Agustinus , Pratanu Iswanto , Yudi Hartono
Published: January 2017

We report a case of a 59-year-old man who presented with an acute stroke involving the territory of his left middle cerebral artery, and who was treated with combined systemic and intra-arterial thrombolysis. After these treatments, the segment remained stenotic. An urgent intracranial angioplasty was performed, resulting in satisfactory recanalization of the stenotic segment, and significant improvement of his National Institutes of Health Stroke Scale (NIHSS) from 14 to 5. This case report suggests an effective alternate protocol for treatment of acute stroke with arterial occlusion: immediate smaller dose of IV tissue plasminogen activator (tPA), followed by angiogram, intra-arterial thrombolysis, and angioplasty if indicated.
Transvenous Embolization of Primitive Trigeminal Artery Variant-Cavernous Fistula with Guglielmi Detachable Coils
Authors: Wu Yi-Ming , Wong Ho-Fai
Published: January 2017

Here, we present a 32-year-old male with proptosis and chemosis of the left eye following a close head injury. Digital subtraction angiography of the left internal carotid artery showed a left carotid-cavernous fistula (CCF) associated with a primitive trigeminal artery (PTA) variant. The patient was successfully treated with transvenous Guglielmi detachable coils embolization via the inferior petrosal sinus.

The PTA variant was preserved without cerebellar or brainstem infarct.
Decrease of Visual Fields Due to Re-Growth of a Big Aneurysm after Coiling
Authors: Harsan H. , Eka JW , Julius J.
Published: January 2017

We report the case of a 50-year-old man with the chief complaint of narrowing of the visual fields and blurring in his right eye. He had undergone coiling for bilateral aneurysms of the ophthalmic segment of the internal carotid arteries 15 months previously. Angiography showed re-growth of the left ophthalmic aneurysm. The patient underwent clipping and resection the coiled aneurysm. Following surgery his visual fields improved. Therefore, re-growth of aneurysms following coiling sometimes requires resection for decompression.
A Promising Adjuvant to Detachable Coils for Cavernous Packing: Onyx
Authors: Lv X. , Jiang C. , Li Y. , Wu Z.
Published: January 2017

Transvenous embolization of cavernous dural arteriovenous fistulae (CDAVFs) with Onyx has recently been reported. This study was undertaken to assess the value of Onyx in transvenous treatment of CDAVFs. We retrospectively reviewed 18 patients who underwent transvenous embolization for CDAVFs of Barrow Type D with detachable coils and Onyx at our institution over five years. Patients were divided into two groups: group A, patients who had been treated with detachable coils; group B, patients who had been treated with a combination of detachable coils and Onyx.

The approach routes, angiographic results, complications and clinical outcome were assessed for both groups.

Eighteen patients with CDAVFs of Barrow Type D were treated: nine women and nine men; mean age was 41.9 years. Eleven patients treated by 19 procedures of transvenous coiling belonged to group A. Seven patients treated by eight procedures of transvenous Onyx injection belonged to group B. The periprocedural complication rate associated with coiling for both groups was 18.2% vs 16.7% with Onyx.

The duration of the procedure in both groups was 6.77±2.49 hours vs 3.75±1.63 hours with coiling vs Onyx, and the cost of Onyx was cheaper than coils. An excellent outcome was achieved in both groups: 90.9% vs 100% (group A vs group B). Our results associated with both modalities of CDAVFs treatment with clinical outcome show that transvenous embolization with Onyx is a safe alternative to detachable coils in the treatment of CDAVFs. However, more cases need to be evaluated.
Management of Vertebral Re-Fractures after Vertebroplasty in Osteoporotic Patients
Authors: Guarnieri G. , Ambrosanio G. , Pezzullo M.G. , Zeccolini F. , Vassallo P. , Galasso R. , Lavanga A. , Muto M.
Published: January 2017

This study illustrates the usefulness of vertebral biopsy in osteoporotic patients previously treated with vertebroplasty (VP) who present at follow-up with a new fracture in a vertebral so-ma adjacent or distant from the collapsed vertebral body.

Five hundred and fifty patients with osteoporotic vertebral collapse underwent a minimally invasive treatment with vertebroplasty (VP) for a total of 980 vertebral bodies. The approach was unipedicular in 520 patients and bipedicular in 30. Only cases with unclear findings at MR or CT (23 patients) were scheduled for a vertebral biopsy before VP treatment. The biopsy results were positive for haematological disease in only eight patients. A vertebral biopsy was carried out during re-treatment with VP in all patients who presented a vertebral refracture in the three month follow-up at a site adjacent to or distant from the previously treated vertebra (21 patients). We have found new fractures of adjacent vertebrae in 15 patients and new fractures of distant vertebrae in 16 patients at three month follow-up examination. Five of the 31 cases (16%) of spinal refracture, where during vertebroplasty treatment a bone biopsy and a sternal medullary aspiration had been carried out, an anatomopathological response to multiple myeloma was responsible for the refracture.

It is useful to perform a spinal bone biopsy during re-treatment of the vertebroplasty procedure to rule out multiple myeloma or other disease as the cause of the new collapse in patients with osteoporotic disease presenting a new vertebral fracture in an adjacent or distant site from the previously collapsed vertebral body.
A Poorly Treated Carotid-Cavernous Fistula Rescued by Coils through a PComA Approach
Authors: Yu J. , Shi Z. , Lv M. , Yang X. , Wu Z.
Published: January 2017

This study describes a case of traumatic carotid-cavernous fistula poorly treated with balloons and rescued by coils through a PComA approach. A six-year-old boy suffered a left temporal bone puncture wound. Digital subtraction angiography disclosed a left carotid cavernous fistula. Five balloons were implanted into the cavernous sinus and the parent artery was sacrificed unwillingly, but the residual fistula retro-engorged by the ophthalmic artery communicated with the maxillary artery and the post circle through the PComA. We finally occluded the residual fistula through the PComA with coils. Once the parent artery was sacrificed and the distal residual fistula still retro-engorged, another patent communicating artery may be a rescue approach.
Lessons from the Diagnosis and Treatment of Spontaneous Vertebral Arterial Dissection
Authors: Shi S. , Chen K. , Ge X. , Ni B.
Published: January 2017

A 36-year-old man presented a sudden left occipital headache and right limb weakness after tooth-brushing. Conventional catheter digital subtraction angiography (DSA) showed a left VA occlusion at the crotch of the posterior inferior cerebellar artery. Four days later, the patient got worse. The angiogram showed the left vertebral artery had reopened and the basilar trunk occluded above the AICA. He died two days later and autopsy demonstrated a dissection of the basilar arteries. Based on the autopsy data from the patient in this study, we suggest that the BA dissection might be due to left VA dissection, and placing a stent on the juncture between the uninjured VA and the basilar trunk might be an effective method to prevent fatal BA occlusion.
Use of the New Solitaire™ AB Device for Mechanical Thrombectomy When Merci Clot Retriever Has Failed to Remove the Clot
Authors: Castaño C. , Serena J. , Dávalos A.
Published: January 2017

The Merci Retrieval System™ (Concentric Medical, Mountain View, CA, USA) was approved in 2004 for restoring blood flow in patients experiencing an acute stroke who are otherwise ineligible for intravenous tPA, or in whom intravenous tPA treatment has failed. However, this treatment results in successful recanalization in less than 60% of treatable vessels (Multi MERCI trial). We describe the use of a novel device, the Solitaire™ AB Neurovascular Remodeling Device (ev3 Inc., Irvine, CA, USA) that received the CE Mark for the treatment of neurovascular disease in 2007 and can recanalize arteries when MERCI has failed.

We describe a case of mechanical thrombectomy in which a new device, Solitaire™ AB, was used for acute cerebral ischemia in the setting of middle cerebral artery occlusion after unsuccessful recanalization with the MERCI® Retriever. Excellent angiographic and good clinical results were obtained without any complication.

The Solitaire™ AB device was able to retrieve and remove clots efficiently from the middle cerebral artery when the MERCI system failed, thereby offering a new alternative in the treatment of acute ischemic stroke.
Containing a Clot in the Mid-Basilar Artery Using a Self-Expandable Stent to Prevent Distal Clot Migration during Intra-Arterial Thrombolysis
Authors: Kim S.M. , Lee D.H. , Choi J.W. , Choi B.S. , Kwon S.U. , Jeong K.S. , Suh D.C.
Published: January 2017

During local intra-arterial thrombolysis (LIT), management of the secondary embolization of a fragmented or dislodged clot can be cumber-some. The fate could be dismal if without pursuit and lysis of the migrated clot. Recently, we successfully managed a patient with acute ischemia due to a large clot impinged in the mid basilar trunk while avoiding distal migration of the clot by containing the impinged clot using a self-expandable stent during LIT.
Onyx Distal Embolization in Transarterial Embolization of Dural Arteriovenous Fistula with Subtotally Isolated Transverse-Sigmoid Sinus
Authors: Jiang Y. , Li Y. , Wu Z.
Published: January 2017

We describe a 39-year-old woman with dural arteriovenous fistula in the region of transverse-sigmoid sinus. A combination approach was designed to treat the fistula but the balloon failed to pass the severely stenosed proximal end of a subtotally isolated sinus. Although successfully occlusion of most feeding arteries from a single arterial injection was achieved, Onyx was found to shift to the outflow tract of the right heart ventricle and then to the lung latterly on six month follow-up.
Posterior Circulation Stroke following Embolization of Glomus Tympanicum — Relevance of Anatomy and Anastomoses of Ascending Pharyngeal Artery
Authors: Sawlani V. , Browning S. , Sawhney I.M. , Redfern R.
Published: January 2017

Embolization in the territory of the ascending pharyngeal artery (APA) can be unsafe even after detailed pretherapeutic angiographic evaluation due to changes in haemodynamics and opening of anastomotic channels. A 60-year-old woman underwent angiogram and embolization for glomus tympanicum tumour. The glomus tympanicum tumour was embolized using contour PVA particles of 150–250 um. At the end of the particulate injection the patient had posterior circulation stroke. The check angiogram showed near total devascularisation of the tumour and in addition filling of the left vertebral artery through an anastomotic channel. MRI confirmed the infarct in the posterior circulation.

The ascending pharyngeal artery has potential anastomoses to all neighbouring major arteries, and the anastomoses to the vertebral artery in our case were through the musculospinal artery. This case highlights the importance of potential vascular anastomotic channels as a cause of ischaemic complication during the embolization procedure. It also highlights the fact that dangerous anastomoses may only be visualised in the later phase of embolization probably due to changes in the haemodynamic pressure. The angiographic anatomy of APA is reviewed with potential communications with the internal and external carotid and vertebrobasilar systems.
Brain Arteriovenous Malformations and Endovascular Treatment: Effect on Seizures
Authors: Lv X. , Li Y. , Jiang C. , Yang X. , Wu Z.
Published: January 2017

We report our experience in treating patients with seizures associated with brain arteriovenous malformations (AVM) without a clinical history of intracranial hemorrhage.

Between 2001 and 2003, the neurovascular unit at Beijing Tiantan Hospital treated 109 patients with brain AVM endovascularly. Thirty patients (27.5%) experienced seizures before treatment. We studied the following factors: sex, age, AVM size, AVM location, seizure type, duration of seizure history, endovascular treatment and AVM obliteration. Clinical follow-up was via telephone interview.

Thirty patients with seizure disorders due to brain AVMs were endovascularly treated. The age of the patients ranged from eight to 55 years. There were 22 males and eight females. The AVMs were smaller than 3 cm in five patients, between 3 cm and 6 cm in 22, and larger than 6 cm in three. The most frequent location of the AVMs was in the frontal, followed by the parietal, temporal and occipital lobes. Sixty-seven embolization procedures were performed and total obliteration was achieved in four patients. Two patients developed a hemiparesis and three suffered temporary dysphasia after embolization. Two patients had visual field deficits. There were no deaths. The results of post-embolization seizure control during the average follow-up period of 80 months were excellent in 21 patients, good in four, fair in two and poor in three. Successful seizure control can be obtained with endovascular embolization.
Periprocedural Bleeding Complications of Brain AVM Embolization with Onyx
Authors: Liu L. , Jiang C. , He H. , Li Y. , Wu Z.
Published: January 2017

The advent of Onyx has provided a new method for neurointerventional therapists to treat brain AVMs. Although some retrospective studies have reported complications for AVM embolization with Onyx, periprocedural bleeding complications with Onyx embolization have not yet been described in detail. The aim of this retrospective study was to analyze the factors of Onyx-related bleeding complications and to find a way to avoid and manage these complications.

From January 2003, patients with AVMs recruited in our institution started to be treated by Onyx embolization. From January 2007 to July 2009, 143 consecutive interventions were performed in 126 patients using flow-independent microcatheters and Onyx as embolic agents. Seven patients encountered bleeding complications (5.4% per patients and 4.7% per procedures) during or after the endovascular procedures. Among them, five bleeding episodes occurred during procedures, the other two after procedures. Details of the seven patients' clinical presentations, imaging presentations, speculative reasons and management of these complications were recorded. Follow-up data, including postoperative course, clinical symptoms and duration of follow-up were documented.

The five active bleedings discovered in procedures were managed in time, and the patients recovered without any new neurological symptoms compared with preoperation. However, of the two bleeding episodes that occurred after interventional procedures, one was detected half an hour later: the patient was remained comatose two months later after resection of right occipital hematoma; the other who encountered intraventricular and midbrain hemorrhage was treated conservatively and suffered Parinaud syndrome and hemianesthesia.

Conclusion: Periprocedural bleeding of AVMs embolization is considered a severe and devastating complication. The clinical course and prognosis of bleeding mostly depends on prompt detection and management. Interventional embolization is an effective method to manage bleeding during procedures, and the detection of risk factors and imaging signs of bleeding is extremely important.
Thromboembolic Complication Induced Stable Occlusion of a Ruptured Basilar Tip Aneurysm
Authors: Kulcsår Z. , Berentei Z. , Marosföi M. , Vajda J. , Szikora I.
Published: January 2017

We describe a case of a ruptured basilar bifurcation aneurysm that thrombosed during preparation for endovascular therapy as a complication of diagnostic angiogaphy, and showed a favorable evolution during long-term follow-up.

Endogenous thrombosis of ruptured, non giant aneurysms is uncommon. The persistence of occlusion over time in such cases is not well established.

Two weeks after rupture, a 6 × 8 mm basilar bifurcation aneurysm was referred for endovascular treatment. During preparation for endovascular coil occlusion, without having any endovascular material at the level of the basilar artery, a complete thrombotic occlusion of the basilar bifurcation and aneurysm was observed. Given the good collateral circulation for both posterior cerebral arteries no thrombolysis was undertaken. The early follow-up of seven days, three and six months showed a complete recanalization of the basilar artery and remodeling of the basilar bifurcation. The 20 months imaging follow-up demonstrated a small aneurysm regrowth at the prevoius location that remained stable during the follow-up of seven years. Unchanged biological and hemodynamic characteristics. however, may pose an elevated risk of a new aneurysm formation over time, making long-term imaging follow-up, and in case of progression, aneurysm occlusion necessary for the patient.
Idiopathic Lingual Artery Aneurysm: CT Findings and Endovascular Therapy
Authors: Brindle R.S. , Fernandez P.M. , Sattenberg R.J. , Flynn M.B. , Heidenreich J.O.
Published: January 2017

We describe a 65-year-old woman with an asymptomatic idiopathic lingual artery aneurysm which is suspected to be congenital. We review the literature on external carotid artery branch aneurysms, diagnostic evaluation and discuss treatment options for the various types and the specific chosen in the case presented.
Endovascular Treatment Accounts for a Change in Brain Arteriovenous Malformation Natural History Risk
Authors: Lv X. , Wu Z. , Jiang C. , Li Y. , Yang X. , Zhang Y. , Lv M. , Zhang N.
Published: January 2017

This study estimated the risk and rates of intracranial hemorrhage (ICH) in patients harboring brain arteriovenous malformation (BAVM) after endovascular embolization. One hundred and forty-four consecutive patients with BAVM treated with endovascular embolization between 1998 and 2003 were retrospectively reviewed. The risk of ICH subsequent to endovascular embolization was studied using Kaplan-Meier curves.

We reviewed 144 patients with BAVM treated with endovascular embolization. Two hundred and sixty-nine procedures were performed, 69 were performed with silk sutures, 18 with coils, 137 with NBCA and 36 with Onyx18. Twenty-three (16.0%) patients were treated with additional gamma-knife radiosurgery and one (0.7%) with additional surgical AVM excision. Complete obliteration of BAVMs was achieved in 20 patients (13.9%). During a mean follow-up of 5.9 years for the ICH group and 6.9 years for the non-ICH group, hemorrhages occurred in 11 (17.7%) of the ICH patients and in nine (11%) of the non-ICH group (p>0.1). The annual risk of hemorrhage was 3.0% and 1.6%, respectively. In the multivariate regression model, the adjusted relative risk (RR) for hemorrhage at initial presentation was 1.6 (95% CI 1.2–3.2; p>0.1). Deep venous drainage, male sex, age or AVM size were not significantly associated with subsequent hemorrhage. ICH and non-ICH groups did not differ in progression to subsequent ICH after endovascular embolization (log-rank X2 = 1.339, p>0.1) in survival analyses. The overall annual hemorrhage risk for all patients after endovascular embolization was 2.1%.

Endovascular embolization alone or combined with gamma-knife radiosurgery or surgical treatment are able to decrease ICH occurrence compared to abstention.
The Many Faces of Intracranial Arterial Dissections
Authors: Krings T. , Choi I-S.
Published: January 2017

Intracranial arterial dissecting diseases are rare and challenging diseases with a high associated morbidity and mortality. Their common pathomechanic origin is related to blood entering the vessel wall via an endothelial and intimal tear.

Depending on the fate of the thus established intramural hematoma, different symptoms may ensue including mass effect, subarachnoid hemorrhage or ischemia. If the mural hematoma ruptures all vascular layers of the intradural artery, a subarachnoid hemorrhagic will occur. If the intramural hematoma reopens distally into the parent vessel on the other hand, ischemic embolic events may happen following intramural clot formation.

If the mural hematoma does neither open itself into the parent vessel nor into the subarachnoid space, the vessel wall may dilate leading to occlusion of perforator branches and local ischemia.

Organization of the mural hematoma may result in a chronic dissecting process which may eventually lead to formation of a “giant partially thrombosed” aneurysm with thrombus of varying ages within the vessel wall, ingrowth of vasa vasorum and recurrent dissections with subsequent growth of the aneurysm from the periphery.

Treatment strategies of these diseases should take the underlying pathomechanism into consideration and include, depending on the presentation medical treatment, parent vessel occlusion, flow reversal or diversion, surgical options or a combined treatment protocol.
Dissection of the Distal Vertebral Artery Treated by Modified Parent Artery Trapping and a Contralateral Stent Barricade
Authors: Ryu C-W. , Koh J-S. , Kim E-J.
Published: January 2017

Endovascular trapping is the preferred treatment method for a vertebral dissecting aneurysm. We describe a case of ruptured dissecting aneurysms located just proximal to the vertebrobasilar junction treated by trapping the dissecting segment and barricading the basilar artery with a stent to protect against coil protrusion. Modified parent artery trapping with a stent barricade allows preservation of the adjoining confluent zone or side branch during endovascular trapping of the vertebral dissection.
Subarachnoid Hemorrhage following Posterior Spinal Artery Aneurysm
Authors: Geibprasert S. , Krings T. , Apitzsch J. , Reinges M.H.T. , Nolte K.W. , Hans F.J.
Published: January 2017

Isolated posterior spinal artery aneurysms are rare vascular lesions. We describe the case of a 43-year-old man presenting with spinal subarachnoid hemorrhage after a minor trauma who was found to have a dissecting aneurysm of a posterior spinal artery originating from the right T4 level. Endovascular treatment was not contemplated because of the small size of the feeding artery, whereas surgical resection was deemed more appropriate because of the posterolateral perimedullary location that was well appreciated on CT angiography. After surgical resection of the aneurysm the patient had a complete neurological recovery. In comparison to anterior spinal artery aneurysms whose pathogenesis is diverse, posterior spinal aneurysms are most often secondary to a dissection and represent false or spurious aneurysms. Although the definite diagnosis still requires spinal angiography, MRI and CT may better delineate the relationship of the aneurysm to the spinal cord in order to determine the best treatment method. Prompt treatment is recommended as they have high rebleeding and mortality rates.
Long-Term Follow-up Study of Endovascularly Treated Intracranial Aneurysms
Authors: Pyysalo L.M. , Keski-Nisula L.H. , Niskakangas T.T. , Kähärä V.J. , Öhman J.E.
Published: January 2017

Long-term follow-up studies after endovascular treatment for intracranial aneurysm are still rare and inconclusive. The aim of this study was to assess long-term clinical and angiographic outcome of patients with endovascularly treated aneurysms.

The Clinical outcome of all 185 patients with endovascularly treated aneurysms were analyzed and 77 out of 122 surviving patients were examined with MRI and MRA nine to 16 years (mean 11 years) after the initial endovascular treatment.

Sixty-three patients were deceased at the time of follow-up. The cause of death was aneurysm-related in 34 (54%) patients. The annual rebleeding rate from the treated aneurysms was 1.3% in the ruptured group and 0.1% in the unruptured group. In long-term follow-up MRA 18 aneurysms (53%) were graded as complete, 11 aneurysms (32%) had neck remnants and five aneurysms (15%) were incompletely occluded in the ruptured group. Occlusion grade was lower in the unruptured group with 20 aneurysms (41%) graded as complete, 11 (22%) had neck remnants and 18 (37%) were incomplete. However, only three aneurysms were unstable during the follow-up period and needed retreatment.

Endovascular treatment of unruptured aneurysms showed incomplete angiographic outcome in 37% of cases. However, annual bleeding rate was as low as 0.1%. Endovascular treatment of ruptured aneurysms showed incomplete angiographic outcome in 15% of cases and the annual rebleeding rate was 1.3%.
Stent-Assisted Coil Embolization of Wide-Necked Intracranial Aneurysms Using a Semi-Deployment Technique: Angiographic and Clinical Outcomes in 31 Consecutive Patients
Authors: Gao X. , Liang G. , Li Z. , Qu H. , Wei X.
Published: January 2017

We describe a modified stent-assisted coiling technique, named the semi-deployment technique, in the endovascular treatment of wide-neck aneurysms. Thirty-one consecutive patients with 31 wide-necked or fusiform intracranial aneurysms were treated with the semi-deployment technique. The technical feasibility of the procedure, procedure-related complications, angiographic results, clinical outcome and follow-up angiography were evaluated. In every case, the semi-deployment technique was successfully deployed. Immediate angiography demonstrated complete occlusion in 24 cases (77.4%), neck remnant in four cases (12.9%), and incomplete occlusion in three cases (9.7%). Procedural-related morbidity occurred in one patient (3.2%) but no procedural-related mortality. A favorable clinical outcome (Modified Ran-kin Scale score 0–2) was observed in 90.3% of the patients (average follow-up time, 23.1 months). No rehemorrhage of treated aneurysms occurred. Angiography follow-up was obtained in 22 cases (71.0 %). Three aneurysms (13.6 % of the follow-up angiograms) demonstrated recanalization. No delayed coil or stent migration was found. One patient had in-stent stenosis as a delayed complication. We found that the semi-deployment technique was helpful in the treatment of wide-neck aneurysms.