bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment and Short-Term Follow-up of Symptomatic Atherosclerotic Intracranial Artery Stenosis by Stent-Assisted Angioplasty
Authors: Feng Miao Zhongrong Ling , Shengmao Li , Fengshui Zhu , Yang Hua , Moli Wang 
Published: January 2017

Atherosclerotic intracranial artery stenosis can cause hypoperfusion of brain tissues and embolus formation, causing stroke. Conservative medical treatment seemed to have little effect on the natural history and prevent the stroke attack caused by artery stenosis. The purpose of stent-assisted angioplasty is to reconstruct the damaged vessels: the indications, feasibility, effectiveness, complications and follow-up for this new treatment method are discussed. A series of 32 cases with symptomatic intracranial artery stenosis were accepted from 1998 to 2002. The mean age was 42 yrs (31∼76 yr), male/female ratio=23/9. All patients were refractory to optimal medical therapy. Lesions included 12 middle cerebral arteries (37.5%), six basilar arteries (18.75%), three distal ICAs (9.38%) and 12 intracranial Vas (37.5%). All patients were treated by methods of transluminal stent-assisted angioplasty under general anesthesia. Patients were premedicated with Aspirin (300mg/per day) and Ticlopidine (250mg/per day), this was continued for six weeks after the procedure. Medical history, anamnesis, and treatment protocol were reviewed and evaluated retrospectively, short-term follow-up (2mths ∼ 1 yr) was also obtained. Primary clinical presentations were TIAs (21/32, 65.63%), minor stroke (8/32, 25%) and severe stroke (3/32, 9.38%). 31 cases (96.86%) were successfully implanted with coronary stents within the stenosed vessels; technical success rate was 96.86%. Instant angiographic results showed the stenosed extent had decreased from 72.36%±5.69 to 10.16%±6.94. One vessel ruptured during the procedure, the patient recovered after surgical repair of the ruptured vessel. Clinical follow-up demonstrated symptoms resolved in most patients (30/32, 93.75%) within the follow-up period, two cases with MCA stenosis had TIAs within two months after the procedure. 12 cases accepted angiographic follow-up. Velocities of stented vessels of five cases (5/21, 23.81%) increased compared to instant results, suggesting restenosis, three of them were confirmed by angiography which included two cases with MCA stenosis (figure 3) and one with distal VA, one of the five cases had recurred TIAs. With the newer generation of coronary stent, this technique seemed safe, feasible and effective to prevent stroke attack, but the indication is very important for the technical success. Restenosis remains a common problem as with coronary stenting. Long-term follow-up will be needed.
GDC Embolization of Intracranial Aneurysms with SAH and Mass Effect by Subdural Haematoma
Authors: Kim J.-K. , Kim Y.-J. 
Published: January 2017

A 43-year -old woman was brought to the emergency room due to the sudden onset of severe headache and stuporous consciousness. She had no history of head injury. Computerized tomography scan revealed subarachnoid haemorrhage and left SDH with midline shift of about 10 mm. Cerebral angiography demonstrated anterior communicating artery and right middle cerebral artery bifurcation aneurysms. Her family refused operation due to her religion never to permit blood transfusion. So just aneurysm coiling and medical ICP control was planned. Guglielmi detachable coil (GDCs) embolization of the two aneurysms was successfully performed. She made a neurological recovery after embolization without evacuation of the SDH. She was discharged from hospital with no neurological deficit on day 21. We report our experience of successful GDC embolization on multiple aneurysms without craniotomy even in the selected case of mass effect.
Simultaneous Bilateral Carotid Stenting under the Circumstance of Neuroprotection Device
Authors: Lee Y.H. , Kim T.-K. , Suh S.-I. , Kwon B.J. , Lee T.H. , Kwon O-Ki , Han M.H. , Lee N.J. , Kim J.H. , Seol H.Y. 
Published: January 2017

In this study, in order to evaluate the feasibility and outcomes of simultaneous bilateral carotid artery stenting (CAS) with the use of neuroprotection in symptomatic patients, we conducted a retrospective analysis of 27 patients (19 men, eight women; median age, 69.2 years), all of whom had been scheduled to undergo bilateral CAS in a single setting. All patients presented with severe atherosclerotic bilateral carotid stenosis (>50% for symptomatic side, >80% for asymptomatic side), exhibiting symptoms of either a cerebrovascular accident or of a transient ischemic attack on at least one side. 48 arteries were treated with self-expandable stents. Neuroprotection devices were utilized for bilateral CAS in 11 patients, and in 16 unilateral CAS patients. We did not perform the second procedure in six patients, in cases in which a patient exhibited (a) hemodynamic instability, (b) a new neurological impairment, or (c) restlessness after a prolonged time for the first CAS. The second procedure was postponed in a staged manner. We achieved a mean residual stenosis of 8.1 ± 5.0 % in the treated lesions. The mean procedural time for bilateral CAS was three hours and 18 minutes. 17 patients (63%) developed transient bradycardia during the balloon dilatation of one or both of the relevant arteries. Three patients (11%) exhibited persistent bradycardia and hypotension, which required the administration of intravenous vasopressors for several days (2!7 days). None of the patients ultimately required pacemakers, or any further therapy. Two of the patients (7%) developed transient ischemic attack during the periprocedural period, but recovered completely. One patient developed a new minor stroke after the first procedure, and the second procedure was delayed in a staged manner. We observed no periprocedural deaths, major strokes, or myocardial infarctions, nor did we detect any cases of hyperperfusion syndrome within 30 days. In summary, simultaneous bilateral CAS with neuroprotection can be performed in a single setting without increased concerns with regard to hyperperfusion syndrome, hemodynamic instability, thrombo-embolism, or procedure time, when the first CAS has been safely completed with no evidence of complications in a well-managed procedure time.
Method to Quantify Flow Reduction in Aneurysmal Cavities of Lateral Wall Aneurysms Produced by Stent Implants Used for Flow Diversion
Authors: Fujimura N. , Ohta M. , Abdo G. , Ylmaz H. , Lovblad K.-O , Rüfenacht D.A. 
Published: January 2017

Stent implants placed across the neck of cerebral aneurysms are capable of reducing aneurysmal flow when coils are not used for filling the aneurysms. It is important to evaluate the effects of flow reduction caused by stent implants used for the treatment of cerebral aneurysms. Subtracted vortex centers path line method (SVC method) is one of the image post processing methods employed for quantitative flow measurement. We developed a modified SVC method by employing Cinematic Angiography (25 frames/s) and digital video recording (30 frames/s) with a commercial digital camera. We successfully compared the flow effectiveness using a tubular silicon model with a sidewall aneurysm. The result suggests that our modified SVC method is useful for a comparative examination of the effect of aneurysmal flow reduction caused by stent implants.
Arteriovenous Fistula of the Mandible Simulating an Odontogenic Cyst
Authors: Granata F. , De Ponte F. , Pandolfo I. , Pitrone A. , Vinci S. , Blandino A. , Longo M. 
Published: January 2017

We describe a rare case of mandibular high-flow arteriovenous malformation (AVM) mimicking an odontogenic cyst in a young man. The diagnosis of mandibular AVM was made by CT angiography and confirmed by digital subtraction angiography. CT scan showed the extent of mandibular bone alteration and a double enlarged mandibular canal on the same side. An AVM containing a large aneurysm was demonstrated by CT angiography. The mandibular AVM was successfully treated by endovascular therapy with Guglielmi detachable coils. On panoramic radiogram, mandibular AVMs can appear as cystic lesions without pathognomonic features. Several benign and malignant tumours of this anatomical region must be considered in the differential diagnosis. We emphasize the radiological sign of double enlarged mandibular canal and the diagnostic role of CT, particularly CT angiography, to discriminate a mandibular AVM from neoplastic entities of this region, sparing the risks of a needle biopsy.
Delayed Thrombosis of the Basilar Artery after Stenting for a Basilar Trunk Dissection Aneurysm
Authors: Liu L. , Jiang C. , He H. , Li Y. , Wu Z. 
Published: January 2017

A 30-year-old man was referred in our department for treatment of a midbasilar trunk aneurysm. His presenting symptoms included headache and dizziness. A CT scan at another hospital showed no significant findings whereas a digital subtraction angiogram disclosed a dissecting aneurysm in the midbasilar trunk, and there was severe stenosis in the basilar artery. After discussion, we planned to use stent-assisted-coil embolization technique. During the procedure, a LEO stent (Balt, Montmorency, France) was implanted into the basilar artery across the aneurysm neck, but fearing acute basilar artery occlusion because of stent collapse or thrombus we did not fill coils into the aneurysm. After the procedure, the completion angiography demonstrated considerably decreased flow into the aneurysm, with stasis persisting into the venous phase of angiography. The patient awoke from general anaesthesia after the procedure and had no additional neurological symptoms, he was discharged three days later and used clopidogrel and aspirin for antiplatelet therapy. Six months later when he was admitted for a recheck, a DSA showed the basilar artery was occluded completely and the aneurysm had disappeared even though the patient remained neurologically normal.
A Mechanical Coil Insertion System for Endovascular Coil Embolization of Intracranial Aneurysms
Authors: Haraguchi K. , Miyachi S. , Matsubara N. , Nagano Y. , Yamada H. , Marui N. , Sano A. , Fujimoto H. , Izumi T. , Yamanouchi T. , Asai T. , Wakabayashi T. 
Published: January 2017

Like other fields of medicine, robotics and mechanization might be introduced into endovascular coil embolization of intracranial aneurysms for effective treatment. We have already reported that coil insertion force could be smaller and more stable when the coil delivery wire is driven mechanically at a constant speed. Another background is the difficulty in synchronizing operators' minds and hands when two operators control the microcatheter and the coil respectively. We have therefore developed a mechanical coil insertion system enabling a single operator to insert coils at a fixed speed while controlling the microcatheter. Using our new system, the operator manipulated the microcatheter with both hands and drove the coil using foot switches simultaneously. A delivery wire force sensor previously reported was used concurrently, allowing the operator to detect excessive stress on the wire. In vitro coil embolization was performed using three methods: simple mechanical advance of the coil; simple mechanical advance of the coil with microcatheter control; and driving (forward and backward) of the coil using foot switches in addition to microcatheter control. The system worked without any problems, and did not interfere with any procedures. In experimental coil embolization, delivery wire control using the foot switches as well as microcatheter manipulation helped to achieve successful insertion of coils. This system could offer the possibility of developing safer and more efficient coil embolization. Although we aim at total mechanization and automation of procedures in the future, microcatheter manipulation and synchronized delivery wire control are still indispensable using this system.
Role of 3D Display MR Angiography in the Study of Intracranial Aneurysms
Authors: Dumas J.-L. , Abdennebi A. , Belin C. , Sellier N. , Moret J. , Goldlust D. 
Published: January 2017

This paper determines the usefulness of three-dimensional (3D) phase-contrast (PC) magnetic resonance (MR) angiography with 3D display in characterizing large intracranial saccular aneurysms. Eight patients referred for non invasive confirmation of unruptured aneurysm (n=9) detected by conventional CT and/or MR imaging were studied by 3D PC (VENC of 20 cm/s, 3 axes) in axial acquisition localised on the circle of Willis using a 0.5 T unit (Vectra, GE). We used 3D display images to assess the feasibility of selective treatment. Results were correlated with catheter angiograms in 3 patients. In two thirds of the cases, location and size of the orifice, size of the sac, and clarification of parent artery were clearly provided allowing prediction of therapeutic management. In the remaining cases results remained doubful because of lack of spatial resolution. The benefit of the method was coupled with the clinical status of the patients to influence the final decision. 3D PC MR angiography with 3D display has emerged as an improvement in predicting therapeutic management, and is especially useful in large unruptured aneurysms in elderly or ill patients.
The Arithmetics of Risk
Authors: Mansmann U. 
Published: January 2017

In the following note the basic principles of event data analysis and censored data will be explained. The concept of risk will be defined. The interaction of estimation and confidence interval will be discussed. We explain the estimator of risk and show how to use it for the calculation of probability statements. An example is given to make the formal statements more explicit. We define the Kaplan-Meier estimator and compare it to the risk concept. Two common fallacies in risk assessment are discussed.
Expansion of a Haematoma after Urokinase Thrombolysis of Superior Sagittal Sinus Thrombosis
Authors: Moran C.J. , Cross D.-W.T. , Derdeyn C.P. , Dromerick A.W. , Dacey R.G. 
Published: January 2017

Thrombosis of the superior sagittal sinus may result in significant morbidity and recently up to 20% mortality. Primary treatment has consisted of anticoagulation and methods for controlling increased intracranial pressure. The development of interventional neuroradiologic techniques has enabled infusion of thrombolytics at the clot. We describe a woman with a cerebral haemorrhage due to a thrombosed superior sagittal sinus. Her decreased level of consciousness and increasing hemiparesis prompted direct thrombolytic therapy (urokinase). Flow was restored in the occluded sinus, but an acute expansion of the haematoma an hour after conclusion of the infusion resulted in temporary worsening of her neurologic deficits. Although the ultimate outcome was satisfactory, the possibility of further intracranial bleeding must be balanced against the risk of death with conservative therapy.
Embolisation of Spinal Cord Arteriovenous Malformations with Glue through the Anterior Spinal Axis
Authors: Rodesch G. , Hurth M. , Alvarez H. , Lasjaunias P. 
Published: January 2017

We reviewed the clinical and morphological results of spinal cord arteriovenous malformations (SCAVMs) embolised with acrylic glue through the anterior spinal axis (ASA), and assessed the anatomical guidelines that should be followed to safely embolise the ASA. Twenty consecutive SCAVMS seen between 1982 and 1996 were reviewed. There were 15 lesions in the thoracolumbar cord and 5 in the cervical cord. Haemorrhage was the revealing symptom in 13 patients (65%). Embolisation through the ASA was done in 19 SCAVMs (2 with PVA particles in our early experience and 17 with Histoacryl*). One patient was not embolised because of a spastic reaction of the ASA that led to secondary subtotal thrombosis of the SCAVM without neurological deficit. The ASA was chosen as arterial approach to the AVM because it was the only feeder to the lesion (1 case) and/or because it was one of the accessible pedicles harbouring particular angioarchitectural weakness points. Vascular occlusion was always indicated and performed following precise anatomical analysis of the lesion and of the regional vascular disposition. In all cases embolisation of the ASA feeders to a SCAVM was performed under general anaesthesia, without any evoked potentials or provocative tests. However, 3/19 (16%) patients presented transient worsening of their clinical condition. Permanent morbidity occurred in 2/19 patients (11%): one patient cured from a cervical intramedullary AVM presents mainly a deltoid palsy, the other with a thoracic intramedullary AVM has worsened his paraparesis. At follow-up, 6/19 patients (32%) are neurologically normal and 10/19 (53%) have improved their neurological conditions and deficits. One patient embolised recently is currently stable but is expected to improve. No embolised patient bled or rebled during follow-up. Neurological symptoms recurred in one patient who had been stable for one year after his first embolisation. For an experienced interventional neuroradiology team, embolisation of SCAVMs through the ASA is feasible with acrylic glue with good clinical results. Proper analysis of the vascular architecture is mandatory to select the cases that can benefit from such approach.
Determining the Optimal Fluoroscopic View during Aneurysmal Embolization with Rotation DSA
Authors: Bundo M. , Negoro M. , Fukasaku K. , Miyachi S. , Yoshida J. 
Published: January 2017

To prevent coil protrusion into the parent artery, the fluoroscopic view during coil packing is quite important. However it is not always easy to find out the optimal fluoroscopic view. We applied a rotation DSA to predict the optimal fluoroscopic view for the endovascular treatment of 4 cases with a cerebral aneurysm. Since the trajectory of the C-arm is restricted within 60 degrees only around the patient's head and the number of DSA shots are limited rather than conventional DSA, we employed three dimensional CT angiography (3D-CT angiography) to focus the range of C-arm rotation. Rotation DSA proved quite useful to determine the optimal fluoroscopic view, when combined with pre-estimation by 3D-CT angiography.
Direct PTA for Acute Ischemic Stroke
Authors: Uno J. 
Published: January 2017

We have performed direct PTA for 23 patients with acute ischemic stroke. Occlusion was identified at extracranial internal carotid artery (ICA) in 6 patients, at extracranial vertebral artery (VA) in 1, at intracranial ICA in 3, at middle cerebral artery (MCA) in 12, and at basilar artery (BA) in 1. Stenosis was identified at extracranial VA in 1 patient. In 4 of 6 patients of extracranial ICA, 1 of 1 patient of extracranial VA, 1 of 3 patients of intracranial ICA, 7 of 12 patients of MCA and 1 of 1 patient of BA, recanalization was observed. Fourteen of 22 occluded arteries (64%) were recanalized. The recanalization rate approximated that of local intraarterial fibrinolytic therapy. We have not experienced complications with this procedure. Direct PTA is promising and might be a novel recanalization technique.
Intra-Arterial Thrombolytic Therapy for Acute Vertebrobasilar Artery Occlusion
Authors: Kinoshita Y. , Terada T. , Nakai E. , Nakai K. , Itakura T. , Naka Y. , Kido T. , Kuwata T. , Matumoto H. , Moriwaki H. 
Published: January 2017

We report on the results of intra-arterial thrombolysis in 11 patients with vertebrobasilar artery occlusion treated within 6 hours after onset of symptoms. Urokinase (5 patients) or recombinant tissue plasminogen activator (t-PA) (6 patients) was injected through a microcatheter conducted to the thrombus. Eight patients showed recanalization of the thrombus. The outcome was excellent in 5 patients, good in 2 patients, and poor in one patient. Recanalization could not be achieved in 3 of the 11 procedures; all patients in whom recanalization failed died. There were no hemorrhagic complications after thrombolysis. Two patients with residual stenosis after thrombolysis underwent successful percutaneous transluminal angioplasty (PTA) to prevent re-occlusion. Intra-arterial thrombolysis for vertebrobasilar artery occlusion is a safe and effective treatment if it is performed within 6 hours.
Reperfusion Therapy for Acute Vertebrobasilar Occlusion
Authors: Ohta H. , Nakano S. , Yano T. , Ohnishi T. , Miyahara D. , Yokogami K. , Goya T. , Wakisaka S. 
Published: January 2017

We reviewed retrospectively our experience in treating 10 patients with acute vertebrobasilar occlusion. Nine patients were treated with interventional reperfusion therapy and the remaining one patient with top of the basilar embolism was treated conservatively because of deep coma and decerebrate rigidity with severely reduced cerebral blood flow (CBF) in the brain stem. Among 9 patients with reperfusion therapy, 8 patients underwent intra-arterial thrombolytic therapy and the other one patient had direct percutaneous transluminal angioplasty (PTA). Eight patients had basilar artery occlusion, 1 patient treated with direct PTA had bilateral intracranial vertebral artery occlusion and the other patient had left posterior cerebral artery occlusion presumably preceding top of the basilar embolism. In 4 of 10 patients, residual CBF was evaluated by single photon emission computed tomograpy (SPECT). Successful recanalization with clinical improvement was achieved in 6 of 9 patients (66.7%) treated with reperfusion therapy. In patients with progression or fluctuation of incomplete brain stem syndrome, SPECT revealed preserved residual CBF and successful recanalization with clinical improvement was achieved by interventional reperfusion therapy. On the other hand, in patients with persistent deep coma and decerebrate rigidity, SPECT revealed marked reduction of residual CBF in the brain stem and recanalization could not improve clinical outcome. Preoperative SPECT may be useful to make a decision whether reperfusion therapy should be performed or not in case of vertebrobasilar occlusion.
Surgery of a Large Paraclinoid Aneurysm with the Support of Coil Embolization
Authors: Nakazawa T. , Nakajima M. , Matsuda M. , Handa J. 
Published: January 2017

An attempt was made to clip the neck of a large paraclinoid aneurysm with the support of a balloon catheter, using a trapping-evacuation technique. The clip applied to the neck slipped off because of blood pressure through the posterior communicating artery which arose from the dome of the aneurysm. Therefore, using portable digital subtraction angiography (DSA) equipment, we placed interlocking detachable coils (IDCs) in the aneurysm for the purpose of reducing the intraaneurysmal pressure. Although the aneurysm was eventually trapped with two clips, this case indicates the supportive role of intravascular intervention in aneurysmal surgery when clipping an aneurysm or immediately after clip failure.