bluuebunny/crossref_metadata_2025_split huggingface dataset:
Foramen Magnum Dural Arteriovenous Fistulae with Repeated Subarachnoid Haemorrhage
Authors: Kai Y. , Hamada J. , Morioka M. , Ushio Y. , Fujioka S. 
Published: January 2017

We report a patient who had dural arteriovenous fistulae in the region of the foramen magnum with repeated subarachnoid haemorrhage. Magnetic resonance imaging revealed abnormal vascular structures on the right side of the medulla oblongata in an extra-axial portion. Angiographic findings showed that the lesion was supplied from the meningeal arteries and drained directly into the subarachnoid vein. There was venous dilatation. Embolisation was performed via the transarterial approach using a micro coil and liquid material. Three years after treatment, the patients' condition is good and follow-up angiograms confirmed the stability of the treatment outcome. While dural arteriovenous fistulae of the foramen magnum are rare, this malformation results in a high rate of bleeding and requires treatment.
Multiple Intracranial Arterial Aneurysms: A Congenital Metameric Disease?
Authors: Campos C. , Churojana A. , Rodesch G. , Alvarez H. , Lasjaunias P. 
Published: January 2017

We reviewed the angiographic study and clinical charts of 398 consecutive cases of intracranial arterial aneurysms, involving adults and children in the last 11 years (1986–1997). Giant aneurysms, dissecting aneurysms, mycotic aneurysms, and fusiform aneurysm were excluded. From the 341 patients presenting so-called berry aneurysm disease, attention was paid to multiple aneurysm sub group. One hundred and thirteen cases were analysed and compared with a group of single AA (228 cases) from the same material. Three longitudinal embryological territories giving rise to cranial endothelial cells and media were used to regroup the aneurysm sites. Eighty four cases presented aneurysms in the rostral region (74%), 20 cases with aneurysms involving rostral and middle territories (18%), 1 case presented aneurysm involving the middle and caudal territories (0.9%), 5 cases had aneurysms in the rostral and caudal territories (4.4%) and three cases presented aneurysm involving rostral, medial and caudal territories at the same time (2.7%). No multiple group was located in the middle or caudal territories alone. When several arterial territories were concerned they were adjacent in 95.6% of cases. Multiple AA could therefore result from mesodermal/neural crest stem cell or focal endothelial cell defect within one or two (usually consecutive) embryonic segments. Mirror lesions would correspond to bilateral symmetrical impairment in the same territory or involvement of a group of cells with bilateral distribution. AA may result from a constitutional vasculopathy, later expressed with focal overproduction of the arterial wall without remodelling correction. Secondary mutations and triggers are likely to be needed to lead to such AA production.
Thrombolytic Therapy for Cerebral Embolism
Authors: Hyogo T. , Kataoka T. , Hayase K. , Nakagawara J. , Takeda R. , Nakamura H. , Nakamura J. 
Published: January 2017

We summarized our clinical experience of thrombolytic therapy for cerebral embolism to evaluate the relation between the prognosis and the occlusion site, and the role of pre-treatment CBF measurement for supratentorial cerebral embolism. 56 cases of thrombolysis were analyzed and results were compaired with conservative medical therapy group. For ICA embolism, we stopped thrombolysis in the early period because of its poor collateral circulation. MCA embolism seemed to be a good candidate for this treatment and results were significantly better than the conservative medical therapy group in good recovery rate, severe disablity rate and large size infarction rate. In basilar artery embolism, thrombolysis seemed to be the most effective treatment in spite of the high mortality rate. Pre-treatment CBF measurement was important and useful to estimate the severity of ischemia, and it could make it possible to avoid severe hemorrhagic complications.
Intravascular Ultrasound with Percutaneous Transluminal Angioplasty for Supra-Aortic Arteries
Authors: Uno J. , Kawashima M. , Miyazono M. , Nakamura T. , Gi H. 
Published: January 2017

One of the major complications during or after percutaneous transluminal angioplasty (PTA) is distal embolism. We performed intravascular ultrasound (IVUS) to assess the morphological characteristics of atheromatous plaques which caused stenosis of arteries. In 7 cases of ICA stenosis, IVUS demonstrated hyperechoic plaques which were considered to be fibrous. Mixed type of plaque was observed in one case of ICA stenosis and another one case of ICA stenosis had plaque which was hyperechoic with acoustic shadowing. In all cases of SCA stenosis, plaques were hypoechoic, indicating fatty plaque. Distal embolism occurred after PTA in the case of ICA stenosis which had a mixed type of plaque. It is important to evaluate plaque morphology to prevent distal embolism. PTA is considered to he contraindicated in cases of ICA stenosis having hypoechoic plaques or ulceration.
PTA for Internal Carotid Artery Stenosis
Authors: Ezura M. , Takahashi A. , Fukuchi M. , Yoshimoto T. 
Published: January 2017

Thirty-one lesions of internal carotid artery (ICA) stenosis were treated by percutaneous transluminal angioplasty (PTA). All the patients were males except two. There were 18 extracranial ICA stenosis and 13 intracranial ICA stenosis. Four patients were treated in acute stage and 27 were in chronic stage. In 27 patients in the chronic stage, clinical presentation was transient ischemic attack or reversible ischemic neurological deficits or minor completed stroke. Dilatation of any degree was observed in all patients except one in the chronic group. Good dilatation (stenosis ratio after PTA is less than 50%) was observed in 11 out of 13 intracranial lesions and in 10 out of 14 extracranial lesions. Restenosis was two out of 11 intracranial good dilated lesions and 6 out of 10 good dilated extracranial lesions. No patients but one have experienced recurrent symptoms. Symptomatic complications occurred in only one patient who encountered arterial dissection during PTA resulting in severe hemiparesis. In four patients in the acute stage, dilatation of any degree was observed in two and good dilatation was seen in two. In conclusion, PTA for chronic ICA stenosis is an effective and safe technique. However, extracranial lesions tend to develop restenosis. Self-expandable stent will be one of the solutions for extracranial lesions. Major complications of PTA are distal embolism and arterial dissection. PTA for acute ICA stenosis is a challenging technique.
Follow-up Study after Percutaneous Transluminal Cerebral Angioplasty
Authors: Kazita K. , Mori T. , Fukuoka M. , Mori K. 
Published: January 2017

The purpose of this study was to assess the safety and efficacy of percutaneous transluminal cerebral balloon angioplasty (PTCBA) of extra- and intra-cranial arteries by investigating procedural outcome. Eighty haemodynamically significant extra- and intra-cranial lesions (% diameter stenosis >70) in 74 clinically symptomatic patients were treated by elective and initial PTCBA between March 1991 and February 1996 and followed thereafter. Death, stroke including transient ischemia, surgery, or repeated angioplasty of restenosis or new lesions were regarded as cerebral events after the initial PTCBA. Crescendo ischaemic symptoms disappeared completely after clinically successful dilatation. The clinical success rate was 81% (65/80). Angiographic restenosis rate at 3 months was 22% (14/65). By life-table method, the death/stroke risk was 16% and death/stroke/surgery/repeated PTCBA risk was 49 % at 2 years following PTCBA, respectively. In conclusion, PTCBA successfully, decreased recurrent neurological symptoms and produced a favourable short-term outcome, whereas restenosis limited long-term benefit.
Intra-Aneurysmal Embolization for the Treatment of Cerebral Aneurysms Using Detachable Coils
Authors: Hyodo A. , Kato N. , Anno I. , Sato H. , Nose T. , Okazaki M. , Kamezaki T. , Ito M. 
Published: January 2017

From October 1993 to February 1998, intraaneurysmal embolization by endovascular treatment with detachable coils was performed for 41 cases of cerebral aneurysm. As a detachable coil, interlocking detachable coils (IDC) were used in the initial 15 cases and Guglielmi detachable coils (GDC) were used in the subsequent 26 cases. As for 15 cases treated with IDC, complete occlusion was performed in 9 cases, subtotal occlusion in 4 cases and partial occlusion in 2 cases. In one of the partial occluded cases, a coil compaction occurred 6 months after embolization. Distal emboli were recognized on CT after embolization in 3 cases, however, only one case was symptomatic. Intra-operative bleeding occurred in one case, but no obvious hemorrhage after coil embolization in any case. As for 26 cases treated with GDC, complete occlusion was performed in 18 cases, subtotal occlusion in 8 cases. In one case of basilar-tip aneurysm, a mild coil compaction occurred 6 months after embolization. Distal emboli were recognized on CT after embolization in 3 cases, however, only one case was symptomatic (minor stroke). No intra-operative bleeding and no obvious hemorrhage after coil embolization occurred in any case. From our experiences, treatment for poor-grade ruptured aneurysm is still difficult, but intra-aneurysmal embolization for cerebral aneurysms using detachable coils is possible and a useful alternative, especially for surgically difficult aneurysms. The results of treatment of aneurysm with GDC are much better than those with IDC, so the indications for intra-aneurysmal embolization with GDC might increase in the future.
Coil Embolization for Intracranial Aneurysm by Direct Puncture of the Carotid Artery in Elderly Patients
Authors: Takata H. , Iida T. , Akai T. , Kumano K. , Iizuka H. , Kadoya S. 
Published: January 2017

Seven aneurysms in elderly patients (average 78 year-old) were treated by intra-aneurysmal coil embolization. The 19 gage elastic needle or 4.0Fr. sheath introducer was placed into the carotid artery, and 3.0Fr. microcatheter was advanced into the aneurysm. An operative difficulty to approach to the aneurysm due to arteriosclerosis was ameliorated by this method. Mobility related to this procedure was a local hematoma at the puncture site in one case.
A Case of Partially Thrombosed Giant Basilar Aneurysm Successfully Treated by Coil Embolization Followed by Proximal Clipping
Authors: Manabe H. , Fujita S. , Kimura M. , Hatayama T. , Suzuki S. 
Published: January 2017

A case of unclippable partially thrombosed giant basilar artery (BA) aneurysm was treated successfully by intra-aneurysmal GDC embolization followed by proximal BA occlusion. Balloon occlusion test of the BA showed a good opacification of the aneurysm angiographically through plentiful collateral flow from anterior circulation. This combination may prevent coil compaction and will promote intra-aneurysmal thrombosis.
The Strategy of Dural Arteriovenous Fistula with Isolated Sinus
Authors: Masuo O. , Terada T. , Tsuura M. , Kinoshita Y. , Yokote H. , Itakura T. , Yamaga H. , Maeshima S. , Ozaki F. , Moriwaki H. , Oobayashi S. , Kuwata T. , Hyoutani G. , Nishiguchi T. 
Published: January 2017

We treated 7 cases of dural arteriovenous fistulas (dAVF) with isolated sinus by transvenous direct embolization. The fistulas located in the transverse-sigmoid sinus in 5 cases, superior sagittal sinus in 1 case and transverse-sigmoid and superior sagittal sinus in 1 case. The initial symptoms were generalized convulsion in 2 cases, disturbed consciousness in 1 case, tinnitus in 2 cases and transient ischemic attack in 2 cases. We performed sinus packing with coils in all cases following transarterial embolization. All patients improved neurologically after the treatments and AVFs completely disappeared in all cases.
Embolization of Posterior Circulation Aneurysms with Detachable Coils
Authors: Kazekawa K. , Fukushima T. , Tomonaga M. , Kawano T. , Kawaguchi T. , Kaneko Y. , Koizumi T. , Dosaka A. , Ooigawa H. , Hosoda H. , Gondo G. , Ideguchi H. , Ono A. 
Published: January 2017

We evaluated the usefulness of endovascular treatment of posterior circulation aneurysms with GDCs and IDCs, Five cases were treated with IDCs, and 15 cases were treated with GDCs. In this study, 8 aneurysms were identified at the basilar bifurcation, 3 at the P1 segment of the pasterior cerebral artery, 1 at the origin of the superior cerebellar artery, 2 at the vertebrobasilar junction, 1 at the origin of the posterior inferior cerebellar artery, 1 at the distal anterior inferior cerebellar artery, and 4 dissecting aneurysms at the vertebral artery. Thirteen of the aneurysms were small (< 12 mm), 5 were large (13–24 mm), and 2 were giant (> 25 mm). Of the 20 patients, 14 patients returned to their previous occupation. Patients with permanent deficits included 2 patients with infarction caused by thromboembolic complications during the embolization procedure, and 2 with infarction caused by vasospasm. There were 2 deaths. The outcomes of the patients seemed favorable. However, long-term follow-up is necessary to determine the usefulness of detachable coils.
Surgical Management of Cerebral Aneurysms in Comparison with Endovascular Treatment
Authors: Ohnishi H. , Kosimae N. 
Published: January 2017

We report our surgical results of 92 intrabasal (below the ophthalmic segment) carotid aneurysms and 16 basilar aneurysms after the era of skull base surgery. These lesions were the most difficult location for neck clipping of aneurysms. Mortality, surgery associated mortality and morbidity of intrabasal carotid aneurysm surgery were 2.2%, 0% and 9.7% respectively. Mortality and morbidity of basilar ameurysm surgery were 0% and 6.2% respectively. Although endovascular treatment of cerebral aneurysms with detachable coils is premising treatment due to its convenience and less invasiveness, results of this treatment must be superior to the results of microsurgery for it to become a widely accepted therapy.
An in Vitro Study to Define the Term “Dense Packing” of Aneurysms with Detachable Coils, Liquid Embolic Material and Their Combination
Authors: Mandai S. , Rüfenacht D.A. , Kinugasa K. , Ohmoto T. 
Published: January 2017

The purpose of this study was to define the terms minimal and maximal “dense packing” of a given cavity with platinum coils and liquid material (cellulose acetate polymer; CAP) using precise in vitro volumetric methods. Tests were performed using a simple in vitro aneurysm model, precisely measured in volume and thereafter filled with platinum coils and/or CAP. The volume of the aneurysmal cavity was measured with a very precise special micropump. The volume of each platinum coil (GDC) was also calculated. Minimal dense packing was defined as the point where there was angiographic evidence of complete filling of the cavity and exclusion from the parent lumen of the aneurysm. Maximal dense packing was defined as the point where introduction of additional coils resulted in their protrusion into the parent artery. At minimal dense packing the ratio of aneurysm volume to coil volume ranged from 25.97% to 32.50%. At maximal dense packing the ratio ranged from 29.55% to 36.16%. The volumetric ratio of minimal and maximal dense packing obtained was lower than we had expected. The volumetric ratio with CAP was 106.08% and 126.08% and the ratio obtained by the combined use of coils and CAP ranged from 103.78% to 140.2%. When the volumetric ratio of the packing is much lower than the ratio of dense packing by rough estimate, we should expect coil compaction and careful follow-up should be done. Liquid material filled the lumen more densely and the additional use of liquid may be useful to prevent coil compaction.
Percutaneous Transluminal Angioplasty (PTA) with Wallstent for Internal Carotid Artery Stenosis
Authors: Nishizaki J. , Arakawa Y. , Ishii A. , Morimoto M. , Yoshizumi H. , Goto Y. , Yamagata S.S. , Mitsudo K. 
Published: January 2017

A 67 year-old male who had suffered from myocardial infarction, was admitted to our clinic to examine his internal carotid artery stenosis revealed by preoperative study for heart surgery. Although he had no neurological symptoms, the angiograms showed severe stenosis of his right internal carotid artery. To improve stenotic internal carotid artery, PTA was performed employing a self-expanding stent. The stenotic right internal carotid artery was improved from 75% to 11% immediately after the stenting though restenosis mildly occurred up to 16% three months later. No complication occurred during this stenting procedure. Afterwards the patient uneventfully received coronary artery bypass grafting (CABG) surgery.
Spinal Dural AVF Two Cases with MRI Follow-up
Authors: Nishi S. , Hashimoto N. , Nakahara I. , Iwama T. , Sawada M. , Kojima A. , Nagata I. , Ishikawa M. 
Published: January 2017

Spinal dural arteriovenous fistula (d-AVF) is one of the arteriovenous malformations that are treatable by surgery or embolization. We present two cases treated by embolization and stress the necessity of early diagnosis and treatment, and the usefulness of T2WI on MRI for follow-up after embolization. One was a 51-year-old man who presented with gait disturbance and sphincter dysfunction. MRI revealed diffuse swelling on T1WI, and intramedullary high signal intensity on T2WI. A spinal d-AVF was found through tiny radicullomeningeal arteries via the right Th12 intercostal artery that drained into engorged retromedullary veins. The spinal d-AVF was embolized with 50% NBCA. Six months after the embolization, he was able to go back to his job, T2WI showed disappearance of the high signal intensity, which was confirmed at angiography one year after the embolization. The other case was a 62-year-old man who presented with sensory disturbance and gait disturbance, MRI showed the same findings, without the flow voids on them in case 1. The high signal area in the central spinal cord was thought to be syringomyelia, in which a syrinx-subarachnoid shunt was tried in vain. On the surface of the spinal cord, abnormally engorged and tortuous vessels were found. The syrinx was not confirmed. An angiogram showed a spinal d-AVF fed by the radicullomeningeal artery through a common trunk of the Th11/12 intercostal arteries with drainage into the retromedullary vein. The spinal d-AVF was embolized. Six months after the embolization, T2WI showed a decrease of high intensity areas. Early diagnosis and treatment are important for the prognosis of spinal d-AVF, T2WI may be the best way to check for recurrence.
Treatment of a Giant Aneurysm of the Right Middle Cerebral Artery with GDCs after Extracranial to Intracranial Bypass
Authors: Castro E. , Fortea F. , Villoria F. , Muñoz L. , Benito C , Morales F. 
Published: January 2017

A case of a giant aneurysm of the right middle cerebral artery treated with Guglielmi detachable coils is reported. Extracranial to intracranial bypass had previously been performed and surgical trapping had been attempted. During the endovascular procedure, balloon test occlusion of the middle cerebral artery was performed in order to demonstrate clinical and angiographic tolerance to parent vessel occlusion. A previous occlusion test in the right common carotid artery did not show sufficient flow through the bypass to perform safe parent vessel occlusion. Diagnostic imaging, the endovascular procedure, and haemodynamic aspects in cases in which parent vessel occlusion is required after extracranial-intracranial bypass are described and the literature is reviewed.
Endovascular Treatment for Internal Carotid Stenoses
Authors: Terada T. , Tsuura M. , Yokote H. , Matsumoto H. , Masuo O. , Nakai K. , Itakura T. , Yamaga H. , Moriwaki H. , Hyotani G. , Kamei I. 
Published: January 2017

Seventy four cases of internal carotid stenoses greater than 60% were treated by PTA and/or stenting 86 times. Sixty one cases of cervical ICA stenosis were treated 71 times. 11 cases of high cervical - intracranial ICA stenosis were treated 13 times. Two cases of ICA dissection were treated by stent deployment. Stenotic ratio reduced from 79% to 29% in cervical ICA stenosis and 71 % to 32% in high cervical to intracranial ICA stenosis in average. Morbidity related to PTA and/or stenting was 2/74 (2.7%) and mortality was 0%. One was an ischemic complication and the other was a hemorrhagic complication due to hyperperfusion. Restenosis (stenosis greater than 70%) rate was 32%. Asymptomatic cerebral embolism were found in three cases (4.2%) on angiogram immediately after PTA and/or stenting. The complication rate related to PTA and/stenting was low but asymptomatic emboli were found in three cases. Considering these results, the indication for PTA and/stenting should be restricted to patients with high risk group, such as cases with high medical risks or difficult CEA cases, if appropriate protective systems for cerebral emboli were not available.
Endovascular Treatment Using Detachable Coils for Non-Ruptured Intracranial Aneurysm
Authors: Satoh K. , Satomi J. , Nakajima N. , Nagahiro S. 
Published: January 2017

Detachable coil embolization was performed on 34 non-ruptured cerebral aneurysms in 33 patients. Patients consisted of 28 females and five males, with an age range of 26 to 77 years. Angiographic examination after coil embolization revealed complete or near-complete occlusion in 24 aneurysms (70.5%) and partial occlusion in three (8.8%). Detachable coil embolization was attempted unsuccessfully in seven aneurysms (20.5%). Transient ischemic attack occurred in one case with coil migration. The combined mortality/morbidity rate was 0%.
Endovascular Treatment of Incidental Cerebral Aneurysms
Authors: Murayama Y. , Viñuela F. , Duckwiler G.R. , Gobin Y.P. , Guglielmi G. 
Published: January 2017

One hundred and fifteen patients with 120 intracranial incidental aneurysms were embodied using the GDC endovascular technique at UCLA Medical Center. Angiographic results showed complete or near complete aneurysm occlusion in 109 aneurysms (91%) and an incomplete occlusion in five aneurysms (4%). An unsuccessful GDC embolization was attempted in six aneurysms (5%). One hundred and nine patients (94.8%) remained neurologically intact or unchanged from initial clinical status. Five patients (43%) deteriorated due to immediate procedural complications. All these complications occurred in the first 50 patients. No clinical complications were observed in the last 65 patients. In Groups 1 and 3, the average length of hospitalization was 3.3 days. The technical evolution of the GDC technology has proved to be safe for the treatment of incidental aneurysms (0% morbidity in the last 65 patients). The topography of the aneurysm/s and the clinical condition of the patient did not influence final anatomical or clinical outcomes. GDC technology also brings a positive economical impact by decreasing hospitalization time and eliminating postembolization ICU care.
Angiographic Classification of Cerebral Embolism
Authors: Otsuka Y. , Waki R. , Fukazawa S. , Kitajima H. , Shimizu K. 
Published: January 2017

Since 1994, we have treated 62 cases with hyperacute cerebral embolism with local intraarterial thrombolysis (LIT), but not all cases showed recanalization. We tried to classify these cases by angiographic results. Angiographically they could be classified into four types; tapering type, fading type, stump type, and edge type. The tapering and fading type had a significantly higher tendency to recanalize than the stump and edge type. We think these classifications indicate the dissolubility of the cerebral emboli; the former two types dissoluble, the latter two types indissoluble. The tapering and fading type are the good indicators for LIT, but the stump and edge type may not be.