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Interventional Neuroradiology

Thomas Raphael Meinel, Frauke Pult, Jan Gralla, Marcel Arnold, Claudio Bassetti, Simon Jung
A 76-year-old man with a history of arterial hypertension, obstructive sleep apnea, dyslipidemia, family history of cardiovascular events, prestroke and overweight presented 90 minutes after acute onset of right-sided sensorimotor hemiparesis, hemiataxia and dysarthria (National Institutes of Health Stroke Scale (NIHSS) 9/42). Magnetic resonance imaging (MRI) revealed a pontine ischemia and MR angiography showed a thrombus in the middle to distal portion of the basilar artery. Owing to the location, an occlusion of one lumen of a fenestrated basilar artery was suspected...
August 9, 2018: Interventional Neuroradiology
Anna Luisa Kühn, Peter Kan, Visish Srinivasan, David E Rex, Katyucia de Macedo Rodrigues, Mary C Howk, Ajay K Wakhloo, Ajit S Puri
Background To evaluate the feasibility and efficacy of the pipeline embolization device in the treatment of unruptured intracranial mirror segment aneurysms. Methods Out of a total of 338 subjects, 14 were identified harboring a total of 32 internal carotid artery mirror segment aneurysms that were treated with the pipeline embolization device and were consecutively enrolled into our study. We collected data on patient demographics, modified Rankin scale (mRS) at admission, aneurysm characteristics, clinical outcome at discharge, 3-9 and at 12-18 months as well as angiography results at follow-up...
August 6, 2018: Interventional Neuroradiology
Christoph Schwartz, Hans-Christoph Aster, Rahman Al-Schameri, Erasmia Müller-Thies-Broussalis, Christoph J Griessenauer, Monika Killer-Oberpfalzer
Objective Treatment of middle cerebral artery (MCA) aneurysms has been historically considered as the almost exclusive domain of microsurgical clipping. This retrospective single-center study assesses whether microsurgical clipping or endovascular treatment (i.e. coiling and/or stenting) for MCA aneurysms yielded better occlusion rates and clinical outcome. Methods We identified patients with a minimum clinical follow-up of 12 months who had undergone MCA aneurysm repair either by clipping or by endovascular treatment between 2005 and 2015...
August 2, 2018: Interventional Neuroradiology
Shouyuan Sun, Yongping Ji, Wenjun Ji, Aihua Liu, Zhongxue Wu
Objective Hemorrhage during embolization of dural arteriovenous fistula (DAVF) is a rare but devastating complication. This study was undertaken to analyze the causes of hemorrhage and avoid complication. Methods The clinical data of a case of DAVF with hemorrhagic complication were retrospectively collected and analyzed. Results The patient in this case presented with DAVF and two de novo aneurysms of a feeder artery after the first embolization. One de novo aneurysm ruptured during the second embolization of the DAVF because of hemodynamic change...
August 2018: Interventional Neuroradiology
Marco Varrassi, Sergio Carducci, Aldo V Giordano, Carlo Masciocchi
Endovascular approach represents today the first option in treatment of ruptured and unruptured cerebral aneurysms. Nevertheless, wide-neck bifurcation aneurysms still represent a technical challenge for endovascular treatment due to the need to protect vessels arising next to the aneurysmal neck. A variety of devices have been implemented to ensure adequate assistance for coiling of these lesions. Among these devices, the new pCONus 2 represents an evolution of the well-known pCONus; compared to the previous one in fact, it allows a degree of articulation and flexibility between the shaft and the distal part (crown), making it more suitable for treatment of aneurysms presenting an angle between the longitudinal axis of the dome and parent vessel...
August 2018: Interventional Neuroradiology
Nimer Adeeb, Justin Moore, Christoph J Griessenauer, Raghav Gupta, Ahad A Fazelat, Christopher S Ogilvy, Ajith J Thomas
Introduction Ophthalmic segment aneurysms may present with visual symptoms due to direct compression of the optic nerve. Treatment of these aneurysms with the Pipeline embolization device (PED) often results in visual improvement. Flow diversion, however, has also been associated with occlusion of the ophthalmic artery and visual deficits in a small subset of cases. Case report A 49-year-old Caucasian female presented with subarachnoid hemorrhage due to a ruptured anterior communicating artery aneurysm. On follow-up imaging, the patient was found to have a right asymptomatic ophthalmic segment aneurysm...
August 2018: Interventional Neuroradiology
Chao Li, Jing Yu, Kailing Li, Kun Hou, Jinlu Yu
The lateral foramen magnum region is defined as the bilateral occipital area that runs laterally up to the jugular foramen. The critical vasculatures of this region are not completely understood. Dural arteriovenous fistulas that occur in this region are rare and difficult to treat. Therefore, we searched PubMed to identify all relevant previously published English language articles about lateral foramen magnum dural arteriovenous fistulas, and we performed a review of this literature to increase understanding about these fistulas...
August 2018: Interventional Neuroradiology
G Foa Torres, F Roca, A Noguera, J Godes, S Petrocelli, I Aznar, S Ales, P Muszynski, R Maehara, M Vicente, J M Pumar
Background Flow-diverter stents have been successfully used in the treatment of complex aneurysms with limited therapeutic alternatives. We report our experience using the Silk flow diverter (SFD; Balt Extrusion, Montmorency, France) for the treatment of complex aneurysms in four Argentine centers. Methods We conducted a retrospective review of 246 consecutive patients who were treated with the SFD at four Argentine centers between January 2009 and January 2017. The patient and aneurysm characteristics, as well as the details of the procedure, were analyzed...
August 2018: Interventional Neuroradiology
Thomas W Link, Benjamin I Rapoport, Stephanie M Paine, Hooman Kamel, Jared Knopman
Background and purpose Embolization of the middle meningeal artery (MMA) has recently been proposed as an alternative to surgery for treatment of chronic subdural hematoma (SDH), and several case reports have been published supporting its efficacy. It has been suggested that the primary pathologic process in chronic SDH is repeated microhemorrhaging into the subdural collection from fragile neovasculature within the SDH membrane that arises from distal branches of the MMA. Embolization could thus provide a means of eliminating this chronic rebleeding...
August 2018: Interventional Neuroradiology
Shogo Oshikata, Kei Harada, Haruto Fujimura, Kozo Fukuyama
Stent-retriever thrombectomy for atherosclerotic acute occlusion of cerebral arteries is difficult. We experienced three patients with middle cerebral artery atherosclerotic occlusion who achieved successful recanalization with the combined use of aspiration thrombectomy devices and cerebral angioplasty balloons. The combination is feasible in terms of smooth delivery of the balloon catheter.
August 2018: Interventional Neuroradiology
T Mehta, N Desai, K Mehta, R Parikh, S Male, M Hussain, M Ollenschleger, G Spiegel, A Grande, M Ezzeddine, B Jagadeesan, R Tummala, L McCullough
Introduction Proximal cervical internal carotid artery stenosis greater than 50% merits revascularization to mitigate the risk of stroke recurrence among large-vessel anterior circulation strokes undergoing mechanical thrombectomy. Carotid artery stenting necessitates the use of antiplatelets, and there is a theoretical increased risk of hemorrhagic transformation given that such patients may already have received intravenous thrombolytics and have a significant infarct burden. We investigate the outcomes of large-vessel anterior circulation stroke patients treated with intravenous thrombolytics receiving same-day carotid stenting or selective angioplasty compared to no carotid intervention...
August 2018: Interventional Neuroradiology
Krishnan Nagarajan, Elango Swamiappan, Sathiaprabhu Anbazhagan, Ashwin Dalal, Subathra Adithan, Timo Krings
ACTA2 mutations are recently described genetically defined abnormalities of blood vessels in various organs of the body with specific abnormalities in cerebral vessels in the form of straightening of all cerebral arteries ("twig-like" pattern), stenosis/occlusions, proximal dilatation, and absent "moyamoya" type of collaterals. We describe a one-and-a half year-old girl child who presented with mild motor developmental delay and on neuroimaging showed septo-preoptic holoprosencephaly, diffuse radial polymicrogyria, and pontine hypoplasia along with magnetic resonance angiographic features suggestive of ACTA2 mutation type of cerebral vessels...
August 2018: Interventional Neuroradiology
Dong Yang, Min Lin, Shuiping Wang, Huaiming Wang, Yonggang Hao, Wenjie Zi, Penghua Lv, Dequan Zheng, Guodong Xiao, Gelin Xu, Yunyun Xiong, Xinfeng Liu
Objective The objective of this article is to compare the effectiveness of primary angioplasty and/or stenting with stent retriever thrombectomy in acute anterior large-vessel occlusion due to atherosclerotic disease. Methods Patients were retrospectively reviewed from the endovascular treatment for acute anterior circulation ischemic stroke registry. Patients with large-vessel occlusions due to atherosclerosis were selected. We evaluated modified Rankin Scale (mRS) score at 90 days, modified thrombolysis in cerebral infarction (mTICI) score immediately post-procedure, and symptomatic and asymptomatic intracranial hemorrhage within 72 hours...
August 2018: Interventional Neuroradiology
Tomotaka Ohshima, Shigeru Miyachi, Naoki Matsuo, Reo Kawaguchi, Aichi Niwa, Ryuya Maejima, Taiki Isaji, Masakazu Takayasu
Background and purpose In our previous study, we established the utility of 8-F balloon guide catheters for anterior circulation aneurysms. This study aims to assess the efficacy of the proximal flow control method using 8-F balloon guide catheters for coil deployment into the aneurysms as a novel adjunctive technique for aneurysmal coil embolisation along with local balloon neck remodeling, stent assist and double catheter techniques. Materials and methods We retrospectively analysed patients who underwent endovascular coiling of anterior circulation aneurysms between August 2013 and December 2017...
August 2018: Interventional Neuroradiology
Pervinder Bhogal, Leonard L Yeo, Hans Henkes, Timo Krings, Michael Söderman
Intracranial dural arteriovenous fistulae are a commonly encountered pathology that can present with a variety of different clinical symptoms. Although there is a significant body of work relating to the natural history and treatment of dural arteriovenous fistulae the exact underlying pathogenesis remains elusive. Various different pathogenetic models have been put forward but there is now a growing body of evidence implicating angiogenesis and the involvement of angiogenetic factors. In this review we attempt to show how the various animal and human studies performed over the past two decades have contributed to the proposed hypothesis on the development of dural arteriovenous fistulae...
August 2018: Interventional Neuroradiology
Jung Ho Ko, Young-Joon Kim, Hyun Ho Jung
A 24-year-old man was admitted with sudden severe headache. Brain computed tomography (CT) revealed a subarachnoid hemorrhage in the basal cistern and both Sylvian cisterns and a left internal carotid artery angiogram showed a small aneurysm on the bifurcation of the left middle cerebral artery. We performed Y-configured stent-assisted coil embolization. On the fifth post-embolization day, the patient had chills, and his body temperature was over 38℃. Staphylococcus aureus was cultured from the venous blood sample...
August 2018: Interventional Neuroradiology
Mostafa Mahmoud, Ramez Nader Abdalla, Ayman Hemdan Mohamed, Mostafa Farid
Cerebral pial fistula is a rare vascular pathology with no more than 150 cases reported. Most cases reported in infancy have been published as case reports. Owing to its high flow, its occurrence in this age group carries the potential risk of heart failure, chronic venous hypertension, seizures and, less frequently, cerebral haemorrhage. We present two cases of pial fistulae in infancy treated by endovascular embolisation using N-butyl cyanoacrylate. A review of the English-language literature was performed for this age group with special emphasis on ruptured cases...
August 2018: Interventional Neuroradiology
Alexandros Rentzos, Jan-Erik Karlsson, Christer Lundqvist, Lars Rosengren, Mikael Hellström, Gunnar Wikholm
Background and purpose Recent randomized clinical trials have proved the efficacy of endovascular treatment of acute ischemic stroke in the anterior circulation. However, the benefit of endovascular treatment of ischemic stroke in the posterior circulation remains to be proven since it was excluded from these trials. We evaluate the benefit of endovascular treatment in posterior circulation strokes. Methods A total of 110 consecutive patients with posterior circulation stroke who underwent endovascular treatment in our institute in the period 1991-2015 were included...
August 2018: Interventional Neuroradiology
Suresh Giragani, Santhosh Kumar Pavunesan, Anandh Balasubramaniam
Cerebral proliferative angiopathy (CPA) is a rare vascular abnormality and separate from "classical" brain arteriovenous malformations. Haemorrhage due to proliferative angiopathy is rarely reported. We describe the clinical features, imaging findings and targeted endovascular management for a 12-year-old boy having proliferative angiopathy of the posterior fossa presenting with haemorrhage. Targeted endovascular embolisation in CPA is not previously described in the literature. The optimal treatment options for haemorrhagic CPA are debatable, and we wish to highlight the role of targeted treatment for culprit focal lesion demonstrable on imaging...
August 2018: Interventional Neuroradiology
Marius Georg Kaschner, Julian Caspers, Christian Rubbert, Raul Lande, Bastian Kraus, John-Ih Lee, Michael Gliem, Sebastian Jander, Bernd Turowski
Introduction While effectiveness of mechanical thrombectomy (MTE) in M1 segment occlusion is approved for patients with severe impairment, there is a lack of evidence for a potential benefit of MTE in patients with minor to moderate symptoms. The purpose of this study was to evaluate neurological outcome and occurrence of periprocedural complications after MTE in patients with low National Institutes of Health Stroke Scale (NIHSS) scores. Materials and methods A retrospective analysis of 1081 consecutive patients with anterior circulation ischemic stroke due to M1 occlusion detected by computed tomography angiography and treated with MTE at our hospital between February 2012 and November 2017 was performed...
August 2018: Interventional Neuroradiology
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