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Interventional Neuroradiology

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https://www.readbyqxmd.com/read/27903925/onyx-extravasation-during-embolization-of-a-brain-arteriovenous-malformation
#1
Hiroyuki Ikeda, Hirotoshi Imamura, Yuji Agawa, Yukihiro Imai, Shoichi Tani, Hidemitsu Adachi, Tatsuya Ishikawa, Yohei Mineharu, Nobuyuki Sakai
During Onyx embolization to treat brain arteriovenous malformation (AVM), carefully observing the penetration of Onyx to the nidus is important in order to avoid complications such as hemorrhage, ischemia, and difficulty with microcatheter removal. We encountered a case of Onyx extravasation during embolization of a cerebellar AVM confirmed by surgical resection and pathological analysis. The patient was a 44-year-old man with Spetzler-Martin grade I cerebellar AVM who underwent Onyx embolization prior to resection of the brain AVM...
November 30, 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27895243/contrast-less-stent-placement-for-vertebral-artery-origin-stenosis
#2
Shinzo Ota, Yoshinobu Sekihara, Takahiro Himeno, Yasue Tanaka, Tatsuya Ohtonari
We performed stent placement under intravascular ultrasound (IVUS), without the use of contrast medium, in a male patient in his 70s who had vertebral artery origin stenosis and decreased renal function. Satisfactory dilatation was achieved without complications, and the patient remained asymptomatic at 2 years of follow-up. We now report the details of this procedure. Stent placement under IVUS guidance may be useful in patients in whom contrast medium is contraindicated.
November 28, 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27895242/availability-of-endovascular-therapies-for-cerebrovascular-disease-at-primary-stroke-centers
#3
Mark J Alberts, Jean Range, William Spencer, Vicki Cantwell, M J Hampel
BACKGROUND: Endovascular therapies (EVTs) are useful for treating cerebrovascular disease. There are few data about the availability of such services at primary stroke centers (PSCs). Our hypothesis was that some of these services may be available at some PSCs. METHODS: We conducted an internet-based survey of hospitals certified as PSCs by the Joint Commission. The survey inquired about EVTs such as intra-arterial (IA) lytics, IA mechanical clot removal, coiling of aneurysms, and cervical arterial stenting, physician training, coverage models, hospital type, and outcomes...
November 28, 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27895241/secular-pattern-of-aneurismal-rupture-with-the-lunar-cycle-and-season
#4
Jillian C Banfield, Mohamed Abdolell, Jai S Shankar
BACKGROUND: The lunar cycle and seasons may be associated with rates of rupture of intracranial aneurysms, but the literature is mixed. Studies of the association between the lunar cycle and rates of aneurysm rupture used the eight qualitative moon phases. The purpose of this study was to assess any association of aneurysm rupture with the lunar cycle and with the season. MATERIALS AND METHODS: We retrospectively reviewed all cases of subarachnoid haemorrhage secondary to ruptured intracranial aneurysm treated with endovascular coiling in our institution over a 10-year period...
November 28, 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27837112/endovascular-treatment-of-vein-of-galen-aneurysmal-malformation-using-rapid-ventricular-pacing-a-case-report
#5
Birgitta Ramgren, Olof Rask, Jan Gelberg, Petru Liuba, Per Undrén, Johan Wassélius
The treatment of choice of vein of Galen aneurysmal malformation (VGAM) involves endovascular procedures that can be difficult to perform in high-flow fistulas. We describe the use of rapid ventricular pacing (RVP), a well-known cardiologic technique, to safely treat a high-flow fistula in an infant with VGAM.
November 10, 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27815339/should-future-interventional-neuroradiologists-be-screened-for-mutations-that-impair-radiation-induced-dna-repair
#6
REVIEW
Kieran Murphy, Adam Thakore, Marie Constance Lacasse, Danyal Z Khan
In our current medical practice, an increasing number of specialists now have access to radiology technical platforms in order to perform imaging-guided procedures. Although knowledge about the current guidelines and radiation protection devices is a pre-requisite for the use of radiation, the preventive measures are often more or less strictly followed, leading to chronic daily exposure to significant doses of radiation and large accumulated lifetime exposures. Aortic intervention, electrophysiology, and neuro intervention in particular can result in large doses to the operators...
November 4, 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27789620/scalp-congenital-hemangioma-with-associated-high-output-cardiac-failure-in-a-premature-infant-case-report-and-review-of-literature
#7
Sumedh S Shah, Brian M Snelling, Samir Sur, Alexandra R Ramnath, Emmalee S Bandstra, Dileep R Yavagal
INTRODUCTION: Scalp congenital hemangiomas (CHs) are rare vascular malformations among infants; they can be associated with an array of complications, including cardiac and cosmetic issues. Here, we report the endovascular treatment of a premature infant with a suspected large right parietal scalp hemangioma and associated high-output cardiac failure. CASE DESCRIPTION: A two-day-old female premature infant (29 weeks gestational age; 1330 g birth weight) was referred by the neonatologists to our department for consultation and potential treatment of a large right parietal CH causing abrupt hypotension and high-output cardiac failure...
October 27, 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27789619/coil-embolization-through-the-marathon-microcatheter-advantages-and-pitfalls
#8
Joel S Beckett, Gary R Duckwiler, Satoshi Tateshima, Viktor Szeder, Reza Jahan, Nestor Gonzalez, Fernando Vinuela
Due to technical limitations, small, distal, and tortuous intracranial pathology is sometimes out of reach of the current armamentarium of microcatheters designed for intracranial coil embolization. The Marathon microcatheter (Medtronic, Minneapolis, Minnesota, USA), designed specifically for the delivery of Onyx, is longer and more flexible than most coil delivery catheters. We report on nine patients (three with arteriovenous fistula, three with arteriovenous malformation, two with intracranial aneurysm, and one with tumor) where Marathon was used to deliver commercially available platinum coils...
October 27, 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27798328/cerebral-venous-sinuses-thrombosis-in-both-transverse-sinus-and-torcula-multistep-endovascular-treatment-and-stenting
#9
G Cabral de Andrade, A Lesczynsky, V M Clímaco, E R Pereira, P O Marcelino, Aoc Franco, D F De Almeida
PURPOSE: Cerebral venous sinus thrombosis (CVST) is an unusual and potentially life-threatening condition with variable and nonspecific clinical symptoms and high morbimortality rates. Standard therapy consists of systemic anticoagulation; although there is no clear evidence about the best choice for treatment, intravenous heparin is used as the first-line treatment modality. Intravenous sinus thrombolysis can be an effective and relatively safe treatment for acutely deteriorating patients who have not responded to conventional therapy...
October 26, 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27798327/effects-on-vessel-measurement-accuracy-and-subsequent-occlusion-after-calcium-channel-blocker-infusion-during-treatment-of-cerebral-aneurysms-with-the-pipeline-embolization-device
#10
M D Alexander, A D Nicholson, R J Darflinger, F Settecase, D L Cooke, C F Dowd, M R Amans, R T Higashida, S W Hetts, V V Halbach
INTRODUCTION/PURPOSE: To achieve aneurysm occlusion, flow diverters (FDs) must be accurately sized to maximize coverage over the neck and induce thrombosis. Catheterization for diagnostic angiography can cause vasospasm that may affect vessel measurements. This study evaluates impacts of intra-arterial infusion of a calcium channel blocker (CCB) on angiographic measurements in patients treated with FDs to determine effects on final diameter of the FD and subsequent occlusion. MATERIALS AND METHODS: Pre-treatment measurements were recorded for diameter of the distal and proximal landing zones and maximum and minimum diameters between these segments...
October 26, 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27798326/traumatic-arteriovenous-fistula-between-the-extracranial-middle-meningeal-artery-and-the-pterygoid-plexus-a-case-report-and-literature-review
#11
Jinlu Yu, Yunbao Guo, Zhongxue Wu, Kan Xu
The formation of a traumatic arteriovenous fistula (AVF) between the extracranial middle meningeal artery (MMA) and the pterygoid plexus (PP) is very rare, and understanding of this condition is limited. This paper reports the case of an 8-year-old who suffered minor injuries after a high fall four months prior to admission and showed good recovery after one month. However, the child gradually developed exophthalmos of the left eye and conjunctival redness one month prior to admission. Auscultation revealed an intracranial murmur near the left side of the face, in the temporal region...
October 26, 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27798325/dynact-angiography-for-the-diagnosis-of-bilateral-bow-hunter-s-syndrome
#12
Tony Lu, Ponraj Chinnadurai, Javier E Anaya-Ayala, Orlando M Diaz
We herein present a rare case of bilateral positional vertebrobasilar insufficiency secondary to mechanical obstruction of the V2 segment of the vertebral artery in a 71-year-old patient presenting with vertigo, occipital headache, tremors and respiratory irregularities. Two-dimensional digital subtraction angiography is the traditional diagnostic imaging standard but does not capture any peri-vascular bony or soft tissue abnormalities that are important to understand the three-dimensional pathophysiology. Intra-procedural cone-beam computed tomography (CT) is an increasingly used diagnostic adjunct, available in most modern angiographic suites that allows for the three-dimensional visualization of the vasculature as well as CT-like soft tissue visualization of its surrounding anatomy...
October 26, 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27798324/intentional-subintimal-carotid-stenting-of-internal-carotid-dissection-in-a-patient-with-acute-ischaemic-stroke
#13
Nicola Limbucci, Sergio Nappini, Andrea Rosi, Leonardo Renieri, Arturo Consoli, Salvatore Mangiafico
Carotid artery dissection is a common cause of juvenile stroke. Endovascular treatment of acute stroke due to carotid dissection can be challenging, and endoluminal crossing of the dissection is sometimes impossible. We describe a case of intentional subintimal recanalisation of a cervical carotid dissection followed by intracranial thrombectomy and stenting. We report the case of a young woman with severe acute ischaemic stroke due to carotid artery dissection and intracranial embolism. After failure of endoluminal crossing of the dissected segment, intentional subintimal crossing with re-entry distally to the dissection was achieved and a stent was deployed...
October 26, 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27765866/unexpected-complications-with-head-and-neck-hydrogel-microsphere-particle-embolization-a-case-series-and-a-technical-note
#14
Naim N Khoury, Pierre-Olivier Champagne, Marc Kotowski, Jean Raymond, Daniel Roy, Alain Weill
Endovascular particle embolization is a common procedure with a relatively safe profile. We report here four cases in which cranial nerves, skin and mucosal ischemic complications occurred with the use of hydrogel microspheres (250-500 µm in size). Given the compressibility and higher penetration potential of microsphere particles compared with polyvinyl alcohol particles of similar size, we suggest oversizing hydrogel microsphere particles for head and neck embolizations.
October 20, 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27760885/prasugrel-versus-clopidogrel-in-stent-assisted-coil-embolization-of-unruptured-intracranial-aneurysms
#15
Jacques Sedat, Yves Chau, Jean Gaudart, Marina Sachet, Stephanie Beuil, Michel Lonjon
BACKGROUND: Thromboembolic complications are the main problem in stent-assisted coil embolization of unruptured intracranial aneurysms. The combination of aspirin and clopidogrel is generally used to decrease these complications, but some patients do not respond to clopidogrel and have a higher risk of stent thrombosis. In cardiology, clinical trials have shown that prasugrel reduced the incidence of ischaemic events in patients with acute coronary syndrome compared with clopidogrel but, according to several authors, prasugrel would produce an increased risk of cerebral haemorrhagic complications...
October 19, 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27760884/embolization-with-larger-caliber-coils-can-increase-packing-density-evidence-from-the-pilot-phase-of-a-randomized-trial
#16
Francis Cloutier, Naim Khoury, Jimmy Ghostine, Behzad Farzin, Marc Kotowski, Alain Weill, Daniel Roy, Jean Raymond
BACKGROUND AND PURPOSE: Endovascular coil embolization of cerebral aneurysms is associated with suboptimal angiographic results in up to 20-30% of patients. Coil packing density has been used as an index of the success of the initial procedure. The trial sought to study the effects of using 15-caliber coils, as compared with 10-caliber coils, on packing density. METHODS: Does Embolization with Larger coils lead to better Treatment of Aneurysms (DELTA) is an investigator-initiated multicenter prospective, randomized, controlled clinical trial...
October 19, 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27703060/quantitative-assessment-of-parent-vessel-and-distal-intracranial-hemodynamics-following-pipeline-flow-diversion
#17
Sophia F Shakur, Victor A Aletich, Sepideh Amin-Hanjani, Ahmed E Hussein, Fady T Charbel, Ali Alaraj
BACKGROUND: Pipeline embolization devices (PEDs) are commonly used for endovascular treatment of cerebral aneurysms but can be associated with delayed ipsilateral intraparenchymal hemorrhage. Although intra-aneurysmal hemodynamic changes have been studied, parent vessel and intracranial hemodynamics after PED use are unknown. We examine the impact of flow diversion on parent artery and distal intracranial hemodynamics. METHOD: Patients with internal carotid cerebral aneurysms treated with PED who had flow volume rate, flow velocities, pulsatility index, resistance index, Lindegaard ratio, and wall shear stress (WSS) obtained after treatment using quantitative magnetic resonance angiography were reviewed...
October 4, 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27609753/early-experience-with-the-penumbra-smart-coil-in-the-endovascular-treatment-of-intracranial-aneurysms-safety-and-efficacy
#18
Christopher J Stapleton, Collin M Torok, Aman B Patel
BACKGROUND: Penumbra SMART coils differ from traditional microcoils used for endovascular coil embolization of intracranial aneurysms (IAs) in that they (1) become progressively softer from their distal to proximal end, rather than being of uniform stiffness, (2) have a tight conformational structure, and (3) have a more robust stretch-resistance platform. These properties aid in preventing microcatheter prolapse and coil herniation during coil deployment and in filling small pockets of the aneurysm sac...
September 8, 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27609752/incidence-and-predictors-of-headache-relief-after-endovascular-treatment-in-patients-with-unruptured-intracranial-aneurysms
#19
Wenjun Ji, Aihua Liu, Xinjian Yang, Youxiang Li, Chuhan Jiang, Zhongxue Wu
OBJECTIVE: Patients with unruptured intracranial aneurysms often present with headaches. We retrospectively determined the incidence of headache relief in patients with unruptured intracranial aneurysms after endovascular treatment, with the main goals of preventing aneurysmal haemorrhage and identifying factors associated with headache relief in a cohort study. METHODS: From a cohort of patients with unruptured intracranial aneurysms who were treated with endovascular coiling and admitted between January 2012 and December 2014, we included 123 patients who had headaches and underwent regular follow-up...
September 8, 2016: Interventional Neuroradiology
https://www.readbyqxmd.com/read/27605545/feasibility-and-value-of-preoperative-embolization-of-a-congenital-choroid-plexus-tumour-in-the-premature-infant-an-illustrative-case-report-with-technical-details
#20
Tariq Aljared, Jean-Pierre Farmer, Donatella Tampieri
We present a case of a preterm boy (born at 35 weeks of pregnancy) who was delivered urgently by a caesarean section due to placental abruption. The baby was found to have a tense fontanelle leading to imaging that showed a 5.5 cm right intraventricular mass centred in the atrium, hydrocephalus and extensive surrounding vasogenic oedema. The mass was avidly enhancing with a few large associated vessels suggesting high vascularity. The condition of the baby was acutely deteriorating. He had multiple seizures followed by persistent low level of consciousness in the third day of life...
September 7, 2016: Interventional Neuroradiology
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