bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stent-Assisted Coil Embolization of Complex Wide-Necked Bifurcation Cerebral Aneurysms Using the “Waffle Cone” Technique
Authors: Liu W. , Kung D.K. , Policeni B. , Rossen J.D. , Jabbour P.M. , Hasan D.M. 
Published: January 2017

Endovascular treatment of complex, wide-necked bifurcation cerebral aneurysms is challenging. Intra/extra-aneurysmal stent placement, the “waffle cone” technique, has the advantage of using a single stent to prevent coil herniation without the need to deliver the stent to the efferent vessel. The published data on the use of this technique is limited. We present our initial and follow-up experience with the waffle cone stent-assisted coiling (SAC) of aneurysms to evaluate the durability of the technique. We retrospectively identified ten consecutive patients who underwent SAC of an aneurysm using the waffle cone technique from July 2009 to March 2011. Clinical and angiographic outcomes after initial treatment and follow-up were evaluated. Raymond Class I or II occlusion of the aneurysm was achieved in all cases with the waffle cone technique. No intraoperative aneurysm rupture was noted. The parent arteries were patent at procedure completion. Clinical follow-up in nine patients (median 12.9 months) revealed no aneurysm rupture. Two patients had a transient embolic ischemic attack at 18 hours and three months after treatment, respectively. Catheter angiography or MRA at six-month follow-up demonstrated persistent occlusions of aneurysms in seven out of eight patients. Another patient had stable aneurysm occlusion at three-month follow-up study. Our experience in the small series suggests the waffle cone technique could be performed on complex, wide-necked aneurysms with relative safety, and it allowed satisfactory occlusions of the aneurysms at six months in most cases.
Angioarchitecture and Treatment Modalities in Posttraumatic Carotid Cavernous Fistulae
Authors: Malan J. , Lefeuvre D. , Mngomezulu V. , Taylor A. 
Published: January 2017

Posttraumatic carotid cavernous fistulae are abnormal direct hole communications between the intracavernous carotid artery and the cavernous sinus that can result from both blunt and penetrating trauma. They can be challenging lesions to treat and a variety of modalities and approaches have been proposed since endovascular treatment has become the standard treatment. An analysis of the angioarchitecture of 32 consecutive patients treated in our service demonstrated that seven could be classified as small hole, eight medium and 17 large. Different size fistulae required varying endovascular tools. Small fistulae were best treated using coils and large and medium lesions with balloons. Large lesions were more likely to require multiple tools in order to achieve closure and had a lower chance of ipsilateral carotid preservation. All patients in the series were cured with a carotid preservation rate of 66%. There was no permanent morbidity associated with endovascular treatment.
Axium MicroFX Coil for the Completing Endovascular Aneurysm Surgery Study (ACCESS)
Authors: Waldau B. , Fargen K.M. , Mack W.J. , Wilson N.M. , Khaldi A. , Hoh B.L. , Mocco J 
Published: January 2017

Recanalization of previously coiled aneurysms remains a major drawback of endovascular aneurysm therapy. We performed a prospective single arm trial to provide early initial data regarding the safety and angiographic durability of a new coil technology, the Axium MicroFX Polyglycolic/polylactic acid (PGLA) coil, which was designed to lower recanalization rates. Fifteen patients (16 aneurysms) were prospectively enrolled. Demographic and peri-procedural data were collected. Angiographic images of the initial coil embolization and three to six month follow-up angiographic images underwent blinded evaluation. Seven (47%) SAH and eight (53%) elective patients were enrolled. Blinded evaluation of the initial embolization demonstrated that 5/16 (31%) aneurysms achieved Raymond grade 1, 5/16 (31%) grade 2 and 6/16 (38%) grade 3. Three to six month angiography was obtained in 12/15 patients (80%); two patients expired (1 SAH, 1 elective) and one was lost to follow-up (SAH). All patients who underwent follow-up angiography had a mRS ≤1. Blinded evaluation of embolization demonstrated 7/13 aneurysms (54%) improved in Raymond grading, five (38%) were stable and one aneurysm (8%) worsened. One patient developed an asymptomatic peri-aneurysmal parent vessel stenosis. Axium MicroFX coils appear to be safe, though the small number of patients in this series obviates comparative analysis with other series. Further studies are needed with more patients to compare the angiographic durability of Axium MicroFX coils to other coils.
Unexpected Silent Infarctions after Embolization of Cerebral Arteriovenous Malformations and Fistulas
Authors: Suazo L. , Putman C. , Vilchez C. , Stoeter P. 
Published: January 2017

We investigated the number and possible causes of clinically silent lesions seen in diffusion-weighted magnetic resonance imaging after embolization of arteriovenous malformations (AVMs) and fistulas using acrylate only or in combination with coils. Included were 19 patients with 18 AVMs and one case of a vein of Galen aneurysm in which 25 interventions were carried out. Results of diffusion-weighted imaging, the appearance of perinidal and distant lesions, were correlated to Spetzler grade, nidus size, flow, number of feeders occluded, rate of nidus occlusion and duration of the intervention. We found seven distant lesions corresponding to non-symptomatic infarcts in the given clinical setting. The only significant correlation between lesion size and parameters analyzed was the degree of nidus occlusion achieved during the intervention. Because most of the lesions presented in cases with a high occlusion rate, they appear to be related to the intention to reach a complete occlusion of the nidus. These results emphasize that the risk involved in eliminating the nidus completely must be reconsidered with special care, particularly in a situation where most high-flow feeders have been occluded.
Early Clinical Outcome of Patients with Ruptured Cerebral Aneurysms Treated by Endovascular (GDC) or Microsurgical Techniques
Authors: Richling B. , Bavinzski G. , Gross C. , Gruber A. , Killer M. 
Published: January 2017

Over the past 3.5 years 220 patients with aneurysmal subarachnoid hemorrhage were treated in the Department of Neurosurgery University of Vienna Medical School using either endovascular techniques (Guglielmi Detachable Coils) or open craniotomy with aneurysm clipping. A retrospective analysis was undertaken to assess whether any difference in outcome could be correlated with the treatment choice. The patients were stratified as to 1) Hunt and Hess grade at time of treatment, 2) method of treatment, and 3) clinical outcome at 2–4 weeks following treatment. The outcomes in this population of patients were consistent with recent published series regardless of whether the aneurysms were treated with microvascular surgery or endovascular surgery. There was a trend toward better outcome in a relatively small sub-group of patients presenting as Hunt and Hess grade III who were treated by the endovascular method. Guglielmi detachable coils have been available for a relatively short time, and although early results are promising, the ultimate long-term efficacy of the coils will have to be assessed.
Intensive Care Management of Patients with Subarachnoid Hemorrhage at San Raffaele Hospital, Milan
Authors: Beretta L. , Sacchi L. , Calvi M. , Cenzato M. 
Published: January 2017

Intensive care of patients with SAH is targeted to recognize and treat the leading cause of death and disability. Hemorrhage, vasospasm, rebleeding, intracranial hypertension can produce ischaemia because the ratio between metabolism (CMRO2) and cerebral blood flow (CBF) is not coupled. Neuro-ICU bedside monitoring provides information on the intracranial dynamics. Aggressive treatment attempts to avoid ischaemia but needs a clipped or thrombosed (via endovascular approach) aneurysm. The authors propose treatment to improve CBF and reduce CMRO2: hypervolemia, hemodilution, hypertension, ICP reduction, normocapnia, mannitol infusion, normothermia or mild hypothermia and sedation with intravenous anaesthetics. Medical complications such as hypovolemia, infections, pulmonary oedema, gastrointestinal bleeding need to be recognized early and treated.
Acute-Sinus Thrombosis in a Child with Antibodies against Cardiolipins
Authors: Söderman M. , Johnsson H. , Ericson K. , Wallstedt L. 
Published: January 2017

A case of thrombosis of the straight sinus and the left transverse sinus in an 11 year old boy is described. The patient had a history of slight trauma followed by infection of the upper airways and presented with severe impressive and expressive dysphasia and stupor. He was treated with in situ fibrinolysis. Despite successful local fibrinolysis and thrombectomy with a balloon catheter the patient rethrombosed his left transverse sinus several times and had a late thrombosis of his jugular vein. Nevertheless, flow in the left sigmoid sinus was facilitated and focal brain oedema was significantly reduced. Serum levels of antibodies against cardiolipins, associated with venous thrombosis, were elevated and interfered with reagents used for measuring the activated partial tromboplastin time, causing it to be falsely prolonged with subsequent underdosage of heparin. He was treated with oral anticoagulants for one year after the episode and recovered completely.
Glued Catheters during Embolisation of Brain AVMs with Acrylic Glue
Authors: Debrun G.M. , Aletich V.A. , Shownkeen H. , Ausman J. 
Published: January 2017

We evaluated the frequency and the side effects associated with gluing a piece of microcatheter in the feeder during embolisation of brain AVMs with acrylic glue. A retrospective analysis of 233 brain AVMs embolised with acrylic glue over a 15 year period has shown that 29 microcatheters were glued into the feeder. This represents 936 superselective catheterizations of different feeders followed by injection of glue. There was no side effect in 27 cases. Eight cases were operated upon a few hours or days after the complication occurred. The piece of tubing was removed in six cases. The reason for early surgery was the fear of extensive thrombosis of a major trunk (MCA or BA) or taking advantage of the catheter being still free in the cerebral vessel. In one case of temporal AVM, a Magic 1.5F coiled up into the distal basilar and PCA. In one case of left parietotemporal AVM, surgery was done one month after having glued a piece of tubing into the left MCA without side effect. The patient became hemiplegic and aphasic two hours after surgery. The thrombosed left MCA was reopened with Urokinase. The patient recovered with minor residual aphasia. The risk of side effects increases with the use of the Magic 1.5F that coils up into the vessel more easily than the Magic 1.8F. Leaving a piece of Magic catheter in the feeder to a brain AVM usually has no side effect. When there is a risk of thrombosis of a major trunk (MCA, BA) or when surgical resection is indicated, surgery should be done as soon as possibile because it is usually possible and easy to retrieve the piece of tubing from the intracranial circulation. The frequency of this complication has decreased since we starded using more diluted acrylic glue.
An Evaluation of the Physical Properties of Current Microcatheters and Guidewires
Authors: Ogata N. , Goto K. , Uda K. 
Published: January 2017

The physical properties of the 16 microcatheters and 7 guidewires currently available were evaluated to assess their manoeuvrability. This investigation included the latest varieties of these products. The test results showed that there was a wide variation in flexibility and friction between the distal segments of the catheters. Even the recently developed hydrophilic polymer-coated catheters show this variation. Comparisons between guidewires also showed differing degrees of flexibility and friction. Torque transmission was also a variable factor. A combination of the most flexible microcatheter with the lowest friction and the most responsive guidewire with the lowest friction was picked for clinical evaluation. The effectiveness and safety of this combination of equipment was proved by embolising various cerebral arteriovenous malformations(AVMs) and thrombolysing cerebral emboli of arteriosclerotic patients. However it remains difficult to reach the nidus of distally located AVMs with extremely long and tortuous feeding pedicles such as parietal lobe AVMs. The efforts to overcome the weaknesses of current materials by further improving equipment and technique is another subject of the current paper. This paper was presented at the 16th Annual Meeting of the Working Group on Interventional Neuroradiology, Val d'Isere, France, January 16th, 1996 and the 22nd European Congress of Neuroradiology, Milan, Italy, September 21st, 1996.
Sticky Platelet Syndrome: A Cause of Neurovascular Thrombosis and Thrombo-Embolism
Authors: Berg-Dammer E. , Henkes H. , Trobisch H. , Kühne D. 
Published: January 2017

Increased platelet aggregation induced by adenosine diphosphate and epinephrine and enhanced platelet activation response to surface contact are the key features of the “sticky platelet syndrome”, in which the phenotype is transmitted with an autosomal dominant pattern. Two thirds of the patients with this syndrome have a positive family history of thrombo-embolic disease, which may be triggered by stress. We have seen two patients suffering from intracranial arterial and venous sinus thrombosis due to sticky platelet syndrome. Hyperaggregability of the platelets after stimulation with adenosine diphosphate and epinephrine was found in both. Case 1: A 43 year old man with a superior sagittal and right transverse venous sinus thrombosis developed subdural hygromas and a venous infarct of the parietal lobe. After burr hole evacuation of the hygromas, aspirin and phenoprocumone were prescribed. The patient made a good neurological recovery. Case 2: A 52 year old woman experienced spontaneous occlusion of a right MCA branch. The work-up revealed bilateral MCA and a basilar tip aneurysm. During the attempt to treat the basilar tip aneurysm by endovascular means, a thrombus formed within the left vertebral artery and was dislodged to both posterior cerebral arteries (PCAs). Local intra-arterial fibrinolysis yielded good recanalization of both PCAs. No new neurological deficit occurred. Continuous prophylaxis with aspirin was started. In sticky platelet syndrome stress and adrenaline release can trigger the thrombosis of intracranial arterial or venous vessels in otherwise healthy subjects. This is a potential cause of thromboembolic complications during endovascular procedures. Low-dose aspirin normalizes platelet hyperaggregability.
Angiographic A-V Shunt during Interventional Thrombolysis for Acute Cerebral Embolism
Authors: Fukazawa S. , Waki R. , Hidaka A. , Kishimoto R. , Kimura K. , Tamakawa N. , Teramachi H. , Shimizu K. 
Published: January 2017

In order to predict the post-therapeutic hemorrhagic complication of interventional thrombolysis, we retrospectively examined angiographic findings and other factors in 44 patients with acute cerebral embolism. All patients were super selectively catheterized within 5 hours of onset and received a fixed regimen of urokinase or t-PA, unless recanalization was achieved or deterioration was apparent before total infusion. Immediate post-therapeutic CT scan revealed hematoma within the basal ganglia in 10 patients (group 1) and no hemorrhage in the remaining 34 (group 2). A series of angiograms during the therapy showed A-V shunt from lenticulostriate arteries to thalamostriate vein in 7 of 10 cases in group 1; no case in group 2 was accompanied by such abnormal shunt. Prognosis after the therapy was worse in group 1 than in group 2. No other factors, such as therapeutic timing after the disease onset or total doses of urokinase or t-PA infused, differed between the two groups. These findings indicate that angiographic A-V shunt during therapy is a predictive sign of a high incidence of hemorrhagic complication. We recommend performing several angiographic controls during therapy and when A-V shunt is detected, the therapy should be discontinued to prevent hemorrhage which leads to a poor prognosis.
Fundamentals of Transarterial Embolization Technique by Drug-Delivery Embolic Emulsion
Authors: Ikeda M. , Shimoyamada K. , Katayama N. , Itoh T. , Takahashi K. , Satoh N. , Tsukune Y. 
Published: January 2017

We developed new embolic drug delivery emulsions to be utilized for malignant neoplasms. We combined additional water-soluble contrast materials (Ioxaglic acid, Iopamidol) with Glyceol, Poloxamer-188, or D-Mannitol to antitumor agent Lipiodol ultrafluid in order to generate stable emulsions. Some of these emulsions have been shown to cause pulmonary embolism in rabbits and to allow gradual diffusion of the antitumor agent in vitro. Good therapeutic utility is indicated. In particular, one emulsion containing D-Mannitol (Mizonokuchi emulsion), is expected to prolong drug delivery in malignant brain tumors.
Tortuosity of the Cervical Segment of the Internal Carotid Artery in AVM Patients
Authors: Hamada J. , Kai Y. , Morioka M. , Kaku T. , Korematsu K. , Ushio Y. 
Published: January 2017

The correlation between the degree of tortuosity of the cervical segment of the internal carotid artery (CICA) and the size of the nidus in AVM patients was investigated on angiograms. Fifteen AVM patients underwent embolization of vessels that were fed primarily by the internal carotid artery. The patients were divided into two groups according to the size of nidus: in group 1 (n = 5), the size of the nidus was rated as small (less than 6 cm), in group 2 (n = 10) as large (greater than 6 cm). The tortuosity was rated as mild, moderate, or severe. The tortuosity of the ipsilateral CICA in group 1 was severe while in group 2 it was either mild or moderate. The tortuosity of the CICA seems to be an important factor to be considered when distal embolization is contemplated in AVM patients.
Percutaneous Transluminal Angioplasty for Bilateral ICA Occlusive Lesions
Authors: Masuo O. , Terada T. , Yokote H. , Tsuura M. , Itakura T. , Yamaga H. , Maeshima S. , Kuwata T. , Moriwaki H. 
Published: January 2017

We performed Percutaneous Transluminal Angioplasty (PTA) in 50 patients with internal carotid artery (ICA) stenosis. Fifteen of these patients also showed signs of contralateral ICA occlusive lesions. Various neurological symptoms, such as hemiparesis or convulsions, frequently appeared in these patients with contralateral lesions during PTA. The balloon inflation time was restricted in 2 patients who experienced convulsions during PTA, resulting in an unsuccessful dilatation in one case. No permanent neurological deficits appeared as a result of PTA in these cases. The treatment for these cases is discussed in this report.
Percutaneous Transluminal Angioplasty for Acute Thrombotic Occlusion of the Cervical Internal Carotid Artery Using a Perfusion Balloon Catheter
Authors: Kurashima A. , Otuka A. , Saito T. , Tuchiya T. , Uzuka T. , Kawasaki K. , Totuka N. 
Published: January 2017

We performed emergency percutaneous transluminal angioplasty (PTA) with a perfusion balloon catheter (PBC) for PTCA and, at the same time, thrombolytic therapy was administered by urokinase (UK) perfusion in five cases of severe cervical internal carotid artery stenosis in which sudden cerebral hemisphere ischemia occurred due to acute thrombotic obliteration. In four out of the five cases, effective revascularization was obtained; three resulted in Good recovery, but one showed extensive cerebral infarction after PTA. In the remaining one case, where stenosis of the internal carotid artery of the opposite side occurred subclinically, effective revascularization by PTA was impossible resulting in the death of this patient. While “artery to aetery embolism” was confirmed in all four cases in which revascularization was successful, most emboli were dissolved by combined thrombolysis. As poor prognostic factors, findings of a low density area and closing of cerebral sulci in an initial CT and poor development of the collateral circulation mediating the circle of Willis and leptomeningeal collateral on the cerebral surface were indicated. Since PBC is capable of performing PTA while assuring circulation distant from the balloon, it facilitates gradual and prolonged balloon inflation, which is said to be safer and more effective, and is considered a reasonable method of revascularization at the time of an acute obliteration in the cervical internal carotid artery. In addition, this method can be used as a bridge to carotid endarterectomy. However, “artery to artery embolism” accompanying PTA in the acute stage remains a major problem, and a combination of thrombolysis seems indispensable.
Endovascular Treatment of Vein of Galen Aneurysmal Malformations
Authors: Iizuka Y. , Maehara T. , Katayama H. , Sato K. , Kugimiya T. , Yamashiro Y. 
Published: January 2017

We report two cases of vein of Galen aneurysmal dilatation (VGAD) and four cases of vein of Galen aneurysmal malformation (VGAM) with special reference to clinical features and therapeutic indications of endovascular treatment. A case with VGAD was treated by radiosurgery in 1985 with no amelioration to the patient, A case of choroidal type VGAM underwent an operation in 1987, but died of massive hemorrhage 2 years later. The other case of VGAD has been followed-up conservatively. The remaining cases of VGAM (two choroidal type and one mural type) were treated by endovascular treatment. The two cases of choroidal type were successfully embolized but died of systemic complications, and the only case of mural type was cured.
An Experimental and Angiographic Explanation of Why Ulcerated Carotid Bulbs Embolize
Authors: Imbesi S.G. , Kerber C.W. 
Published: January 2017

The flow dynamics and pressure relationships in an ulcerated atherosclerotic carotid bulb obtained at post-mortem were studied and correlated with angiographic findings in a similar live patient. Using the lost wax technique, we created replicas of an ulcerated atherosclerotic carotid bulb from a fresh cadaver, and placed those replicas in a circuit of pulsating non-Newtonian fluid. Flow profiles were adjusted to replicate human physiologic flows, and flow rates of 400,600, and 800 milliliters per minute were evaluated. In the replicas, the slipstreams were opacified with iso-baric dyes, and images were recorded both on 35 mm film and on SuperVHS high speed video. Data were collected from needles placed radially in the common carotid artery, in the region of the maximal atherosclerotic narrowing, and in the internal carotid artery. Though pressure relationships could not be obtained in the live human for ethical reasons, angiography in a similar stenosis was evaluated for slipstream dynamics. The post-mortem replica had a 55% diameter stenosis (88% area stenosis) of the carotid bulb with a shallow 3 mm ulcer. Flow in the common carotid artery showed undisturbed slipstreams, but as these slipstreams entered the narrow bulb, they crowded together, accelerating dramatically, with a jet continuing distally beyond the maximal narrowing for at least 2 vessel diameters, where flow again became normal. As fluid entered the narrowed bulb, radial pressures decreased and within the ulcer a vortex circulation was found. Similar findings were observed on the angiographic images of the live patient. This combination of events, the slowly swirling fluid in the ulcer, which would allow platelet aggregates to form, and the intermittent low pressure of the Bernoulli effect which could pull the aggregates into the adjacent rapidly flowing blood may help explain how ulcerated carotid plaques lead to embolic stroke.