bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental Determination of Minimal Stimulation Current and Period for Electrical Thrombosis in Dogs
Authors: Suzuki S. , Kurata A. , Ohmomo T. , Oka H. , Nakayama S. , Hirayama H. , Yasui Y. , Fujii K.
Published: January 2017

Endovascular surgery has been proposed as an alternative treatment for cerebral aneurysms. However, for wide neck and large sized lesions it is very difficult to obtain complete occlusion and tissue organization.

The present study was conducted to examine the efficacy of electrical thrombosis for cerebral aneurysms and parent arterial occlusions using Interlocking Detachable Coils (IDCs), focusing on the minimum current volume and stimulation time required for stable electrical thrombosis formation.

We used ten mixed-breed adult dogs (in the study body weights 9–12 kg; males: 5, females: 5). Guiding catheter sand microcatheters were introduced into both sides of the distal external carotid artery (ECA) and placed at the same level. To prevent migration, IDCs (4 mm × 12 cm) were placed in the ECA without being detached. After confirming no vessel occlusion, we applied a positive current (2–6 mA) to the coil on one side and performed angiography every ten minutes to observe whether vessel occlusion with electrothrombosis had occurred.

It was determined that to achieve complete occlusion of the external carotid arteries in mixed-breed dogs, a minimum stimulation current of 4mA and a minimum stimulation time of ten to 20 minutes are required.
Emergency Rescue Primary Stenting for Atherosclerotic Basilar Artery Occlusion with Acute Thrombosis
Authors: Ihn Y.K. , Baik J.H. , Park Y.H.
Published: January 2017

We demonstrate endovascular stent deployment for the treatment of atherosclerotic basilar artery occlusion with acute thrombosis. Application of a microstent without previous balloon dilatation resulted in vessel reopening and good clinical improvement. Emergency primary stent application can be technically feasible and improve the outcome in acute basilar artery occlusion and clinical status.
Accurate Positioning of Detachable Coils Using Alternate Electric Current
Authors: Guglielmi G.
Published: January 2017

A new method of positioning detachable coils is presented. It does not rely on markers, but on the decrease of electric resistance that occurs when the platinum-stainless steel junction emerges from the microcatheter tip.
Endovascular Embolization with Radiopaque Silk Threads: A Feasibility Study in Swine
Authors: Guglielmi G. , Benati A. , Perini S.
Published: January 2017

Surgical suture endovascular embolization of brain arteriovenous malformations (AVMs) is an accepted method of preoperative treatment. A major drawback of AVM embolization with surgical sutures is that the sutures are not visible under fluoroscopy. An experimental study using swine is presented where surgical sutures were rendered radiopaque using platinum markers.
Heparin or Local Thrombolysis in the Management of Cerebral Venous Sinus Thrombosis?
Authors: Anand S. , Siddhartha W. , Karnad D.R. , Shrivastava M. , Ghatge S. , Limaye U.S.
Published: January 2017

Patients with acute cerebral venous sinus thrombosis treated with Heparin or in situ thrombolysis in our department were evaluated in an attempt to rationalize treatment with heparin or thrombolysis. 279 patients with angiographically proven acute cerebral venous sinus thrombosis were included in the study. Patients were classified into mild and severe clinical grade. The study was divided into three phases. Phase I included 27 patients treated with systemic heparin. Phase II included 72 patients, 30 in severe grade and 42 in mild. 26 were thrombolysed with 14 in severe and 12 in mild grade. Phase III included 180 patients treated according to a defined protocol. 133 were in mild grade and 47 in severe. 67 patients were thrombolysed. In the thrombolysed group 27 patients were in mild grade and 40 in severe. 113 patients were treated with systemic heparin. Following acute management all were anticoagulated for six months.

The baseline characteristics were found to be same in all three phases. On comparison of outcome in Phase III with Phase 1 the likelihood ratio was found to be statistically significant in favor of Phase III (p < 0.0001). The likelihood ratio was found to be statistically significant in mild and severe clinical grade in favor of thrombolysis in Phase III (p 0.039 in mild and p 0.00001 in Severe clinical grade). This ratio was insignificant (p = 0.716) for intracranial bleed; however, local puncture site bleeding was found to be significant in the thrombolysed group (0.00005).
Coil Embolization Training Using a Rabbit Saccular Aneurysm Model
Authors: Tsumoto T. , Terada T. , Yamaga H. , Itakura T.
Published: January 2017

We developed a rabbit saccular aneurysm model for coil embolization training. Elastase-induced aneurysms were created successfully in about 80% of the rabbits.

The aneurysms were usually broad in the neck and lengthy. At the 28th postoperative day, the aneurysms were about 1.5 times larger in both width and height than they had been at the 14th day. All aneurysms were successfully embolized with 18-sized electrically detachable (ED) platinum coils. After embolization, almost all aneurysms had a neck remnant. In conclusion, this model is useful not only for learning the technique of coil embolization but also for testing new embolic materials. The rabbit aneurysm model proved to be an efficacious training modality for endovascular coil embolization.
Result of Neck Clipping and Coil Embolization as a Treatment for Subarachnoid Haemorrhage
Authors: Iwamuro Y. , Nakahara I. , Higashi T. , Watanabe Y. , Oku T. , Hirata E.
Published: January 2017

The report of the International Subarachnoid Aneurysm Trial (ISAT) study showed that coil embolization was superior to neck clipping as a treatment for subarachnoid haemorrhage (SAH) 1. We compared the results of coil embolization and neck clipping in our institute. Generally better outcomes were obtained by endovascular surgery than neck clipping. Symptomatic vasospasm and symptomatic hydrocephalus occurred less frequently in coil embolization than neck clipping.

Because not all cases of SAH can be treated by coil embolization due to the width of aneurysmal neck and relation of the aneurysm to parent arteries, we should also be able to perform neck clipping as another modality.
Coil Embolization Combined with Stenting for a Giant Basilar Trunk Aneurysm
Authors: Nakamura M. , Fujita A. , Kohmura E.
Published: January 2017

A 52-year-old male presented with left oculomotor nerve palsy. Angiograms revealed a giant basilar trunk aneurysm with a maximum diameter of 32 mm and a wide neck of 18 mm, located between the superior cerebellar artery and the anterior inferior cerebellar artery and without opacification of posterior communicating arteries. Intra-aneurysmal embolization of the dome was followed by deployment of a 24mm-long coronary balloon-expandable stent across the neck of the aneurysm.

Additional coil embolization of the aneurysmal neck produced good clinical and angiographic results.
Parent Artery Occlusion for Posterior Cerebral Artery Aneurysms
Authors: Hoya K. , Nagaishi M. , Yoshimoto Y. , Morikawa E. , Takahashi H.
Published: January 2017

We review four cases of posterior cerebral artery (PCA) aneurysm, of which three showed intolerance of parent artery occlusion. In two, balloon test occlusion (BTO) indicated poor opacification of the PCA branches from the anastomoses, and therefore, permanent occlusion was not attempted.
The Platinum Ball
Authors: Ozawa H. , Kurata A. , Suzuki S. , Fujii K. , Kan S.
Published: January 2017

Polyvinyl alcohol (PVA) particles have been widely used as an embolic material for endovascular treatment of vascular enriched tumors, especially for meningiomas. However, there are disadvantages with their use due to the fact that they are radiolucent, with a very irregular shape and a tendency for self-adhesion. With alternative organic liquids there is also a possibility of toxicity.

We have therefore developed a new embolic material, platinum balls, which feature radioopacity, a relatively well-defined oval shape, multi-pitted and indented surfaces on electron microscopy and a lower tendency for self-adhesion Based on positive findings in experimental studies, embolization of meningiomas was conducted with platinum balls in 27 patients and the results compared with findings for a matched group previously treated with PVA particles. Total volume of blood transfused during surgery was comparable in the two cases, although a tendency for lower values was noted with the platinum balls, and outcome was equally positive.
Endovascular Therapy Followed by Stereotactic Radiosurgery for Cerebral Arteriovenous Malformations
Authors: Arai Y. , Handa Y. , Ishii H. , Ueda Y. , Uno H. , Nakajima T. , Hirose S. , Kubota T.
Published: January 2017

Pre-radiosurgical embolization was carried out using cyanoacrylate in seven of 13 patients with cerebral arteriovenous malformations (AVMs) treated by stereotactic radiosurgery (SRS) with a linear accelerator (LINAC). The aim of embolization before SRS was the reduction of AVM volume and/or the elimination of vascular structures bearing an increased risk of haemorrhage. Staged-volume SRS was also performed in two patients because of residual irregular shaped nidus of AVMs even after the embolizations.

Complete obliteration of the AVM nidus on angiogram was presented in five patients with embolizations (including one with staged-volume SRS) and in three of six patients with SRS alone, during follow-up periods after radiosurgery. No patients experienced haemorrhagic events after SRS. Although transient neurological symptoms were observed after embolizations in two patients, no permanent neurological deficits were presented in all patients with SRS. Pre-radiosurgical embolization may allow the effective influence on irradiation therapy in relatively large AVMs and promote more frequent obliteration in more small sized AVMs compared to those with SRS alone. However, further study must be needed to determine whether staged-volume SRS provides a high rate of AVM obliteration and its safeness.
Computed Tomography Angiography of Carotid Stent
Authors: Sakai C. , Sakai N. , Okada T. , Kuroiwa T. , Ishihara H. , Morizane A. , Yano T. , Kikuchi H.
Published: January 2017

We evaluated Computed Tomography Angiography (CTA) of four different self-expandable stents in phantom model. Three stents ware made of nitinol and one was made of cobalt-based alloy. Each stent placed in plastic injector, filled with diluted iodinated contrast material, and placed on a plastic case filled with saline. CTA was performed on a four-detector CT scanner (detector collimation, 0.5mm: helical pitch 3.5). Axial and longitudinal reconstructions of CT imaging were compared with the in-stent attenuation. Three nitinol stents showed few artifact, and cobalt-based alloy stent was appeared artificial narrowing. In conclusion, CTA is useful for follow-up examination after carotid artery stenting (CAS) as a less invasive evaluation method.
The Stenting to Internal Carotid Artery Stenosis (ICS) in Petrous Portion
Authors: Hayashi K. , Seyama H. , Yamada N. , Murao K. , Iihara K. , Takahashi J.C. , Nakajima N. , Sayama T. , Morimoto M. , Mori H. , Yamamoto M. , Hishikawa T. , Nonaka Y. , Ayabe J. , Kikuchi T. , Hyuga M. , Ookawa M. , Kudo T. , Miyamoto S.
Published: January 2017

In the safety stenting, it is important to get to know the characteristics of a plaque. In petrous carotid artery stenosis, it is difficult to know the characteristics of the plaque. We paid our attention to the MPRAGE (Magnetization Prepared Rapid Acquisition with Gradient Echo) method on high resolving power MRI.

By the MPRAGE method, low intensity was observed in these lesions of all cases. This result suggested that the plaque in petrous portion was a fibrous plaque. This method is useful to get to know the characteristics of a plaque in petrous portion before endovascular treatment.
Carotid Artery Angioplasty and Stenting as a First-Choice Revascularization Therapy for Cervical Carotid Artery Stenosis
Authors: Satomi J. , Moroi J. , Sasaki M. , Sawada M. , Suzuki A. , Matsubara S.
Published: January 2017

We examined the patients with cervical carotid artery stenosis (>70%) treated by carotid artery angioplasty and stenting (CAS) as a first-choice direct revascularization therapy. The patients consisted of 45 men and seven women; their mean age was 70.4 years (range, 54–84 yr), with 60 cervical carotid stenosis (39 symptomatic and 21 asymptomatic).

Sixty procedures resulted in successful stent deployment in 55 cases, percutaneous transluminal angioplasty (PTA) only without stenting in three, and failed angioplasty due to inaccessibility in two. Morbidity was seen in three cases associated with thromboembolic complication.

Instent restenosis was observed in one case, which was successfully treated with subsequent PTA. CAS seems reasonable treatment for cervical carotid artery stenosis, although further accumulation of the cases will be needed to evaluate the efficacy between CAS and carotid endarterectomy.
Infantile Dural Arteriovenous Shunt Draining into a Developmental Venous Anomaly
Authors: Geibprasert S. , Krings T. , Pereira V. , Lasjaunias P.
Published: January 2017

A three-year-old girl with an incidentally discovered infantile type of dural arteriovenous shunts (DAVs) along the superior sagittal sinus during investigation of a minor head trauma is presented.

The DAVs drained into a developmental venous anomaly of the right cerebral hemisphere. In addition, there was a small cavernoma within the territory drained by the DVA. The patient underwent multiple transarterial embolizations to decrease the shunt flow and thus the constrained venous drainage of the DVA and right cerebral hemisphere. Pediatric dural arteriovenous shunts are a different entity from the adult type DAVs and should be managed according to the growth and development of the child. DVAs are extreme variations of the venous system with reduced flexibility to increased venous drainage. Regardless of the type of treatment employed, the DVA and its drainage pathway must be preserved.
Spinal Arteriovenous Epidural Fistula with Acute Paraplegia
Authors: Reul J. , Braun V.
Published: January 2017

We report a case of a 68-year-old woman with an acute paraplegia due to venous congestion of the spinal cord caused by an exclusive epidural arteriovenous fistula. Diagnosed by MRI and selective spinal angiography the fistula was embolized during emergency treatment via transarterial access. Immediately after the intervention the paraplegia declined and the patient recovered completely. Epidural AV fistulae are a very rare and therefore relatively unknown cause of vascular myelopathy. They may require emergency management to avoid permanent neurological deficits.
Patterns of Cranial Venous System from the Comparative Anatomy in Vertebrates: Part I, Introduction and the Dorsal Venous System
Authors: Aurboonyawat T. , Suthipongchai S. , Pereira V. , Ozanne A. , Lasjaunias P.
Published: January 2017

Many classifications of the cerebral venous system are found in the literature but they are seldom based on phylogenic study. Among vertebrates, venous drainage of the brain vesicles differs depending on the species. Due to the variability, poorly descriptive articles, and many different names used for the veins, the comparative study of the cranial venous system can hardly be performed in detail. The cranial venous system in vertebrates can be divided into three systems based on the evolution of the meninges and structures of the brain vesicles: the dorsal, lateral-ventral and ventricular systems.

This study proposes a new classification of the venous drainage of brain vesicles using knowledge from a comparative study of vertebrates and focusing on the dorsal venous system. We found that the venous drainage of the neopallium and neocerebellum is involved with this system which may be a recent acquisition of cranial venous evolution.
Sub-Tenon's Steroid Irrigation for Treatment of Intraorbital Capillary Hemangioma
Authors: Firat P.G. , Doganay S. , Bilak S. , Alkan A.
Published: January 2017

A four-month-old male infant underwent sub-Tenon's steroid irrigation for treatment of orbital capilary hemangioma that was causing exposure keratopathy risk to the left eye from progressive proptosis. The temporal inferior sub-Tenon's space was irrigated with a mixture of triamcinolone acetonide (40 mg/ml) and betamethasone sodium phosphate (6 mg/ml) by a blunt-tipped sub-Tenon's cannula. We describe this procedure as irrigation because reflux of the mixture from the incision was permitted. Two weeks after treatment, a marked reduction of proptosis was noted. One month after treatment, the volume of the intraorbital hemangioma resolved significantly in MRI examination.

Steroid treatment can be applied local or systemically to treat orbital capillary hemangioma but side effects must be considered carefully. Sub-Tenon's steroid irrigation may be a benefical, effective, pratical and safe application route in the treatment of orbital capillary hemangiomas.
A New Grading System for Evaluation of Technical Difficulty of Aneurysm Treatments
Authors: Ota S. , Ota TO , Fukushima T. , Sato S. , Ota TA , Goto K.
Published: January 2017

We introduced our grading system that enables us to objectively evaluate the degree of technical difficulty of aneurysm treatment modalities, i.e. neck clipping and coil embolization. The characteristics of our grading system were that the difficulty of each treatment was indicated on a ten point scale obtained by adding the scores for various technical factors. We studied annual change of treatments selected for ruptured aneurysms and the treatment results at our institute. In the earlier half of the study period, neck clipping was more frequently selected despite the fact that the difficulty score of coil embolization was lower than that of neck clipping. However, in the later half, the treatment modality was selected in accordance with the difficulty score in most of the cases. As a result, there was a tendency for the proportion of mRS 0 to increase and that of mRS 6 to decrease as the years passed. Our grading system may be useful in objectively selecting a more appropriate treatment, and further improve treatment results.
Conus Medullaris Spinal Arteriovenous Malformation in a Patient with Klippel-Trenaunay-Weber Syndrome
Authors: Iizuka Y. , Suzuki M. , Komura S. , Takada T. , Shimoji K.
Published: January 2017

We describe a 24-year-old woman who presented with twice previously unverified subarachnoid hemorrhages from the conus medullaris spinal arteriovenous malformation with Parkes-Weber-syndrome.

Spinal MRI examination is considered to be necessary for the diagnosis of Klippel-Trenaunay-Weber syndrome. For diagnosis of the spinal cord arteriovenous malformation, it is indispensable to search carefully for the presence of accompanying lesions. Transarterial glue embolization is effective for the management of the spinal vascular lesion.
Stenting for Left Subclavian Artery Stenosis before and after Coronary Artery Bypass Grafting Using the Internal Mammary Artery
Authors: Chokyu I. , Terada T. , Matsuda Y. , Okumura H. , Shintani A. , Nakamura Y. , Ohura Y. , Tsumoto T. , Masuo O. , Matsumoto H. , Itakura T.
Published: January 2017

Stenosis of the subclavian artery proximal to the origin of the internal mammary artery (IMA) used for coronary artery bypass grafting may produce flow reversal (steal syndrome) and cause myocardial ischemia. We present three cases of subclavian artery stenosis proximal to the IMA before and after CABG. The first case developed symptomatic myocardial ischemia resulting from a variant of coronary-subclavian steal syndrome. The second case had asymptomatic subclavian artery stenosis proximal to the IMA used for CABG. In the third case we planned to perform CABG using the left IMA to treat cardiac ischemia. All of the patients were successfully treated by stent placement without the use of a protection device. In the first and second cases, cardiac ischemia did not appear during balloon inflation of the subclavian artery and no embolic complication occurred. In the third case, CABG was performed six months after stenting. Subclavian artery stenting is a valid alternative to surgical treatment to restore the flow to the IMA before or after CABG.
Transarterial Embolization of Traumatic Carotid-Cavernous Fistulae by Gugliemi Detachable Coils
Authors: Luo Chao-Bao , Teng Michael Mu-Huo , Lin Chung-Jung , Chang Feng-Chi , Chang Cheng-Yen
Published: January 2017

We report our experience with transarterial embolization of traumatic carotid-cavernous fistulae (TCCFs) by using Gugliemi detachable coil (GDC). From 2000 to 2007 at our institution, 11 patients with 12 TCCFs underwent transarterial GDC embolization because of failure to occlude fistulae by detachable balloon with preservation of the parent artery.

The cause of the failure to occlude the fistula by detachable balloon was small fistula tract (n=9) and/or tortuous parent artery (n=3) or repeated balloon puncture by bony fragment (n=1). All TCCFs were successfully occluded by a single session transarterial GDC embolization. The average number of coils were eight (range, two-16) with an average length of 104 cm (range, 12–283 cm). No statistically significant procedure-related neurological complication or recurrent TCCF was observed in any of the patients.

Transarterial GDC embolization is a useful method in the treatment of TCCFs, particularly in those TCCFs with small fistula tract or small CS.
Small In-Stent Low Density on CT Angiography after Carotid Artery Stenting
Authors: Okahara Mika , Kiyosue Hiro , Kashiwagi Junji , Ueda Shinya , Hori Yuzo , Mori Hiromu
Published: January 2017

Carotid stenting (CAS) for carotid stenosis has developed rapidly over the last decade. In-stent low density area supposed plaque protrusion or thrombus is sometimes observed on CT angiography after CAS. We evaluate the frequency and time course of the small in-stent low density after carotid artery stenting and discuss its nature and clinical significance.

Between May 2005 to November 2007, 23 CASs were performed for 20 patients with carotid artery stenosis. All patients had no in-stent defect on digital subtraction angiography (DSA) immediately after the procedure. Follow-up CT angiography was performed at seven 7–10 days, 1–2 months, 6 months, and then every 6 months following CAS. We retrospectively reviewed the follow-up CT angiographic findings and clinical ischemic events.

Small in-stent low density areas on CT angiography were observed in 6 lesions (26%). Four cases were added warfarin to antiplatlets and the other two cases had antiplatlets only. The in-stent low density areas were disappeared within four months after CAS and no ischemic event was observed in five patients.

In the other patient, a small in-stent low density area had decreased at one month after CAS, but another small in-stent low density area appeared at five months.

Subacute small in-stent low density areas were frequently observed on CT angiography following CAS, however, the low density area will disappear without clinical events by medication in most case.
Treatment of Giant Intracranial Aneurysms
Authors: Lv X. , Jiang C. , Li Y. , Yang X. , Zhang J. , Wu Z.
Published: January 2017

We report on report the clinical outcome obtained in treatment of giant intracranial aneurysms (GAs). Between 2005 and 2007, 51 patients with 51 GAs presented at our hospital. Twenty-nine were treated with primary parent vessel occlusion without distal bypass and ten underwent treatment preserving the parent artery. Twelve patients could not be treated endovascularly.

Selective embolization (including two remodeling techniques and two stent-coil embolizations) resulted in only one cure. Two patients died as a result of subarachnoid hemorrhage periprocedurely. Twenty-nine patients treated primarily with parent vessel occlusion and three patients treated with covered stent were considered cured after their treatments. Only one patient treated with parent vessel occlusion experienced ischemia during follow-up, which resulted in a mild neurological deficit. Of the twelve patients who could not be treated endovascularly, one succumbed to surgery, four died while being treated conservatively, and three were lost to follow-up.

Parent artery occlusion, covered stent and coil occlusion provide effective protection against bleeding. In treatment of paraclinoid GAs of the internal carotid artery, the use of a stent, and stent-assisted coil embolization may be a pitfall.
Evaluation of the Clinical Curative Effect of an O2-O3 mixture to Treat Lumbar Disc Herniation with Different Treatment Sessions
Authors: Xu L. , Li Z-L. , He X-F. , Xiang D-C. , Ma J. , Hong C-J. , He J-X. , Yang L. , Gong Z-H. , Qiu J.
Published: January 2017

To compare the effective rates among one week, two week and four week treatment sessions of ozone therapy for lumbar disc herniation to provide a foundation for clinical decision-making. One hundred and eighty-seven lumbar disc herniation patients were divided into three groups, 103 cases for one week, 61 cases for two week and 23 cases for four week treatment sessions.

The clinical curative effective rates in the three groups were 82.52%, 85.24% and 95.65% respectively. The effective rate among the three groups showed no significant difference at statistical analysis. Considering the cost-effectiveness of ozone therapy, increasing the treatment course does not enhance the curative effect.
Giant Intracranial Aneurysm in a Ten-Year-Old Boy with Parry Romberg Syndrome
Authors: Bosman T. , Van Beijnum J. , Van Walderveen M.A.A. , Brouwer P.A.
Published: January 2017

Parry-Romberg syndrome (PRS) is a rare acquired syndrome consisting of progressive hemiatrophy of the face. We present a child with PRS and progressive neurological deficit caused by a giant intracranial aneurysm and reviewed the literature concerning all intracranial abnormalities in patients with PRS. A literature search identified 27 articles reporting on 88 patients with PRS and intracranial abnormalities. Ipsilateral brain calcification and hemiatrophy are the most prominent features on CT scan and hyper-intense white matter lesions are most frequently seen on T2-weighted MRI. Although lacking precise prevalence data, intracranial abnormalities are not uncommon in patients with PRS. We found three other PRS patients with intracranial aneurysms. Our case and literature search suggests a possible association between PRS and intracranial aneurysms.

We consider this association important for clinical practice and recommend including intracranial vascular diseases in the differential diagnosis when dealing with a PRS patient with neurological symptoms.
A Case of Aneurysm on a Persistent Hypoglossal Artery Treated by Endovascular Coiling
Authors: De Blasi R. , Medicamento N. , Chiumarulo L. , Salvati A. , Maghenzani M. , Dicuonzo F. , Carella A.
Published: January 2017

We describe a 22-year-old woman admitted to hospital in emergency with nuchal headache and vomiting. CT scan disclosed subarachnoid hemorrhage. Digital subtraction angiography with three-dimensional rotational acquisitions showed a ruptured aneurysm of a right persistent primitive hypoglossal artery as the cause of symptoms and hemorrhage. The patient was successfully treated with endovascular coiling of the aneurysm. This is the second literature report describing endovascular treatment in this unusual condition.
A Newly Developed 3 cm Marker Balloon Microcatheter
Authors: Ezura M. , Matsumoto Y. , Furui E. , Takahashi A.
Published: January 2017

No balloon microcatheter with a 3 cm marker has been developed to date. We developed a new balloon microcatheter with a double marker. This balloon microcatheter, with an outer diameter of 2.8 F, has a balloon on the most distal portion with a maximum inflation diameter of 4 mm and two markers, one is on the tip and the other is 3 cm proximal to the tip. This balloon microcatheter would make interventional procedures, especially for parent artery occlusion, simple to perform and safer.
Early Endovascular Management of Oculomotor Nerve Palsy Associated with Posterior Communicating Artery Aneurysms
Authors: Santillan A. , Zink W.E. , Knopman J. , Riina H.A. , Gobin Y.P.
Published: January 2017

Palsy of the third cranial nerve (oculomotor nerve, CNIII) is a well-known clinical presentation of posterior communicating artery (P-com) aneurysm. We report a series of 11 patients with partial or complete third nerve palsy secondary to P-com aneurysm. All were treated with endovascular embolization within seven days of symptom onset. Third nerve palsy symptoms resolved in 7/11 (64%), improved in 2/11 (18%) and did not change in 2/11 (18%) patients
Treatment of Ruptured ICA during Transsphenoidal Surgery
Authors: Ghatge S.B. , Modi D.B.
Published: January 2017

Rupture of the internal carotid artery (ICA) during transsphenoidal surgery is a rare but potentially lethal complication. Direct surgical repair of the ICA may be difficult and time-consuming in an acute setting. Urgent endovascular treatments with vascular plug or stent-graft have been the feasible options to date.

We desrcibe two cases of iatrogenic rupture of ICA during transsphenoidal surgery. In the first case we occluded the ICA with a vascular plug at the site of tear where cross circulation was adequate. In the second case we had to preserve the ICA with stent-graft since there was no adequate cross circulation. These two strategies are discussed below.
The Incidence of Trigeminocardiac Reflex in Endovascular Treatment of Dural Arteriovenous Fistula with Onyx
Authors: Lv X. , Li Y. , Jiang C. , Wu Z.
Published: January 2017

This paper reports the incidence of trigeminocardiac reflex (TCR) in endovascular treatment of dural arteriovenous fistulas (DAVFs) with Onyx.

The consecutive case histories of 45 patients with DAVFs, treated with Onyx transarterially and transvenously, from February 2005 to February 2008 at Beijing Tiantan Hospital, China, were retrospectively reviewed. The time period was limited as the anesthetic and intravascular procedure was performed under the same standardized anesthetic protocol and by the same team. The TCR rate was subsequently calculated.

Of the 45 patients, five showed evidence of TCR during transarterial Onyx injection and transvenous DMSO injection. Their HR fell 50% during intravascular procedures compared with levels immediately before the stimulus. However, blood pressure values were stable in all cases. The TCR rate for all patients was 11.1% (95% CI, 4 to 24%), 7.7% (95% CI, 2 to 21%) in patients treated intraarterially and 33.3% (4 to 78%) in patients treated intravenously. Once HR has fallen, intravenous atropine is indicated to block the depressor response and prevention further TCR episodes.

TCR may occur due to chemical stimulus of DMSO and Onyx cast formation under a standardized anesthetic protocol and should be blunted by atropine.
Balloon Kyphoplasty for Acute Osteoporotic Compression Fractures
Authors: Yang T. , Liu S. , Lv X. , Wu Z.
Published: January 2017

We reviewed the effectiveness of balloon kyphoplasty in the treatment of acute symptomatic vertebral compression fractures.

We assessed radiographic and functional outcome in 11 patients with a 24.3 month follow-up from a retrospectively monitored series of 11 patients who underwent balloon kyphoplasty (BKP). A visual analogue scale (VAS) and the short McGill questionnaire (MPQ) were used to assess average symptoms.

Eleven patients with 19 treated vertebrae completed the study. The VAS showed significant improvement after treatment: the initial score was 9.1 ± 0.6 (mean ± SD), falling to 2.7 ± 1.07 by 24.3 months (P<0.001). The MPQ also showed a significant improvement (P<0.001) at follow-up. A new fracture was seen in one patient affecting two vertebrae adjacent to the treated level. On CT following the procedure, there was cement leakage in the disc in 9% of cases.

BKP is a minimally invasive procedure that has been shown to be effective in the treatment of acute symptomatic vertebral compression fractures. It appears that BKP is associated with a low incidence of procedure-related complications and cement extravasation.
Bilateral Agenesis of the Internal Carotid Artery Associated with Basilar Artery Aneurysm Treated via the Endovascular Route
Authors: Barbosa L.G. , Barbosa L.A. , Pimentel D.P. , Mata B.E.L. , Guerra L.R. , Viana L.S.
Published: January 2017

Bilateral agenesis of the internal carotid artery is a rare anomaly of embryonic development frequently associated with intracranial aneurysm. We describe a case involving an aneurysm that burst in the third middle of the basilar artery and exhibited a bilateral agenesis of the internal carotid artery. The aneurysm was treated via an endovascular route using detachable coils.
Changes in Perfusion-Weighted Magnetic Resonance Imaging after Carotid Angioplasty with Stent
Authors: Tavares A. , Caldas J.G. , Castro C.C. , Puglia P. , Frudit M.E. , Barbosa L.A.
Published: January 2017

Carotid artery stenosis due to arteriosclerosis increases the risk of cerebral ischemia via embolic phenomena or reduced blood flow. The changes in cerebral perfusion that may occur after treatment are not clearly understood. This study evaluated the changes in cerebral microcirculation following carotid angioplasty with stenting (CAS) under cerebral protection with filters using ultrafast gradient echo (GRE) perfusion weighted imaging (PWI) with magnetic resonance imaging (MRI). Prospectively, 21 cervical carotid stenosis patients, mean age 69.95 years, underwent MRI 12 h before and 72 h after CAS. PWI parameters were collected for statistical analysis: cerebral blood volume (CBV), mean transit time (MTT) and time to peak (TTP). Statistical analysis was applied to absolute parameters and to values normalized against those from the contralateral parenchyma. The main finding of this study was improved hemodynamics for the normalized data after CAS, shown by reduced MTT (p<0.001) and TTP (p=0.019) in the territory fed by the middle cerebral artery ipsilateral to the CAS. Absolute data showed increased blood volume in the cerebral hemispheres after CAS, which was more accentuated on the stent side (p=0.016) than the contralateral side (p=0.029). Early improvements in cerebral perfusion, mainly seen in the normalized data, were clearly demonstrated in the timing parameters - TTP & MTT - after CAS.
Trans-Cranial Placement of an Amplatzer Device to Control Intractable Cardiac Failure in an Infant with a Vein of Galen Anomaly
Authors: Fourie P.A. , Potze F.P. , Hay N. , Toit E. Du , Lippert M.M. , Mennen J.
Published: January 2017

Neonates presenting with intractable cardiac failure due to vein of Galen aneurysmal malformations (VGAMs) rapidly progress to multisystem organ failure and death if left untreated. Currently the only viable treatment option is endovascular embolization. Although intracranial embolization of a neonate is a high-risk procedure, successful treatment can reverse cardiac failure and prevent neurological complications associated with VGAMs. Embolization via the arterial route is thought to have a better outcome than embolization via the venous system. However, multiple transarterial embolizations in different sessions may well be contraindicated in neonates, because repeat access via the femoral artery, carries a risk of arterial trauma which, in turn, can jeopardize lower limbs. With this case study we show that after repeat failure of arterial embolization, the transcranial placement of an Amplatzer PFO occluder (AGA Medical, Plymouth, USA) in the aneurysm can effectively reduce intrafistular pressure and venous outflow velocity. We also propose a mathematical model that can be used to calculate flow velocity through the aneurysm, which, in turn, could be used to aid clinical decision-making. Unlike some conventional techniques, the placement of an Amplatzer occluder does not pose the risk of completely obstructing venous drainage and therefore does not increase the risk of venous breakthrough hemorrhage. We propose this endovascular technique as a treatment option for high risk neonates in need of emergency embolization of VGAMs, where multiple arterial embolizations failed to control the condition sufficiently.
MR/X-Ray/Operating Suite Developed at Tokai University Hospital
Authors: Matsumae Mitsunori
Published: January 2017

Tokai University Hospital has been operating a magnetic resonance/x-ray/operating suite (MRXO) since 2006. Developed with the support of Philips Healthcare, the MRXO is an operating suite equipped with radiological diagnostic systems.
The Mechanism of Catheter Kickback in the Final Stage of Coil Embolization for Aneurysms: The Straightening Phenomenon
Authors: Miyachi S. , Izumi T. , Matsubara N. , Naito T. , Haraguchi K.-I. , Wakabayashi T.
Published: January 2017

The catheter kickback phenomenon often occurs in the last stage of coil packing for cerebral aneurysms. This behavior is considered the result of either a lack of space in the sac or a stiff detaching zone. In order to clarify its mechanism, focused stretch-resistance (SR) coil simulation models were tested.

Various commercially available SR coils were inserted into a cylinder or an aneurismal sac made from a silicone tube with a smaller than prescribed diameter. A magnified SR coil model (straight type) of fishing line was created for simulation. Numerical analysis for the changes in coil behavior were verified.

All SR coils showed hardening and straightening at the last few millimeters, resulting in catheter kickback. In a magnified coil experiment, straightening was also realized when folding into a narrow cylinder.

The SR line coursed in the canal of the first loops and shifted to the outside in the middle portion. Gaps among first coil pitches were enlarged on after insertion into the narrower space. Shortage of the SR line was calculated to reach a maximum of 32%.

The straightening phenomenon is due to SR line shortening and subsequent condensation of pitches of the first loops at the coil end. Coil tail flexibility was lost, and the coil behaved as a stiff wire.

Straightening is an important factor in the kickback phenomenon. Shorter final SR coils should be selected, and coil designs should be improved.
Endovascular Treatment of Aneurysms Arising from the Basilar Artery Trunk and Branches
Authors: Yu J.-L. , Wang H.-L. , Xu N. , Xu K. , Wang B. , Luo Q.
Published: January 2017

This study reports our experience with the endovascular treatment of basilar artery (BA) trunk and branch aneurysms. Subjects included 16 patients with BA trunk and branch aneurysms who underwent endovascular treatment in our hospital from October 2000 to October 2009, including four patients with associated arteriovenous malformation (AVM), two with associated moyamoya disease, one with multiple aneurysms at adjacent sites, and one with a distant aneurysm. Endovascular coil embolization, together with stent or balloon assistance when necessary, or while occluding the parent artery was performed. Associated diseases were managed intraoperatively or in the second stage, or treated with gamma knife radiotherapy, or followed up. Two patients with unsuccessful embolization died of re-rupture at the fourth month and fifth month follow-up. The remaining 14 patients reported good outcomes and experienced no re-rupture of either the aneurysm or associated disease. Angiographic follow-ups were conducted for the 14 patients for six to 12 months. Digital subtraction angiography (DSA) examination at the last follow-up showed no recurrence of the BA trunk and branch aneurysms. Together, BA trunk and branch aneurysms should be actively managed via endovascular techniques to prevent serious consequences due to aneurysm rupture and bleeding. Favorable outcomes can be obtained by the proper selection of endovascular treatment regimens.
Hemodynamic Studies of Intracranial Dural Arteriovenous Fistulas Using Arterial Spin-Labeling MR Imaging
Authors: Noguchi T. , Irie H. , Takase Y. , Kawashima M. , Ootsuka T. , Nishihara M. , Egashira Y. , Nojiri J. , Matsushima T. , Kudo S.
Published: January 2017

Arterial spin-labeling (ASL) magnetic resonance imaging (MRI) enables non-invasive acquisition of the brain perfusion information in cerebrovascular disease. We investigated hemodynamic changes in intracranial dural arteriovenous fistulas (DAVFs) using ASL-MRI.

ASL-MRI by a Q2TIPS sequence on a 3.0-Tesla MRI was performed for three patients with Cognard's IIa+b type of DAVFs before and after treatment. Perfusion images obtained by ASL-MRI (ASL images) before treatment were visually compared with those by single-photon emission computed tomography images (SPECT images). Increasing rates of temporal changes of regional perfusion values in ASL images (ASL values) before and after treatment were also calculated.

In all three patients, ASL images before treatment demonstrated high perfusion in regions around the shunting areas, where normal or low perfusion were detected on SPECT images; thus, ASL images might have demonstrated the abundant arterial shunting flow via the fistulas. On days eight to 20 after treatment, ASL values around the shunt areas remained the same or decreased, and those in the regions other than the shunt areas increased in all three patients. This might have been due to a combination of the following: a decrease in shunt flow volume, an amelioration of venous congestion, and a sustained an upward shift in the autoregulation of the brain perfusion pressure. All regional ASL values decreased on days 112 and 120 after treatment in two patients, which possibly reflects a reduction in the upward shift in autoregulation.

ASL-MRI might be useful for identifying the hemodynamic behavior of DAVFs before and after treatment.
Recovery of Cerebrovascular Reserves after Stenting for Symptomatic Carotid Artery Stenosis
Authors: Abe A. , Ueda T. , Ueda M. , Nogoshi S. , Nishiyama Y. , Katayama Y.
Published: January 2017

Although a decrease in cerebrovascular reserves (CVR) is known to enhance the risk of stroke, changes in this parameter after carotid artery stenting (CAS) have rarely been investigated. The present study is the first to compare CVR recoveries after applying CAS to patients with symptomatic carotid artery disease.

CAS was performed for 31 consecutive patients with symptomatic carotid artery disease. They underwent acetazolamide-challenged single photon emission computed tomography (SPECT) before and after CAS to obtain data on resting stage cerebral blood flow (CBFrest values) in various regions of interest (ROIs) defined by a three-dimensional stereotactic ROI template. CVR values on ipsilateral and contralateral hemispheric sides were then calculated based on the CBFrest data.

The 31 patients were dichotomized into unilateral (n=22) and bilateral (n=9) lesion groups, and no significant between-group differences were observed in CBFrest before and after CAS. In the unilateral group, there were no differences in CVR values before and after CAS. In the bilateral group, however, the CVR values significantly increased in nearly all the investigated ROIs on the contralateral side. Also, the hemispheric CVR values on both sides significantly increased after CAS in the bilateral group, while no such increase was observed in the unilateral group.

CAS in patients with symptomatic bilateral carotid artery disease has the potential utility for their haemodynamic improvement even on the contralateral hemispheric side.
Intra-Arterial Nimodipine Infusion for Cerebral Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage
Authors: Cho W-S. , Kang H-S. , Kim J.E. , Kwon O-K. , Oh C.W. , Son Y.J. , Kwon B.J. , Jung C. , Han M.H.
Published: January 2017

This study evaluated the efficacy of intra-arterial nimodipine infusion for symptomatic vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH). Clinical data collected from 42 consecutive patients with symptomatic vasospasm after aSAH were retrospectively reviewed. Forty-two patients underwent 101 sessions of intra-arterial nimodipine infusion. Angiographic response, immediate clinical response, and clinical outcome were evaluated at discharge and six months later.

Angiographic improvement was achieved in 82.2% of patients. The immediate clinical improvement rate was 68.3%, while the deterioration rate was 5.0%. A favorable clinical outcome was achieved in 76.2% at discharge and 84.6% six months. Vasospasm-related infarction occurred in 21.4%. There was no drug-related complication. The nimodipine group showed satisfactory outcomes. Nimodipine can be recommended as an effective and safe intra-arterial agent for the treatment of symptomatic vasospasm after aSAH.
Achieving Faster Recanalization Times by IA Thrombolysis in Acute Ischemic Stroke: Where Should We Direct Our Efforts?
Authors: Eesa M. , Menon B. K. , Hill M.D. , Demchuk A. , Goyal M.
Published: January 2017

Faster recanalization correlates with better outcomes in acute ischemic stroke. We analyzed times from arrival in ER to end of treatment in patients undergoing endovascular treatment for acute ischemic stroke at our institution.

We retrospectively studied patients who underwent IA procedures for stroke from 2005 to 2009 noting the times of arrival to ER, CT scan, arrival to DSA, arterial puncture and recanalization from our endovascular database. A subgroup analysis was performed based on administration of GA, use of mechanical devices and whether the procedure was performed during regular hours or after hours.

Of 101 patients, 53 were male, with a median age of 66 years (range 18–87). There were 81 anterior circulation strokes. Median ER to CT time was 22 min (2–1025), CT to DSA arrival time 80 min (range 4–990), DSA arrival to puncture time 24 min (range 0–75) and puncture to recanalization time 84 min (range 11–206). 23.3% of patients had an ER to CT time interval of > 60 min and 71.3 % had a CT to DSA time interval of > 60 min contributing to significant in-hospital delays. For subgroup analysis the Mann-Whitney test was used. No significant differences in CT to DSA arrival (p=0.8), DSA arrival to puncture (p=0.1) and puncture to recanalization (p=0.59) times were noted between patients with and without GA. No significant difference was noted in puncture to recanalization times with or without device (p=0.78). 39 cases were done during regular (R) hours and 62 after (A) hours. Median ER to CT time (R=18 min, A = 27 min, p 0.02), CT to DSA arrival time (R=64 min, A=90 min, p 0.004) and DSA arrival to puncture time (R=18 min, A=25 min, p 0.003) was significantly higher after hours.

ER to CT and CT to DSA arrival times in patients undergoing endovascular stroke therapy show wide variability and therefore, considerable scope for reduction. Time differences during regular and after hours should serve as a reminder to make efforts to reduce overall ischemic times in spite of staffing patterns and resource availability.
Observer Agreement in the Assessment of Minor and Major Cerebral Aneurysm Recurrence
Authors: Cloft Harry J. , Kallmes David F.
Published: January 2017

We studied the use of minor and major recurrence classifications with regard to observer variability, which directly affects validity of these terms as outcome measures.

Recurrences at the time of a three to six month follow-up angiogram were assessed independently by two experienced observers in 83 cases. Intra- and interobserver concordance is approximately 90% for assessment of minor and major recurrence.
Insight into the Periprocedural Embolic Events of Internal Carotid Artery Angioplasty
Authors: Jiang L. , Ling F. , Wang B. , Miao Z.
Published: January 2017

Thromboembolism is a major risk of carotid angioplasty and stenting (CAS). Although the incidence of distal embolism has been documented by MRI and TCD studies, the mechanisms and management of this complication are rarely reported. Here we describe four patients with periprocedural embolic events to demonstrate the mechanisms of thromboembolism in CAS. Different remedies were applied to these patients according to the underlying mechanisms of thromboembolism and good clinical outcomes were achieved.