bluuebunny/crossref_metadata_2025_split huggingface dataset:
Carotid Artery Angioplasty and Stenting as a First-Choice Revascularization Therapy for Cervical Carotid Artery Stenosis
Authors: Satomi J. , Moroi J. , Sasaki M. , Sawada M. , Suzuki A. , Matsubara S. 
Published: January 2017

We examined the patients with cervical carotid artery stenosis (>70%) treated by carotid artery angioplasty and stenting (CAS) as a first-choice direct revascularization therapy. The patients consisted of 45 men and seven women; their mean age was 70.4 years (range, 54–84 yr), with 60 cervical carotid stenosis (39 symptomatic and 21 asymptomatic). Sixty procedures resulted in successful stent deployment in 55 cases, percutaneous transluminal angioplasty (PTA) only without stenting in three, and failed angioplasty due to inaccessibility in two. Morbidity was seen in three cases associated with thromboembolic complication. Instent restenosis was observed in one case, which was successfully treated with subsequent PTA. CAS seems reasonable treatment for cervical carotid artery stenosis, although further accumulation of the cases will be needed to evaluate the efficacy between CAS and carotid endarterectomy.
Infantile Dural Arteriovenous Shunt Draining into a Developmental Venous Anomaly
Authors: Geibprasert S. , Krings T. , Pereira V. , Lasjaunias P. 
Published: January 2017

A three-year-old girl with an incidentally discovered infantile type of dural arteriovenous shunts (DAVs) along the superior sagittal sinus during investigation of a minor head trauma is presented. The DAVs drained into a developmental venous anomaly of the right cerebral hemisphere. In addition, there was a small cavernoma within the territory drained by the DVA. The patient underwent multiple transarterial embolizations to decrease the shunt flow and thus the constrained venous drainage of the DVA and right cerebral hemisphere. Pediatric dural arteriovenous shunts are a different entity from the adult type DAVs and should be managed according to the growth and development of the child. DVAs are extreme variations of the venous system with reduced flexibility to increased venous drainage. Regardless of the type of treatment employed, the DVA and its drainage pathway must be preserved.
Patterns of Cranial Venous System from the Comparative Anatomy in Vertebrates: Part I, Introduction and the Dorsal Venous System
Authors: Aurboonyawat T. , Suthipongchai S. , Pereira V. , Ozanne A. , Lasjaunias P. 
Published: January 2017

Many classifications of the cerebral venous system are found in the literature but they are seldom based on phylogenic study. Among vertebrates, venous drainage of the brain vesicles differs depending on the species. Due to the variability, poorly descriptive articles, and many different names used for the veins, the comparative study of the cranial venous system can hardly be performed in detail. The cranial venous system in vertebrates can be divided into three systems based on the evolution of the meninges and structures of the brain vesicles: the dorsal, lateral-ventral and ventricular systems. This study proposes a new classification of the venous drainage of brain vesicles using knowledge from a comparative study of vertebrates and focusing on the dorsal venous system. We found that the venous drainage of the neopallium and neocerebellum is involved with this system which may be a recent acquisition of cranial venous evolution.
Sub-Tenon's Steroid Irrigation for Treatment of Intraorbital Capillary Hemangioma
Authors: Firat P.G. , Doganay S. , Bilak S. , Alkan A. 
Published: January 2017

A four-month-old male infant underwent sub-Tenon's steroid irrigation for treatment of orbital capilary hemangioma that was causing exposure keratopathy risk to the left eye from progressive proptosis. The temporal inferior sub-Tenon's space was irrigated with a mixture of triamcinolone acetonide (40 mg/ml) and betamethasone sodium phosphate (6 mg/ml) by a blunt-tipped sub-Tenon's cannula. We describe this procedure as irrigation because reflux of the mixture from the incision was permitted. Two weeks after treatment, a marked reduction of proptosis was noted. One month after treatment, the volume of the intraorbital hemangioma resolved significantly in MRI examination. Steroid treatment can be applied local or systemically to treat orbital capillary hemangioma but side effects must be considered carefully. Sub-Tenon's steroid irrigation may be a benefical, effective, pratical and safe application route in the treatment of orbital capillary hemangiomas.
Conus Medullaris Spinal Arteriovenous Malformation in a Patient with Klippel-Trenaunay-Weber Syndrome
Authors: Iizuka Y. , Suzuki M. , Komura S. , Takada T. , Shimoji K. 
Published: January 2017

We describe a 24-year-old woman who presented with twice previously unverified subarachnoid hemorrhages from the conus medullaris spinal arteriovenous malformation with Parkes-Weber-syndrome. Spinal MRI examination is considered to be necessary for the diagnosis of Klippel-Trenaunay-Weber syndrome. For diagnosis of the spinal cord arteriovenous malformation, it is indispensable to search carefully for the presence of accompanying lesions. Transarterial glue embolization is effective for the management of the spinal vascular lesion.
Transarterial Embolization of Traumatic Carotid-Cavernous Fistulae by Gugliemi Detachable Coils
Authors: Luo Chao-Bao , Teng Michael Mu-Huo , Lin Chung-Jung , Chang Feng-Chi , Chang Cheng-Yen 
Published: January 2017

We report our experience with transarterial embolization of traumatic carotid-cavernous fistulae (TCCFs) by using Gugliemi detachable coil (GDC). From 2000 to 2007 at our institution, 11 patients with 12 TCCFs underwent transarterial GDC embolization because of failure to occlude fistulae by detachable balloon with preservation of the parent artery. The cause of the failure to occlude the fistula by detachable balloon was small fistula tract (n=9) and/or tortuous parent artery (n=3) or repeated balloon puncture by bony fragment (n=1). All TCCFs were successfully occluded by a single session transarterial GDC embolization. The average number of coils were eight (range, two-16) with an average length of 104 cm (range, 12–283 cm). No statistically significant procedure-related neurological complication or recurrent TCCF was observed in any of the patients. Transarterial GDC embolization is a useful method in the treatment of TCCFs, particularly in those TCCFs with small fistula tract or small CS.
Small In-Stent Low Density on CT Angiography after Carotid Artery Stenting
Authors: Okahara Mika , Kiyosue Hiro , Kashiwagi Junji , Ueda Shinya , Hori Yuzo , Mori Hiromu 
Published: January 2017

Carotid stenting (CAS) for carotid stenosis has developed rapidly over the last decade. In-stent low density area supposed plaque protrusion or thrombus is sometimes observed on CT angiography after CAS. We evaluate the frequency and time course of the small in-stent low density after carotid artery stenting and discuss its nature and clinical significance. Between May 2005 to November 2007, 23 CASs were performed for 20 patients with carotid artery stenosis. All patients had no in-stent defect on digital subtraction angiography (DSA) immediately after the procedure. Follow-up CT angiography was performed at seven 7–10 days, 1–2 months, 6 months, and then every 6 months following CAS. We retrospectively reviewed the follow-up CT angiographic findings and clinical ischemic events. Small in-stent low density areas on CT angiography were observed in 6 lesions (26%). Four cases were added warfarin to antiplatlets and the other two cases had antiplatlets only. The in-stent low density areas were disappeared within four months after CAS and no ischemic event was observed in five patients. In the other patient, a small in-stent low density area had decreased at one month after CAS, but another small in-stent low density area appeared at five months. Subacute small in-stent low density areas were frequently observed on CT angiography following CAS, however, the low density area will disappear without clinical events by medication in most case.
Treatment of Giant Intracranial Aneurysms
Authors: Lv X. , Jiang C. , Li Y. , Yang X. , Zhang J. , Wu Z. 
Published: January 2017

We report on report the clinical outcome obtained in treatment of giant intracranial aneurysms (GAs). Between 2005 and 2007, 51 patients with 51 GAs presented at our hospital. Twenty-nine were treated with primary parent vessel occlusion without distal bypass and ten underwent treatment preserving the parent artery. Twelve patients could not be treated endovascularly. Selective embolization (including two remodeling techniques and two stent-coil embolizations) resulted in only one cure. Two patients died as a result of subarachnoid hemorrhage periprocedurely. Twenty-nine patients treated primarily with parent vessel occlusion and three patients treated with covered stent were considered cured after their treatments. Only one patient treated with parent vessel occlusion experienced ischemia during follow-up, which resulted in a mild neurological deficit. Of the twelve patients who could not be treated endovascularly, one succumbed to surgery, four died while being treated conservatively, and three were lost to follow-up. Parent artery occlusion, covered stent and coil occlusion provide effective protection against bleeding. In treatment of paraclinoid GAs of the internal carotid artery, the use of a stent, and stent-assisted coil embolization may be a pitfall.
Evaluation of the Clinical Curative Effect of an O2-O3 mixture to Treat Lumbar Disc Herniation with Different Treatment Sessions
Authors: Xu L. , Li Z-L. , He X-F. , Xiang D-C. , Ma J. , Hong C-J. , He J-X. , Yang L. , Gong Z-H. , Qiu J. 
Published: January 2017

To compare the effective rates among one week, two week and four week treatment sessions of ozone therapy for lumbar disc herniation to provide a foundation for clinical decision-making. One hundred and eighty-seven lumbar disc herniation patients were divided into three groups, 103 cases for one week, 61 cases for two week and 23 cases for four week treatment sessions. The clinical curative effective rates in the three groups were 82.52%, 85.24% and 95.65% respectively. The effective rate among the three groups showed no significant difference at statistical analysis. Considering the cost-effectiveness of ozone therapy, increasing the treatment course does not enhance the curative effect.
Giant Intracranial Aneurysm in a Ten-Year-Old Boy with Parry Romberg Syndrome
Authors: Bosman T. , Van Beijnum J. , Van Walderveen M.A.A. , Brouwer P.A. 
Published: January 2017

Parry-Romberg syndrome (PRS) is a rare acquired syndrome consisting of progressive hemiatrophy of the face. We present a child with PRS and progressive neurological deficit caused by a giant intracranial aneurysm and reviewed the literature concerning all intracranial abnormalities in patients with PRS. A literature search identified 27 articles reporting on 88 patients with PRS and intracranial abnormalities. Ipsilateral brain calcification and hemiatrophy are the most prominent features on CT scan and hyper-intense white matter lesions are most frequently seen on T2-weighted MRI. Although lacking precise prevalence data, intracranial abnormalities are not uncommon in patients with PRS. We found three other PRS patients with intracranial aneurysms. Our case and literature search suggests a possible association between PRS and intracranial aneurysms. We consider this association important for clinical practice and recommend including intracranial vascular diseases in the differential diagnosis when dealing with a PRS patient with neurological symptoms.
Treatment of Ruptured ICA during Transsphenoidal Surgery
Authors: Ghatge S.B. , Modi D.B. 
Published: January 2017

Rupture of the internal carotid artery (ICA) during transsphenoidal surgery is a rare but potentially lethal complication. Direct surgical repair of the ICA may be difficult and time-consuming in an acute setting. Urgent endovascular treatments with vascular plug or stent-graft have been the feasible options to date. We desrcibe two cases of iatrogenic rupture of ICA during transsphenoidal surgery. In the first case we occluded the ICA with a vascular plug at the site of tear where cross circulation was adequate. In the second case we had to preserve the ICA with stent-graft since there was no adequate cross circulation. These two strategies are discussed below.
The Incidence of Trigeminocardiac Reflex in Endovascular Treatment of Dural Arteriovenous Fistula with Onyx
Authors: Lv X. , Li Y. , Jiang C. , Wu Z. 
Published: January 2017

This paper reports the incidence of trigeminocardiac reflex (TCR) in endovascular treatment of dural arteriovenous fistulas (DAVFs) with Onyx. The consecutive case histories of 45 patients with DAVFs, treated with Onyx transarterially and transvenously, from February 2005 to February 2008 at Beijing Tiantan Hospital, China, were retrospectively reviewed. The time period was limited as the anesthetic and intravascular procedure was performed under the same standardized anesthetic protocol and by the same team. The TCR rate was subsequently calculated. Of the 45 patients, five showed evidence of TCR during transarterial Onyx injection and transvenous DMSO injection. Their HR fell 50% during intravascular procedures compared with levels immediately before the stimulus. However, blood pressure values were stable in all cases. The TCR rate for all patients was 11.1% (95% CI, 4 to 24%), 7.7% (95% CI, 2 to 21%) in patients treated intraarterially and 33.3% (4 to 78%) in patients treated intravenously. Once HR has fallen, intravenous atropine is indicated to block the depressor response and prevention further TCR episodes. TCR may occur due to chemical stimulus of DMSO and Onyx cast formation under a standardized anesthetic protocol and should be blunted by atropine.
Balloon Kyphoplasty for Acute Osteoporotic Compression Fractures
Authors: Yang T. , Liu S. , Lv X. , Wu Z. 
Published: January 2017

We reviewed the effectiveness of balloon kyphoplasty in the treatment of acute symptomatic vertebral compression fractures. We assessed radiographic and functional outcome in 11 patients with a 24.3 month follow-up from a retrospectively monitored series of 11 patients who underwent balloon kyphoplasty (BKP). A visual analogue scale (VAS) and the short McGill questionnaire (MPQ) were used to assess average symptoms. Eleven patients with 19 treated vertebrae completed the study. The VAS showed significant improvement after treatment: the initial score was 9.1 ± 0.6 (mean ± SD), falling to 2.7 ± 1.07 by 24.3 months (P<0.001). The MPQ also showed a significant improvement (P<0.001) at follow-up. A new fracture was seen in one patient affecting two vertebrae adjacent to the treated level. On CT following the procedure, there was cement leakage in the disc in 9% of cases. BKP is a minimally invasive procedure that has been shown to be effective in the treatment of acute symptomatic vertebral compression fractures. It appears that BKP is associated with a low incidence of procedure-related complications and cement extravasation.
The Mechanism of Catheter Kickback in the Final Stage of Coil Embolization for Aneurysms: The Straightening Phenomenon
Authors: Miyachi S. , Izumi T. , Matsubara N. , Naito T. , Haraguchi K.-I. , Wakabayashi T. 
Published: January 2017

The catheter kickback phenomenon often occurs in the last stage of coil packing for cerebral aneurysms. This behavior is considered the result of either a lack of space in the sac or a stiff detaching zone. In order to clarify its mechanism, focused stretch-resistance (SR) coil simulation models were tested. Various commercially available SR coils were inserted into a cylinder or an aneurismal sac made from a silicone tube with a smaller than prescribed diameter. A magnified SR coil model (straight type) of fishing line was created for simulation. Numerical analysis for the changes in coil behavior were verified. All SR coils showed hardening and straightening at the last few millimeters, resulting in catheter kickback. In a magnified coil experiment, straightening was also realized when folding into a narrow cylinder. The SR line coursed in the canal of the first loops and shifted to the outside in the middle portion. Gaps among first coil pitches were enlarged on after insertion into the narrower space. Shortage of the SR line was calculated to reach a maximum of 32%. The straightening phenomenon is due to SR line shortening and subsequent condensation of pitches of the first loops at the coil end. Coil tail flexibility was lost, and the coil behaved as a stiff wire. Straightening is an important factor in the kickback phenomenon. Shorter final SR coils should be selected, and coil designs should be improved.
Hemodynamic Studies of Intracranial Dural Arteriovenous Fistulas Using Arterial Spin-Labeling MR Imaging
Authors: Noguchi T. , Irie H. , Takase Y. , Kawashima M. , Ootsuka T. , Nishihara M. , Egashira Y. , Nojiri J. , Matsushima T. , Kudo S. 
Published: January 2017

Arterial spin-labeling (ASL) magnetic resonance imaging (MRI) enables non-invasive acquisition of the brain perfusion information in cerebrovascular disease. We investigated hemodynamic changes in intracranial dural arteriovenous fistulas (DAVFs) using ASL-MRI. ASL-MRI by a Q2TIPS sequence on a 3.0-Tesla MRI was performed for three patients with Cognard's IIa+b type of DAVFs before and after treatment. Perfusion images obtained by ASL-MRI (ASL images) before treatment were visually compared with those by single-photon emission computed tomography images (SPECT images). Increasing rates of temporal changes of regional perfusion values in ASL images (ASL values) before and after treatment were also calculated. In all three patients, ASL images before treatment demonstrated high perfusion in regions around the shunting areas, where normal or low perfusion were detected on SPECT images; thus, ASL images might have demonstrated the abundant arterial shunting flow via the fistulas. On days eight to 20 after treatment, ASL values around the shunt areas remained the same or decreased, and those in the regions other than the shunt areas increased in all three patients. This might have been due to a combination of the following: a decrease in shunt flow volume, an amelioration of venous congestion, and a sustained an upward shift in the autoregulation of the brain perfusion pressure. All regional ASL values decreased on days 112 and 120 after treatment in two patients, which possibly reflects a reduction in the upward shift in autoregulation. ASL-MRI might be useful for identifying the hemodynamic behavior of DAVFs before and after treatment.
Recovery of Cerebrovascular Reserves after Stenting for Symptomatic Carotid Artery Stenosis
Authors: Abe A. , Ueda T. , Ueda M. , Nogoshi S. , Nishiyama Y. , Katayama Y. 
Published: January 2017

Although a decrease in cerebrovascular reserves (CVR) is known to enhance the risk of stroke, changes in this parameter after carotid artery stenting (CAS) have rarely been investigated. The present study is the first to compare CVR recoveries after applying CAS to patients with symptomatic carotid artery disease. CAS was performed for 31 consecutive patients with symptomatic carotid artery disease. They underwent acetazolamide-challenged single photon emission computed tomography (SPECT) before and after CAS to obtain data on resting stage cerebral blood flow (CBFrest values) in various regions of interest (ROIs) defined by a three-dimensional stereotactic ROI template. CVR values on ipsilateral and contralateral hemispheric sides were then calculated based on the CBFrest data. The 31 patients were dichotomized into unilateral (n=22) and bilateral (n=9) lesion groups, and no significant between-group differences were observed in CBFrest before and after CAS. In the unilateral group, there were no differences in CVR values before and after CAS. In the bilateral group, however, the CVR values significantly increased in nearly all the investigated ROIs on the contralateral side. Also, the hemispheric CVR values on both sides significantly increased after CAS in the bilateral group, while no such increase was observed in the unilateral group. CAS in patients with symptomatic bilateral carotid artery disease has the potential utility for their haemodynamic improvement even on the contralateral hemispheric side.
Intra-Arterial Nimodipine Infusion for Cerebral Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage
Authors: Cho W-S. , Kang H-S. , Kim J.E. , Kwon O-K. , Oh C.W. , Son Y.J. , Kwon B.J. , Jung C. , Han M.H. 
Published: January 2017

This study evaluated the efficacy of intra-arterial nimodipine infusion for symptomatic vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH). Clinical data collected from 42 consecutive patients with symptomatic vasospasm after aSAH were retrospectively reviewed. Forty-two patients underwent 101 sessions of intra-arterial nimodipine infusion. Angiographic response, immediate clinical response, and clinical outcome were evaluated at discharge and six months later. Angiographic improvement was achieved in 82.2% of patients. The immediate clinical improvement rate was 68.3%, while the deterioration rate was 5.0%. A favorable clinical outcome was achieved in 76.2% at discharge and 84.6% six months. Vasospasm-related infarction occurred in 21.4%. There was no drug-related complication. The nimodipine group showed satisfactory outcomes. Nimodipine can be recommended as an effective and safe intra-arterial agent for the treatment of symptomatic vasospasm after aSAH.
Achieving Faster Recanalization Times by IA Thrombolysis in Acute Ischemic Stroke: Where Should We Direct Our Efforts?
Authors: Eesa M. , Menon B. K. , Hill M.D. , Demchuk A. , Goyal M. 
Published: January 2017

Faster recanalization correlates with better outcomes in acute ischemic stroke. We analyzed times from arrival in ER to end of treatment in patients undergoing endovascular treatment for acute ischemic stroke at our institution. We retrospectively studied patients who underwent IA procedures for stroke from 2005 to 2009 noting the times of arrival to ER, CT scan, arrival to DSA, arterial puncture and recanalization from our endovascular database. A subgroup analysis was performed based on administration of GA, use of mechanical devices and whether the procedure was performed during regular hours or after hours. Of 101 patients, 53 were male, with a median age of 66 years (range 18–87). There were 81 anterior circulation strokes. Median ER to CT time was 22 min (2–1025), CT to DSA arrival time 80 min (range 4–990), DSA arrival to puncture time 24 min (range 0–75) and puncture to recanalization time 84 min (range 11–206). 23.3% of patients had an ER to CT time interval of > 60 min and 71.3 % had a CT to DSA time interval of > 60 min contributing to significant in-hospital delays. For subgroup analysis the Mann-Whitney test was used. No significant differences in CT to DSA arrival (p=0.8), DSA arrival to puncture (p=0.1) and puncture to recanalization (p=0.59) times were noted between patients with and without GA. No significant difference was noted in puncture to recanalization times with or without device (p=0.78). 39 cases were done during regular (R) hours and 62 after (A) hours. Median ER to CT time (R=18 min, A = 27 min, p 0.02), CT to DSA arrival time (R=64 min, A=90 min, p 0.004) and DSA arrival to puncture time (R=18 min, A=25 min, p 0.003) was significantly higher after hours. ER to CT and CT to DSA arrival times in patients undergoing endovascular stroke therapy show wide variability and therefore, considerable scope for reduction. Time differences during regular and after hours should serve as a reminder to make efforts to reduce overall ischemic times in spite of staffing patterns and resource availability.