bluuebunny/crossref_metadata_2025_split huggingface dataset:
Carotid-Cavernous Fistula Associated with an Intracranial Lesion Caused by Cortical Venous Reflux
Authors: Takahashi S. , Sakuma I. , Otani T. , Yasuda K. , Tomura N. , Watarai J. , Kinouchi H. , Yanagisawa T. , Mizoi K. 
Published: January 2017

Digital subtraction angiography (DSA) and magnetic resonance imaging (MRI) findings in 20 patients with carotid-cavernous fistula (CCF; 3 direct CCFs and 17 indirect CCFs) were retrospectively reviewed to evaluate venous drainage patterns that may cause intracerebral haemorrhage or venous congestion of the brain parenchyma. We evaluated the relationship between cortical venous reflux and abnormal signal intensity of the brain parenchyma on MRI. Cortical venous reflux was identified on DSA in 12 of 20 patients (60.0%) into the superficial middle cerebral vein (SMCV; n=4), the uncal vein (n=2), the petrosal vein (n=2), the lateral mesencephalic vein (LMCV; n=1), the anterior pontomesencephalic vein (APMV; n=1), both the APMV and the petrosal vein (n=1) and both the uncal vein and the SMCV (n=1). Features of venous congestion, such as tortuous and engorged veins, focal staining and delayed appearance of the veins, were demonstrated along the region of cortical venous reflux in the venous phase of internal carotid or vertebral arteriography in six of 20 patients (30.0%). These findings were not observed in the eight CCF patients who did not demonstrate cortical venous reflux. MRI revealed abnormal signal intensity of the brain parenchyma along the region with cortical venous reflux in four of 20 indirect CCF patients (20%). Of these four patients, one presented with putaminal haemorrhage, while the other three presented with hyperintensity of the pons, the middle cerebellar peduncle or both on T2-weighted images, reflecting venous congestion. The venous drainage routes were obliterated except for cortical venous reflux in these four patients and the patients without abnormal signal intensity on MRI had other patent venous outlets in addition to cortical venous reflux. CCF is commonly associated with cortical venous reflux. The obliteration or stenosis of venous drainage routes causes a converging venous outflow that develops into cortical venous reflux and results in venous congestion of the brain parenchyma or intracerebral haemorrhage. Hyperintensity of brain parenchyma along the region of cortical venous reflux on T2-weighted images reflects venous congestion and is the crucial finding that indicates concentration of venous drainage into cortical venous reflux.
A Case of Posterior Fossa Dural Arteriovenous Fistulas Successfully Treated with Transarterial Embolization
Authors: Watanabe K. , Kinkori T. , Takagi T. , Inoue T. , Takayasu M. 
Published: January 2017

A 40-year-old man was transferred to our hospital due to sudden headache while swimming in the pool. CT revealed cerebellar haematoma within vermis associated with subarachnoid haemorrhage (SAH). Digital subtraction angiography (DSA) showed dural arteriovenous fistulas (DAVFs) with venous pouch on the surface of cerebellar vermis. Fistulas were on the meningeal surface near the sinus confluence. Draining veins formed venous pouch invaginating into cerebellar vermis. Transarterial embolization (TAE) was performed under the concept that main feeder should be embolized last to occlude the DAVFs completely. Post-embolization 3D-CT showed the cast of N-butyl –cyanoacrylate (NBCA) in the fistulas as well as in the drainer. The good order of occlusion made the embolization complete.
Cerebral Blood Flow Change before and after Carotid Angioplasty and Stenting (CAS) in Cases with Contralateral Carotid Artery Occlusion
Authors: Kataoka T. , Hyogo T. , Hayase K. , Nakamura H. 
Published: January 2017

Contralateral carotid artery occlusion is thought to represent a significant risk factor in carotid endarterectomy (CEA). There is also evidence that intraoperative and postoperative hypotention may cause contralateral hemodynamic ischemia. As such, contralateral carotid artery occlusion is regarded as a risk factor for carotid angioplasty and stenting (CAS). In this paper, we report on five cases of severe ICA stenosis with contralateral carotid artery occlusions. Cerebral blood flow(CBF) and cerebral vasore-activity(CVR) of the contralateral carotid artery occlusions were measured before and after CAS. Additionally, the influence that ipsilateral CAS exerted on the occluded side was examined. 123I-IMP SPECT was performed before and after CAS, both at rest and at the time of acetazoramide administration. The CBF was evaluated quantitatively using the ARG method. The mean CBF of the treated side rose from 30.0 ± 7.1 ml/100g/min to 34.4 ± 8.3 ml/100g/min (p<0.05), and the mean CBF of the occluded side similarly rose from 28.3 ± 6.1 ml/100g/min to 31.7 ± 6.4 ml/100g/min (p<0.05). Correspondingly, the regional CVR (rCVR) increased from 5.9% ± 16.3% to 35.0% ± 16.4%(p<0.05) on the treated side, and from 3.7% ± 14.7% to 10.7% ± 16.9% (p<0.05) on the occluded side. This demonstrates that ipsilateral CAS seems to improve both CBF and CVR on the contralateral occluded side. The fact that some cases developed cross flow from the anterior communicating artery was both remarkable and significant. Where there was poor cross flow from the anterior communicating artery, improvement in cerebral vaso reactivity was limited.
Endovascular Treatment of Multiple Severe Atherosclerotic Stenoses with Cerebral Hypoperfusion
Authors: Uchiyama N. , Okada Y. , Higashi S. 
Published: January 2017

A 60-year-old man presented with syncope and transient left-sided motor weakness. Cerebral angiography revealed multiple severe atherosclerotic stenoses of bilateral internal carotid arteries, bilateral intracranial vertebral artery (VA), and left VA origin. A SPECT study showed poor cerebral perfusion and vascular reserve in the right cerebral hemisphere and the posterior circulation. We performed angioplasty and stentings for the VA stenoses first by using balloon-expandable stents. The patient had shown no syncope attack ever since, which might be due to an increased vascular reserve in the posterior circulation. The following bilateral carotid angioplasty and stentings could be performed safely. Angioplasty and stenting is feasible, and can improve cerebral perfusion even in a patient with multiple severe atherosclerotic stenoses by pre-operative appropriate haemodynamic assessment.
Balloon Test Occlusion with Perfusion CT Imaging Utilizing Intraarterial Contrast Injection
Authors: Ebara M. , Murayama Y. , Saguchi T. , Ishibashi T. , Irie K. , Takao H. , Sadaoka S. , Klotz E. , Abe T. 
Published: January 2017

Balloon Test Occlusion (BTO) is performed to evaluate the collateral flow when a permanent therapeutic occlusion of unilateral carotid artery is planned. BTO with neurological evaluation alone, however, has a rather high false negative rate. In order to improve the sensitivity, several adjunctive procedures such as induced hypotension or cerebral blood flow (CBF) measurement with various modalities have been combined. Perfusion CT (PCT) is another imaging modality that is mainly used for the diagnosis of acute stroke. In this study, we evaluate the efficacy and the safety of BTO combined with PCT in the same procedure utilizing intraarterial contrast injection from the catheter. Seven patients underwent BTO with PCT in our institution. All the procedures were performed in the angio/CT combination suite. BTO was performed in the usual fashion and when the patient passed the 30 minutes' BTO clinically, PCT was performed subsequently. Contrast material was injected from a Pig Tail catheter placed in the ascending aorta. The obtained data were transferred to a workstation and perfusion maps of CBF, cerebral blood volume (CBV), and time to peak (TTP) were generated using software. In three patients, single photon emission CT (SPECT) was also obtained with administering 99mTc-ethyl cysteinate dimer (99mTc-ECD) intravenously during BTO. Although all the patients had passed the BTO clinically, the CBF maps of three patients revealed significant decrease in the occluded hemisphere. There was no procedure-related morbidity. PCT using intraarterial contrast injection during BTO was performed successfully and safely. Intraarterial injection allowed us to obtain excellent time-attenuation curves by utilizing less contrast material and less radiation doze.
Intracranial Stenting in the Treatment of Wide-Necked Aneurysms
Authors: Leonardi M. , Dall'olio M. , Cenni P. , Raffi L. , Simonetti L. 
Published: January 2017

We positioned the following self-expanding stents certified for intracranial application: 16 Neuroform (Boston Scientific), three INX (Medtronic), one Leo (Balt). 6F calibre femoral introducers and guiding catheters were used for stent placement changing to 5F calibre introducers and guiding catheters (Envoy, Cordis) for the Neuroform 2 and 3 stents. All procedures were carried out under general anaesthesia and heparinization. Our pharmacological protocol consisted of adjunctive treatment with anti-aggregants during the interventional procedure and for the following six months, without premedication. From November 2000 to August 2006 we treated 28 patients (27 F/1M) with giant wide-necked aneurysms and one dissecting basilar artery aneurysm requiring the placement of 29 stents. We successfully positioned 20 stents: 11 stents combined with coils (8 immediate; 3 late) with complete exclusion of the aneurysm from the circulation in seven cases and subtotal exclusion in four; nine stents not followed by embolization with complete exclusion of the aneurysm from the circulation in six cases and subtotal exclusion in three. Stenting was not possible in nine cases due to extreme vessel tortuosity and the poor flexibility of release systems for the first stents. No late stent occlusion or subarachnoid haemorrhage were encountered after treatment.
Early Experiences of Neuroform Stent-Assisted Coiling in Ruptured Intracranial Aneurysms
Authors: Kim Young-Joon 
Published: January 2017

Endovascular treatment of ruptured intracranial aneurysms with detachable coils has proven a favorable alternative to surgical clipping. However, coiling has limitations in the treatment of complex or broad neck aneurysms because of possible coil prolapse or coil migration into the parent vessel and long-term angiographic recurrences. To achieve reconstruction of intracranial vessels with preservation of the parent artery, the use of stents has the greatest potential for assisted coil embolization. Three-dimensional coils and reconstructive techniques such as balloon-assisted remodeling may overcome these problems. But these methods had some drawbacks. The Neuroform stent is the most recently developed endovascular stent with self-expandable and micro-delivery properties that are specially designed for the treatment of unruptured intracranial broad neck aneurysms. Aim of the following working is to report a single center experience of stent-assisted coiling on ruptured intracranial aneurysms with assessment of its efficacy and safety, and follow-up findings.
A New Hemostasis Valve for Neuroendovascular Procedures
Authors: Namba K. , Song J.K. , Niimi Y. , Heran N.S. , Berenstein A. 
Published: January 2017

A hemostasis valve is routinely used in neuroendovascular procedures to decrease the risk of thromboembolism 1,2. Recently, a new hemostasis valve that is designed to minimize blood loss has been introduced. We report our initial experience in using this new hemostasis valve. In neuroendovascular procedures, a hemostasis valve is commonly used for continuous irrigation of guide and microcatheters to decrease the risk of thromboembolism 1,2,3. A conventional hemostasis valve has a rotating seal at the end, which is turned open or closed each time a wire or microcatheter/guidewire is introduced or extracted. Often this results in significant back bleeding. When a rotating seal is adjusted suboptimally during a wire or microcatheter manipulation, leakage of pressurized saline from the end of a hemostasis valve results in stagnation of blood within a guiding catheter, which becomes a potential source of emboli during a procedure. The Guardian Haemostasis Valve (Zerusa Limited, Galway, Ireland) is a new hemostasis valve that is designed to minimize blood loss during interventional procedures by minimizing the opening time of the valve during wire or microcatheter insertion. A continuous sealing mechanism during wire or microcatheter positioning minimizes blood loss and stagnation of blood within the guide catheter. We report our initial experience with the Guardian hemostasis valve.
In Vivo Thrombogenicity of Embolic Protection Systems for Angioplasty and Stenting
Authors: Raymond J. , Guilbert F. , Metcalfe A. , Salazkin I. , Gevry G. , Leblanc P. , Weill A. , Roy D. 
Published: January 2017

Despite the increasing use of embolic protection systems (EPS) for carotid stenting, their intrinsic in vivo thrombogenicity remains unknown. We studied three different types of EPS (n = 24) deployed in the carotid arteries of pigs in which pools of platelets and fibrinogen were labelled with 111In and 125I. The amount of clot deposition seen on photography was also scored using a qualitative scale. EPS made of fabric nets under normal flow conditions were 5–6 and 15–16 times more thrombogenic (for both platelet (P=.04) and fibrin (P=.007)) than Nitinol mesh nets. Clot deposition on Nitinol mesh nets was more abundant under flow arrest than under normal flow conditions (P=.018). EPS differ in intrinsic thrombogenicity, a characteristic of the material that could be investigated in pre-clinical studies designed to optimize devices.
Surgical Management of Parkinson's Disease: Update and Review
Authors: Chao Y. , Gang L. , Na Z.L. , Ming W.Y. , Zhong W.S. , Mian W.S. 
Published: January 2017

Although medical therapy is still the mainstay of treatment for Parkinson's disease, the development of surgical precision and decreased morbidity have made stereotatic lesioning and deep brain stimulation more popular. Neurosurgical ablations include pallidotomy, thalamotomy, and, more recently, subthalamotomy. Because of concern over the high risk of side-effects resulting from bilateral ablative procedure, alternative approaches have been explored. With improved deep brain stimulation (DBS) technology, DBS has been successfully applied in the internal globus pallidus, ventral intermediate nucleus and subthalamic nucleus for Parkinson's disease. In addition, recent surgical approaches including biological neurorestorative technologies — surgical therapies with transplantation, gene therapy, and growth factor are all being discussed in this review. Although a great deal of work remains to be done for researchers, advances in surgical therapies for the treatment of Parkinson's disease are moving forward at an unprecedented pace, and, not surprisingly, would give PD patients more choices and hope.
Treatment of Vasospasm Secondary to Subarachnoid Hemorrhage Using Intra-Arterial Nimodipine in Low Dosage
Authors: Bandeira A. , Ribeiro C. , Reis J. 
Published: January 2017

There are currently no consensus criteria to define the dosage of intra-arterial Nimodipine to be used to obtain permanent remission of vasospasm secondary to subarachnoid haemorrhage. The purpose of this paper is to establish a mathematical relation between the number of vessels affected by this kind of vasospasm and the Nimodipine dose that must be used for intra-arterial angioplasty to obtain permanent remission of the vasospasm.
Patterns of the Cranial Venous System from the Comparative Anatomy in Vertebrates
Authors: Aurboonyawat T. , Pereira V. , Krings T. , Toulgoat F. , Chiewvit P. , Lasjaunias P. 
Published: January 2017

Ontogenetically, the ventricular venous system may develop in order to drain the gray matter (cells of the mantle layer of the neural tube) which migrates dorsally. On primitive brain vesicles of submammals especially fish, amphibian and reptile, the ventricular venous system is the major venous collector located on the mid-dorsal surface, in between the meningeal layers comparable to the subarachnoid space in mammals. The ventricular venous system functions as a major drainage system for the brain vesicles in these submammals but its role decreases when the other two venous systems develop. Concerning the route of venous exit from the brain vesicles, we found that it resembles the spinal cord but could not be found all the way along the brain vesicles.
Carotid Stenting without Angioplasty and without Protection
Authors: Leonardi M. , Dall'Olio M. , Raffi L. , Cenni P. , Simonetti L. , Marasco R. , Giagnorio F. 
Published: January 2017

Endovascular stenting is a consolidated alternative to thrombendarterectomy in the treatment of extracranial carotid artery atheromasic stenosis. The most common complication of stenting is a distal embolism causing clinically silent or symptomatic cerebral ischaemia. To prevent this complication distal embolism protection devices are often used but their effectiveness remains unsettled. In addition, there is some evidence that distal embolism may actually be triggered by the protection systems due to clot formation at their distal surface or in the intimal lesions these systems cause. Another rarer complication is hyperperfusion syndrome arising during both stenting and thrombendarterectomy but more common in endovascular procedures. To avoid these complications the Neuroradiology Service at Bellaria Hospital (Bologna Local Health Trust) has devised a mini-invasive carotid stenting technique that does not require either distal embolism protection or angioplasty. The technique uses only the radial force exerted by the self-expanding stent to widen the atherosclerotic stenosis slowly and gradually. The goal of treatment has also changed from a prompt restoration of the atheromasic vessel's original calibre to slow transformation of the hemodynamic significance of the stenosis. The technique's success lies mainly in selecting the stenosis to treat using CT angiography to analyse plaque morphology and structure. We used the technique to treat 83 stenotic lesions in 75 patients. The study aims to describe and discuss our experience.
Direct Ascending Pharyngeal Artery to Jugular Vein Arteriovenous Fistula
Authors: Tomsick S.D. , Tomsick T.A. 
Published: January 2017

A 32-year-old female developed a bruit, determined to arise from a rare direct arteriovenous (AV) fistula from the ascending pharyngeal artery to the internal jugular vein. The fistula was treated by transarterial silicone balloon occlusion, with occlusion of fistulous flow, ablation of symptoms, and excellent long-term result.
The Prevention of Hemorrhagic Stroke
Authors: Raymond J. , Mohr JP ,   The Team-Aruba Collaborative Groups
Published: January 2017

There is currently no evidence that preventive treatment of unruptured aneurysms or AVMs is beneficial and randomized trials have been proposed to address this clinical uncertainty. Participation in a trial may necessitate a shift of point of view compared to a certain habitual clinical mentality. A review of the ethical and rational principles governing the design and realization of a trial may help integrate clinical research into expert clinical practices. The treatment of unruptured aneurysms and AVMs remains controversial, and data from observational studies cannot provide a normative basis for clinical decisions. Prevention targets healthy individuals and hence has an obligation of results. There is no opposition between the search for objective facts using scientific methods and the ethics of medical practice since a good practice cannot forbid physicians the means to define what could be beneficial to patients. Perhaps the most difficult task is to recognize the uncertainty that is crucial to allow resorting to trial methodology. The reasoning that is used in research and analysis differs from the casuistic methods typical of clinical work, but clinical judgement remains the dominant factor that decides both who enters the trial and to whom the results of the trial will apply. Randomization is still perceived as a difficult and strange method to integrate into normal practice, but in the face of uncertainty it assures the best chances for the best outcome to each participant. Some tension exists between scientific methods and normal practice, but they need to coexist if we are to progress at the same time we care for patients.
The Hydrodynamic Effect of Bare Platinum Coils versus Hydrogel-Coated Platinum Coils
Authors: Sorteberg A. , Bakke S.J. 
Published: January 2017

HydroCoils (HES) were designed to obtain a better initial aneurysm occlusion and increased durability of endovascular treatment. We compared the immediate hydrodynamic effects of HES versus bare platinum coils (Guglielmi detachable coils, GDC). Intra-aneurysmal pressure and flow were measured with a 0.014 inch guide-wire mounted transducer in silicone aneurysms mounted onto a pulsatile flow phantom before and after consecutively coiling with GDC and HES. We evaluated flow using the thermodilution technique along with changes in steady pressure and sudden increases in pressure. We also considered the effect of the coils on the transmission of pressure from the parent artery to the dome of the aneurysm. Intra-aneurysmal pressure remained unchanged after maximal packing with either GDC or HES. Sudden increases in pressure were less attenuated within the aneurysm after coiling with HES. In spite of HES obtaining a much higher percentage filling volume in the aneurysms, GDC equivalently virtually abolished intra-aneurysmal flow apart from in one instance where there was significant persistent flow after coiling with GDC. The effects of HES in terms of pressure and flow attenuation within the aneurysm could hence not be proven superior to GDC.
Intracranial Pseudoaneurysms, Fusiform Aneurysms and Carotid-Cavernous Fistulas
Authors: Lv Xianli , Jiang Chuhan , Li Youxiang , Lv Ming , Zhang Jingbo , Wu Zhongxue 
Published: January 2017

The study assessed the effectiveness and safety of endovascular covered stents in the management of intracranial pseudoaneurysms, fusiform aneurysms and direct carotid-cavernous fistulas. Fourteen endovascular covered stents were used to repair three pseudoaneurysms, six fusiform aneurysms and six direct carotid-cavernous fistulas. Aneurysms were in the carotid artery in seven cases, in the vertebral artery two cases. It was not possible to treat two additional cases transcutaneously for technical reasons 2/15. Percutaneous closure of the lesions with an endovascular covered stent was successful in 13 of 15 cases. Initial follow-up showed good stent patency. No complications were observed after stent implantation. During follow-up, stent thromboses were detected in two of nine patients with follow-up digital subtracted angiography. One carotid-cavernous fistula of Barrow Type A transformed into Barrow Type D at nine month follow-up study was cured with a procudure of Onyx-18 injection. Endovascular covered stents may be an option for percutaneous closure of intracranial pseudoaneurysms, fusiform aneurysms and direct carotid-cavernous fistulas. Endoluminal vascular repair with covered stents offers an alternative therapeutic approach to conventional modalities.