bluuebunny/crossref_metadata_2025_split huggingface dataset:
Problems in Endovascular Procedures in Acute Ruptured Intracranial Aneurysms
Authors: Shibuya T. , Kushi H. , Kinoshita K. , Saito T. , Hayashi N. 
Published: January 2017

Fifteen patients with acute ruptured intracranial aneurysms were treated with interlocking detachable coil (IDC) embolization. All graded poorly, i.e., Hunt & Kosnik grades IV and V. Aneurysm occurred in the anterior circulation in 14 patients and at the basilar tip in one, of these, 13 were small and 2 large. The endovascular procedure was conducted in a transfemoral approach under local anesthesia. Aneurysmal obliteration was examined transitionally after embolization. Final outcome was evaluated using the Glasgow outcome scale (GOS). Total aneurysmal occlusion was observed immediately after IDC embolization in 11 patients. Two cases of coil migration to the parent artery occurred during endovascular procedure in patients with severe atherosclerosis. Aneurysmal rupture occurred during the endovascular procedure in a small internal carotid artery aneurysm when coil detachment failed. Follow-up angiography showed coil compaction in 2 patients, one patient experienced deterioration when the aneurysm ruptured. Eleven patients (73.3%) retained total aneurysmal occlusion and had no rebleeding. The overall GOS indicated good recovery in 5 patients, severe disability in 2, persistent vegetative state in 2, and death in 6. IDC embolization in severe acute ruptured intracranial aneurysm successfully prevented rebleeding, but our series was limited by the very small aneurysm size and the presence of severe atherosclerosis.
3D CT Angiography as a Pre-Embolization Study for Embolization of Cerebral Aneurysms
Authors: Fukasaku K. , Negoro M. , Bundo M. , Kourogi N. , Yamano K. , Sone S. 
Published: January 2017

An image guide for aneurysm embolization based on three dimensional CT angiography is reported. Multiplanner reformation (MPR) can measure the neck and dome of the aneurysm accurately enough to select the first coils for aneurysms. For neck evaluation, cut model and virtual endoscope are helpful because we can observe the neck from inside of dome or parent artery. Proximal arteries are visualized by 3D images and MPR if needed. Using laser lithography, we can get a real model of aneurysm and parent artery through which we can insert microcatheters and coils. 3D CTA is a dependable modality for embolization of cerebral aneurysms.
Intravascular Neurosurgery for Cerebral Aneurysm Using Interlocking Detachable Coils
Authors: Hyodo A. , Matsumaru Y. , Anno I. , Sato H. , Kato N. , Hashimoto T. , Yoshii Y. , Nose T. , Kamezaki T. , Okazaki M. 
Published: January 2017

Instead of the Guglielmi detachable coil (GDC; Target Therapeutics, Fremont, California), the interlocking detachable coil (IDC; Target Therapeutics, Fremont, California) was the only available detachable and retractable coil in Japan until February 1997. From October 1993 to February 1997, endovascular treatment with IDCs were attempted for 25 cases of cerebral aneurysm. Within 25 trials, 15 cases were treated by intra-aneurysmal coil embolization, 9 cases by parent artery or proximal occlusion using IDCs and one case could not be treated due to anatomical problems of the aneurysm. As for 15 cases of intra-aneurysmal coil packing, 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. Intraoperative bleeding occurred in one case, but no obvious hemorrhage after coil embolization in any case. From our experiences, treatment for poor-grade ruptured aneurysm is still difficult, but intravascular surgery for cerebral aneurysms using IDC is possible and a useful alternative, especially for surgically difficult aneurysm.
Ion Implantation Modifies the Surface of GDCs: An Experimental Study in Swine Aneurysms
Authors: Murayama Y. , Viñuela F. , Suzuki Y. , Massoud T.F. , Guglielmi G. , Iwaki M. , Kamio M. , Abe T. 
Published: January 2017

Ion implantation and protein-coatings were utilized to alter the surface properties (endothelial cellular adhesion) and enhance the thrombogenicity of Guglielmi detachable coils (GDCs) for endovascular treatment of cerebral aneurysms. These modified GDCs were compared with standard GDCs in the treatment of experimental swine aneurysms. Standard GDCs and ion-implanted protein coated GDCs were used to treat 32 aneurysms in 16 swine. GDCs were coated with either proteins, collagen (n = 5), vitronectin (n = 4), fibrinogen (Fn = 3), laminin (n = 2), or fibronectin (n = 2) and underwent Ne+ or He+ implantation with a fluence of 1 × 1014– 1015 ions/cm2 at an energy of 150 keV. Bilateral experimental swine aneurysms were embolized with standard GDCs (n = 16) on one side and with ion-implanted protein-coated GDCs (n = 16; total) on the other side. The necks of aneurysms were evaluated macroscopically and histopathologically at autopsy using day 14 post-treatment specimens. Greater fibrous coverage of the necks of aneurysms were observed in the ion-implanted coil group. The results of this experimental study indicate that Ion implantation combined with protein coating of GDCs improved cellular adhesion and proliferation. Future application of this technology may provide early wound healing at the necks of embolized wide-necked cerebral aneurysms.
Endovascular Approach vs Microsurgical Approach for Posterior Circulation Aneurysms
Authors: Nakabayashi K. , Negoro M. , Itou Y. , Ichihara K. 
Published: January 2017

We compare the results of detachable coil embolization with those of surgical clipping in patients with posterior circulation aneurysms. Surgical procedure was performed in 31 patients (basilar tip: 13 cases, SCA: 8 cases, basilar trunk: 1 case, VA: 9 cases). Thirty one aneurysms were treated by embolization with Guglielmi detachable coil (GDC) and interlocking detachable coil (IDC) (basilar tip: 14 cases, SCA: 1 case, basilar trunk: 6 cases, VA: 10 cases). In surgical cases, clinical outcome at discharge showed good recovery (GR) in 14 cases, moderate deficits (MD) in 11 cases, severe deficits (SD) in 2 cases, and dead (D) in 4 cases. In embolization cases, clinical outcome at discharge showed GR in 19 cases, MD in 4 cases, SD in 1 case, and D in 1 case. Embolization with detachable coils is less invasive than surgical clipping in the management of patients with posterior circulation aneurysms. Embolization with detachable coils in ruptured posterior circulation aneurysm cases at an early stage of SAH may improve clinical outcome.
2D-TOF MRA Follow-up Study of Percutaneous Transluminal Angioplasty for Severely Stenotic Cervical Internal Carotid Artery
Authors: Ueda T. , Yoshimura S. , Kaku Y. , Shirakami S. , Andoh T. , Sakai N. 
Published: January 2017

Percutaneous transluminal angioplasty (PTA) for severe arteriosclerotic stenosis in the cervical internal carotid artery (ICA) was successfully carried out in 23 cases between December 1994 and August 1996. In order to analyze the condition of the cervical ICA in the early stage after PTA, 12 stenotic lesions of 11 cases were exposed to follow-up study of stenotic cervical ICA after PTA with magnetic resonance angiography (MRA) 1 to 150 days postoperatively. In six lesions, the diameter of the cervical ICA was dilated sequentially. In another four lesions, the diameter of the cervical ICA was decreased in the first three weeks and dilated over the next three weeks. Angiographically, these lesions had a small intimal flap at the balloon dilated portion, which was speculated to cause the turbulent flow in the first stage. In the remaining 2 lesions, restenotic changes in cervical ICAs were observed within three weeks after PTA. Follow-up angiography was performed over three months after PTA in five cases of this series and compared with MRA. Consequently, the diameters of the cervical ICA between angiography and MRA were closely correlated. The evaluation of the lesion after PTA of the cervical ICA demonstrated that MRA is beneficial, but within three weeks after PTA, caution should be paid for underestimation of the small intimal flap on MRA.
Correlation of Continuous EEG Monitoring with [O-15]H2O Positron Emission Tomography Determination of Cerebral Blood Flow during Balloon Test Occlusion of the Internal Carotid Artery
Authors: Murphy K.J. , Payne T. , Jamadar D.A. , Beydoun A. , Frey K.A. , Brunberg J.A. 
Published: January 2017

The purpose of this paper was to evaluate the utility of continuous electroencephalography (EEG) during balloon test occlusion (BTO) of the internal carotid artery (ICA). Continuous EEG monitoring and [O-15] H2O PET cerebral blood flow (CBF) studies were completed in 34 patients undergoing BTO of the ICA. CBF determinations were obtained as a baseline without carotid occlusion, and following balloon occlusion, with continuous EEG monitoring. Patients were divided into three groups based on clinical and CBF response to BTO. Group I had no clinical signs or symptoms and had a CBF decrease less than 10 ml/100 g/min ipsilateral to the occlusion. Group II had no symptoms but CBF fell to 35 to 25 ml/100 g/min on the occluded side. Group III were clinically unable to tolerate occlusion or CBF fell to less than 25 ml/100 g/min on the occluded side. The results of continuous 21 channel EEG monitoring were assessed at the time of the examination and retrospectively reviewed for changes in the EEG pattern indicative of ischaemia. On the basis of PET CBF, eighteen patients were classified as Group I, four as Group II, and twelve as Group III. EEG evidence of ischaemia was seen in three patients, all members of Group III. Of the three patients, only one patient had clinical signs or symptoms of ischaemia. All four patients in Group II had PET quantitated CBF levels indicating carotid sacrifice should be done with caution or following a presacrifice by-pass procedure, and nine patients in Group III with PET quantitated CBFs below eligibility for carotid sacrifice, were not identified by EEG monitoring. Even when CBF falls below 25 ml/100 g/minute continuous EEG monitoring is insensitive to reduction in perfusion. Reliance upon EEG for detection of cerebral hypoperfusion in interventionl neuroradiological procedures will significantly underestimate ischaemic risk.
Penetration Difference of n-Butyl 2-Cyanoacrylate into the Nidus in the Embolisation of Brain Arteriovenous Malformation
Authors: Suh Dae Chul , Kim Jun-Hyoung , Lee Moo Song , Park Sangsoo , Kim Sung Tae , Choi Choong Gon , Lee Ho Kyu , Kim Chang Jin , Song Ho-Young 
Published: January 2017

Prediction of nidal penetration of the glue is difficult in the embolisation of brain arteriovenous malformations (AVM). We evaluated penetration differences of glue-lipiodol mixtures with and without tungsten powder for embolisation of brain AVM. Fifty eight injections during embolisation of brain AVM in 15 patients were evaluated. Glue contained lipiodol only (N=25), or lipiodol and tungsten powder (N=33). Glue concentration ranged from 20 to 80%. Injection was done at the pedicle (N=41) or nidus (N=17). Degree of penetration was rated as good, fair, or poor according to penetrated glue amount in the nidus. Penetration difference was compared in each injection at the pedicle or nidus. When the glue mixtures were injected at the pedicle, the glue-lipiodol mixture (GLM) penetrated into the nidus in eight of 16 injections (50%) and the glue-lipiodol-tungsten mixtures (GLTM) in 23 of 25 (92%). When glue was injected at the nidus, GLM was confined to the nidus in nine of nine injections (100%) and GLTM in seven of eight (88%). Penetration into the vein was noted in two of 25 injections (8%) in GLM and six of 33 (18%) in GLTM. Penetration difference into the nidus between GLM and GLTM was statistically significant (p < 0.05) when the glue mixtures were injected at the pedicle. GLM and GLTM can be used effectively at the nidus. In contrast to GLM, GLTM can be used effectively at the pedicle. However, the risk of venous penetration seemed to be higher with GLTM than in GLM.
Motor Evoked Potentials Predicting Early Recovery from Paraparesis after Embolisation of a Spinal Dural Arteriovenous Fistula
Authors: Kothbauer K. , Pryor J.C. , Berenstein A. , Setton A. , Deletis V. 
Published: January 2017

Spinal dural arteriovenous malformation is an increasingly diagnosed cause of ischaemic myelopathy. Though routine intraoperative monitoring has been demonstrated to be of benefit in the endovascular treatment of these lesions, its predictive value has not been well documented. We present the case of an elderly woman with progressive spastic paraparesis who demonstrated marked improvement in limb muscle motor evoked potentials of the lower extremities immediately following endovascular occlusion of the lesion. The patient subsequently showed improvement in strength, sensation and sphincter control.
Basilar Tip Aneurysms and Basilar Tip Anatomy
Authors: Campos C. , Churojana A. , Rodesch G. , Alvarez H. , Lasjaunias P. 
Published: January 2017

Five hundred and eighty one cerebral aneurysms seen from 1986–1997 were reviewed. Fifty five basilar tip aneurysms were demonstrated. The analysis of the anatomic disposition of the distal basilar artery in 47 of them showed the prevalence of caudal fusion in 91% of cases. The fusion is either symmetrical or asymmetrical. The neck of the aneurysm is preferentially implanted on the caudal part of the fusion. Recognition of the distal basilar artery anatomy allows the origin and extent of the perforating branches territory arising from the P1 segment to be predicted in each type of basilar tip disposition. The caudal variant supplies a small ipsilateral territory, whereas the cranial one often provides a bilateral supply. In the cranial arrangement one can observe interpeduncular anastomoses between the perforators across the midline prior to penetrating the mesencephalo-diencephalic structures. The risks involved in the sacrifice of the P1 segment can then be anticipated.
Spontaneous Resolution of a Ruptured Dissecting PICA Aneurysm
Authors: Piske R.L. , Darwich R. , Campos C.M.S. , Fonseca N.C. , Oliveira E. , Souza A. 
Published: January 2017

Spontaneous dissecting aneurysms (SDAs) seldom involve the intradural vertebral artery VA, the posterior cerebral, basilar or postero inferior cerebellar arteries (PICAs), where they produce subarachnoid haemorrhage and/or ischaemia. These lesions may develop spontaneously or occasionally after minor trauma and occur in young people in whom there is no underlying abnormality to explain the appearance of the dissection in most cases. Spontaneous dissecting aneurysm of the PICA is rare and its natural history is not well understood. Surgery or endovascular treatment for PICA dissection remain controversial because they suggest vessel occlusion. Only in a few cases is the bypass between the occipital artery and the PICA possible with trapping of the dissected segment. Reinforcement of the arterial wall does not seem efficient and the surgical approach per se with sole exclusion of the aneurysm may be disastrous. We describe two cases of SDA of PICA that presented with subarachnoid haemorrhage (SAH), treated conservatively, with spontaneous cure of the lesions, angiographically confirmed at mid-time follow-up of five and four months. These favourable spontaneous thromboses, like 11 other similar case reported in the literature, did not show any rebleed. The possibility of a benign clinical course of this lesion exists; clinical and angiographic management of the patient before a decision for a aggressive treatment is proposed.
Repositioning of Displaced Guglielmi Detachable Coils after Endosaccular Embolisation Using a Modification of the Neck Plastic Technique
Authors: Chaloupka J.C. , Huddle D.C. 
Published: January 2017

After undergoing prior partial surgical clipping of an acutely ruptured internal carotid aneurysm, a 29-year-old woman was referred for endovascular treatment of the gradually enlarging aneurysm remnant. The aneurysm had a somewhat peculiar ellipsoid configuration due to placement of the clip, with the largest dimension measuring less than 4 mm, and the neck measuring approximately 2 mm. Using the conventional endosaccular coil embolisation technique, two small electrolytically detachable coils were carefully folded into the aneurysm sac to produce excellent tight packing. However, immediately after detachment, a loop of the second coil inadvertently herniated out of the aneurysm into the center of the parent artery, exhibiting substantial pulse synchronous displacement. This created a potentially unstable situation for the remaining coils within the embolised aneurysm. To correct this problem we attempted to reposition the loop into the aneurysm using a modification of the previously described neck plastic technique. This technique succeeded without untoward complication. Although there are theoretical risks and limitations, the modified neck plastic technique may be useful in selective cases of inadvertent coil misplacement during endosaccular coil embolisation of aneurysms with the GDC system.
Evaluation of Intra-Aneurysmal Blood Flow: Investigation of the Flow in Experimental Aneurysms
Authors: Asakura F. , Tenjin H. , Matsumoto K. , Ueda S. 
Published: January 2017

We evaluated the flow in experimental pig aneurysms using a high speed video system with tracer particles and digital subtraction angiography (DSA). We found that flow velocity in experimental aneurysms was fast on the inflow of aneurysms. There was a certain correlation between mean transit time (MTT) and velocity in experimental aneurysms. Therefore, the differences of flow velocity in aneurysms will be detected using DSA. The flow in aneurysms was much changed by platinum coil embolization.
Spontaneous Dissecting Pseudoaneurysm of the Extracranial Internal Carotid Artery: Endovascular Treatment with a Palmaz Stent
Authors: Deguchi J. , Nagasawa S. , Tanaka H. , Suzuki S. , Hirota Y. , Ohta T. 
Published: January 2017

This case illustrates the usefulness of an endovascular stent to treat a pseudoaneurysm of the cervical internal carotid artery. A 46-year-old male patient presented with a spontaneous dissection of the cervical internal carotid artery. After failing conservative therapy, he was treated by endovascular placement of a Palmaz stent at level of the pseudoaneurysm and dissection. Immediate obliteration of pseudoaneurysm was achieved, and patency of the internal carotid artery was maintained. The patient sustained no neurological complications and the stenosis of treated carotid artery did not occur during the 6-month follow-up period. For internal carotid artery dissection, stent placement seems to be a reasonable therapeutic alternative to direct surgery.
Vein-Loaded Stent System to Occlude Wide-Necked Aneurysms
Authors: Okamoto T. , Iwakoshi T. , Negoro M. , Miyachi S. , Bundou M. , Yoshida J. 
Published: January 2017

We devised a vein-loaded stent system to immediately close the aneurysmal orifice without interrupting the parent arterial flow. Ten experimental wide-necked aneurysms located on canine common carotid arteries were treated with the implantation of a newly modified vein-loaded stent system. After deploying the stent, half of them were managed under administration of 50 mg of ticlopidine hydrochloride per day and the other half followed up without any anticoagulation therapy. Immediately after the stent placement, all aneurysms were completely obliterated with patency of the parent artery in the successfully implanted vessels in both groups. Follow-up angiography one week later disclosed complete occlusion of the aneurysm with patency of the parent artery in 67% (2/3) of the group with ticlopidine, while none of the group without drugs showed patency of the parent artery. The rate of patency of the parent artery was found to be improved by administration of ticlopidine, but was still lower than that of a conventional stent. Further modifications will be needed before clinical use.
Treatment of Cerebral Aneurysms: Surgical, Endovascular or Combined Intervention
Authors: Sano H. , Kato Y. , Singh F.B. , Kanaoka N. , Shankar K. , Katada K. , Kanno T. 
Published: January 2017

A retrospective study of 437 cases of cerebral aneurysms over a 4 year period is reported. Surgical clipping was performed in 322 cases (254 ruptured and 68 incidental aneurysms) and endovascular embolization was done in 50 cases (26 ruptured and 24 incidental aneurysms). No intervention (either surgical or endovascular) was performed in 65 patients. In the direct surgical treatment group, mortality was 1.5% in incidental and 9.8% in ruptured aneurysms and good recovery was seen in 98.5% and 74.8% cases respectively. In the endovascular intervention group, results were poor due to the severity of their neurological grading and older age. Mortality was 42.3% in ruptured and 4.2% in incidental aneurysms. Six out of 26 ruptured and 11 out 24 incidental aneurysm patients had complications in the endovascular treatment group. We have discussed the results and indications for both modes of treatment in our study.
Efficacy of Palmaz Stent Deployment for Subclavian Artery Stenosis
Authors: Nakagawa H. , Kichikawa K. , Fukusumi A. , Takayama K. , Higashiura W. , Kubota Y. , Nakane M. , Taoka T. , Iwasaki S. , Ohishi H. , Uchida H. , Sakaki T. 
Published: January 2017

Percutaneous angioplasty is a useful method for improvement of posterior circulation of the brain in subclavian artery stenosis and occlusion. Recently, the Palmaz stent was introduced for peripheral vessels stenosis. We evaluated the efficacy and care point of Palmaz stent deployment for subclavian artery stenosis in seven cases (5 stenosis and 2 occlusion) with symptoms and a mean age of 65.1 years. The stents could be deployed exactly at the stenotic region in all cases. The pressure gradient disappeared in all cases, and the clots were fixed between vessel wall and stent. Antegrade circulation and significant clinical symptoms improvement were obtained in all cases. In angioplasty of subclavian artery stenosis, as compared with balloon angioplasty alone, Palmaz stent is a very useful device with fewer complications including distal thrombosis of the vertebrobasilar circulation.
Separate Origin of the Left Internal and External Carotid Artery from the Aortic Arch Associated with Contralateral Intracranial Giant Aneurysm
Authors: Warschewske G. , Benndorf G. 
Published: January 2017

One of the rare anomalies of the common carotid artery is the separate origin of the internal and external carotid artery. We present the case of a patient who was admitted to hospital for cerebral angiography to exclude an intracranial aneurysm. The DSA revealed a giant aneurysm of the right internal carotid artery and separate origins of external and internal carotid arteries from the aortic arch. To our best knowledge no similar case has previously been reported.