bluuebunny/crossref_metadata_2025_split huggingface dataset:
CT Angiography in an Acute Stroke Protocol: Correlation between Occlusion Site and Outcome of Intravenous Thrombolysis
Authors: Porelli S. , Leonardi M. , Stafa A. , Barbara C. , Procaccianti G. , Simonetti L. 
Published: January 2017

Thrombolysis with intravenous rt-PA is the current therapy for acute ischemic stroke. Unlike other outcome factors, relatively little is known about the prognostic value of the occlusion site on treatment outcome. We compared the effectiveness and safety of intravenous thrombolysis in patients with different levels of occlusion identified by CT angiography (CTA) in anterior circulation stroke, and analyzed the influence of the occlusion site on treatment outcome in relation to other outcome factors. We selected 71 patients from a stroke database collected between June 2007 and December 2011 at our hospital. All of the studied patients had anterior circulation stroke with intracranial occlusion detected by CTA and were treated with intravenous rt-PA. They were divided into two groups according to the site of occlusion along the middle cerebral artery course: proximal (carotid “T”, complete M1 and mild M1 occlusions) and distal (M2/M3 occlusions). Treatment effectiveness was assessed by modified Rankin Scale (mRS) at three months, considering a positive outcome a mRS value ≤ 2. Treatment safety was assessed by evaluating the rate of hemorrhagic complications seen on unenhanced CT at 24 hours. Binary logistic regression was performed to evaluate the interaction between occlusion site and other variables such as sex, age, ASPECT score on admission and baseline NIHSS value in determining treatment outcome. The degree of effectiveness and safety differed when considering patients with proximal and distal occlusions. The percentage of successfully treated cases was 28.6% in the first group compared to 72% in the second, and the rate of hemorrhagic complications was 28.6% and 6% respectively. After adjustment for sex, age, ASPECT score on admission and baseline NIHSS value, occlusion site was the only variable significantly influencing treatment safety and, together with baseline NIHSS value, the only valid predictor of treatment effectiveness. We demonstrated a correlation between the site of arterial occlusion and outcome of intravenous thrombolysis. By helping the choice of the best therapeutic strategy depending on the identified occlusion site, CTA could be usefully added to the examinations included in the Stroke Protocol for the baseline evaluation of patients with suspected acute stroke.
Swine Hybrid Aneurysm Model for Endovascular Surgery Training
Authors: Namba K. , Mashio K. , Kawamura Y. , Higaki A. , Nemoto S. 
Published: January 2017

The aim of this study was to develop a technically simple swine aneurysm-training model by inserting a silicone aneurysm circuit in the cervical vessels. A silicone aneurysm circuit was created by designing multiple aneurysms in size and configuration on a silicone vessel. Five swine underwent surgical implantation of this circuit in the cervical vessels: one end in the common carotid artery and the other in the external jugular vein. Using this model, an aneurysm coiling procedure was simulated under fluoroscopic guidance, roadmapping and digital subtraction angiography. Creating an aneurysm model for training purposes by this method was technically simple and enabled the formation of a wide variety of aneurysms in a single procedure. The quality of the model was uniform and the model was reproducible. Coiling training using this model resembled a realistic clinical situation. The swine hybrid aneurysm-training model was advantageous from the standpoint of technical simplicity in the creation and variety of aneurysms it provided. The swine hybrid aneurysm model may be an additional option for aneurysm coiling training.
Seizures in Cerebral Arteriovenous Malformations: Type, Clinical Course, and Medical Management
Authors: Osipov A. , Koennecke H.-C. , Hartmann A. , Young W.L. , Pile-Spellman J. , Hacein-Bey L. , Mohr J.P. , Mast H. 
Published: January 2017

We investigated the type and early clinical course of seizure disorders in cerebral arteriovenous malformations (AVMs). Decisions on invasive treatment for AVMs depend on detailed knowledge of the natural course and prognosis of neurologic sequelae. Among 328 patients of a prospective cerebral AVM databank 92 (28%) presented with seizures unrelated to haemorrhage. Under a median observation time of 2.2 years (mean 3.8 years) the 92 patients received 454 follow-up examinations (median time interval 4.6 months). All patients were treated with anticonvulsant medication. During the observation period sixty (65%) patients received staged endovascular glue embolisation. The effect of staged embolisation on seizure recurrence was tested univariately by comparing patients undergoing embolisation versus those without endovascular treatment. At the time of enrolment in the database, elementary (motor or sensory) and partial complex seizures were described in twenty (22%) and one (1%) patients, respectively. Generalized seizures without focal initiation were reported in sixty (65%) and with focal initiation in 11 (12%) patients. 57 (62%) cases had suffered a seizure as a first single event, ten (11%) had weekly, 17 (19%) monthly, and eight (9%) patients had seizures once per year. In the following clinical course, complete cessation of seizure activity was seen in 69 (75%). Ten (11%) patients continued to have seizures at a rate of once per year or less. 13 (14%) cases continued to have weekly to monthly events with only four (4%) of them showing (monthly) grand mal. An early beneficial effect of staged embolisation on seizure recurrence was not observed. Seizure disorders in cerebral AVMs show a benign early course, leaving few patients with insufficient seizure control. The differential long-term effect of invasive AVM treatment on seizure control should be subject to clinical trials.
Large Haemangiopericytoma of the Posterior Cervical Space
Authors: Horky J.K. , Chaloupka J.C. , Putman C.M. , Roth T.C. , Sasaki C.T. 
Published: January 2017

We report a case of a 39-year old woman who upon developing a rapidly enlarging posterior cervical space tumour, underwent incisional biopsy prior to diagnostic imaging that resulted in nearly catastrophic haemorrhage. Subsequently, MR imaging showed evidence of marked hypervascularity, prompting diagnostic angiography and endovascular microembolization prior to surgical resection. The tumour turned out to be a large haemangiopericytoma arising from the paravertebral musculature. The case is instructive by highlighting the need for considering rare locations of hypervascular tumours in the head and neck region before attempting biopsy, which can be predicted by cross-sectional imaging studies, and the benefits of pre-operative devascularization with modern superselective microembolisation techniques.
Broad Neck Basilar Tip Aneurysm Treated by Neck Plastic Intra-Aneurysmal GDC Embolisation with Protective Balloon
Authors: Takahashi A. , Ezura M. , Yoshimoto T. 
Published: January 2017

A 56-year-old male was found to have a basilar artery aneurysm by magnetic resonance imaging. Angiography demonstrated a broad neck basilar tip aneurysm. He refused surgical clipping but accepted intravascular embolisation. Introducing catheters were inserted into each of the bilateral vertebral arteries. A microcatheter was introduced into the aneurysm through one of the introducing catheters and a double lumen balloon catheter was introduced into the left posterior cerebral artery (PCA) through the other. The balloon was located from the left PCA to the basilar artery across the aneurysmal neck with the aid of a guidewire passed through the inner lumen of the balloon catheter. The balloon was inflated, and a Guglielmi detachable coil (GDC) was inserted until the platinum part was placed inside the aneurysm. The balloon was deflated to confirm the stability of the GDC, and then the GDC was electrically detached. This procedure was repeated until nine GDCs were successfully inserted. The aneurysm was tightly embolised despite its broad neck. Angiography comfirmed complete neck closure and stable preservation of the basilar artery and bilateral PCAs immediately, 1 week, 3 months, 6 months, and 12 months after embolisation without evidence of thrombo-embolic complications. Neck plastic intra-aneurysmal GDC embolisation using a protective balloon can be used to treat broad-neck aneurysms.
Usefulness of MRA in the Treatment of Dural AVM
Authors: Kurokawa S. , Tanaka Y. , Ikeya F. , Maruki C. , Ebato M. , Ohtomo T. 
Published: January 2017

We report 5 cases of dural AVMs, in which MRA images were considered very useful for evaluating the effectiveness of treatments, such as transvenous embolization therapy. MRA by time of flight method (TOF) with contrast medium for dural AVMs involving the cavernous sinus (dural CCFs) is necessary to assess the caliber of superior ophthalmic veins (SOVs) prior to treatment as well as immediately after treatment and during follow-up. MRA for dural AVM at the transverse-sigmoid sinus is useful for verifying thrombosed sinus in the dural AVM prior to transvenous embolization therapy and necessary to determine the approach to the nidus of the dural AVM2.
De Novo Appearance of Three Cavernomas in an Infant with Dural AV Shunts
Authors: Janz C. , Meisel J. , Brock M. , Lasjaunias P. 
Published: January 2017

Cavernomas of the brain and spinal cord are malformations which are generally considered congenital and often found in young adults. Although the distinction of a sporadic and a hereditary type is discussed, the natural history is still poorly understood. We present the unusual case of an infant first submitted to CT scan, MRI and MR-angiography at the age of three months, revealing multiple AV shunts of the superior sagittal and the sigmoid sinus, with a small pial supply. A second angiogram at the age of six months showed an additional parietal pial AVM. At this time, partial embolisation of the dural AV shunts was performed. At the age of three, the child was restudied by MRI and three formerly invisible cavernomas were detected.
Percutaneous Treatment of Herniated Lumbar Disc by Intradiscal Oxygen-Ozone Injection
Authors: Muto M. , Avella F. 
Published: January 2017

We report our experience of treating lumbar herniated disc by intradiscal injection of an oxygen-ozone mixture. Ozone (03, MW = 48) is a triatomic molecule, having antiviral, disinfectant and antiseptic properties. Several mechanisms of action have been proposed to explain the efficacy of the treatment: analgesic action; anti-inflammatory action; oxidant action on the proteoglycan in the nucleus pulposus. We treated 93 patients (50 women, 43 men) aged from 24 to 45 yrs (average age 38 yrs) from June 1996 to April 1998. All patients presented sciatica and/or low back pain, lasting two or more months; patients had in the mean time received both medical and physical therapy with mild or no benefit. Diagnostic tests in all patients included plain film x-ray, CT and/or MR at the level of the lumbar spine disclasing a herniated or protruded disc with nerve root or thecal sac compression. We divided patients to be treated in to two groups: the first one group included 35 patients already selected for surgery who presented herniated or protruded disc with radicular pain with associated neurological deficit (hypoesthesia and partial loss of reflex). Those patients had already had medical and physical therapy for two or more months and agreed to try the percutaneous treatment before surgery. CT or MR in this group demonstrated the presence of intraforaminal, extra or sub-ligamentary and sequestrated herniated disc. The second group included 58 patients with radicular pain but without neurological deficit; patients in this group had received medical and/or physical therapy for two or more months and CT showed the presence of a small subligamentary herniated or protruded disc. We considered the results according to the modified MacNab method. In the first group we had “failure” in all patients; in seven cases the symptoms improved for one month, but recurred later on. In the second group 45 patients had “success” showing complete clinical recovery within five to six days after treatment, all remained without symptoms up to six months or more of follow-up. The remaining 13 patients presented the same symptoms again within three months after a temporary clinical recovery. The goal of this study was to present this new technique that can also be compared with a previous study of different percutaneous treatment. Clinical and neuroradiological indications and the contraindications are well known, and must be followed to achieve good results and avoid complications.
Six Cases of Ruptured Aneurysm, Treated with Cellulose Acetate Polymer
Authors: Matsunaga M. , Kinugasa K. , Mandai S. , Ohmoto T. 
Published: January 2017

We review 6 cases of ruptured aneurysm which were elderly, poor-grade SAH or requiring high-risk surgery treated with Cellulose Acetate Polymer (CAP). A 76-year-old female with A-com aneurysm was comatose. Heart failure was her complication (case 1). An 81-year-old female with A-com aneurysm was semicomatose (case 2). An 89-year-old female with MCA aneurysm was semicomatose and had right hemiplegia (case 3), An 88-year-old female with MCA aneurysm was comatose (case 4). A 55-year-old male with IC-PC aneurysm had a small intracerebral hematoma and was semicomatose (case 5). A 52-year-old female with IC-Ach aneurysm was somnolent (case 6). All cases had no rebleeding after embolization. CAP embolization was complete in all cases but case 1. Case 4 died from primary brain damage on the day 7. Three cases stayed in a severely disabled state and died after 3 months (case 1), 2 months (case 2) and 4 months (case 3) from onset respectively. Case 5 remains in a moderately disabled state after 2 years, Case 6 had a anterior choroidal artery which was hard to spare on aneurysmal clipping. She is free from neurological deficits after CAP embolization. Angiography after 2 years demonstrated complete obstruction of the aneurysm. CAP is good for cases which are elderly, poor-grade SAH or difficult to treat with surgery. CAP embolization has some advantages over GDC coil obstruction for aneurysm treatment.
Application of Three Dimensional Angiography for Diagnosis of Patients and Intravascular Surgery
Authors: Konishi Y. , Sato E. , Tomita Y. , Isamu S. 
Published: January 2017

We examined newly developed three-dimensional angiography to understand the anatomy for surgery and for intravascular surgery in order to decide when treatment should be stopped. The subjects were 23 patients chosen randomly (angiography, 22). The diagnoses in these patients included aneurysm (5), arteriovenous malformation (6), meningioma, glioma, vascular tumours of the brain and the neck (5), and vascular diseases (6) including carotid artery stenosis, Moya-Moya disease, middle cerebral artery occlusion, and megadolico-ectasia (6). The new technique was used for intravascular surgery in six cases, which allowed the neck of the aneurysm and the bifurcation to be revealed. This method is useful for determining whether another coil should be inserted. In patients with basilar top aneurysm using this technique during coil embolization the intra-aneurysmal blood flow disappeared because complete embolization was performed. This technique was more useful during coil embolization, especially to decide the timing of withdrawal in intravascular surgery compared with conventional DSA.
Stereotactic Transcerebellar Approach to Pontine Lesions through the Middle Cerebellar Peduncle
Authors: Parker F. , Levesque M.F. , Bittoun J. , Doyon D. , Tadie M. 
Published: January 2017

A stereotactic approach to the pons through the middle cerebellar peduncle based on MR studies was used to biopsy 18 patients. The stereotactic coordinates and angles were defined with reference to three orthogonal planes (mid-sagittal, IVth ventricular floor and pontomedullary junction). The pathological diagnoses were in keeping with clinical outcome and comprised five high-grade astrocytomas, three low-grade astrocytomas, two glioblastomas multiforme, two oligodendrogliomas, two primitive neuroectodermic tumours, two lymphomas, one medulloblastoma, and one tuberculosis. This approach provides a high yield of positive histological diagnoses with little morbidity (transient neurological deficits in two cases) and thereby avoids inappropriate therapy.
Extracavernous Arteriovenous Fistulae
Authors: Sedat J. , Kominami S. , Siriwimonmas S. , Pongpech S. , Suthipongchai S. , Alvarez H. 
Published: January 2017

We report five cases of arteriovenous fistulae (AVFs) of the carotid system. Two were traumatic non penetrating injuries and involved the subarachnoid, extracavernous part of the intracranial internal carotid artery; two were spontaneous and involved the internal carotid artery in its extracranial portion; one was a spontaneous AVF of the ascending pharyngeal artery. All the symptoms due to these AVFs were not related to the location of the fistula, but to the congestive venous drainage. The revealing symptoms regressed and/or improved after transarterial detachable balloon embolisation that led to complete occlusion of the AVFs.
How to Embolize Wide-Necked Aneurysms?
Authors: Kazekawa K. , Oka K. , Aikawa H. , Tomonaga M. , Yoshimura S. , Yoshioka T. , Hosoda H. 
Published: January 2017

Novel endovascular approaches are needed for safer and more definitive treatment of wide-necked aneurysms, to overcome the limitations of the Guglielmi detachable coil (GDC) system and further, the application of this technique. The double GDC technique (DGT), for embolization of wide-necked aneurysms, and the combination of stent placement and coil deposition (CTSC) for management of fusiform aneurysms have been developed and their usefulness is reviewed. The DGT involves scaffolding of a GDC coil to form a stabilizing frame inside the aneurysmal neck and then positioning of a second coil to reinforce the first coil. After confirming the absence of coil herniation in the parent artery, both coils are released together. A patient with a wide-necked large aneurysm of the left internal carotid artery was treated using this technique, and followed up angiographically and clinically for a period of three months. The follow-up angiograms revealed complete embolization of the aneurysm. The patient had no neurological changes or adverse events during the procedure. The CTSC involves reconstructing the artery with a stent and packing the aneurysm lumen with GDCs through the stent interstices. A patient with a dissecting fusiform aneurysm of the vertebral artery associated with hypoplasia of the contralateral vertebral artery was treated using this technique to prevent rebleeding. His clinical course was uneventful over a six-month follow-up period. Angiography performed two months after the procedure confirmed excellent flow through the right vertebral artery and absence of filling of the daughter aneurysm.
Angioarchitecture Predicting Hemorrhage in Cerebral Arteriovenous Malformations
Authors: Hirai S. , Mine S. , Kobayashi E. , Yamakami I. , Yamaura A. 
Published: January 2017

To find out lesions responsible for hemorrhage in arteriovenous malformations (AVMs), a retrospective study of angioarchitecture around the nidus was conducted in 27 patients who underwent conservative treatment. Comparison of angiograms revealed disappearance of an intranidal aneurysmal dilatation after the hemorrhagic events in two cases. The hematomas were adjacent to the dilatation, and no subarachnoid hemorrhage was evident. Obstruction of venous drainage, noticed in a case of spontaneous regression of AVM, was not demonstrated in the cases of hemorrhage. The intranidal aneurysmal dilatation is likely to have caused the hemorrhage in our cases. Careful endavascular embolization using proper materials should be indicated for an intranidal aneurysmal dilatation to prevent subsequent hemorrhage.
Efficacy of Diluted NBCA Mixture for Embolization of Arteriovenous Malformations
Authors: Tamatani S. , Ito Y. , Koike T. , Abe H. , Kumagai T. , Kurashima A. , Koizumi T. , Takeuchi S. , Tanaka R. 
Published: January 2017

The purpose of this study is to evaluate the efficacy and problems of the embolization for cerebral arteriovenous malformations (AVMs) with diluted cyanoacrylate adhesives. Twelve consecutive AVM cases were treated with N-butyl-2-cyanoacrylate (NBCA) glues between January 1997 and July 1998. The mean age of the patients was 37 years old. Intracerebral hemorrhage was the presenting symptom in seven cases, seizure in three, headache in one and mental deterioration in one. According to the classification of Spetzler and Martin, seven were Grade 11, five were Grade III. We used a mixture of NBCA (normally 25% Histoacryl, 75% Ethidol) for embolization. Microcatheter was navigated into the nidus and the tip of the catheter was set in a wedged position. Then the glue was injected using complete column technique. Nineteen sessions of embolization were performed in 12 patients. The mean volume of each nidus was reduced from 22.5 ml to 3.4 ml (85%) after embolization. Four cases were cured by embolization alone. Surgical resection was performed after embolization without any residual nidus in three cases. Five were treated with stereotactic radiosurgery following embolization. One was completely cured in 18 months after and the other four have been decreasing their sizes of nidus. One case was suffered from delayed intracerebral hemorrhage three days after embolization, and resulted in mild hemiparesis and memory disturbance. The others had no complications and were clinically improved or unchanged after embolization. It is possible to embolize the nidus of AVMs more accurately and safely with diluted mixture of NBCA, compared with the method using relatively higher concentration of NBCA glues. This technique is useful and effective method for the treatment of AVMs.
Coil Embolization for Ruptured Dissection on the Vertebral Artery Distal to the Origin of Posterior Inferior Cerebellar Artery
Authors: Manabe H. , Fujita S. , Hatayama T. , Suzuki S. 
Published: January 2017

Although many surgical or endovascular treatments for ruptured vertebral dissection have been reported, the best treatment remains controversial. Recently endovascular vertebral occlusion using coils has been reported, the appropriate occlusion site has not yet been fully discussed. Five cases of ruptured vertebral dissection located distally to the origin of posterior inferior cerebellar artery were occluded by platinum coil packing in the angiographical “pearl” portion or “fusiform dilatation” together with its proximal vertebral artery. All dissections were occluded completely together with occlusion of distal portion of vertebral artery to PICA's origin. No complications related to procedure were seen in this series. Occlusion of rupture point with preserving tiny perforators arising from vertebral artery would be an ideal method for this lesion. The present cases suggest that the short segment occlusion by coil packing in the angiographical “pearl” portion or “fusiform dilatation” together with its proximal vertebral artery would be near to the ideal.