bluuebunny/crossref_metadata_2025_split huggingface dataset:
Observer Agreement in the Assessment of Minor and Major Cerebral Aneurysm Recurrence
Authors: Cloft Harry J. , Kallmes David F. 
Published: January 2017

We studied the use of minor and major recurrence classifications with regard to observer variability, which directly affects validity of these terms as outcome measures. Recurrences at the time of a three to six month follow-up angiogram were assessed independently by two experienced observers in 83 cases. Intra- and interobserver concordance is approximately 90% for assessment of minor and major recurrence.
Life-Threatening Arteriovenous Malformation of the Maxillomandibular Region and Treatment Outcomes
Authors: Churojana A. , Khumtong R. , Songsaeng D. , Chongkolwatana C. , Suthipongchai S. 
Published: January 2017

We report on cases of life-threatening maxillomandibular arteriovenous malformations (AVM) whereby patients had successful endovascular treatment with good outcomes. Out of a total 93 facial AVMs treated endovascularly between 1991 and 2009, five patients (5.4%) had maxillomandibular AVMs. All presented with uncontrolled dental bleeding. Endovascular procedure was the primary treatment of choice in all cases, either transfemoral approach with arterial feeder embolization or transosseous puncture, depending on the accessible route in each patient. NBCA (glue) was the only embolic agent used. Tooth extraction and dental care were performed after bleeding was controlled. All five patients (8–18 years) with a mean age of 12.4 years presented with massive dental bleeding following loosening of teeth, dental extraction and/or cheek trauma. The plain films and CT scans of four patients with AVMs of mandibles and one of maxilla, revealed expansile osteolytic lesions. The mean follow-up period was 6.6 years (ranging between one and 19 years). Three cases developed recurrent bleeding between two weeks to three months after first embolization, resulting from residual AVM and infection. Late complications occurred in two patients from chronic localized infection and osteonecrosis, which were successfully eradicated with antibiotic therapy and bony curettage. Complications occurring in two patients which included soft tissue infection, osteomyelitis and osteonecrosis were successfully treated with antibiotics, curettage and bone resection. No patient had a recurrence of bleeding after the disease had cured Initial glue embolization is recommended as the effective treatment of dental AVMs for emergent bleeding control, with the aim to complete eradicate the intraosseous venous pouches either by means of transarterial superselection or direct transosseous puncture. Patient care by a multidisciplinary team approach is important for sustained treatment results.
Superior Sagittal Sinus Dural Arteriovenous Fistulas Treated by Stent Placement for an Occluded Sinus and Transarterial Embolization
Authors: Ohara N. , Toyota S. , Kobayashi M. , Wakayama A. 
Published: January 2017

We describe a case of dural arteriovenous fistulas (DAVFs) involving the superior sagittal sinus (SSS) successfully treated with stent placement for an occluded sinus and transarterial embolization. A 61-year-old man who had been treated with anticoagulation for a known SSS thrombosis presented with a sudden onset of headache. CT scan revealed an intraventricular hemorrhage and cerebral angiography revealed DAVFs involving the SSS which had severe venous congestion and sinus occlusion. We treated this case with a staged endovascular approach which consisted of stent placement for the occluded sinus and transarterial intravenous embolization resulting in complete eradication of DAVFs. Recanalization of an occluded sinus by stent placement can reduce venous congestion and transarterial intravenous embolization can obliterate dural arteriovenous shunts. This staged strategy is feasible and should be considered a first option of treatment, especially for DAVFs which presented with intracranial hemorrhage and aggressive venous hypertension.
The Rapid Pull-Back Technique for Navigation across a Wide-Necked Aneurysm
Authors: Oran I. , Çinar C. , Bozkaya H. , Beşir F.H. 
Published: January 2017

Embolization of wide-necked and/or giant aneurysms may fail due to the inability to pass across the aneurysm neck. We describe the rapid bull-back technique used in four patients in which a small diameter microcatheter with the aid of a hydrophilic microguidewire was navigated along the inner surface of the aneurysm, making a loop in the dome, exiting the neck to reach distal intracranial vessels. After withdrawal of microguidewire, the microcatheter is pulled back rapidly up to a predetermined length. This maneuver results in elimination of the loop, straightening the microcatheter to allow an exchange procedure for another device to cross the neck distally and continue the embolization procedure. The rapid pull-back technique is useful during the endovascular treatment of wide-necked and/or giant aneurysms as it helps to achieve reliable access to the distal parent vessel with the microcatheter. This is of increasing importance since an increasing number of aneurysms will be treated in the future with refinements in various intracranial stents.
Effects of Hyper-Early (<12 Hours) Endovascular Treatment of Ruptured Intracranial Aneurysms on Clinical Outcome
Authors: Consoli A. , Grazzini G. , Renieri L. , Rosi A. , De Renzis A. , Vignoli C. , Nappini S. , Ammannati F. , Capaccioli L. , Mangiafico S. 
Published: January 2017

Despite the encouraging results obtained with the endovascular treatment of ruptured intracranial aneurysms, few data are available on the effects of the timing of this approach on clinical outcome. The aim of our study was to evaluate the effects of the hyper-early timing of treatment and of pre-treatment and treatment-related variables on the clinical outcome of patients with ruptured intracranial aneurysms. Five hundred and ten patients (167 M, 343 F; mean age 56.45 years) with 557 ruptured intracranial aneurysms were treated at our institution from 2000 to 2011 immediately after their admission. The total population was divided into three groups: patients treated within 12 hours (hyper-early, group A), between 12–48 hours (early, group B) and after 48 hours (delayed, group C). A statistical analysis was carried out for global population and subgroups. Two hundred and thirty-four patients (46%) were included in group A, 172 (34%) in group B and 104 (20%) in group C. Pre-treatment variables (Hunt&Hess, Fisher grades, older age) and procedure-related variable (ischaemic/haemorrhagic complications) showed a significant correlation with worse clinical outcomes. The hyper-early treatment showed no correlation with good clinical outcomes. The incidence of intraprocedural complications was not significantly different between the three groups; 1.2% of pre-treatment rebleedings were observed. The hyper-early endovascular treatment of ruptured intracranial aneurysm does not seem to be statistically correlated with good clinical outcomes although it may reduce the incidence of pre-treatment spontaneous rebleedings without being associated with a higher risk of intraprocedural complications. However, since no significant differences in terms of clinical outcome and pre-treatment rebleeding rate were observed, a hyper-early treatment is not be supported by our data.
Spinal Cord Arteriovenous Malformations in a Pediatric Population Children below 15 Years of Age the Place of Endovascular Management
Authors: Rodesch G. , Pongpech S. , Alvarez H. , Zerah M. , Hurth M. , Sebire G. , Lasjaunias P. 
Published: January 2017

Among a global group of 164 spinal arteriovenous shunts, a series of 16 spinal cord arteriovenous malformations (SCAVMs) were diagnosed in a pediatric population below 15 years of age. The majority of the lesions affected the male population; 6 were located in the cervical spine and 10 at the thoracolumbar level. Hemorrhage was the most frequent symptom encountered (63%). Half of the bleeds occurred only in the subarachnoid spaces. Neurological deficits (acute or progressive) revealed the SCAVM in 31% of patients. The lesion was an incidental finding in one patient (6%). All the diagnoses (except one) were made by MRI. Selective angiography confirmed the diagnosis and identified the type of the lesion (nidus or fistula) and its angioarchitecture, stressing that the veins and their related features are the key point in the clinical eloquence of SCAVMs. All the treatments performed were endovascular; no patient was deemed a surgical candidate. Therapeutic abstention was decided in 37% of cases, mainly for anatomical reasons. All the patients in this group improved (50% being normal and 50% presenting slight non-handicapping deficits due to the initial accidents). Embolisation was indicated in 10 patients (63%) and was performed with fluid agents (histoacryl*) except in the first patient who had been treated with particles. Twelve percent of patients were cured (fistula), the remaining 88% having their lesion controlled to more than 50%. This partial treatment was always targetted towards the angioarchitectural weak points of the lesion. All patients improved after embolisation, 45% of them being neurologically normal. Follow-up in this group ranges from 1.5 to 13 Years. No complications occurred after embolisation. No bleed, rebleed or clinical worsening has occurred after endovascular treatment. The results in this series suggest that endovascular treatment (even partial but targetted) represents a safe and stable therapeutic alternative in the management of SCAVMs in this population.
Angio-CT
Authors: Grossi G. , Romanzi F. , MacChia G. , Ruffinengo U. , Calia S. 
Published: January 2017

After nine months' experience with helical CT (Elscint Twin), we describe an epicrisis in 13 patients with intracranial aneurysms, 12 of whom were referred to us by the emergency room for suspect subarachnoid hemorrhage. After standard CT scan confirming subarachnoid hemorrhage, patients underwent angio-CT with display of the sac responsible for bleeding in all cases. All patients subsequently underwent digital angiography which confirmed the angio-CT findings and in three cases disclosed associated malformations. The sensitivity, specificity and diagnostic accuracy of the technique are assessed in relation to the quality of the images obtained (MIP) in such a short time (15 min on average). The diagnostic information is comparable to that offered by angio-MR with the obvious positive and negative aspects linked to each method. Digital angiography remains the technique of choice in terms of diagnostic accuracy, but carries some risk to the patient.
Follow-up MR of Intracranial Cavernomas the Relationship between Haemorrhagic Events and Morphology
Authors: Willinsky R. , Harper W. , Wallace M.C. , Kucharczyk W. , Montanera W. , Mikulis D. , terBrugge K. 
Published: January 2017

The purpose of this review was to determine whether a classification scheme for cavernomas based on the MR appearance is predictive of the natural history of the lesions with particular reference to the risk of haemorrhage. We reviewed the clinical and MR findings in 156 patients with intracranial cavernomas. The dominant or symptomatic cavernoma was graded into three groups according to the appearance of the blood products. The presence of haemorrhage, mass effect and oedema was evaluated. Sixty patients had serial MRs with a mean follow-up of 1.9 years. Subacute haemorrhage with mass effect and oedema was evident on the initial MR in 30 patients (19%). In seven patients follow-up MR showed haemorrhage with mass effect and oedema. Six of these bleeds were in the posterior fossa. The haemorrhages seen on follow-up MR occurred in all three morphological types. Regression was found on follow-up MR in five of the seven patients who initially showed a bleed. In 35% of patients, the dominant or symptomatic cavernoma changed on serial MR. Intracranial cavernomas are dynamic lesions with both active and regressive changes seen on follow-up MR. A classification system based on morphology was not found to be useful in predicting future bleeds. Bleeding rates, based on MR follow-up, were 10.9% in the posterior fossa and 1.7% in the supratentorial compartment.
The “Remodelling Technique” in the Treatment of Wide Neck Intracranial Aneurysms
Authors: Moret J. , Cognard C. , Weill A. , Castaings L. , Rey A. 
Published: January 2017

The main factor limiting endovascular treatment of intracranial aneurysms is the shape of the aneurysmal sac, particularly the width of the neck. In this study we present a new technique to occlude wide neck aneurysms that involve the temporary inflation of a non-detachable balloon in front of the aneurysm neck during each coil placement. The aim of the study is to present the feasibility, efficacy and safety of this “remodelling technique” (RT) compared to that of “normal” GDC treatment. We selected 56 aneurysms in 54 patients for treatment with the RT. Thirty-seven (70%) of the patients presented with subarachnoid haemorrhage. Twenty-five (45%) of the aneurysms were located at the vertebrobasilar artery, 24 (43%) at the internal carotid artery, and seven at the level of smaller arteries. Treatment was achieved in 52 aneurysms in 50 patients. Two aneurysms which were initially not completely occluded underwent a second treatment using the RT. Final results (i.e. the last follow-up angiography or results at the end of the treatment for the cases that have not yet had follow-up) consisted of total occlusion in 40 cases (77%), subtotal occlusion in nine cases (17%), and incomplete occlusion in three cases (6%). Angiographic evidence of clotting was observed during the procedure in three cases, resulting in one permanent deficit (quadranopia). Rupture of the aneurysmal sac occurred during the procedure in three cases, all of which were asymptomatic in the follow-up. Thus, morbidity due to the technique was 1/52 (1%) and mortality was 0/56 patients. The remodelling technique allowed the treatment of 52 wide neck or badly shaped aneurysms that were not treatable without this technique. The results of occlusion with the RT seem better than those in our series of normal GDC treatment, and complications related to the technique are fewer. This technique thereby extends the spectrum of treatable aneurysms without increasing the risk incurred by treatment.
Treatment of a Small Hole Post-Traumatic Carotid-Cavernous Fistula with a Non-Detachable Balloon Catheter
Authors: Kurata A. , Miyasaka Y. , Saegusa H. , Fujii K. , Kan S. 
Published: January 2017

Transarterial detachable balloon embolisation has become a well established primary treatment of post-traumatic carotid cavernous fistula (CCF). However, in some instances due to the complexity of the fistula, the treatment can be difficult or impossibile. A simple and useful technique using a non-detachable balloon catheter to easily navigate the microcatheter into the fistula via the transarterial route is discussed in this paper. The non-detachable balloon catheter allows easy navigation of the microcatheter into the small hole fistula, and complete occlusion of the fistula was obtained using one interlocking detachable coil (IDC) in the draining veins. The method of using a non-detachable balloon catheter to navigate a microcatheter into a fistula is relatively easy via the transarterial route.
Percutaneous Transluminal Angioplasty for Intracranial Arteriosclerotic Lesions
Authors: Yokote H. , Terada T. , Ryujin K. , Kinoshita Y. , Tsuura M. , Nakai E. , Moriwaki H. , Hayashi S. , Itakura T. 
Published: January 2017

Recent developments of the interventional neuroradiological technique made percutaneous transluminal angioplasty (PTA) possible even for intracranial arteries1. We report our experiences of 17 cases treated by PTA including 9 intracranial internal carotid (ICA), 4 middle cerebral (MCA) and 4 vertebro-basilar arterial (VBA) stenoses and discuss the problems of the procedure. All patients had cerebral ischemic symptoms and stenoses more than 60% calculated angiographically. Three of them were treated by PTA for residual stenoses after thrombolytic therapy for acute occlusion. We used PTA balloon catheters 2.0 mm to 3.5 mm in diameter (Stealth, Target therapeutics) for all PTA procedures. A PTA balloon was inflated for 1 min at 6 atm as a rule. All were successfully dilated (stenosis less than 50%) except one treated by PTA for residual MCA stenosis after thrombolytic therapy. The patient died from massive infarction due to MCA re-occlusion caused by MCA dissection. Restenosis appeared in 4 of 16 patients. Repeated PTA was successfuly carried out for the 4 patients. However, restenosis appeared in one of them but the patient is now on follow-up because of asymptomatic course. PTA for intracranial arteries is an effective treatment but its indication should be determined strictly because of potential risk such as acute occlusion derived from dissection.
Angioplasty of Acute Occluded Cerebral Arteries
Authors: Nakayama T. , Tanaka K. , Kaneko M. 
Published: January 2017

22 cases of stenosed or occluded cerebral arteries were treated by percutaneous transluminal angioplasty (PTA) in acute stage. There were 10 internal carotid lesions, 4 middle cerebral artery lesions, 5 intracranial vertebral artery lesions, and 3 basilar artery lesions. 14 cases were treated for residual stenosis after recanalization using urokinase. Successful dilatation (over 50%) was achieved in 16 cases (73%). 3 lesions were inaccessible due to atherosclerotic change. There were no major complications. Restenosis was observed in 4 internal carotid lesions and 1 middle cerebral lesion. 7 (50%) cases with internal carotid lesions and 5 (63%) cases with vertebrobasilar lesions returned to their previous life. The results suggest that PTA in acute stage is feasible for occlusive disease of cerebral arteries.
Endovascular Stenting of the Cervical Internal Carotid Artery
Authors: Hosotani K. , Okamoto S. , Yamashita K. 
Published: January 2017

The purpose of this study was to determine the value of stenting in the treatment of occlusive vascular disease involving the cervical internal carotid artery. Clinical and angiographical results of stenting were compared those of conventional angioplasty alone up to 20 months of follow-up. The Palmaz-Schatz stent was implanted in two patients with acute intimal dissection, whereas conventional angioplasty alone was performed in seven patients with arteriosclerotic stenosis. Initial procedural success was achieved in all the patients, and acute or subacute complications were not encountered at all. One of the patients (14%) treated with conventional angioplasty alone developed late restenosis at three-month follow-up. The patients treated with stenting revealed satisfactory results clinically and angiographically. The present results may suggest that stenting is an effective and safe method to treat dissection of cervical internal carotid artery, but larger clinical trials as well as experimental studies would be necessary to define the indications and refine the stents.
Intravascular Ultrasound Image System for Experimental Implantation of Various Stents
Authors: Konishi Y. , Damrinjap G. , Shiota M. , Sato E. , Hara M. , Saito I. 
Published: January 2017

This report describes the experiments we have conducted with an ultrasound image system (IVUS) and a three-dimensional intravascular ultrasound image system (3-D IVUS), to examine where and how vascular stents should be applied in the lesion, as a step towards mastering the techniques of this therapeutic approach. Based on the IVUS findings, it appears to be of importance to select an appropriate type of stent, and the indiscriminate application of stents must be avoided, except in emergency cases.
Classification of the Venous Route of Carotid Cavernous Sinus Fistula
Authors: Usami S. , Abe T. , Hata Y. 
Published: January 2017

It is important to investigate the venous routes in and around the carotid cavernous sinus before endovascular interventional treatment to avoid complications such as glaucoma and central retinal vein thrombosis. This paper classifies the anatomical features of the cavernous sinus and its venous routes and discusses four successfully treated cases.
Intra-Aneurysmal Occlusion of Cerebral Aneurysms Using Detachable Coils: Correlation of Aneurysm Neck Size and Treatment Results
Authors: Irie K. , Taki W. , Nakahara I. , Sakai N. , Isaka F. , Kikuchi H. , Nagao S. 
Published: January 2017

The aneurysmal neck size seems to be an import ant factor in the endovascular treatment outcome4,5. The purpose of the present study was to measure aneurysm neck size on angiographic films, and compare the measured value with the extent of intra-aneurysmal occlusion performed with detachable coils. The subjects were 22 patients with intracranial aneurysms treated using detachable coils. The cases were divided into two groups according to the aneurysmal neck size, 4 mm being the discriminating value for small neck. The neck of the aneurysm was successfully occluded in 19 of 22 patients. Ten aneurysms had a small neck and 9 aneurysms had a wide neck. Complete aneurysm occlusion was observed in 70% of small neck aneurysms and 25% of wide neck aneurysms. The results support that the size of the aneurysm neck correlates well with the effectiveness of endovascular treatment.
Long-Term Results of Ruptured Cerebral Aneurysms Embolized in Acute Stage with Interlocking Detachable Coils
Authors: Manabe H. , Fujita S. , Akasaka K. , Suzuki S. 
Published: January 2017

We report on a series of eight patients presenting with SAH secondary to ruptured saccular (n=7) or dissecting (n=1) aneurysm, treated in the acute stage (within 14 days) by embolization with interlocking detachable coils (IDCs) who survived at least 3 months following initial hemorrhage. Embolization resulted in complete occlusion in 2 of 7 cases of saccular aneurysm, 90–95% occlusion was obtained in the remaining 5 cases of saccular aneurysm. Proximal occlusion with intra-aneurysmal coil packing was achieved in 1 case of dissecting aneurysm. In all 5 cases with partial occlusion, follow-up angiograms taken 2–4 months after the embolization showed partial recanalization due to coil compaction, while no recanalization was recognized in cases with complete occlusion in follow-up angiograms at 5 and 9 months respectively. Clinical disability, at 9 months after the embolization was rated as none in 4 cases, moderate in 1, and severe in 1. Two patients died of re-rupture at 4 and 8 months respectively after the embolization. Of the other 3 cases with partial recanalization, 2 were retreated by re-embolization or surgical clipping, one has been followed clinically and angiographically. Histological findings of the re-ruptured aneurysm showed neither endothelialization of the aneurysmal orifice nor organization of the clot around the coils. Aneurysmal re-rupture secondary to coil compaction related recanalization remains a critical factor in long-term clinical outcome and prognosis.