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Interventional Neuroradiology

Xuelei Zhang, Gang Luo, Baixue Jia, Dapeng Mo, Ning Ma, Feng Gao, Jingyu Zhang, Zhongrong Miao
BACKGROUND: Therapeutic strategies and outcomes vary with stroke subtypes for patients with acute vertebrobasilar occlusion (VBAO). This study aimed to compare characteristics and outcomes of VBAO due to intracranial atherosclerotic disease (ICAD) and embolisms and identify baseline predictors of ICAD. METHODS: Patients with VBAO who received endovascular therapy (EVT) were retrospectively analyzed. Participants fulfilling the criteria were classified as the ICAD group (focal stenosis of >70%, or fixed stenosis >50% in addition to either flow and perfusion impairment on angiography or an evident reocclusion tendency) and the embolism group (defined as no evidence of focal significant stenosis after thrombolysis or thrombectomy)...
December 4, 2018: Interventional Neuroradiology
Issei Takano, Yoshiyuki Matsumoto, Yoshiko Fujii, Yuki Inoue, Yoshiki Sugiura, Yosuke Kawamura, Ryotaro Suzuki, Ryuta Nakae, Yoshihiro Tanaka, Masaya Nagaishi, Tomoji Takigawa, Akio Hyodo, Kensuke Suzuki
BACKGROUND: Neuroendovascular therapy is typically performed via the femoral artery, but there are rare cases in which a tortuous upstream angioarchitecture makes it difficult to access the intracranial circulation via this route. METHODS: In this case series, we describe six cases treated by surgical cut-down in the neck, with puncture of the carotid artery. Antiplatelet and anticoagulation agents were used in all cases. The indications for the technique were postsurgical thoracic aortic aneurysm (two cases), postsurgical abdominal aortic aneurysm (one case), major vessel tortuosity of the common carotid artery (two cases) and aortic arch anomaly (one case)...
November 28, 2018: Interventional Neuroradiology
Anna L Kühn, Katyucia de Macedo Rodrigues, Ajay K Wakhloo, Ajit S Puri
Flow diverter malapposition has been described as a technical complication during endovascular procedures and can be associated with, potentially delayed, life-threatening aneurysm rupture or ischemic events. We performed a retrospective review of our flow diverter database to identify all patients in whom device malapposition was detected on follow-up angiogram immediately after device deployment. Feasibility and technical success of different endovascular approaches aiming to correct the inadequate vessel wall apposition were evaluated...
November 28, 2018: Interventional Neuroradiology
Bruno Bartolini, Francesco Puccinelli, Steven D Hajdu, Christina Stathopoulos, Maja Beck-Popovic, Francis L Munier, Guillaume Saliou
We report the intentional occlusion of the middle meningeal artery arising from the lacrimal artery, a novel technique to improve drug delivery in a 14-month-old boy with a history of right sporadic unilateral cavitary retinoblastoma group D. The patient was referred to our institution for intra-arterial chemotherapy after two systemic chemotherapy treatments. The digital subtraction angiography showed a large middle meningeal artery arising from the right lacrimal artery and decrease choroidal enhancement thus decreased flow to the tumor...
November 28, 2018: Interventional Neuroradiology
Fabio Settecase
Distal emboli and emboli to new territories occur in up to 14% and 11% of large vessel occlusion mechanical thrombectomies, respectively. A retrospective review was conducted of 18 consecutive patients with large vessel occlusion acute stroke undergoing mechanical thrombecomy, subsequently developing distal emboli and/or emboli to new territory for which thromboaspiration using the 3MAX catheter was performed. Eighteen distal emboli and two emboli to new territory in 18 patients were treated in the distal M2 and M3 middle cerebral artery, pericallosal and callosomarginal arteries, and P2 posterior cerebral artery (all arteries ≥1...
November 21, 2018: Interventional Neuroradiology
Abdul Rahman Al-Schameri, Aviraj Deshmukh, Hadi Debaseh, Christoph Griessenauer, Monika Killer-Oberpfalzer
Endovascular thrombectomy is now the standard of care for large vessel occlusion stroke. The aim is to achieve rapid and complete recanalisation while avoiding complications. Apart from the conventional complications of neurointerventional procedures, mechanical thrombectomy has its unique set of complications, inherent to the disease pathophysiology. We describe an unusual complication of catheter fracture and subsequent distal embolisation into the cerebral vasculature, which was noticed 24 hours after the procedure...
November 21, 2018: Interventional Neuroradiology
Justin Christopher Ng, Anchalee Churojana, Sirintara Pongpech, Luu Dang Vu, Cindy Sadikin, Jeyaledchumy Mahadevan, Josephine Subramaniam, Victor Erwin Jocson, Wickly Lee
Acute stroke care systems in Southeast Asian countries are at various stages of development, with disparate treatment availability and practice in terms of intravenous thrombolysis and endovascular therapy. With the advent of successful endovascular therapy stroke trials over the past decade, the pressure to revise and advance acute stroke management has greatly intensified. Southeast Asian patients exhibit unique stroke features, such as increased susceptibility to intracranial atherosclerosis and higher prevalence of intracranial haemorrhage, likely secondary to modified vascular risk factors from differing dietary and lifestyle habits...
November 21, 2018: Interventional Neuroradiology
Timothy L Miao, Enriqueta Lucar Figueroa, Khalid Bajunaid, Michael Mayich, Sandrine de Ribaupierre, Sachin K Pandey
Pediatric neuroendovascular procedures are increasingly performed as several studies have shown the safety of these interventions. In the literature, an upper limit of 4 French catheter size is conventionally used for femoral access in neuroangiography of very young infants. However, this constraint in luminal size may not allow for more complex procedures. We present the previously unreported use of a radial 5 French slender catheter with ultrathin walls for femoral access for aneurysm embolization in a 3-month-old boy presenting with left M2 aneurysm rupture...
November 21, 2018: Interventional Neuroradiology
Seán Fitzgerald, Asim Rizvi, Daying Dai, Eric E Williamson, Giuseppe Lanzino, Karen M Doyle, David F Kallmes, Waleed Brinjikji
Cardiac surgery has been shown to be associated with increased risk of acute ischemic stroke. This report presents a case of a successful mechanical embolectomy procedure to treat a patient for an acute ischemic stroke, which was caused by the cardiac embolization of a 'foreign body' containing debris following a redo sternotomy procedure for mitral valve replacement and tricuspid valve annuloplasty.
November 14, 2018: Interventional Neuroradiology
Runqi Wangqin, Kaya Xu, Haydy Rojas, Zeguang Ren
Treatment options for aneurysmal bone cysts include intralesional curettage, segmental excision, en bloc resection and endovascular embolization. The most commonly used treatment is intralesional curettage and selective arterial embolization is normally an adjunctive therapy, not a definitive treatment. We report a case of a C1 lateral mass aneurysmal bone cyst treated with a single session of endovascular embolization. Long-term follow up demonstrated complete resolution of the cyst. A study of aneurysmal bone cyst embolization was conducted and the key points for obtaining maximal devascularization of the cyst along with embolic material and technique are discussed...
November 8, 2018: Interventional Neuroradiology
Mario Martínez-Galdámez, Jorge Escartín, Boris Pabón, Carlos Diaz, Roberto Martín-Reyes, Antonio Hermosín, Eduardo Crespo, Claudio Rodríguez, Gonzalo Monedero, Krishna Joshi, Demetrius K Lopes
BACKGROUND: The new generation of flow diverters includes a surface modification with a synthetic biocompatible polymer, which makes the device more biocompatible and less thrombogenic. Optical coherence tomography (OCT) can be used to visualize perforators, stent wall apposition, and intra-stent thrombus. Unfortunately real world application of this technology has been limited because of the limited navigability of these devices in the intracranial vessels. In this report, we share our experience of using 3D-printed neurovascular anatomy models to simulate and test the navigability of a commercially available OCT system and to show the application of this device in a patient treated with the new generation of surface modified flow diverters...
November 5, 2018: Interventional Neuroradiology
Andreas Simgen, Toshiki Tomori, Hagen Bomberg, Umut Yilmaz, Christian Roth, Wolfgang Reith, Ruben Mühl-Bennighaus
PURPOSE: Conventional intra-arterial digital subtraction angiography, which requires surgical exposure and ligation of the femoral or carotid artery, is a limited method of evaluating elastase-induced aneurysms in New Zealand white rabbits. The purpose of this study was to assess aneurysm morphology, occlusion rates and complications after flow diverter treatment comparing intravenous and intra-arterial digital subtraction angiography. METHODS: We previously published a preclinical study in which we evaluated the occlusion rates of elastase-induced aneurysms after treatment with a prototype flow diverter, by using intra-arterial digital subtraction angiography at three months ( n = 9) and six months ( n = 9)...
November 4, 2018: Interventional Neuroradiology
Fuat Arikan, Dario Gandara, Marielle Esteves, Alejandro Tomasello, Juan Sahuquillo
We describe a new, elegant, two-phase, microsurgical method that minimizes the surgical preparation time for different complex vascular lesions in a swine model. In the first phase, the model is prepared microsurgically in the experimental laboratory using arterial or/and venous grafts. In the second phase, the model is implanted in the experimental animal. This two-fold method allows for increasing the complexity and accuracy of the model while reducing preparation time on the day of the training session.
November 4, 2018: Interventional Neuroradiology
Elisa Francesca Ciceri, Mauro Plebani, Raffaele Augelli, Alessandra Agnello, Claudio Ghimenton, Davide Soloperto, Daniele Marchioni, Giuseppe Kenneth Ricciardi
The technique of direct intratumoral injection of permanent liquid agents has evolved significantly over the past few decades. The percutaneous direct puncture technique is being utilised more and more for embolisation of head and neck hypervascular lesions. We describe a case treated via the direct percutaneous transnasal (TN) puncture technique for embolisation of a sinonasal hypervascular tumour, performed in a 21-year-old male patient. Due to extensive vascularisation of the tumour, preoperative embolisation was requested by our otolaryngologist team in order to minimise intraoperative bleeding and reduce surgical morbidity...
November 4, 2018: Interventional Neuroradiology
Alejandro Santillan, Jared Knopman, Athos Patsalides, Y Pierre Gobin
Myxomas are slowly growing benign neoplasms and represent the most common tumor of the heart. Embolism from cardiac myxoma occurs in 30-45% of patients and in at least half of the cases cerebral arteries are affected leading mainly to embolic ischemic strokes and rarely to delayed intracranial aneurysm formation. We present two cases with delayed intracranial aneurysmal formation 14 years and 18 years after cardiac myxoma resection. To the best of our knowledge these two cases represent the longest time interval between aneurysm detection after complete cardiac myxoma resection with no recurrence confirmed by transesophageal echocardiogram...
November 4, 2018: Interventional Neuroradiology
Philipp Gruber, Martin Hlavica, Jatta Berberat, Benjamin Victor Ineichen, Michael Diepers, Krassen Nedeltchev, Timo Kahles, Luca Remonda
BACKGROUND: Carotid artery stenting requires antiplatelet therapy for prevention of in-stent thrombosis. Patients suffering from acute ischemic stroke undergoing intravenous thrombolysis and emergent carotid artery stenting (eCAS) are at high risk for intracranial bleeding. We assessed efficacy and safety of acute administration of intravenous tirofiban versus aspirin in these patients. METHODS: A retrospective, single center, cohort study was carried out of 32 patients who underwent eCAS (18 received tirofiban, 14 received aspirin) at our comprehensive stroke center (2008-2016)...
November 4, 2018: Interventional Neuroradiology
Manoj Bohara, Kosuke Teranishi, Kenji Yatomi, Takashi Fujii, Takayuki Kitamura, Munetaka Yamamoto, Hidenori Oishi
BACKGROUND: Flow diversion with the Pipeline embolization device (PED) is a widely accepted treatment modality for aneurysm occlusion. Previous reports have shown no recanalization of aneurysms on long-term follow-up once total occlusion has been achieved. CASE DESCRIPTION: We report on a 63-year-old male who had a large internal carotid artery cavernous segment aneurysm. Treatment with PED resulted in complete occlusion of the aneurysm. However, follow-up angiography at four years revealed recurrence of the aneurysm due to disconnection of the two PEDs placed in telescoping fashion...
November 4, 2018: Interventional Neuroradiology
Hidemichi Ito, Masashi Uchida, Taigen Sase, Yuichiro Kushiro, Tetsuya Ikeda, Hiroshi Takasuna, Ichiro Takumi, Kotaro Oshio, Yuichiro Tanaka
The transfemoral approach is a common technique for carotid artery stenting. However, it has the risk of distal embolism when stenting for a stenosis of the proximal common carotid artery because of poor stability of the guiding catheter resulting in difficulty in setting the embolic protection device prior to stenting. We present a novel therapeutic approach and technique for the treatment of tandem carotid stenoses including the proximal common carotid artery. A 63-year-old man presented with double stenoses at the common carotid artery and internal carotid artery...
November 4, 2018: Interventional Neuroradiology
George H Tse, Andrew Martin, Richard A Dyde, Stuart C Coley
A persistent hypoglossal artery was first described in 1889 and is one of the more common anatomical variations arising from aberration in normal development. Endovascular coiling has been recognised as a robust treatment for acutely ruptured intracranial arterial aneurysms, although specific data regarding an aneurysm arising from a persistent hypoglossal artery is lacking due to the low incidence. Here we report both the oldest patient reported to be treated with a persistent hypoglossal artery-associated aneurysm and also explicitly report endovascular treatment of a persistent hypoglossal artery aneurysm arising at the posterior inferior communicating artery origin...
November 4, 2018: Interventional Neuroradiology
Zeynep Hüseyinoglu, Marvin D Oppong, Andrew S Griffin, Erik Hauck
Direct carotid-cavernous fistulas (CCFs) are high flow lesions that can be challenging to treat. A number of recent reports suggest that flow diversion may be a viable treatment option. We present a case of a post-traumatic CCF successfully treated with flow diversion and provide a review of the literature. Our results suggest that flow diversion is a potentially effective treatment option for CCFs and is most successful when used as an adjunctive therapy.
October 31, 2018: Interventional Neuroradiology
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