bluuebunny/crossref_metadata_2025_split huggingface dataset:
Snare-Assisted Trans-Brachial Stenting for the Cervical Internal Carotid Artery Stenosis of Patient with Aorto-Iliac Occlusion
Authors: Oowaki H. , Matsuura N , Ishikawa M. 
Published: January 2017

We describe a case of endo-luminal stent placement with Snare-assist for a cervical internal carotid artery stenosis in which percutaneous access was obtained via the brachial artery. A 68-year-old man with known disease of the carotid, peripheral, and coronary arteries, with Human T-cell Lymphotrophic Virus type-1 (HTLV-1) Associated Myelopathy (HAM) presented for endoluminal revascularization of a severe, progressive right internal carotid artery stenosis, but with aorto-iliac occlusion. Transfemoral access was complicated by an aorto-iliac occlusion. A trans-brachial approach was successfully attempted, and a SMARTer stent (Cordis Endovascular, Miami Lakes, FL) was successfully placed through a 7-French Shuttle-SL guide sheath (Cook, Bloomington) under Snare-assist. The trans-brachial approach is becoming an increasingly viable alternative route for stent placement in patients with contra-indicated or complicated femoral access routes. As devices become increasingly more pliable and smaller, the trans-brachial route will be used with increasing frequency in the select patient population for stenting of both the cervical and intracranial circulation.
The Potential of Flow Modification in the Treatment of Intracranial Aneurysms
Authors: Szikora I. , Nelson P.K. , Berentei Z. , Kulcsar Z. , Marosfoi M. , Berez A. 
Published: January 2017

Background and purpose: To summarize the theoretical background and existing technical achievements of flow modification techniques in the treatment of intracranial aneurysms. The evolution of the concept of flow modification for aneurysm treatment is overviewed within the published literature on application of stents for aneurysms. The newest achievements using dedicated flow modifying devices is discussed. Reconstruction of laminar flow within intracranial arteries harboring aneurysms is feasible. Reorientation of flow using dedicated flow modifying devices is a highly effective technique in the treatment of large, broad neck, otherwise untreatable aneurysms.
Cerebral Sinovenous Thrombosis
Authors: Chen Hsian-Min , Chen Clayton Chi-Chang , Tsai Fong Y , Shy Cherng-Gueih , Wu Chen-Hoa , Chen Wen-Shien , Hung Hao-Chun 
Published: January 2017

Cerebral sinovenous thrombosis (CSVT) is an uncommon disorder that affects the dural venous sinus and cerebral vein. In our study, thirty-four patients were examined. Pre and/or post contrast-enhanced CT was done in 28 patients. MRI studies were done in 24 patients. 2-D TOF MR venography (MRV) and contrast-enhanced MRV (CEMRV) were done in 19 cases. Digital subtraction angiography (DSA) was done in 18 patients. Sixteen patients received systemic intravenous heparinization, and 12 received endovascular thrombolytic treatment with urokinase combined with anticoagulant therapy. Neuroimages of CSVT can be acquired by direct visualization of the thrombus within the dural sinus or by parenchymal changes secondary to venous occlusion. As there are some pitfalls to MRI in the diagnosis of CSVT, the combination of MRI and MRV is now the gold standard in the diagnosis of CSVT. Usually, accuracy can be improved by applying 2-D TOF MRV and CE MRV. Furthermore, the source image of MRV is critical in differentiating between normal sinus variations and diseased ones. DSA is the best tool for demonstrating dynamic intracranial circulation in CSVT and mostly is used for endovascular treatment. Systemic intravenous anticoagulant therapy with heparin is accepted as a first line treatment. Except for clinical manifestations after systemic heparinization, abnormal MR findings of parenchymal change can be used to determine when to initiate thrombolytic treatment. Endovascular therapy can be finished at the ante-grade flow within the dural sinus and continuous anticoagulation is sufficient to facilitate clinical improvement. Clinical suspicion and excellent neuroimaging are crucial in making the diagnosis of CSVT. Proper management with anticoagulants and/or endovascular thrombolytic therapy is mandatory in preventing propagation of the thrombosis and improving the clinical outcome.
Percutaneous Intravertebral Body Embolization of a Traumatic Spinal Epidural Arteriovenous Fistula with Secondary Perimedullary Venous Reflux
Authors: Gjertsen Ø. , Nakstad P. HJ. , Pedersen HK , Dahlberg D. 
Published: January 2017

Arteriovenous fistulas following vertebral fractures are probably very rare. We present a case with fistulous connection between arteries and veins within the fractured 12th thoracic vertebral body with retrograde venous drainage to perimedullary veins resulting in spinal venous hypertension and a cauda equina like symptomatology. Pre-treatment 3D CT enabled us to puncture the venous pouch within the vertebra and deposit glue in the vertebral fistula. The procedure led to a complete occlusion of the fistula and relief of pain and neurological symptoms.
Delayed Complication from a Percutaneous Vascular Closure Device following a Neuro-Interventional Procedure
Authors: Khaldi A. , Waldau B. , Skowlund C. , Velat G.J. , Mocco J. , Hoh B. L. 
Published: January 2017

Percutaneous vascular closure devices are being increasingly used as alternatives to manual compression for the closure of femoral arteriotomy after endovascular procedures as they appear to reduce time to ambulate, improve patient's comfort, and are implicated with cost saving. However, vascular closure devices have been associated with an increased risk of complications including hematoma formation, local bleeding, arteriovenous fistula formation, pseudoaneurysm and arterial leg ischemia. To our knowledge, if the above complications occur it is usually within the first 30 days after the procedure. None have been reported in a delayed fashion ten months or longer after closure. We describe a 30-year-old man with a history of a giant basilar trunk aneurysm. He was placed on aspirin and clopidogrel prior to the procedure. He had bilateral femoral access with 6 French sheaths. Following the procedure, 6 French Angio-Seals (St. Jude Medical, St. Paul, MN, USA) were used for closure of bilateral femoral arteriotomies. Ten months after the procedure, the patient kicked a metal cart and developed a large right retroperitoneal iliopsoas hematoma. There was no evidence of pseudoaneurysm. The patient was managed conservatively and his serial hematocrit stayed stable. He did not require surgical intervention. Use of percutaneous vascular closure devices is associated with complications including risk of hematoma, pseudoaneurysm, intravenous fistula, rectal peritoneal hemorrhage, limb ischemia and possible surgical repair. Most complications occur peri-procedure or within 30 days postprocedure. This is the first reported case of a delayed complication at ten months after the initial procedure. Site-related complications associated with percutaneous vascular closure devices may occur in a delayed fashion, even ten months postprocedure, so should be considered in the management of patients.
Endovascular Treatment of Tentorial Dural Arteriovenous Fistulae
Authors: Wajnberg E. , Spilberg G. , Rezende M.T. , Abud D.G. , Kessler I. , Mounayer C. 
Published: January 2017

Tentorial dural arteriovenous fistula (DAVF) is a rare vascular disease, which accounts for less than 4% of all cases of intracranial DAVF. Because of the high risk of intracranial hemorrhage, patients with tentorial DAVF need aggressive treatment. Management approaches are still controversial, and endovascular treatment has emerged as an effective alternative. In the current work, we describe our experience with the endovascular approach in the treatment of these deep and complex DAVF of the tentorium. Eight patients were treated between January 2006 and July 2009. Six patients (75%) presented with intracranial hemorrhage related to the DAVF rupture. Four patients (50%) had subarachnoid bleeding and two had intraparenchymal hematoma. Endovascular treatment was performed via the transarterial route alone in five cases (62.5%), by the transvenous approach in two cases (25.0%) and in a combined procedure using both arterial and venous routes in one patient (12.5%). Complete obliteration of the fistula was achieved in all cases. The outcome at 15 months was favorable (modified Rankin scale 0–3) in seven (87.5%) patients. Complete cure of the lesion was confirmed in these cases. This paper reports on the effectiveness of endovascular treatment in tentorial DAVF management. The choice of the venous versus the arterial approach is determined by regarding different anatomical dispositions.
Bone Healing Using a Bi-Phasic Ceramic Bone Substitute Demonstrated in Human Vertebroplasty and with Histology in a Rabbit Cancellous Bone Defect Model
Authors: Hatten H.P. , Voor M.J. 
Published: January 2017

A non-exothermic material that demonstrates clinical pain relief comparable to polymethylacrylate (PMMA) for vertebroplasty and promotes bone healing is desirable. The purpose of this investigation is to demonstrate clinical pain score improvement and bone healing following vertebroplasty with a novel bi-phasic ceramic cement. Twenty patients were prospectively treated for compression fractures in a single center in the USA with the injectable bi-phasic ceramic bone substitute. Statistical comparison of pain scores was made during a 12 month follow-up retrospectively against a matched cohort of patients treated with PMMA vertebroplasty by the same neuroradiologist (HPH) in the same setting. The bone remodeling material was also evaluated with histology in a New Zealand white rabbit model. The bi-phasic material demonstrated a preoperative mean VAS score of 8.5 (± 1.6) with a significant post-operative pain relief mean VAS score of 1.8 (± 2.5) after one week, which was maintained throughout the 12 month follow-up period. These data are in line with the pain scores for the PMMA treated cohort. CT scans six and 12 months after surgery with the bi-phasic cement showed healing of the osteoporotic fractures. In the rabbit model, histology with the study material showed evidence of incorporation, new bone growth and bone healing in a cancellous bone defect. Both the clinical results and the histologic evidence of bone healing and new bone growth support the application of this new bioinjectable material as an alternative to the use of PMMA for vertebroplasty.
Peripheral Disc Margin Shape and Internal Disc Derangement: Imaging Correlation in Significantly Painful Discs Identified at Provocation Lumbar Discography
Authors: Bartynski W.S. , Rothfus W.E. 
Published: January 2017

Annular margin shape is used to characterize lumbar disc abnormality on CT/MR imaging studies. Abnormal discs also have internal derangement including annular degeneration and radial defects. The purpose of this study was to evaluate potential correlation between disc-margin shape and annular internal derangement on post-discogram CT in significantly painful discs encountered at provocation lumbar discography (PLD). Significantly painful discs were encountered at 126 levels in 86 patients (47 male, 39 female) studied by PLD where no prior surgery had been performed and response to intradiscal lidocaine after provocation resulted in either substantial/total relief or no improvement after lidocaine administration. Post-discogram CT and discogram imaging was evaluated for disc-margin characteristics (bulge/protrusion), features of disc internal derangement (radial annular defect [RD: radial tear/fissure/annular gap], annular degeneration) and presence/absence of discographic contrast leakage. In discs with focal protrusion, 50 of 63 (79%) demonstrated Grade 3 RD with 13 (21%) demonstrating severe degenerative change only. In discs with generalized-bulge-only, 48 of 63 (76%) demonstrated degenerative change only (primarily Dallas Grade 3) with 15 of 63 (24%) demonstrating a RD (Dallas Grade 3). Differences were highly statistically significant (p<0.001). Pain elimination with intra-discal lidocaine correlated with discographic contrast leakage (p<0.001). Disc-margin shape correlates with features of internal derangement in significantly painful discs encountered at PLD. Discs with focal protrusion typically demonstrate RD while generalized bulging discs typically demonstrated degenerative changes only (p<0.001). Disc-margin shape may provide an important imaging clue to the cause of chronic discogenic low back pain.
Endovascular Management of Vascular Injury during Transsphenoidal Surgery
Authors: Çinar C. , Bozkaya H. , Parildar M. , Oran I. 
Published: January 2017

Vascular injury is an unusual and serious complication of transsphenoidal surgery. We aimed to define the role of angiography and endovascular treatment in patients with vascular injuries occurring during transsphenoidal surgery. During the last ten-year period, we retrospectively evaluated nine patients with vascular injury after transsphenoidal surgery. Eight patients were symptomatic due to vascular injury, while one had only suspicion of vascular injury during surgery. Four patients presented with epistaxis, two with subarachnoid hemorrhage, one with exophthalmos, and one with hemiparesia. Emergency angiography revealed a pseudoaneurysm in four patients, contrast extravasation in two, vessel dissection in one, vessel wall irregularity in one, and arteriovenous fistula in one. All patients but one were treated successfully with parent artery occlusion, with one covered stent implantation, one stent-assisted coiling method, while one patient was managed conservatively. One patient died due to complications related to the primary insult without rebleeding. Vascular injuries suspected intra or postoperatively must be investigated rapidly after transsphenoidal surgery. Endovascular treatment with parent artery occlusion is feasible with acceptable morbidity and mortality rates in the treatment of vascular injuries occurring in transsphenoidal surgery.
Usefulness of Intravascular Doppler Flow Measurements in Cerebral Endovascular Treatment
Authors: Fukui K. , Negoro M. , Takahashi I. , Fukasaku K. , Nakabayashi K. , Yoshida J. 
Published: January 2017

Measurement of cerebral blood flow in cerebral endovascular procedures is useful for the assessment of treatment effects. We used transcranial Doppler sonography (TCD) and Doppler guide wires (SmartWire®, Cardiometrics Co.) in intravascular treatment. The cases were 6 brain arteriovenous malformations (AVM), 2 carotid cavernous fistulas (CCF), 2 facial angiomas, and 2 carotid stenoses. Intravascular cerebral blood flow measurements with the SmartWire were performed during the endovascular procedure. TCD was used pre- and post-endovascular treatment, and velocity, pulsatility index (PI) and resistance index (RI) were compared with the SmartWire. For both TCD and SmartWire, blood velocity of the main artery decreased, and PI and RI were improved after embolisation of AVM. In angioplasty cases, post stenotic flow velocity, as measured by SmartWire, was improved, and the flow of MCA measured with TCD was also improved after treatment. The SmartWire is useful to assess cerebral blood flow changes during the neuroendovascular procedure. Combined with repeated follow up with TCD, Doppler flow measurements are useful to assess the effect of endovascular treatment.
Anatomic Variations and Pathologic Conditions as Risk Factors of Complications in Percutaneous Lumbar Nucleotomy
Authors: Dullerud R. , Johansen J.G. , Haakonsen M. , Nakstad P.H. 
Published: January 2017

This study was carried out to assess anatomic variations and pathologic changes associated with a potentially increased risk of complications during percutaneous nucleotomy. The MRI and CT examinations of 88 patients were reviewed with regard to the positional relationship between the trajectory to the disc and the bowel and iliac vessels respectively at the L4-L5 and L5-S1 levels. Pathologic conditions involving the anterior part of the annulus were assessed both by MRI and by CT-discography of 97 discs. The shortest distance from the needle course to the bowels was 29 mm. At ten other disc levels this distance was less than 40 mm. The position of the bowels is influenced by the size of the patient, the size and course of the psoas muscles and the amount of retroperitoneal fat. The bowels are at greaten distance from the trajectory at the L5-S1 than at the L4-L5 level. The risk of bowel puncture seems to be minimal. The iliac vessels were positioned behind the midportion of the disc in three patients. There was greater variation and a shorter distance to the trajectory at the L5-S1 than at the L4-L5 level. Anterior disc hernias, and particularly severe annular degeneration involving the anterior part of the annulus are frequently seen. These conditions include a weakening of the annulus and may increase the risk of anterior perforation during nucleotomy.
Endovascular Stenting for Pseudoaneurysms of the Cervical Carotid Artery
Authors: Miyachi S. , Ishiguchi T. , Taniguchi K. , Miyazaki M. , Maeda K. 
Published: January 2017

The authors report two cases of pseudoaneurysm of the cervical carotid artery treated with endovascular stenting. One patient presented with cerebral ischemia due to traumatic carotid dissection and underwent stent placement 3 weeks after injury when the wide-necked pseudoaneurysm was seen to enlarge at the dissecting portion. The aneurysm thrombosed while the carotid artery remained patent without ischemic complications for 2 years. The other patient developed repeated massive bleeding from an exposed pseudoaneurysm at the right carotid-subclavian junction resulting from radiotherapy for thyroid cancer with subsequent skin infection. Since skin grafting failed and two attempts at coil embolization resulted in compaction with recurrent enlargement of the aneurysm, endovascular stenting was performed with endosaccular coil packing between the stent struts. Hemostasis was achieved for 2 months. Both cases illustrate successes of the stent in highly difficult situations.
Detection of Embolic Signals during and after Percutaneous Transluminal Angioplasty of Subclavian and Vertebral Arteries Using Transcranial Doppler Ultrasonography
Authors: Sawada M. , Hashimoto N. , Nishi S. , Akiyama Y. 
Published: January 2017

We investigate the safety and/or risk of PTA for vertebral and subclavian artery stenosis by monitoring embolic signals using transcranial Doppler (TCD) ultrasonography. Twelve consecutive patients undergoing PTA for subclavian and vertebral artery stenosis of atherosclerotic origin were studied. Before, during and after PTA, TCD monitoring was performed to detect embolic signals for 30 minutes at each time. No embolic signals were detected in any patient before angioplasty. During angioplasty, one embolic signal was detected immediately after balloon deflation in one of 12 patients. Several embolic signals were detected after the procedure in six of 12 patients, but thereafter embolic signals became less frequent in number. Three days after angioplasty, embolic signals were not detected in any patient. TCD monitoring could be a useful modality for detection of microemboli during and after PTA in the posterior circulation. Our present study suspected that subclinical microemboli are released from the dilated vessels for three days after vertebral and subclavian PTA and anticoagulant or antiplatelet therapies may prevent embolic complications after the procedure.
Successful Treatment of Superior Sagittal Sinus Thrombosis
Authors: Niwa J. , Ohyama H. , Mastumura S. , Sasaki T. 
Published: January 2017

A 22-year-old pregnant women showed a rapid deterioration in her clinical condition. Superior sagittal sinus thrombosis was diagnosed, and direct transvenous infusion of t-PA into the superior sagittal sinus was performed. This treatment resulted in recanalization of the occluded superior sagittal sinus and in a dramatic improvement of neurological deficits.
A Microguide Wire with a Scale (Scaler Guide)
Authors: Nishi S. , Hashimoto N. , Todaka T. , Nomura A. 
Published: January 2017

There are various methods for measuring an affected vascular size during embolization or percutaneous transluminal angioplasty (PTA). Metallic balls, electrodes, grids, coins on the skin were simple and useful in this sense, but not stable and exact for measuring. A 0.014 “or 0.016” microguide wire with 5 gold markers in the tip is newly developed and used clinically (a scaler guide). One marker measures 1 mm in length. There is a distance of 4 mm between two neighboring markers. A microcatheter is navigated using a standard microguide wire into the vessels of the lesion. Bilateral digital subtraction angiography (DSA) is performed after exchange of a microguide wire with a scaler guide. Magnification ratio between distance measured by DSA and real distance from markers is calculated. Thereafter, the size of the vessels will be measured. With this method, the size of vessels was measured in patients with aneurysm or arteriovenous malformation or stenotic lesion. Selection of coils or PTA balloons could be made easily and effectively. Interventions were more safely performed with this new scaler guide.
Transforming Growth Factor-Beta Binds Reversibly in Vitro to Guglielmi Detachable Coils
Authors: Kallmes D.F. , Hankins G.R. , Borland M.K. , Cloft H.J. , Jensen M.E. , Dion J.E. , Helm G.A. 
Published: January 2017

We determined the propensity for and reversibility of transforming growth factor-ß (TGFß) binding to uncoated Guglielmi Detachable Coils (GDC) and to GDC coated with extracellular matrix (ECM) proteins. Three 1.0 centimetre samples each of uncoated GDC-18 and of GDC-18 coated with either poly-L-lysine, laminin, type I collagen, type IV collagen, fibronectin, or poly-L-lysine and laminin were prepared. These samples were immersed briefly in a solution containing I125-labelled TGFß at a concentration of 0.225 μg/ml with initial specific activity of 123.3 mCi/mg (DuPont-NEN, Billerica, MA), and were counted using a scintillation counter. Each sample was then placed in a vial containing saline, shaken for 60 seconds, and counted again. Selected samples were immersed for varying periods within the TGFß solution and counted before and after saline rinse. Samples were rinsed one week after initial rinsing and counted again. The amount of binding between coil types was compared using the Student t test. For all samples initial binding of TGFß was in the order of 60–120 pg/cm. For the pre-rinse data there were no statistically significant differences between the amount bound to any single coil coating type relative to other coatings. Compared to the initial accumulations, the amount remaining after rinsing ranged from 40% (poly-L-lysine) to 63% (poly-L-lysine with laminin), with a mean of 55% among the seven coil types. After rinsing there was more growth factor remaining on uncoated coils than on poly-L-lysine-coated coils (p=0.05), fibronectin-coated coils (p=0.01), and type IV collagen-coated coils (p=0.04). There was a trend toward greater residual growth factor on coils coated with poly-L-lysine and laminin compared to coils coated with poly-L-lysine alone (p=0.10). Delayed, second rinsing of the samples one week after initial testing demonstrated only minor incremental loss of TGFß from the coil surfaces. After five minutes of immersion, accumulation was approximately 200% greater than that noted with brief submersion, but immersions lasting over five minutes did not yield increasing levels of TGFß binding. TGFß binds to GDC coils. Binding is not improved with ECM protein-coated coils compared to uncoated coils. The absolute amount of TGFß bound to the coil will likely result in local concentrations of growth factor in the order of those required for biological activity in vivo.