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Interventional Neuroradiology

Stanimir Sirakov, Adriana Panayotova, Alexander Sirakov, Krasimir Minkin, Hristo Hristov
Internal carotid artery (ICA) injury is a rare but potentially life-threatening complication of skull base and neck surgery. Although usually manifested by massive intraoperative haemorrhage, impairment of the ICA might go unnoticed and result in formation of a pseudoaneurysm, causing delayed bleeding. Often additional complications are observed such as thrombosis, spasm, embolism or carotico-cavernous fistula formation. The risk of carotid artery injury in aggressive endonasal skull base surgical interventions ranges from 1% to 9%...
October 9, 2018: Interventional Neuroradiology
Pierre De Marini, Sanjeev Nayak, François Zhu, Serge Bracard, René Anxionnat, Romain Tonnelet, Liang Liao, Sébastien Richard, Lisa Humbertjean, Gioia Mione, Jean-Christophe Lacour, Anne-Laure Derelle, Benjamin Gory
Background and purpose A direct aspiration first pass technique involves first-line aspiration to remove the thrombus through a large-bore aspiration catheter in large vessel strokes. The aim of this study was to assess safety and clinical outcomes with a direct aspiration first pass technique using the new ARC catheter. Methods A retrospective analysis of prospectively collected data from three university hospitals was performed between June 2016 and May 2018. The following parameters of all acute ischemic stroke interventions using the ARC catheter were analyzed: use of intravenous thrombolysis, National Institutes of Health Stroke Scale scores at presentation and discharge, successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b-3), procedure duration, procedure-related complications and 90-day clinical outcome (modified Rankin Scale score)...
October 5, 2018: Interventional Neuroradiology
Dong Yang, Zhonghua Shi, Min Lin, Zhiming Zhou, Wenjie Zi, Huaiming Wang, Yonggang Hao, Fuqiang Guo, Wenhua Liu, Gelin Xu, Yunyun Xiong, Xinfeng Liu
Objective The endovascular treatment strategy for acute tandem occlusion stroke is challenging, and controversy exists regarding which lesion should be treated first. This study addresses the uncertainty regarding the priority choice for thrombectomy in acute anterior circulation tandem occlusion stroke. Methods We analysed the clinical and angiographic data of tandem stroke patients who underwent interventional therapy from the endovAsCular Treatment of acUte Anterior circuLation ischaemic stroke (ACTUAL) registry...
October 5, 2018: Interventional Neuroradiology
Claire Schwegel, Nicole Rothman, Kimberly Muller, Stephanie Loria, Katherine Raunig, Jamie Rumsey, Johanna Fifi, Thomas Oxley, J Mocco
Growth in the neurointerventional field, as a result of the emergence of thrombectomy as the gold standard treatment for large vessel occlusions, has created complex challenges. In an effort to meet evolving demands and fill workflow gaps, nurse practitioners have taken on highly specialized roles. Neurointerventional care has rapidly evolved similarly to interventional cardiac care, in that nurse practitioners are successfully being incorporated as procedural assistants in catheterization laboratories. Similar utilization of nurse practitioners in interventional neuroradiology holds the capacity to decrease physician workload, mitigate stresses contributing to burn-out, and reallocate more physician time to procedures...
September 30, 2018: Interventional Neuroradiology
Ryuichiro Kajikawa, Toshiyuki Fujinaka, Hajime Nakamura, Manabu Kinoshita, Takeo Nishida, Haruhiko Kishima
Background and purpose We report the outcomes of carotid artery stenting for patients with angiographically visible occipital artery-vertebral artery anastomosis. Methods Among 47 consecutive patients who underwent carotid artery stenting from January 2007 to December 2010, seven patients for whom cerebral angiograms clearly showed occipital artery-vertebral artery anastomosis were selected. Four different protection methods were used: distal internal carotid artery protection; carotid flow reversal; seatbelt and airbag technique; and double protection method of protecting both the external and internal carotid artery...
September 30, 2018: Interventional Neuroradiology
Baorui Zhang, Xin Feng, Fei Peng, Luyao Wang, Er Kang Guo, Yupeng Zhang, Peng Liu, Zhongxue Wu, Aihua Liu
Background Brain arteriovenous malformation (bAVM)-related epilepsy can significantly affect patient quality of life. We aimed to identify the factors associated with seizures occurrence and evaluate the long-term outcome following Onyx embolization in bAVM patients. Methods Between July 2014 and July 2016, 239 consecutive patients underwent treatment for bAVMs in our institute and were respectively analyzed. Demographics, seizure status and bAVM morphologic characteristics were recorded. Modified Engel classification was used to evaluate the long-term seizure outcomes...
September 30, 2018: Interventional Neuroradiology
Prasert Iampreechakul, Wuttipong Tirakotai, Adisak Tanpun, Yodkhwan Wattanasen, Punjama Lertbusayanukul, Somkiet Siriwimonmas
Spontaneous regression of direct carotid-cavernous fistulas (CCFs) is extremely rare. Most of the patients with direct CCFs are usually treated using endovascular techniques. Spontaneous obliteration of the direct fistulas probably results from thrombosis of the venous drainage and/or cavernous sinus. We report spontaneous closure of nine direct CCFs in nine patients. From literature review, we found another 37 patients with 43 fistulas due to spontaneous obliteration of bilateral lesions in six cases. There was no spontaneous closure in large-sized fistula...
September 23, 2018: Interventional Neuroradiology
Iacopo Valente, Francesco D'Argento, Andrea Alexandre, Emilio Lozupone, Giuseppe Garignano, Alessandro Pedicelli
Background The Barrel vascular reconstruction device is an electrolytically detachable laser-cut closed-cell stent used for neck reconstruction in wide-necked bifurcation aneurysms to support coiling without necessitating dual stent implantation. The purpose is to lower the metal-to-artery ratio and its inherent risk of thromboembolic complications of multiple stents. Case description A 53-year-old woman presenting with subarachnoid hemorrhage due to acutely ruptured basilar tip aneurysm underwent emergency endovascular embolization with the Barrel vascular reconstruction device...
September 20, 2018: Interventional Neuroradiology
Edward Am Duckworth, Gouthami Chintalapani, Kevin M Camstra, Peter Kan
Objective Contrast-enhanced cone-beam computed tomography (CBCT) imaging is commonly used for evaluating neurovascular stents and their relationship to the parent artery or vascular pathologies such as arteriovenous malformations (AVMs) and dural arteriovenous fistulas (dAVFs) in the context of surrounding anatomical structures. The purpose of this study was to understand the effects of varying concentrations of contrast medium used in CBCT imaging for optimal visualization of various endovascular devices and anatomical pathologies...
September 19, 2018: Interventional Neuroradiology
Krishna Amuluru, James P Ho, Fawaz Al-Mufti, Sten Solander, Charles E Romero
A fetal posterior cerebral artery (FPCA) is an anatomic variant in which the posterior cerebral artery is an embryological derivative of the internal carotid artery. Although most cases of ischemic strokes in patients with FPCAs involve embolic infarcts, emergent large vessel occlusion of a FPCA is extremely rare. We present two cases of successful endovascular intervention for emergent occlusion of a FPCA, one of which is only the second reported case of a mechanical thrombectomy of a FPCA. We review the embryology of FPCA, the controversy regarding its association with cerebral infarcts, and various approaches used in the treatment of such occlusive lesions...
September 19, 2018: Interventional Neuroradiology
Norito Fukuda, Kazuya Kanemaru, Koji Hashimoto, Hideyuki Yoshioka, Nobuo Senbokuya, Takashi Yagi, Hiroyuki Kinouchi
A peripheral cerebral aneurysm is known to develop at collateral vessels as a result of hemodynamic stress by the occlusion of the intracranial major arteries. We report a case of successful embolization of a ruptured aneurysm through a transdural anastomotic artery. The aneurysm formed at the developed collateral vessel from the meningeal branch of the occipital artery (OA) to the posterior pericallosal artery. A 59-year-old man presented with acute-onset headache, and computed tomography revealed subarachnoid hemorrhage and intracerebral hemorrhage at the splenium of the corpus callosum with intraventricular hemorrhage...
September 19, 2018: Interventional Neuroradiology
Behnam Hosseini, Mehrdad Taheri, Kourosh Sheibani
Purpose To evaluate the therapeutic efficacy of intradiscal ozone injection in reducing pain and improving patients' performance in different types of intervertebral disc herniation based on Michigan State University (MSU) classification. Patients and methods Consecutive patients with low back pain and radiculopathy treated in our center with ozone chemonucleolysis from May 2017 through to January 2018 entered the study. Patients had a disc herniation classified as group 1-A, 2-A, 1-B, 2-B, 1-C, 2-C, 1-AB or 2-AB based on MSU classification in magnetic resonance imaging...
September 18, 2018: Interventional Neuroradiology
Patrick Nicholson, Christopher Hilditch, Waleed Brinjikji, Timo Krings
There are fewer than 20 published case reports of bradycardia or asystole during intracranial embolisation procedures. These are well described in open neurosurgical procedures, particularly involving the skull base. We present a case of a 59-year-old male patient who presented for elective embolisation of a dural arteriovenous fistula. During the injection of Onyx, the patient experience sudden asystole, which recurred after a second Onyx injection. Following successful treatment, a third injection proceeded without incident...
September 18, 2018: Interventional Neuroradiology
Zongli Han, Yanli Du, Jinhui Chen, Hui Qi
Entrapment of aneurysm embolization hardware is an extremely rare complication of endovascular neurointerventional procedures. We describe a case of a retained guidewire in a 42-year-old male during an aneurysm embolization. After unsuccessful attempts at removal via interventional methods, we decided to leave the guidewire within the vessel. A guidewire fracture resulted in several fragments in the carotid artery and aorta with subsequent cardiac tamponade, pseudoaneurysm and aortojejunal fistula two years later...
September 18, 2018: Interventional Neuroradiology
Tomoaki Suzuki, Kouichirou Okamoto, Nobuyuki Genkai, Yasushi Ito, Hiroshi Abe
Background Peripheral anterior inferior cerebellar artery (AICA) aneurysms are rare and commonly associated with vascular malformations, such as cerebellar arteriovenous malformations (AVMs). We present a case wherein multiple AICA feeding aneurysms on the subarcuate artery as a feeding artery of a Borden type I transverse-sigmoid dural arteriovenous fistula (dAVF) manifested as subarachnoid hemorrhage. Case description A 67-year-old woman presented with acute severe headache. Brain computed tomography (CT) demonstrated subarachnoid hemorrhage mainly in the posterior fossa...
September 18, 2018: Interventional Neuroradiology
Stanimir S Sirakov, Alexander Sirakov, Krasimir Minkin, Hristo Hristov, Kristian Ninov, Marin Penkov, Vasil Karakostov, Kirill Orlov, Anton Gorbatykh, Dmitry Kislitsin, Radoslav Raychev
Background Precipitating hydrophobic injectable liquid is a newly introduced liquid embolic agent for endovascular embolization with some technical advantages over other liquid embolic agents. We present our initial experience with precipitating hydrophobic injectable liquid in the endovascular treatment of cerebral arteriovenous malformations. Methods From October 2015 to January 2018, 27 patients harboring cerebral arteriovenous malformations underwent endovascular embolization with precipitating hydrophobic injectable liquid 25...
September 17, 2018: Interventional Neuroradiology
Jun Tsukano, Satoshi Kurabe, Tsutomu Sugai, Manabu Wada, Takashi Kumagai
We describe a case of acute middle cerebral artery occlusion in a patient with ipsilateral internal carotid artery dysgenesis successfully treated with mechanical thrombectomy utilising a collateral pathway. During the procedure, a triaxial system using a balloon guiding catheter, flexible large lumen aspiration catheter and stent retriever was advanced from the left vertebral artery to the occluded left middle cerebral artery through the left posterior communicating artery. Because proximal aspiration from the balloon guiding catheter alone might have insufficient suction force due to the retrograde blood flow from large vascular communications (e...
September 12, 2018: Interventional Neuroradiology
Sbt van Rooij, W J van Rooij, M Sluzewski, J P Peluso
Introduction The Woven EndoBridge (WEB) device is a novel intrasaccular flow disrupter designed for wide-necked aneurysms. We present our results of WEB treatment in previously treated and reopened aneurysms. Materials and methods Between February 2015 and December 2017, 17 patients with reopening of previously treated aneurysms were treated using the WEB device. Initial treatment was clipping in one, WEB in five and coiling in 11 aneurysms. Six aneurysms had two or three previous treatments. Mechanism of aneurysm reopening was clip remnant in one, compaction without regrowth in three, focal regrowth in five, reopening in partially thrombosed aneurysms in three and WEB compression in five aneurysms...
September 12, 2018: Interventional Neuroradiology
Nicholas Befera, Andrew S Griffin, Erik F Hauck
A 48-year-old woman presented with an acute ischemic stroke (National Institutes of Health Stroke Scale (NIHSS) 21) six hours after symptom onset. Workup revealed a left cervical internal carotid artery (ICA) occlusive dissection, which was emergently reconstructed with a flow-diverting stent. A routine Duplex scan one hour later suggested reocclusion of the ICA, confirmed by angiography. The true lumen of the ICA could not be accessed and therefore the "false lumen" of the ICA dissection was entered proximally...
September 6, 2018: Interventional Neuroradiology
Alejandro Santillan, Justin Schwarz, Srikanth Boddu, Y Pierre Gobin, Jared Knopman, Athos Patsalides
Background and purpose This retrospective study evaluates the safety and mid-term and long-term effectiveness of stent-assisted coil embolization of anterior communicating artery (Acomm) aneurysms treated with the LVIS Jr stent. Materials and methods All patients treated with the LVIS Jr stent for Acomm aneurysms between June 2015 and March 2018 were included in the analysis. Details of the procedure's periprocedural adverse events, immediate aneurysm occlusion rates, and clinical and angiographic follow-up assessment were collected...
September 4, 2018: Interventional Neuroradiology
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