bluuebunny/crossref_metadata_2025 huggingface dataset:
Axium MicroFX Coil for the Completing Endovascular Aneurysm Surgery Study (ACCESS)
Authors: Waldau B. , Fargen K.M. , Mack W.J. , Wilson N.M. , Khaldi A. , Hoh B.L. , Mocco J
Published: January 2017

Recanalization of previously coiled aneurysms remains a major drawback of endovascular aneurysm therapy. We performed a prospective single arm trial to provide early initial data regarding the safety and angiographic durability of a new coil technology, the Axium MicroFX Polyglycolic/polylactic acid (PGLA) coil, which was designed to lower recanalization rates.

Fifteen patients (16 aneurysms) were prospectively enrolled. Demographic and peri-procedural data were collected. Angiographic images of the initial coil embolization and three to six month follow-up angiographic images underwent blinded evaluation.

Seven (47%) SAH and eight (53%) elective patients were enrolled. Blinded evaluation of the initial embolization demonstrated that 5/16 (31%) aneurysms achieved Raymond grade 1, 5/16 (31%) grade 2 and 6/16 (38%) grade 3. Three to six month angiography was obtained in 12/15 patients (80%); two patients expired (1 SAH, 1 elective) and one was lost to follow-up (SAH). All patients who underwent follow-up angiography had a mRS ≤1. Blinded evaluation of embolization demonstrated 7/13 aneurysms (54%) improved in Raymond grading, five (38%) were stable and one aneurysm (8%) worsened. One patient developed an asymptomatic peri-aneurysmal parent vessel stenosis.

Axium MicroFX coils appear to be safe, though the small number of patients in this series obviates comparative analysis with other series. Further studies are needed with more patients to compare the angiographic durability of Axium MicroFX coils to other coils.
Rescue Stenting in Endovascular Treatment of Acutely Ruptured Cerebral Aneurysms
Authors: Mahmoud M.
Published: January 2017

Thromboembolic events and major artery occlusion following cerebral aneurysm coiling may lead to serious complications and even death if not treated. The use of an intracranial stent in the setting of subarachnoid hemorrhage (SAH) is risky due to the need for antiplatelet therapy. However in some conditions it could be an effective solution for this major problem. This study describes a revascularization technique using a Solitaire stent for treatment of anterior cerebral artery (ACA) occlusion following coiling of anterior communicating artery (Acom) aneurysms. Three cases of ruptured Acom aneurysms treated during the course of SAH underwent unplanned deployment of an intracranial stent. Complete occlusion of the ACA at the origin of the A2 segment developed during or shortly after coiling. Emergent CT brain scan was done in two cases to exclude rebleeding. Follow-up CT or MRI scans were performed 24 hours after stenting. Technical success was achieved in all cases. Complete revascularization of the Acom was achieved post stent deployment (TIMI grade 3). Time from onset of symptoms to full revascularization in the three cases was 35 minutes, one hour 50 minutes and two hours 40 minutes respectively. No intracranial bleeding occurred in any case following the procedure. No neurological changes occurred in case 1; mild neurological and radiological changes occurred in cases 2 and 3. Deployment of an intracranial stent achieved complete revascularization of the occluded Acom. Its use in a context of SAH is relatively risky but the technique resulted in a significant improvement of symptoms following flow restoration and probably helped prevent symptoms worsening, major disability or even death. A study on a larger patient sample with long-term follow-up will be of value.
Mirror Image Distal Anterior Cerebral Artery Aneurysms Treated with Coil Embolization
Authors: Enesi E. , Rroji A. , Demneri M. , Vreto G. , Petrela M.
Published: January 2017

Mirror image aneurysms of the distal anterior cerebral arteries (DACA) are rare. To the best of our knowledge this is the first case report of two patients with mirror image DACA aneurysms treated successfully with coil embolization. The association of aneurysms with anatomic variants has been extensively reported. We may speculate that the remnants of the failed regression of the supreme anterior communicating artery could lead to an increase in stress across their territorial bifurcation, leading to the development of mirror image DACA aneurysms. We found the endovascular treatment of mirror image DACA aneurysms to be feasible and effective. If possible, we suggest the treatment of both aneurysms in one procedure.
Developmental Venous Anomaly with Contralateral Impaired Venous Drainage in a 17-Year-Old Male
Authors: Enslin Jmn , Lefeuvre D. , Taylor A.
Published: January 2017

Developmental venous anomalies (DVA) drain normal neural tissue and are mostly discovered incidentally. We describe a young patient with a left hemisphere superficial to deep DVA and right hemisphere venous outflow restriction presenting with a seizure. The right hemisphere drainage variation is not typical of a DVA but represents another drainage pattern on the border of normality.
Unexpected Silent Infarctions after Embolization of Cerebral Arteriovenous Malformations and Fistulas
Authors: Suazo L. , Putman C. , Vilchez C. , Stoeter P.
Published: January 2017

We investigated the number and possible causes of clinically silent lesions seen in diffusion-weighted magnetic resonance imaging after embolization of arteriovenous malformations (AVMs) and fistulas using acrylate only or in combination with coils.

Included were 19 patients with 18 AVMs and one case of a vein of Galen aneurysm in which 25 interventions were carried out. Results of diffusion-weighted imaging, the appearance of perinidal and distant lesions, were correlated to Spetzler grade, nidus size, flow, number of feeders occluded, rate of nidus occlusion and duration of the intervention.

We found seven distant lesions corresponding to non-symptomatic infarcts in the given clinical setting. The only significant correlation between lesion size and parameters analyzed was the degree of nidus occlusion achieved during the intervention.

Because most of the lesions presented in cases with a high occlusion rate, they appear to be related to the intention to reach a complete occlusion of the nidus. These results emphasize that the risk involved in eliminating the nidus completely must be reconsidered with special care, particularly in a situation where most high-flow feeders have been occluded.
Utility of Intraoperative Angiography during Subaxial Foramen Transversarium Decompression for Bow Hunter's Syndrome
Authors: Ding D. , Mehta G.U. , Medel R. , Liu K.C.
Published: January 2017

Bow hunter's syndrome is an uncommon cause of vertebrobasilar insufficiency resulting from rotational compression of the extracranial vertebral artery. While positional compression of any portion of the extracranial vertebral artery has been reported to result in bow hunter's syndrome, the most common site of compression is the V2 segment as it passes through the foramen transversarium of the subaxial cervical spine. A 43-year-old woman presented with increasingly frequent pre-syncopal and syncopal episodes upon leftward head rotation. Pre-operative angiographic studies with the neck rotated to the left demonstrated occlusion of the left vertebral artery by a C4-5 osteophyte arising from the C4 uncinate process. The patient underwent microsurgical decompression of the vertebral artery at C4-5 through a standard anterior transcervical retropharyngeal approach. Selective vertebral artery intraoperative angiography performed with the head passively rotated to the left before and after left vertebral artery decompression showed marked improvement in the luminal diameter and blood flow. The patient's symptoms resolved post-operatively. This case illustrates the second instance of intraoperative angiography used to confirm adequate vertebral artery decompression for bow hunter's syndrome. Intraoperative angiography can be safely used to decrease the extent of vertebral artery decompression in order to minimize the risk of operative complications.
Early Clinical Outcome of Patients with Ruptured Cerebral Aneurysms Treated by Endovascular (GDC) or Microsurgical Techniques
Authors: Richling B. , Bavinzski G. , Gross C. , Gruber A. , Killer M.
Published: January 2017

Over the past 3.5 years 220 patients with aneurysmal subarachnoid hemorrhage were treated in the Department of Neurosurgery University of Vienna Medical School using either endovascular techniques (Guglielmi Detachable Coils) or open craniotomy with aneurysm clipping.

A retrospective analysis was undertaken to assess whether any difference in outcome could be correlated with the treatment choice.

The patients were stratified as to 1) Hunt and Hess grade at time of treatment, 2) method of treatment, and 3) clinical outcome at 2–4 weeks following treatment.

The outcomes in this population of patients were consistent with recent published series regardless of whether the aneurysms were treated with microvascular surgery or endovascular surgery.

There was a trend toward better outcome in a relatively small sub-group of patients presenting as Hunt and Hess grade III who were treated by the endovascular method. Guglielmi detachable coils have been available for a relatively short time, and although early results are promising, the ultimate long-term efficacy of the coils will have to be assessed.
Intensive Care Management of Patients with Subarachnoid Hemorrhage at San Raffaele Hospital, Milan
Authors: Beretta L. , Sacchi L. , Calvi M. , Cenzato M.
Published: January 2017

Intensive care of patients with SAH is targeted to recognize and treat the leading cause of death and disability.

Hemorrhage, vasospasm, rebleeding, intracranial hypertension can produce ischaemia because the ratio between metabolism (CMRO2) and cerebral blood flow (CBF) is not coupled.

Neuro-ICU bedside monitoring provides information on the intracranial dynamics. Aggressive treatment attempts to avoid ischaemia but needs a clipped or thrombosed (via endovascular approach) aneurysm.

The authors propose treatment to improve CBF and reduce CMRO2: hypervolemia, hemodilution, hypertension, ICP reduction, normocapnia, mannitol infusion, normothermia or mild hypothermia and sedation with intravenous anaesthetics.

Medical complications such as hypovolemia, infections, pulmonary oedema, gastrointestinal bleeding need to be recognized early and treated.
Acute-Sinus Thrombosis in a Child with Antibodies against Cardiolipins
Authors: Söderman M. , Johnsson H. , Ericson K. , Wallstedt L.
Published: January 2017

A case of thrombosis of the straight sinus and the left transverse sinus in an 11 year old boy is described. The patient had a history of slight trauma followed by infection of the upper airways and presented with severe impressive and expressive dysphasia and stupor.

He was treated with in situ fibrinolysis. Despite successful local fibrinolysis and thrombectomy with a balloon catheter the patient rethrombosed his left transverse sinus several times and had a late thrombosis of his jugular vein.

Nevertheless, flow in the left sigmoid sinus was facilitated and focal brain oedema was significantly reduced.

Serum levels of antibodies against cardiolipins, associated with venous thrombosis, were elevated and interfered with reagents used for measuring the activated partial tromboplastin time, causing it to be falsely prolonged with subsequent underdosage of heparin. He was treated with oral anticoagulants for one year after the episode and recovered completely.
Glued Catheters during Embolisation of Brain AVMs with Acrylic Glue
Authors: Debrun G.M. , Aletich V.A. , Shownkeen H. , Ausman J.
Published: January 2017

We evaluated the frequency and the side effects associated with gluing a piece of microcatheter in the feeder during embolisation of brain AVMs with acrylic glue.

A retrospective analysis of 233 brain AVMs embolised with acrylic glue over a 15 year period has shown that 29 microcatheters were glued into the feeder. This represents 936 superselective catheterizations of different feeders followed by injection of glue. There was no side effect in 27 cases.

Eight cases were operated upon a few hours or days after the complication occurred. The piece of tubing was removed in six cases. The reason for early surgery was the fear of extensive thrombosis of a major trunk (MCA or BA) or taking advantage of the catheter being still free in the cerebral vessel.

In one case of temporal AVM, a Magic 1.5F coiled up into the distal basilar and PCA. In one case of left parietotemporal AVM, surgery was done one month after having glued a piece of tubing into the left MCA without side effect.

The patient became hemiplegic and aphasic two hours after surgery. The thrombosed left MCA was reopened with Urokinase. The patient recovered with minor residual aphasia.

The risk of side effects increases with the use of the Magic 1.5F that coils up into the vessel more easily than the Magic 1.8F.

Leaving a piece of Magic catheter in the feeder to a brain AVM usually has no side effect. When there is a risk of thrombosis of a major trunk (MCA, BA) or when surgical resection is indicated, surgery should be done as soon as possibile because it is usually possible and easy to retrieve the piece of tubing from the intracranial circulation. The frequency of this complication has decreased since we starded using more diluted acrylic glue.
An Evaluation of the Physical Properties of Current Microcatheters and Guidewires
Authors: Ogata N. , Goto K. , Uda K.
Published: January 2017

The physical properties of the 16 microcatheters and 7 guidewires currently available were evaluated to assess their manoeuvrability. This investigation included the latest varieties of these products.

The test results showed that there was a wide variation in flexibility and friction between the distal segments of the catheters. Even the recently developed hydrophilic polymer-coated catheters show this variation.

Comparisons between guidewires also showed differing degrees of flexibility and friction. Torque transmission was also a variable factor. A combination of the most flexible microcatheter with the lowest friction and the most responsive guidewire with the lowest friction was picked for clinical evaluation.

The effectiveness and safety of this combination of equipment was proved by embolising various cerebral arteriovenous malformations(AVMs) and thrombolysing cerebral emboli of arteriosclerotic patients.

However it remains difficult to reach the nidus of distally located AVMs with extremely long and tortuous feeding pedicles such as parietal lobe AVMs. The efforts to overcome the weaknesses of current materials by further improving equipment and technique is another subject of the current paper.

This paper was presented at the 16th Annual Meeting of the Working Group on Interventional Neuroradiology, Val d'Isere, France, January 16th, 1996 and the 22nd European Congress of Neuroradiology, Milan, Italy, September 21st, 1996.
Sticky Platelet Syndrome: A Cause of Neurovascular Thrombosis and Thrombo-Embolism
Authors: Berg-Dammer E. , Henkes H. , Trobisch H. , Kühne D.
Published: January 2017

Increased platelet aggregation induced by adenosine diphosphate and epinephrine and enhanced platelet activation response to surface contact are the key features of the “sticky platelet syndrome”, in which the phenotype is transmitted with an autosomal dominant pattern. Two thirds of the patients with this syndrome have a positive family history of thrombo-embolic disease, which may be triggered by stress. We have seen two patients suffering from intracranial arterial and venous sinus thrombosis due to sticky platelet syndrome. Hyperaggregability of the platelets after stimulation with adenosine diphosphate and epinephrine was found in both.

Case 1: A 43 year old man with a superior sagittal and right transverse venous sinus thrombosis developed subdural hygromas and a venous infarct of the parietal lobe. After burr hole evacuation of the hygromas, aspirin and phenoprocumone were prescribed. The patient made a good neurological recovery.

Case 2: A 52 year old woman experienced spontaneous occlusion of a right MCA branch. The work-up revealed bilateral MCA and a basilar tip aneurysm. During the attempt to treat the basilar tip aneurysm by endovascular means, a thrombus formed within the left vertebral artery and was dislodged to both posterior cerebral arteries (PCAs). Local intra-arterial fibrinolysis yielded good recanalization of both PCAs. No new neurological deficit occurred. Continuous prophylaxis with aspirin was started.

In sticky platelet syndrome stress and adrenaline release can trigger the thrombosis of intracranial arterial or venous vessels in otherwise healthy subjects. This is a potential cause of thromboembolic complications during endovascular procedures. Low-dose aspirin normalizes platelet hyperaggregability.
Angiographic A-V Shunt during Interventional Thrombolysis for Acute Cerebral Embolism
Authors: Fukazawa S. , Waki R. , Hidaka A. , Kishimoto R. , Kimura K. , Tamakawa N. , Teramachi H. , Shimizu K.
Published: January 2017

In order to predict the post-therapeutic hemorrhagic complication of interventional thrombolysis, we retrospectively examined angiographic findings and other factors in 44 patients with acute cerebral embolism. All patients were super selectively catheterized within 5 hours of onset and received a fixed regimen of urokinase or t-PA, unless recanalization was achieved or deterioration was apparent before total infusion. Immediate post-therapeutic CT scan revealed hematoma within the basal ganglia in 10 patients (group 1) and no hemorrhage in the remaining 34 (group 2). A series of angiograms during the therapy showed A-V shunt from lenticulostriate arteries to thalamostriate vein in 7 of 10 cases in group 1; no case in group 2 was accompanied by such abnormal shunt.

Prognosis after the therapy was worse in group 1 than in group 2. No other factors, such as therapeutic timing after the disease onset or total doses of urokinase or t-PA infused, differed between the two groups. These findings indicate that angiographic A-V shunt during therapy is a predictive sign of a high incidence of hemorrhagic complication.

We recommend performing several angiographic controls during therapy and when A-V shunt is detected, the therapy should be discontinued to prevent hemorrhage which leads to a poor prognosis.
Fundamentals of Transarterial Embolization Technique by Drug-Delivery Embolic Emulsion
Authors: Ikeda M. , Shimoyamada K. , Katayama N. , Itoh T. , Takahashi K. , Satoh N. , Tsukune Y.
Published: January 2017

We developed new embolic drug delivery emulsions to be utilized for malignant neoplasms.

We combined additional water-soluble contrast materials (Ioxaglic acid, Iopamidol) with Glyceol, Poloxamer-188, or D-Mannitol to antitumor agent Lipiodol ultrafluid in order to generate stable emulsions.

Some of these emulsions have been shown to cause pulmonary embolism in rabbits and to allow gradual diffusion of the antitumor agent in vitro.

Good therapeutic utility is indicated. In particular, one emulsion containing D-Mannitol (Mizonokuchi emulsion), is expected to prolong drug delivery in malignant brain tumors.
Tortuosity of the Cervical Segment of the Internal Carotid Artery in AVM Patients
Authors: Hamada J. , Kai Y. , Morioka M. , Kaku T. , Korematsu K. , Ushio Y.
Published: January 2017

The correlation between the degree of tortuosity of the cervical segment of the internal carotid artery (CICA) and the size of the nidus in AVM patients was investigated on angiograms. Fifteen AVM patients underwent embolization of vessels that were fed primarily by the internal carotid artery.

The patients were divided into two groups according to the size of nidus: in group 1 (n = 5), the size of the nidus was rated as small (less than 6 cm), in group 2 (n = 10) as large (greater than 6 cm). The tortuosity was rated as mild, moderate, or severe. The tortuosity of the ipsilateral CICA in group 1 was severe while in group 2 it was either mild or moderate.

The tortuosity of the CICA seems to be an important factor to be considered when distal embolization is contemplated in AVM patients.
Percutaneous Transluminal Angioplasty for Bilateral ICA Occlusive Lesions
Authors: Masuo O. , Terada T. , Yokote H. , Tsuura M. , Itakura T. , Yamaga H. , Maeshima S. , Kuwata T. , Moriwaki H.
Published: January 2017

We performed Percutaneous Transluminal Angioplasty (PTA) in 50 patients with internal carotid artery (ICA) stenosis.

Fifteen of these patients also showed signs of contralateral ICA occlusive lesions. Various neurological symptoms, such as hemiparesis or convulsions, frequently appeared in these patients with contralateral lesions during PTA.

The balloon inflation time was restricted in 2 patients who experienced convulsions during PTA, resulting in an unsuccessful dilatation in one case. No permanent neurological deficits appeared as a result of PTA in these cases. The treatment for these cases is discussed in this report.
Percutaneous Transluminal Angioplasty for Acute Thrombotic Occlusion of the Cervical Internal Carotid Artery Using a Perfusion Balloon Catheter
Authors: Kurashima A. , Otuka A. , Saito T. , Tuchiya T. , Uzuka T. , Kawasaki K. , Totuka N.
Published: January 2017

We performed emergency percutaneous transluminal angioplasty (PTA) with a perfusion balloon catheter (PBC) for PTCA and, at the same time, thrombolytic therapy was administered by urokinase (UK) perfusion in five cases of severe cervical internal carotid artery stenosis in which sudden cerebral hemisphere ischemia occurred due to acute thrombotic obliteration.

In four out of the five cases, effective revascularization was obtained; three resulted in Good recovery, but one showed extensive cerebral infarction after PTA.

In the remaining one case, where stenosis of the internal carotid artery of the opposite side occurred subclinically, effective revascularization by PTA was impossible resulting in the death of this patient. While “artery to aetery embolism” was confirmed in all four cases in which revascularization was successful, most emboli were dissolved by combined thrombolysis.

As poor prognostic factors, findings of a low density area and closing of cerebral sulci in an initial CT and poor development of the collateral circulation mediating the circle of Willis and leptomeningeal collateral on the cerebral surface were indicated.

Since PBC is capable of performing PTA while assuring circulation distant from the balloon, it facilitates gradual and prolonged balloon inflation, which is said to be safer and more effective, and is considered a reasonable method of revascularization at the time of an acute obliteration in the cervical internal carotid artery. In addition, this method can be used as a bridge to carotid endarterectomy. However, “artery to artery embolism” accompanying PTA in the acute stage remains a major problem, and a combination of thrombolysis seems indispensable.
Accentuated Vasospasm during Treatment of an Acutely Ruptured Aneurysm with Electrolytically Detachable Coils: Coincidence or Causation?
Authors: Huddle D.C. , Chaloupka J.C.
Published: January 2017

We report an unusual case of precipitous worsening of vasospasm associated with subarachnoid haemorrhage that developed during endosaccular coil embolisation of a ruptured posterior communicating aneurysm. The acutely worsening vasospasm occurred in the distal ipsilateral anterior circulation remote from the site of microcatheter manipulation, resulting in transient occlusion. Despite successful endovascular treatment of both the aneurysm and vasospasm, the patient continued to clinically decline and eventually died. This case raises important issues regarding the potential mechanisms and optimal therapeutic strategies for this complication, which are reviewed.
Embolization of Ruptured Cerebral Aneurysms with GDC in Acute Stage
Authors: Onizuka K. , Sonobe M. , Sugita K. , Matsumaru Y. , Takahashi S.
Published: January 2017

21 cases of 22 ruptured cerebral aneurysms were treated in acute stage with Guglielmi detachable coils and the outcome was assesed. GDCs were placed intra-aneurysm for intra-aneurysmal occlusion. Cases: age 42–80 (mean; 59) y. o., 7 male and 14 female; 4, 6, 8 and 3 patients were categorized (Hunt and Hess) as grades 1, 2, 3 and 4 respectively. GDC embolization was performed within 24 hours of primary hemorrhage in 11 patients, within 2 to 3 days in 4 patients and 5 to 19 days in 6 patients. The occlusion rate was 100% in 7 ANs, more than 75% in 9 ANs and less than 75% in 6 ANs. There were 7 cases of complications, two coil deposits, one embolism and 4 reruptures.
Endovascular Treatment of Vein of Galen Aneurysmal Malformations
Authors: Iizuka Y. , Maehara T. , Katayama H. , Sato K. , Kugimiya T. , Yamashiro Y.
Published: January 2017

We report two cases of vein of Galen aneurysmal dilatation (VGAD) and four cases of vein of Galen aneurysmal malformation (VGAM) with special reference to clinical features and therapeutic indications of endovascular treatment.

A case with VGAD was treated by radiosurgery in 1985 with no amelioration to the patient, A case of choroidal type VGAM underwent an operation in 1987, but died of massive hemorrhage 2 years later. The other case of VGAD has been followed-up conservatively.

The remaining cases of VGAM (two choroidal type and one mural type) were treated by endovascular treatment. The two cases of choroidal type were successfully embolized but died of systemic complications, and the only case of mural type was cured.
Measurement of Volume Ratio to Predict Coil Compaction, on Aneurysmal Embolization
Authors: Satoh K. , Satomi J. , Matsubara S. , Nagahiro S.
Published: January 2017

The relationship between volume embolization ratio and coil compaction on the intracranial aneurysms occluded using Guglielmi detachable coils (GDCs) was determined. From March 1997 to February 1998, 38 intracranial aneurysms were embolized using GDCs. Aneurysm volume was calculated assuming that aneurysms are ellipsoids of the diameter in three planes. Coil volume was calculated assuming that detachable coils are cylinder of primary coil. Coil compaction was observed in aneurysms embolized at a volume embolization ratio under 21%. There was no coil compaction in aneurysms embolized at a volume embolization ratio of over 21%. Measurement of the volume embolization ratio is useful to predict the coil compaction. Intracranial aneurysms should be embolized at a volume embolization ratio of 25–33%.
An Experimental and Angiographic Explanation of Why Ulcerated Carotid Bulbs Embolize
Authors: Imbesi S.G. , Kerber C.W.
Published: January 2017

The flow dynamics and pressure relationships in an ulcerated atherosclerotic carotid bulb obtained at post-mortem were studied and correlated with angiographic findings in a similar live patient.

Using the lost wax technique, we created replicas of an ulcerated atherosclerotic carotid bulb from a fresh cadaver, and placed those replicas in a circuit of pulsating non-Newtonian fluid. Flow profiles were adjusted to replicate human physiologic flows, and flow rates of 400,600, and 800 milliliters per minute were evaluated. In the replicas, the slipstreams were opacified with iso-baric dyes, and images were recorded both on 35 mm film and on SuperVHS high speed video. Data were collected from needles placed radially in the common carotid artery, in the region of the maximal atherosclerotic narrowing, and in the internal carotid artery. Though pressure relationships could not be obtained in the live human for ethical reasons, angiography in a similar stenosis was evaluated for slipstream dynamics.

The post-mortem replica had a 55% diameter stenosis (88% area stenosis) of the carotid bulb with a shallow 3 mm ulcer.

Flow in the common carotid artery showed undisturbed slipstreams, but as these slipstreams entered the narrow bulb, they crowded together, accelerating dramatically, with a jet continuing distally beyond the maximal narrowing for at least 2 vessel diameters, where flow again became normal. As fluid entered the narrowed bulb, radial pressures decreased and within the ulcer a vortex circulation was found. Similar findings were observed on the angiographic images of the live patient.

This combination of events, the slowly swirling fluid in the ulcer, which would allow platelet aggregates to form, and the intermittent low pressure of the Bernoulli effect which could pull the aggregates into the adjacent rapidly flowing blood may help explain how ulcerated carotid plaques lead to embolic stroke.
Staged Endovascular Management of a Ruptured Intracranial Aneurysm
Authors: Morris P. , Bednar M. , Gross C.
Published: January 2017

The goal of treatment of ruptured intracranial aneurysms is the exclusion of the aneurysm from the intracranial circulation.

Recently endovascular techniques have provided an alternative to open surgery in selected patients. Herein, we present a patient who underwent staged endovascular procedures to achieve definitive treatment of an intracranial fusiform vertebral artery aneurysm.

Definitive immediate therapy for the aneurysm was not possible at first presentation because of the aneurysm location and configuration, and because of absence of collateral circulation. The first stage involved coiling a daughter bleb suspected of being the source of haemorrhage.

This provided acute protection against rebleeding without sacrificing the parent artery. The second and more definitive stage, delayed for 31 days, involved balloon occlusion of a fusiform aneurysm by sacrificing the parent vessel.
Endovascular Management of a Traumatic Basilar Tip Aneurysm following Endoscopic Ventriculostomy in a Child
Authors: Lenthall R.K. , Cinalli G. , Rodesch G , Lasjaunias P.L.
Published: January 2017

We report the case of four year nine month old girl that presented a basilar tip iatrogenic arterial aneurysm following ventriculostomy. Despite being a false aneurysm the lesion was successfully coiled two years later.
Experimental Pseudo Arteriovenous Malformation a Model for Training and Research
Authors: Schumacher M. , Schellhammer F.
Published: January 2017

There are few experimental models of arteriovenous malformations (AVM). The following study was designed to evaluate an easy-to-perform method in a canine model.

Bilateral high-flow carotid to external jugular vein arteriovenous fistulae (AVF) were created in three adult dogs. 21 days after surgery one AVF was occluded by a coated stent, whereas the contralateral side remained patent. Frequent angiograms of the carotid and the vertebral arteries were performed in the nine months after surgery to investigate the effects of long-standing high-flow AVF.

Because of a significant steal effect, the fistulae recruited arterial blood flow at a rapid rate from the ipsilateral vertebral artery and to lesser extent from the contralateral side, which was only disclosed after occlusion of the contralateral AVF. These cephalic pseudo AVMs were seen in all three dogs.

The model presented is easy to establish and shows angioma-like morphological components comparable to human AVM. It is useful for the testing of new catheters and embolic materials as well as in the training of superselective navigation with microcatheters. However, it is unsuitable for examination of intracranial pathophysiology.
Combined Endovascular Stenting and Endosaccular Coiling for the Treatment of a Wide-Necked Intracranial Vertebral Aneurysm
Authors: Bracard S. , Anxionnat R. , Da Costa E. , Lebedinsky A. , Scomazzoni F. , Picard L.
Published: January 2017

We describe a clinical case of the combined application of endovascular stent placement and GDCoils packing in the management of a ruptured wide necked intracranial aneurysm.

A 27-year-old man had a subarachnoid haemorrhage secondary to the rupture of a large wide necked left vertebral aneurysm. This aneurysm was judged to be inoperable. A functional occlusion test failed because of poor collateral flow and combined stenting and coiling was used to occlude the aneurysm with preservation of the parent artery.

A femoral approach was used. An 18 mm long ACS® Duet stent was placed across the base of aneurysm and expanded to 4mm to act as a buttress. A microcatheter was then advanced through the stent mesh and GDC's were deposited for occlusion.

This technique provides new possibilities for wide-necked intracranial aneurysms. Further studies are required on the mechanical and thrombogenic properties of stents and on the long-term follow-up, but this technology may play a role in some cases of aneurysm treatment.
Treatment of External Carotid Artery Fistula by Percutaneous Venous Approach
Authors: Benndorf G. , Lehmann T.N. , Lanksch W.R.
Published: January 2017

Endovascular treatment of high flow arteriovenous fistula following a stab wound injury in a 25 year old man is reported. Previously performed proximal embolisation and surgical ligation failed to occlude the fistula but resulted in changes to the normal vascular anatomy and significant clinical and cosmetic disturbances.

A direct puncture of the draining vein was performed and the fistulous connection occluded by placement of detachable coils and deposition of glue.

Follow-up showed disappearance of the AVF as well as complete clinical recovery.
An Improvement of Cerebral Hemodynamics following Percutaneous Transluminal Angioplasty in Patients with Atherosclerotic Arterial Stenosis
Authors: Nochide I. , Ohta S. , Ueda T. , Fujita M. , Utsunomiya H. , Kumon Y. , Sakaki S.
Published: January 2017

The purpose of this study was to evaluate changes in cerebral hemodynamics following percutaneous transluminal angioplasty (PTA) in patients with atherosclerotic cerebral arterial stenosis. PTA was performed on the patients under the condition that the arterial stenosis ratio was 70% or more and regional cerebrovascular reserve (rCVR) had decreased to 10% or less. Resting regional cerebral blood flow (rCBF) and rCVR responding to acetazolamide loading were measured by 133Xe single photon emission tomography (SPECT) just prior to and 1 month after PTA. The average stenosis ratio was significantly improved from 77% to 36% one month after PTA. There were 185 preoperative normal rCBF and normal rCVR regions, 176 region (95%) of which retained their normal rCBF and normal rCVR postoperatively. In 9 regions (5%) only rCVR worsened. Preoperatively, there were 59 normal rCBF and decreased rCVR regions. Forty-five (76%) regions later showed normalized rCVR. Six regions (10%) remained decreased rCVR regions; no region did not worsen during the course of this study. Twenty-nine regions of both preoperative resting rCBF and rCVR decreased regions. Postoperatively, 18 regions (62%) normalized in regards to both rCVR and resting rCBF; in 4 regions (14%), only the resting rCBF was normalized. In the 24 decreased rCBF and normal rCVR regions, there were no hemodynamic alterations after PTA.

Regions with decreasing rCVR are at high risk of future brain infarction. This study indicates that the risk of cerebral infarction was avoided by PTA in the low rCVR regions.
Stenting Therapy for Extra-Cranial Carotid Stenosis
Authors: Nakahara T. , Sakamoto S. , Kutsuna M. , Yamanaka M. , Sakoda K.
Published: January 2017

We report our initial results of stent placement for extra-cranial carotid stenosis. Fifteen patients aged 54 to 83 years (10 men) with >60% extra-cranial carotid stenosis were treated with percutaneous stent implantation. Four patients were asymptomatic.

The rate of stenosis ranged from 60% to 93% (mean: 74%). Balloon-expandable stents (Palmaz stent 11, Cordis stent: 1, GFX stent:2) were placed for fourteen patients and for one patient a self-expandable stent was used (Memotherm biliary stent). The proximal protective balloon technique was used in the most possible cases during predilatation or stent placement. Angiography or ultrasonography was performed as the evaluation of restenosis after stent placement. The definition of restenosis was > 50% stenosis. The mean period of follow-up was 8.5 months (from 1 to 20 months). In all patients, carotid stents were successfully placed.

The mean rate of stenosis immediately after the procedure decreased to 0%. The protective balloon technique could be used in ten patients during pre-dilatation, in six during stent placement. One patient suffered a transient ischemic attack immediately after predilatation. The symptoms disappeared completely 15 minutes after onset. There was no patient with relapse or deterioration of neurological deficits after the procedure. There was no restenosis and stent deformation in the follow-up period.

In our small series, stent placement for extra-cranial carotid stenosis was performed with a low rate of morbidity and mortality. However, it is necessary to develop more flexible, more controllable stents with increased mesh densities for exclusive neurointervention. In addition, the development of a more reliable protective balloon technique to decrease procedure-related complications is needed.
The Rebuilding of Normal Venous Circulation for Transverse-Sigmoid Dural Arteriovenous Fistulas by Percutaneous Transluminal Angioplasty
Authors: Yoshino K. , Yasuhara T. , Nakagawa M. , Terai Y. , Fujimoto S. , Kusaka N.
Published: January 2017

The etiology of dural arteriovenous fistulas (DAVFs) remains controversial as is the issue of whether occlusion or stenosis of the transverse sinus and sigmoid sinus is a cause or a result of DAVFs.

We report a case of DAVFs with transverse-sigmoid sinus occlusion and cortical venous reflux. In this case, the reconstruction of normal venous circulation by percutaneous transluminal angioplasty (PTA) for the occluded sinus was performed and cortical venous reflux diminished.

PTA may be a useful treatment for DAVFs with occluded or stenotic sinus.
Treatment of Intracranial (Dural) Arteriovenous Fistulas in Unusual Locations
Authors: Kuwayama N. , Kubo M. , Nisihjima M. , Horie Y. , Endo S. , Takaku A.
Published: January 2017

We evaluated retrospectively the treatment modalities and clinical outcome of 14 patients with intracranial dural arteriovenous fistula (AVF) involving cortical veins and dural sinuses except the cavernous and lateral sinuses. The location of arteriovenous shunt was the confluence of the sinuses and superior sagittal sinus (in 2 patients), superior petrosal sinus (1), marginal sinus (1), parasigmoid sinus (1), cortical vein at the anterior fossa (2), cortical vein of the parietal lobe (2), petrosal vein (2), and the cortical vein around the craniocervical junction (3). Of 12 patients who underwent endovascular and/or surgical treatment, five patients were treated only with microsurgery, six only with endovascular therapy, and one with combined surgical and endovascular procedure.

Angioanatomical result was complete occlusion of the lesion in all the cases treated with surgery, and 80 to 100% occlusion in cases with endovascular treatment. Clinical outcome was GR in nine patients, MD in two, SD in one, VS in one, and D in one. The natural history of the lesion at each location and angioanatomical feature including the hemodynamic condition in each case should be precisely evaluated to select endovascular, surgical, or a combined procedure for the management of these unusual types of intracranial dural AVF.
GDC in Ruptured versus Unruptured Aneurysms
Authors: Duckwiler G. , Viñuela F. , Gobin P. , Guglielmi G.
Published: January 2017

We have treated 581 aneurysms in 510 patients from August 1990 to November 1998. In 247 patients the presentation was acute rupture. In 141 patients the aneurysm treated was incidental. Complications in the acute group was 10.1% morbidity with 2.8% procedure related mortality. The corresponding rates were 4.2% and 0% in the incidental group.

In the incidental group all complications occurred up to 1995. In our last 91 patients there has been no morbidity or mortality. Anatomic outcomes were dependent upon aneurysm geometry in both groups. This low rate of complications when compared to the natural history for both ruptured and unruptured aneurysm favors treatment if the long-term follow-up confirms reduced longitudinal hemorrhage rates, and the aneurysm has a favorable geometry.
Novel Peptide Treated Macrophage Induces Apoptosis in Tumor Cell Line P815
Authors: Acharya A. , Tripathi V.
Published: January 2017

In vitro macrophages treated with novel peptides have been shown to develop enhanced tumoricidal activity against tumor target cell (P815), though the exact mechanism is not known. In the present study, we have investigated the mechanism involved in the tumor cell cytotoxicity mediated by novel peptides treated macrophage and involvement of possible effectors molecule. Peritoneal exudated macrophages treated with LPS, peptides, and LPS plus peptides and when cocultured with tumor cell P815 caused tumor cell death by induction of apoptosis. The results of our experiment reveal a specific pattern of intranucleosomal DNA fragmentation detected by agarose gel electrophoresis and also with microscopic examination of the cells revealed nuclear alteration characteristic of apoptosis. Viability studies showed that most of the cells undergoing apoptosis were found to be non-viable even after 24 h coculture. Macrophage induced apoptosis in tumor target cells even in the absence of cell to cell contact through diffusible effectors molecule. The study thus shows that the novel peptide treated macrophage can kill tumor cell P815 by extracellular release of effectors molecule NO (nitric oxide) that act by inducing apoptosis in a target cell-specific manner.
Total Antioxidant Status and Erythrocyte Superoxide Dismutase Activity in Patients with Chronic Hepatitis B and C
Authors: Moulas A.N. , Noulas A. , Makri E. , Papadamou G. , Bonanou-Tzedaki S. , Dalekos G.N.
Published: January 2017

Damage of hepatitis B virus (HBV) and hepatitis C virus (HCV)-infected hepatocytes is mediated by both a direct cytopathic effect of the viruses and by immunologic response of T-cells, However, other mechanisms such as oxidative stress, may also be involved in cellular damage. We conducted a study to investigate the status of superoxide dismutase activity (SOD) and the total antioxidant status (TAS) in a consecutive cohort of patients infected with HBV and HCV infections, including HBV patients in the chronic inactive state of the disease. The latter were included in an attempt to determine whether antioxidant status is affected even in cases where an obvious viral activity is absent. TAS and SOD were measured in 55 patients (43 HBV, 12 HCV) and 25 healthy controls. 17 out of 43 patients had chronic inactive HBV state, 15 had chronic hepatitis Band 11 had HBV-related cirrhosis. In the HCV group, 6 patients had chronic hepatitis C and 6 HCV-related cirrhosis. Erythrocyte SOD activity was determined in haemolysate from red blood cells using a kinetic spectrophotometer method. TAS was measured by a colorimetric assay. The mean TAS and SOD values in the total number of patients (1.20±0.12 mmol/L and 1040±255 Ulg Hb, respectively) were significantly lower (p<0.001) compared to healthy controls (1.57±0.13 mmol/L and 1491±420 D/g Hb), Comparisons between groups showed significantly lower (p<0.001) TAS and SOD values in each subgroup of patients compared to healthy controls. A significant positive correlation was found between TAS and SOD in the total number ofpatients (n= 55, p<0.01), in the chronic hepatitis group (n=21, p=0.01) and in the total group of HBV patients (n=43, p<0.01). We demonstrated a significant reduced antioxidant capacity in patients with chronic HBV and HCV as indicated by low TAS and SOD. These findings were independent of the virological, biochemical and clinical status of the patients, including those with chronic inactive HBV state. This could suggest that the tissue-related consequences of oxidative stress might start from the inactive stage of liver viral diseases. However, our observations should be viewed with caution and need to be tested in a larger numbers of patients in order to determine prospectively whether these findings have pathophysiological and/or clinical significance.
Lack of HCV Replication during the Course of HCV-Associated Arthritis
Authors: Riccio A. , Postiglione L. , Spanò A. , Tarantino G.
Published: January 2017

Viral replication was evaluated by PCR in the serum of 25 subjects with HCV-associated arthritis. Active replication resulted in 16 cases, only 10 of which presenting hypertransaminasemia. A significant correlation appeared between serum Rheumatoid Factor concentrations and viral replication only in 7 patients with hypertransaminasemia. These data suggest that the onset of arthritis in this infection is due to an autoimmune mechanism, not linked to the HCV replication.
IL-34 a Newly Discovered Cytokine
Authors: Castellani M.L. , Anogeianaki A. , Felaco P. , Toniato E. , De Lutiis M.A. , Shaik B. , Fulcheri M. , Vecchiet J. , Tetè S. , Salini V. , Theoharides T.C. , Caraffa A. , Antinolfi P. , Frydas S. , Conti P. , Cuccurullo C. , Ciampoli C. , Cerulli G.
Published: January 2017

In this study we describe some biological effects of IL-34, a newly discovered cytokine. We show that Il-34 stimulates monocyte cell viability and directly modulates the number and function of monocytes and regulates myeloid cell growth and differentiation. Moreover, since IL-34 in mice is involved in osteoporosis, an antagonist of this cytokine could be beneficial for the treatment of this disease.
Comparison of the Bone Turn-over Markers in Patients with Multiple Sclerosis and Healthy Control Subjects
Authors: Hossein-Nezhad A. , Nikoo M. Khoshniat , Mirzaei K. , Mokhtarei F. , Meybodi H.R. Aghaei
Published: January 2017

One of the major concerns for patients with multiple sclerosis (MS) is developing osteoporosis, especially when corticosteroid treatment is used. The aim of the present study is to compare the bone turnover markers in patients with multiple sclerosis and healthy control subjects. A total of 176 subjects were enrolled in this case-control. Ninety-one MS patients with mean age of 35.26 ± 8.76 yrs were randomly selected from the Committee on Multiple Sclerosis Registry. The control group was composed of 85 healthy subjects who were recruited from the Iranian Multicenter Osteoporosis Study (IMOS). Fasting serum levels of parathyroid hormone (PTH), 25 (OH) D3, osteocalcin and cross laps were measured in two groups. Hip and spine BMD were measured using DXA. Our findings showed significant differences in hip BMD and its T-score and Z-score values between MS patients and the control group. Osteoporosis prevalence at hip area of the MS patients was almost 5 times higher than the control group [OR=4.66, (95% CI 0.97 to 22.27), RR=4.29, (95% CI 0.95 to l9.32), p value=0.03]. No significant difference was found in BMD L2-L4, BMD T-score and BMD Z-score of lumbar area between two groups. The PTH and cross laps serum concentrations in MS patients were significantly higher than the control group. We did not find significant difference in serum osteocalcin level between the two groups. We concluded that in our study the serum levels of bone resorbtion markers in MS patients were significantly higher than the healthy control group. This may explain, at least in part, the elevated susceptibility of MS patients for developing osteoporosis.