bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endovascular Covered Stent Reconstruction Improved the Outcomes of Acute Carotid Blowout Syndrome
Authors: Chen Yao-Liang , Wong Ho-Fai , Ku Yi-Kang , Wong Alex Mun-Ching , Wai Yau-Yau , Ng Shu-Hang 
Published: January 2017

Carotid blowout is a devastating complication in patients with head and neck cancer, commonly encountered as a delayed complication of radiation therapy. The clinical outcomes in patients with carotid blowout are discouraging; even transarterial embolization has been performed to control the acute massive bleeding. In recent years, covered stents have been reported as an alternative treatment producing favorable results. In this study, 13 consecutive patients with acute carotid blowout syndrome were treated at our institute by covered-stent reconstruction between December 2005 and December 2007. The median posthemorrhagic survival period after reconstruction (187 days) was more than that reported in patients treated only with transarterial embolization (26 days). Though the estimated mortality was about 54%, those who survived showed favorable outcomes, and only one transit complication of acute in-stent thrombosis occurred. Thus, endovascular covered-stent reconstruction is a safe and effective approach to manage acute carotid blowout syndrome.
Deliberate Parent Artery Occlusion for Non-Saccular Posterior Cerebral Artery Aneurysms
Authors: Liu L. , He H. , Jiang C. , Lv X. , Li Y. , Wu Zhongxue 
Published: January 2017

Posterior cerebral aneurysms are rare vascular lesions and usually present as non-saccular or dissecting in nature. We present a retrospective review of our experience in the deliberate parent artery occlusion of posterior cerebral artery (PCA) aneurysms. From June 2006 to June 2010, 12 patients (seven men, five women) with posterior cerebral artery non-saccular aneurysms presented to our department and were treated by parent artery occlusion. There were eight (66.7%) aneurysms located at the P2 segment, two (16.7%) at the P2–3 junction, one (8.3%) at the P1–2 junction and one (8.3%) at the P3 segment. Ten of the 12 patients were treated by aneurysm together with parent artery occlusion and two were treated by proximal occlusion. The procedure was technically successful in all cases. Angiography was performed immediately after the procedure in all patients and showed occlusion of the parent vessel with no filling of the aneurysm. Only one patient (8.3%) developed procedure-related transient hemianopsia and recovered within one month. The other 11 patients showed no additional neurological symptoms after procedure. Deliberate parent artery occlusion by detachable coils appears to be well tolerated for P2 or distal segment of PCA in our limited case series. We propose that this technique could be a good treatment option in treating non-saccular aneurysms in this location.
Outcomes after Endovascular Treatment of Symptomatic Patients with Takayasu's Arteritis
Authors: Kim H.J. , Lee C-S. , Kim J.S. , Kwon S.U. , Kim J.L. , Park J.W. , Hyun D.H. , Suh D.C. 
Published: January 2017

We report our experience with endovascular treatment of supra-aortic arteries and follow-up results in patients with Takayasu's arteritis (TA) presenting with neurological symptoms. Of the 20 patients with TA who underwent cerebral angiography for neurological manifestations between May 2002 and May 2009, 12 (11 females, one male; mean age, 39 years; range 31–56 years) underwent endovascular treatment and evaluated outcome for 21 lesions, including nine common carotid arteries, four vertebral arteries, four subclavian arteries, two internal carotid arteries, and one brachiocephalic artery. Eight patients underwent multiple endovascular procedures for different lesions in single or multiple stages. Mean angiographic and clinical follow-up durations were 34 months (range, 11–79 months) and 39 months (range 11–91 months), respectively. Technical success was achieved for 20 procedures in 11 patients. One procedure failed, with 50% residual stenosis after stenting due to dense calcification of vessel walls. There were no procedure-related complications. Restenosis occurred at two lesions in two patients were treated by re-stenting. Asymptomatic occlusion occurred at two lesions in one patient. Ten patients remained in 0–1 on the modified Rankin scale (mRs) during mean 39 months. One patient, however, had a score of 3 on mRs due to a traumatic contusion during follow-up. One patient died from cardiac failure 36 months after successful angioplasty. Our data suggest that endovascular treatment of symptomatic supra-aortic lesions of TA is effective and durable in selected patients with neurologic symptoms.
Endovascular Mechanical Thrombectomy for the Treatment of Acute Ischemic Stroke Due to Arterial Dissection
Authors: Fields J.D. , Lutsep H.L. , Rymer M.R. , Budzik R.F. , Devlin T.G. , Baxter B.W. , Malek R. , Padidar A.M. , Barnwell S.L. , Smith W.S. 
Published: January 2017

Arterial dissections account for 2% of strokes in all age groups, and up to 25% in patients aged 45 years or younger. The safety of endovascular intervention in this patient population is not well characterized. We identified all patients in the Merci registry — a prospective, multi-center post-market database enrolling patients treated with the Merci Retriever thrombectomy device — with arterial dissection as the most likely stroke etiology. Stroke presentation and procedural details were obtained prospectively; data regarding procedural complications, intracerebral hemorrhage (ICH), and the use of stenting of the dissected artery were obtained retrospectively. Of 980 patients in the registry, ten were identified with arterial dissection (8/10 ICA; 2/10 vertebrobasilar). The median age was 48 years with a baseline NIH stroke scale score of 16 and median time to treatment of 4.9 h. The procedure resulted in thrombolysis in cerebral ischemia (TICI) scores of 2a or better in eight out of ten and TICI 2b or better in six out of ten patients. Stenting of the dissection was performed in four of nine (44%). The single complication (1/9; 11%) — extension of a dissected carotid artery — was treated effectively with stenting. No symptomatic ICH or stroke in a previously unaffected territory occurred. A favorable functional outcome was observed in eight out of ten patients. Despite severe strokes on presentation, high rates of recanalization (8/10) and favorable functional outcomes (8/10) were observed. These results suggest that mechanical thrombectomy in patients with acute stroke resulting from arterial dissection is feasible, safe, and may be associated with favorable functional outcomes.
A Minimally Invasive Treatment for Lumbar Disc Herniation: DiscoGel® Chemonucleolysis in Patients Unresponsive to Chemonucleolysis with Oxygen-Ozone
Authors: Stagni S. , De Santis F. , Cirillo L. , Dall'Olio M. , Princiotta C. , Simonetti L. , Stafa A. , Leonardi M. 
Published: January 2017

A multitude of therapies is available to treat disc herniation, ranging from conservative methods (medication and physical therapy) to minimally invasive (percutaneous) treatments and surgery. O2-O3 chemonucleolysis (O2-O3 therapy) is one of the minimally invasive treatments with the best cost/benefit ratio and lowest complication rate. Another substance recently made available exploiting the chemical properties of pure ethanol is DiscoGel®, a radiopaque gelified ethanol more viscous than absolute alcohol 8,9. The present study aimed to assess the therapeutic outcome of DiscoGel® chemonucleolysis in patients with lumbar disc herniation unresponsive to O2-O3 therapy. Thirty-two patients aged between 20 and 79 years were treated by DiscoGel® chemonucleolysis between December 2008 and January 2010. The treatment was successful (improvement in pain) in 24 out of 32 patients. DiscoGel® is safe and easy to handle and there were no complications related to product diffusivity outside the treatment site. The therapeutic success rate of DiscoGel® chemonucleolysis in patients unresponsive to O2-O3 therapy was satisfactory. Among other methods used to treat lumbar disc herniation, DiscoGel® chemonucleolysis can be deemed an intermediate procedure bridging conservative medical treatments and surgery.
The Cost of Materials for Intra-Arterial Thrombectomy
Authors: Bing F. , Jacquin G. , Poppe A. , Roy D. , Raymond J. , Weill A. 
Published: January 2017

This paper reports the cost of endovascular materials used for the treatment of large-vessel ischemic stroke in the anterior circulation according to the angiographic score and clinical results at three months. From November 2009 to July 2011, 57 ischemic patients (mean age, 64.6 ±13.8 years) with anterior large vessel occlusion were included. Mean National Institutes of Health Stroke Scale (NIHSS) on admission was 18.4 ± 4.9. Mean duration of symptoms until the arterial puncture was 207±67 minutes. Recanalization was assessed using the Thrombolysis In Myocardial Infarction (TIMI) score. Patient selection was performed on a non-enhanced CT scanner. According to the TIMI final angiographic score and the modified Rankin score (mRS) at three months, we determined the cost of the material used. Complete (n=12, TIMI grade 3) or partial perfusion (n=35, TIMI grade 2) was achieved in 47 (82.5%) lesions. At three months, 33.3% (n=19) had a mRS score ≤ 2. The mean cost of the material used in the operative room was 5018±2402 euro. Intra-arterial thrombolysis presents a substantial initial cost and the long-term economic impact has to be evaluated. Our health system has to take the price of these new technologies into account for future medical choices and urgently evaluate them in randomized controlled trials.
‘Progressive-Onset’ versus Injury-Associated Discogenic Low Back Pain: Features of Disc Internal Derangement in Patients Studied with Provocation Lumbar Discography
Authors: Bartynski W.S. , Dejohn L.M. , Rothfus W.E. , Gerszten P.C. 
Published: January 2017

Chronic low back pain (LBP) can be ‘progressive onset’ or injury-related. This study compares the patient-reported cause of chronic LBP to features of disc internal derangement at painful concordant discs evaluated by provocation lumbar discography. Concordant LBP was identified in 114 patients with chronic LBP studied by provocation discography. LBP cause, discogram pain response and discogram/post-discogram CT features of internal derangement were retrospectively reviewed. ‘Progressive-onset’ LBP was reported in 32 (28%) patients, injury-related LBP in 75 (66%) with LBP equated to non-specific causes in seven. Injury-related LBP was more commonly identified in men (52 of 63 [83%]) with women reporting near-equal frequency of ‘progressive-onset’ (23 of 44 [52%]) and injury-related (21 of 44 [48%]) LBP (p=0.002). In 172 concordant painful discs, near-equal frequency of severely degenerative (Dallas grade-3: 82 of 172 [47.3%]) and full-thickness radial fissure discs (Dallas grade-3: 90 of 172 [52.7%]) were identified. Women with ‘progressive-onset’ LBP demonstrated more frequent severely degenerative discs (24 of 37 [65%]); women with injury-related LBP demonstrated more frequent radial-defect discs (21 of 31 [68%]; p=0.01). In men with injury-related LBP, severe degeneration-only (44 of 89 [49%]) and radial defect discs (45 of 89 [51%] were seen with equal frequency. In men with ‘progressive-onset’ LBP, radial defects are more common (11 of 15 [73%]). ‘Progressive-onset’ and injury-related chronic LBP subgroups are definable. Gender-related differences in incidence and internal derangement features at concordant discs are identified at discogram/post-discogram CT. These differences may have implications related to LBP origin/treatment-response.
Quantified Partial Embolisation in a Vein of Galen Malformation with Congestive Cardiac Failure
Authors: Moersdorf M. , Lasjaunias P. 
Published: January 2017

The aim of the study was to quantify embolisation in a vein of Galen malformation by intraluminal measurements of flow velocities in the feeding vessels and to test a new 0.014-inch Doppler guide wire in the paediatric population. The examination was performed in a seven month old boy who presented with a vein of Galen malformation combined with congestive cardiac failure from birth. The measurements showed a decrease of the systolic and diastolic velocities and an increase in the effective downstream vascular resistance after closure of the high flow fistula. The decrease of the diastolic velocities after embolisation was more prominent because of the reduction of the sump effect responsible for the high diastolic velocity before embolisation. The reduction of about 40% of the vein of Galen malformation estimated with morphological criteria was associated with a decrease of the diastolic velocity in the basilar artery of about 50%. The clinical improvement led to the discontinuance of most of the cardiac treatment over a few days. These measurements seem to offer the possibility to assess the necessary reduction of the shunt to relieve CCF in a vein of Galen malformation.
Transarterial Embolisation of Cerebral Arteriovenous Malformations
Authors: Wikholm G. , Lundqvist C. , Svendsen P. 
Published: January 2017

Arteriovenous malformations of the brain are rare disorders. Embolisation has emerged as an effective treatment with an acceptable, low complication rate. Previously presented results are completed with results from 1994 to 1996. Ninety-six percent of the patients were treated with no or very minor sequelae resulting in total obliteration in 32% and supplementary stereotactic radiation in 49%. Ninety percent of all patients are in excellent or good health at follow up. These results may be jeopardised by the ongoing proliferation of endovascular treatment for AVMs.
Interventional Neuroradiology in Hemifacial Spasm
Authors: Yamashita K. , Okamoto S. , Hosotani K. , Nakatsu S. , Hojo M. , Miyamoto K. , Matsumoto R. 
Published: January 2017

There have never been functional studies in the diagnosis of hemifacial spasm caused by neurovascular compression. We used neurointerventional techniques to conduct a functional investigation of the artery responsible for hemifacial spasm in seven patients. A microcatheter was inserted into the various arteries of the posterior circulation under systemic heparinization, and its effect on the spasm was evaluated clinically and electromyographically. In six patients who underwent microvascular decompression surgery, the vessels compressing the root exit zone of the facial nerve were surgically determined, and compared with the result of the procedure. The catheter was inserted into twelve arteries. The spasms were stopped immediately and completely by the insertion of the catheter into seven arteries. Six of them were surgically proven to compress the root exit zone of the facial nerve. The spasm was changed in frequency or in type by the insertion into two arteries. These arteries were also compressing the root exit zone. One artery was located at a more peripheral part of it and the other was running over another artery compressing the root exit zone. The spasms were not affected at all by the insertion into three arteries. These arteries were not observed in the operative field and had no contact with the nerve. Superselective ‘angiograms showedpositional qnd configurational changes of the arteries. There was no arterial spasm and tight catheterization leading to stasis of contrast material within the arteries. There were no complications related to the procedures. Functional relationship between the artery and the spasms was established in all the patients, and one patient refused surgery because the frequency of the spasm was reduced by the procedure. The result of this study may suggest that a functional investigation of hemifacial spasm is feasible and seems useful for selecting good candidates for microvascular decompression surgery.
Stenting for Extracranial Stenotic Lesions of Carotid and Vertebral Arteries
Authors: Matsushita K. , Akai F. , Taneda M. , Yokoi Y. 
Published: January 2017

We evaluated the feasibility of stenting in four patients. Two cases were vertebral osteal stenosis and the others were carotid stenosis at high position with ulcers. We placed balloon expandable coronary stents by a bared stent technique. The mean preprocedural stenosis (86.58%) was reduced to 13.05%. Patients were examined clinically and angiographically at 1, 3 and 6 months after stenting. There was no minor nor major stroke during and after the procedures. Asymptomatic restenosis occurred in the cases of proximal vertebral arteries. One of these patients needed to repeat balloon dilatation. There were no angiographic restenoses in the location of stenting in the carotid artery. In the treatment for atherosclerotic stenoses, stent placement is a feasible and safe method. However restenosis in a vertebral osteal lesion should be carefully followed after stent placement.
Carotid and Vertebral Stenting: Preliminary Report
Authors: Mori T. , Kazita K. , Fukuoka M. , Mori K. 
Published: January 2017

We report our initial experience of carotid and vertebral stenting. Three haemodynamically significant extra-cranial lesions (% diameter stenosis >70) in 3 clinically symptomatic patients were treated by stenting between March 1996 and September 1996. Two lesions of the internal carotid arteries were ostial and in one case a subtotal stenosis and ostial lesion of the vertebral artery were observed. All lesions looked more widely and smoothly dilated by stenting than by ordinary standard balloon angioplasty.
The Evaluation of Preoperative Embolization of Meningioma
Authors: Sato H. , Hyodo A. , Matsumaru Y. , Anno I. , Kato T. , Nose T. , Kamezaki T. , Kobayashi E. , Tsukada A. 
Published: January 2017

To evaluate the efficacy of preoperative embolization of meningioma, we examined the correlation between the angiographic disappearance of the tumor blush after the embolization and the volume of blood loss and transfusion intraoperatively. Preoperative embolization of meningioma with intravascular neurosurgery was attempted for 42 trials, 41 cases from July 1989 to December 1995. There were no major complications attributed to the embolization procedure. As a subjective assessment in 23 cases the information from the surgeon following the operation was obtained. The angiographic disappearance of the tumor blush and reducing of the bleeding from tumor could be considered to be statiscally significant (p<0.05). As an objective assessment in 37 cases following operation, the volume of both intraoperative blood loss and blood transfusion was examined. The angiographic disappearance of the tumor blush and reduced intraoperative blood transfusion could be also considered to be statiscally significant (p<0.05), otherwise reduced intraoperative blood loss failed to reach the significance level. In this study the efficacy of preoperative embolization of meningioma has been especially shown to reduce intraoperative blood transfusion significantly, therefore it is very useful to increase the chance of complete tumor removal with more safely and less invasively.
IDC Embolization of Aneurysms
Authors: Kanaoka N. , Akashi K. , Kato Y. , Sano H. , Kanno T. , Ogura Y. , Takeshita G. , Katada K. 
Published: January 2017

Embolization using IDC was carried out for 33 aneurysm cases in the last 3 years. The indication for the embolization was that the direct surgery was considered to be difficult, because of 1) technically impossible to do clipping, 2) aneurysm of the posterior fossa, 3) reject of patients. Regarding the location of aneurysm, 27 cases were seen in the anterior circulation, and 6 cases in the posterior circulation. Count of 33 cases, 11 cases were ruptured and 22 cases were non-ruptured. The procedure of embolization of aneurysms are generalized as compared to direct surgery, but there remain some technical problems. 33 cases in our series had no significant complication, except for one which had ruptured again. We emphasize that the weak point of IDC which was so hard, had no variations, especially if it happens to migrate during locking procedure. These complications can be prevented, if we use GDC5,6,7 instead of IDC.
Results and Problems on Direct Embolization of Cerebral Aneurysms Using Interlocking Detachable Coils
Authors: Yoshimura S. , Ueda T. , Kaku Y. , Nishimura Y. , Andoh T. , Sakai N. 
Published: January 2017

The clinical results of direct embolization of cerebral aneurysms using interlocking detachable coils (IDCs) were analysed. In 27 patients who underwent direct embolization of the aneurysm, 19 patients (70%) were treated uneventfully. In the other 8 patients, symptomatic or asymptomatic complications occurred; parent artery occlusion in 3 patients, rupture of the aneurysm in 2 patients, distal embolism in 2 patients, and neurological deterioration due to enlargement of the aneurysm after embolization in 1 patient. In 5 of 8 patients in whom complications occurred, neurological deficits disappeared after additional embolizations or thrombolysis therapies. Permanent deficits were observed in 3 of all patients (11%). These deficits were caused by the parent artery occlusion due to protrusion of the detached coil in wide neck aneurysms. These results suggest that indication of direct embolization of the cerebral aneurysm should be decided according to neck size. Balloon-assisted coil placement in wide-necked aneurysms was useful but unable to prevent protrusion or migration of the coils after balloon withdrawal. Development of a new device, such as a stent for intracranial use, may make it possible.
Clinical Results and Complications of Endovascular Treatment for Intracranial Aneurysms
Authors: Tsuura M. , Terada T. , Nakamura Y. , Kinoshita Y. , Yokote H. , Nishiguchi T. , Nakai K. , Itakura T. 
Published: January 2017

Thirty-two patients with intracranial aneurysm were treated via the endovascular approach and clinical results and complications were accessed. The aneurysms were on the anterior circulation, posterior circulation and feeding artery of AVM in 17, 12 and three patients respectively. In 17 (anterior circulation aneurysm), 12 patients underwent parent artery occlusion. There were two complications: cerebral embolism due to premature detachment of balloons and cerebral infarct due to parent artery occlusion. In 12 (posterior circuration aneurysm), four patients had complications: three infarcts due to parent artery occlusion and one aneurysmal bleeding at the interventional procedure. Coil compactions occurred in four cases. There were no complications in cases associated with AVM. Use of detachable balloons for intra-aneurysmal occlusion and intra-aneurysmal embolisation for partially thrombosed giant aneurysm tends to result in ischemic lesions where patient outcome is poor. We must pay attention to avoid these complications even though intra-aneurysmal embolisation using microcoils is currently performed safely.