bluuebunny/crossref_metadata_2025_split huggingface dataset:
Therapeutic Management of Cerebral Arteriovenous Malformations. Present Role of Interventional Neuroradiology
Authors: Viñuela F. , Duckwiler G. , Jahan R. , Murayama Y. 
Published: January 2017

This chapter summarizes the authors' experience in the endovascular therapy of cerebral arteriovenous malformations (AVMs). This clinical series includes 660 patients treated from 1980 to 2005. The first 148 patients were treated at University Hospital, in London, Ontario Canada, in association with Drs. Allan Fox, Dave Pelz, John Girvin and Charles Drake. The next 512 patients were treated at UCLA Medical Center, Los Angeles, California in association with Drs. Gary Duckwiler, Reza Jahan, Jacques Dion, Pierre Gobin, Neil Martin and John Frazee. Only patients treated with superselective endovascular/intraoperative catheterization and embolization of avm arterial feeders were included. Cerebral arteriovenous malformations treated by non-selective injection of beads in ICA or vertebral arteries were excluded. Modern neuroimaging modalities associated to the anatomical, topographic and functional evaluations of cerebral avms such as brain CT and CTA, MRI, MRA and functional MRI are all utilized at UCLA Medical Center. They have become essential in the therapeutic management of avms closely related to cerebral eloquent areas (figure 1).
Ectatic and Occlusive Diseases of the Venous Drainage System of Cerebral Arteriovenous Malformations (AVMs) -with Emphasis on Spectacular Shrinking Neurological Deficits after Embolization
Authors: Goto K. 
Published: January 2017

During reviewing cases with AVM, the author noticed that stenotic and occlusive changes of the draining veins are commonly seen in high flow cerebral AVMs. However, little attention has been paid to these venous diseases until ectatic veins, generated in the upstream of the venous system, cause mass effect to the surrounding structures, or redistribution and shunting toward regional veins became insufficient after they are markedly overloaded or occluded. Cases with such venous abnormality are clinically important because of the possibility of dramatic improvement of neurological deficits after embolization of AVMs. Following presenting treatment results of 177 AVM case, the author is going to present five cases with abnormality in the Galenic venous system and two cases with abnormality in cortical veins associating with high flow cerebral AVMs. Consideration will be made on symptomatology and pathophysiologic mechanism of venous abnormalities associating with high flow cerebral AVMs.
3T MRI — 3D DSA Fusion Technique on Posterior Cerebral Artery Dissecting Aneurysm: Understanding a Potential Pathophysiologic Mechanism
Authors: Chong W.K.W. , Lee S.K. , terBrugge K.G. 
Published: January 2017

We aimed to show the anatomical relationship between a dissecting aneurysm of the posterior cerebral artery (PCA) and tentorial free edge to understand the pathophysiologic mechanism. A 52-year-old woman with a history of head trauma presented with dizziness and numbness in her left fingers. 3D DSA showed a dissecting aneurysm of the right P2-P3 segment of PCA. The fusion of 3D DSA and 3T MRI was performed at the dedicated workstation using three pairs of landmarks including the ICA termination, MCA bifurcation and A1-A2 junction of the right ACA. Fusion of 3D DSA and 3T MRI clearly demonstrated the dissected segment of PCA crossed the tentorial free edge twice. The fusion images support the direct trauma hypothesis of dissecting aneurysm of the P2-P3 segment of PCA. This novel imaging technique shows future potential to be used to understand the anatomical relationships between various vascular lesions and surrounding structures.
Traumatic Cerebral Aneurysm Associated with a Contralateral Traumatic Carotid Cavernous Fistula
Authors: Fuse A. , Yokota H. , Kominami S. , Yamamoto Y. 
Published: January 2017

This report documents the management of a traumatic carotid aneurysm (TCA) with a traumatic carotid-cavernous fistula (T-CCF) of the contralateral internal carotid artery (ICA) following a closed head injury. A 38-year-old man presented with severe traumatic subarachnoid hemorrhage and pneumocephalus due to a severe head injury. Four months after the accident, the patient presented with clinical symptoms of exophthalmos and retroorbital bruit. Cerebral angiography showed a TCA of the IC-PC region, which coexisted with a contralateral T-CCF. Both lesions were successfully managed with an endovascular treatment using coils to isolate a fistula from the ICA, and direct surgical trapping of the intracranial ICA to eliminate a TCA. Post-operative angiography revealed a good cross-flow through the anterior communicating artery from the contralateral ICA, which was completely obliterated by the T-CCF. No additional surgical or endovascular procedure for traumatic vascular injuries was required. The patient remained asymptomatic during the clinical follow-up period of 24 months. The goal of traumatic carotid injuries is the selective elimination of the vascular pathologic injury with asymptomatic state, using direct surgery and/or an endovascular treatment.
Venous Anatomy of the Sphenoparietal Sinus: Evaluation by MR Imaging
Authors: Takahashi S. , Sakuma I. , Otani T. , Yasuda K. , Tomura N. , Watarai J. , Yanagisawa T. , Mizoi K. 
Published: January 2017

The termination of the superficial middle cerebral vein (SMCV) has been described as entering or being partially equivalent to the venous sinus coursing under the lesser sphenoid wing, which has classically been called the sphenoparietal sinus. However, the recent literature reports that the SMCV is not connected to the sphenoparietal sinus. In this study, the venous anatomy was evaluated to clarify the anatomy of the sphenoparietal sinus and the termination of the SMCV. Magnetic resonance imaging (MRI) was performed on 1.5-T superconductive units using a three-dimensional fast spoiled gradient-recalled acquisition in the steady state (3-D fast SPGR) sequence with fat suppression in a total of 48 sides of 24 patients. Coronal source images and reconstructed axial images were displayed on the Advantage Window Console, and connections to the cavernous sinus were then evaluated for the venous sinus coursing under the lesser sphenoid wing (hereafter called the sinus of the lesser sphenoid wing), the middle meningeal vein, and the SMCV. The following findings were observed bilaterally in all patients. The sinus of the lesser sphenoid wing was connected medially with the cavernous sinus and laterally with the anterior branch of the middle meningeal vein near the pterion. The anterior branch of the middle meningeal vein entered the bony canal laterally above the junction with the sinus of the lesser sphenoid wing and coursed along the inner table of the skull or emerged into the diploic vein, indicating its parietal portion. Although the termination of the SMCV had several patterns, the SMCV was not connected with the sinus of the lesser sphenoid wing in any of the patients. The sphenoparietal sinus is considered to consist of the sinus of the lesser sphenoid wing and the parietal portion of the anterior branch of the middle meningeal vein; these were identified as venous structures distinct to the SMCV.
Result of Neck Clipping and Coil Embolization as a Treatment for Unruptured Aneurysm
Authors: Iwamuro Y. , Nakahara I. , Higashi T. , Iwaasa M. , Watanabe Y. , Tsunetoshi K. , Munemitsu T. , Taha M. 
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 hemorrhage (SAH) 1. Recently, some results of treatments for unruptured aneurysm via coil embolization and neck clipping have been reported2,3. We compared the results of coil embolization and neck clipping in our institute. Generally better outcomes were obtained by endovascular surgery than by neck clipping. Postoperative ischemic strokes occurred in one case (1.8%) as a major stroke and in three cases (5.6%) as a minor stroke among coil-treated cases, and in two cases(2.6%) as a major stroke, and in seven cases(9.0%) as a minor stroke among neck clipping cases. Other complications after these treatments were six cases of subdural effusion/hematoma, four cases of infection, two cases of epidural hematoma, one abducens nerve palsy, one hydrocephalus, and one acute myocardial infarction among 78 neck clipping cases, and two subcutaneous hematoma, one pseudoaneurysm at the puncture points, one direct carotid-cavernous fistula among 54 coil-treated cases. Four coil-treated cases, in which introduction of microcatheters to the aneurysm was impossible, were treated completely by neck clipping after endovascular treatments. In terms of modified Rankin Scale(mRS) three months after treatments, while mRS 3 was noted in only one case in the endovascular treatment group, there were one case of mRS 3, two cases of mRS 4, and two cases of mRS 5 in the neck clipping group. Duration of hospitalization averaged 11.9 days in the endovascular group and 24.1 days in the neck clipping group. The results of endosaccular enbolizations as treatment of the unruptured aneurysm seems to be better than neck clipping. However, not all cases of unruptured aneurysms can be treated by coil embolization due to the width of aneurysmal neck and relation of the aneurysm to parent arteries. Therefore, surgeons should also be able to perform neck clipping as an alternative modality.
Preliminary Report on the Thrombogenic Properties of Tantalum-GDC Coils An Experimental Study
Authors: Guglielmi G. 
Published: January 2017

In order to overcome the possibility of re-canalization and compaction with Platinum GDC coils Tantalum coils were placed in three aneurysms in swine. Comparative coiling was done on the other side in each animal with platinum GDC. More stable thrombus was observed on the aneurysms coiled with Tantalum GDC.
Endovascular Management of Posterior Cerebral Artery Aneurysms
Authors: Zhao Z.-W. , Deng J.-P. , Gao L. , Gao G.-D. 
Published: January 2017

The purposes of this study were to evaluate the efficacy and safety of the endovascular management of posterior cerebral artery aneurysms and compare the efficacy and safety of selective aneurysmal coiling and parent artery occlusion. We reviewed all cases with cerebral aneurysms and attention was paid to the patients with posterior cerebral artery aneurysms. Among 550 aneurysms, eight aneurysms in eight patients were located on the posterior cerebral artery, three of which presented with SAH, whereas five presented with different degrees of headache. Seven were located at the P2 segment and one at the P3 segment. One was a giant serpentine aneurysm, two were giant sac aneurysms, two were large and three were small. All aneurysms were successfully treated, five with selective aneurysmal coiling and three with parent artery occlusion. Two patients presenting with headache with giant aneurysms had suffered an aggravated headache for two weeks which then resolved. Others had an uneventful recovery. All patients were followed from 12 months to 56 months. Four selective aneurysmal coiling aneurysms received digital subtraction angiography, two of which needed another treatment and one was treated with parent artery occlusion, one of which recanalized slightly and one of which had further thrombosis. No rebleeding or any other symptom occurred. Whether selective aneurysmal coiling or parent artery occlusion was performed, endovascular management of PCA aneurysms was a safe and effective method. Under some conditions, parent artery occlusion was better than selective aneurysmal coiling.
Endovascular Treatment of a High-Flow Direct Traumatic Carotid Cavernous Fistula with a Two Year Follow-up
Authors: Fang C. 
Published: January 2017

Endovascular treatment of high-flow direct traumatic carotid cavernous fistula (CCF) carries many difficulties. One of them is that carotid dissection may be associated with pseudo-aneurysm formation even when the CCF can be successfully embolized by detachable balloons. This article details a unique technique of treating pseudo-aneurysm by obstructing the lumen with preservation of the parent artery. The case presented here involves a 50-year-old man with a history of severe trauma. The angiography revealed that his bilateral high-flow carotid cavernous fistula was successfully embolized by detachable balloons and control digital subtraction angiography at the end of the procedure demonstrated the fistula closed and the internal carotid artery preserved. But two months later, a pseudo-aneurysm formed in the right internal carotid artery. Under endovascular treatment along with other techniques including coils, stent-assisted and covered stent, the pseudo-aneurysm was excluded with preserved ICA. Two years later, the fistula and pseudo-aneurysm both disappeared quietly without patent foreign body reaction in the parent arterial wall.
Supratentorial Brain AVM Embolization with Onyx-18 and Post-Embolization Management
Authors: Pan J. W. , Zhou H.J. , Zhan R.Y. , Wan S. , Yan M. , Fan W.J. , Wu Z.X. , Zheng S.S. 
Published: January 2017

Onyx is increasingly used in endovascular therapy of intracranial arteriovenous malformations (AVMs). However, the embolic effect and post-embolization management are still under discussion. We report our experience in the treatment of supratentorial brain arteriovenous malformations (SBAVMs) with Onyx and discuss post-embolic management. From June 2006 to July 2008, 20 patients with SBAVM were embolized with Onyx. There were 14 men and six women ranging from 14 to 64 years of age (mean 38.3 years). Initial symptoms included spontaneous hemorrhage (n=12), headaches (n=4), seizure (n=3) and incidentally disclosed after head trauma (n=1). After the endovascular procedure, all had subsequent treatment (follow-up angiogram, stereotactic radiosurgery or microsurgery) according to the obliteration degree. At angiography, seven patients (35%, 7/20) were completely obliterated (over 95% closure) after embolization while one suffered a small subarachnoid hemorrhage without permanent clinical sequelae. Four patients (20%, 4/20) were subtotally obliterated (over 80% closure), one patient who suffered severe cerebral edema after embolization underwent decompressive craniectomy, two patients had additional radiosurgery and one patient had follow-up angiogram. Nine patients (45%, 9/20) were partially obliterated (20–80% closure), five patients had additional surgery, two patients had additional radiosurgery and two patients had follow-up angiogram (one patient had intraventricular hemorrhage three months after embolization). Of all 20 AVMs, an average of 2.2 ml Onyx was used per patient and average volume reduction was 80% (range, 30%–99%). Onyx is suitable for embolization of SBAVMs because of its diffuse controllable properties. We suggest clinical follow-up after complete obliteration, additional radiosurgery or angiographic follow-up after subtotal obliteration and additional surgery after partially obliteration. More cases with long-term follow-up are needed to evaluate the long-term prognosis of our post-embolization management.
Treatment and Outcome of Intracranial Hemorrhage after Carotid Artery Stenting
Authors: Xu Y. , Wanga Y. , Feng L. , Miao Z. , Ling F. 
Published: January 2017

Intracranial hemorrhage following carotid artery stenting (CAS) is a rare but potentially devastating complication. The present study reviewed intracranial hemorrhage cases from patients undergoing CAS in ten years to find the methods to rescue patients from this fatal complication. Patients with postoperative intracranial hemorrhage following CAS were retrospectively selected, and clinical features, treatments and outcomes were studied. Ten patients with intracranial hemorrhage were identified. The mean onset time of hemorrhage was 6.1 ± 7.1 h. Intracerebral hemorrhage occurred in eight patients and SAH in two patients. The patients were treated by stopping anti-platelet and anticoagulant for at least three days, and surgical drainage of the hematoma/ventricle drainage or conservative treatment. Six patients survived, two had left moderate paralysis, four had a good recovery at four week follow-up, and four patients died. No patients underwent thrombosis in stent after withdrawing of antiplatelet and anticoagulant. Intracranial hemorrhage after CAS occurs usually in a few hours and leads to catastrophic results. Once patients have intracranial hemorrhage, good neurocritical care may help to save them. Stopping antiplatelet and anticoagulant for at least three days may avoid thrombosis in the stenting site.
Y-Crossing of Braided Stents with Stents and Flow Diverters Does Not Cause Significant Stenosis in Bench-Top Studies
Authors: Makoyeva Alina , Darsaut Tim E. , Salazkin Igor , Raymond Jean 
Published: January 2017

Y-stent placement to treat bifurcation aneurysms requires the second device to cross the confines of the first stent, with concerns regarding the formation of stenosis of the second device at the site of crossing. Various braided stents and flow diverters (FDs) were deployed to cross through a high porosity braided stent, in a Y configuration, with the ends of the devices inserted in plastic tubes of various diameters, leaving the mid-portion free to expand. The ensuing constructs were photographed, paying attention to the degree of stenosis, if any, created where the second device crosses the first stent. Experiments were repeated selecting different zones of the first stent as the site of crossing for the second device, different tube diameters, and changing the angle of the bifurcation. Crossing the first stent did not cause the second stent to become significantly stenosed in any case. Crossing through the transition or expansion zone of the first device had no influence on results. Different bifurcation angles had no influence on the occurrence of stenosis. Y-stent placement to treat arterial bifurcations using braided self-expanding stents and FDs does not lead to significant stenosis in bench-top studies.
Endovascular Therapy in Hyperacute Ischaemic Stroke: History and Current Status
Authors: Mortimer Alex M. , Bradley Marcus D. , Renowden Shelley A. 
Published: January 2017

This is a literature review on to the use of endovascular therapy in hyperacute ischaemic stroke secondary to large vessel occlusion (LVO). The prognosis for LVO is generally poor and the efficacy of intravenous tissue plasminogen activator (IV TPA) in the treatment of this subtype of stroke is questionable. It is well documented that recanalisation is associated with improved outcomes but IV TPA has limited efficacy in LVO recanalisation and the complication rates are higher for IV TPA in this stroke subset. Improved recanalisation rates have been demonstrated with intra-arterial TPA and first and second generation mechanical techniques but the rate of favourable outcome has not overtly mirrored this improvement. Several controversial trials using these early techniques have recently been published but fail to reflect modern practice which centres on the use of stent-retriever technology. This has been proven to be superior to older techniques. Not only are recanalisation rates higher, but the speed of recanalisation is greater and clinical results are improved. Multiple observational studies demonstrate consistently high rates of LVO recanalisation; TICI 2b/3 in the order of 65–95% and, rates of favourable outcome (mRS 0–2) in the order of 55% (42.5–77%) in clinically moderate to severe stroke with complicating symptomatic haemorrhage in the order of 1.5–15%. A major factor determining outcome is time to treatment but success has been demonstrated using these devices with bridging therapy, after IV TPA failure or as a stand-alone treatment.
The Guglielmi Detachable Coil in the Treatment of Arteriovenous Fistulae
Authors: Evans A.J. , Jensen M.E. , Mathis J.M. , Dion J.E. 
Published: January 2017

This report describes the use of the Guglielmi Detachable Coil (GDC) (Target Therapeutics, Fremont CA) in the treatment of cervicocerebral arteriovenous fistulae. From March, 1993 to May 1995 we used GDCs in an IRB approved protocol as part of the endovascular treatment of 11 patients with arteriovenous fistulae of internal carotid, external carotid, or vertebral vessels. The patient population included four patients with dural arteriovenous fistulae, three patients with direct carotid cavernous fistulae, three patients with vein of Galen malformations, and one patient with a vertebral artery - vertebral vein fistula. In six of the 11 patients the AVF were completely occluded. Fistula occlusion occurred in two patients immediately, in three patients in a delayed fashion (three days to nine months) and in one patient the fistula was closed immediately, reopened spontaneously, and then reoccluded at a second procedure 17 months later. In five patients the fistula was incompletely occluded (20–95%). In all cases but one the coils were used in conjunction with another embolic agent. In this small series of patients we found that GDCs generally could be deposited predictably at the desired site, and that they could be observed prior to detachment to help ensure that the coil was in a secure position, decreasing the chances of unintended passage into the venous outlet. Although they rarely proved thrombogenic enough to stop the fistula, GDCs can slow the flow in a fistula, allowing other, more thrombogenic embolic agents to be deposited with a decreased risk of distal embolisation. In conclusion, we found GDCs to be a useful tool in the treatment of AV fistulae. In combination with other embolic agents, this device can aid in the safe, effective closure of these lesions.