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Shigeru Miyachi, Ryo Hiramatsu, Hiroyuki Ohnishi, Kenkichi Takahashi, Toshihiko Kuroiwa
For many years, the pathophysiology of idiopathic intracranial hypertension (IIH) was interpreted as "secondary intracranial hypertension," and IIH was considered to be caused by brain edema due to obstructive sleep apnea. Another theory proposed cerebrospinal fluid (CSF) absorption impairment due to excessive medication with vitamin A derivatives. Other reports pointed out the importance of obesity, which may cause an impairment of intracranial venous drainage due to elevated right atrial pressure...
September 2018: Neurointervention
Mario Martínez-Galdámez, Claudio Rodríguez, Antonio Hermosín, Eduardo Crespo-Vallejo, Gonzalo Monedero, Juan Chaviano, Bin Zheng
Endoluminal reconstruction with a flow diverter device has emerged as a viable and often preferable alternative to traditional techniques for the treatment of intracranial aneurysms. Precise measurement and device selection are mandatory steps when considering flow diverters usage in order to avoid potential complications. In this sense, incomplete wall-apposition has been described as a predictive factor for immediate in-stent and delayed thrombosis after stent use. One significant usage limitation of flow diverter devices is the parent artery diameter, since the maximum opening of the sizes available are recommended for vessel diameters between 5...
September 2018: Neurointervention
Boris Pabón Guerrero, Carlos Díaz Pacheco, Ahmed Saied, Krishna Joshi, Claudio Rodríguez, Mario Martínez-Galdámez, Demetrius K Lopes
A 64-year-old female presented with an incidentally-discovered right posterior inferior cerebral artery (PICA) aneurysm, initially treated in 2015 by simple coiling. Follow-up demonstrated significant coil compaction that required retreatment. Retreatment was done uneventfully using a Pipeline embolization device (PED) shield deployed starting from the basilar artery and ending at the V4 segment of the vertebral artery. Eight-weeks post-deployment, a follow-up digital subtraction imaging (DSA) and intravascular imaging with optical coherence tomography were obtained...
September 2018: Neurointervention
Hyun-Seung Kang
No abstract text is available yet for this article.
September 2018: Neurointervention
Dongwhane Lee, Yunsun Song, Minkyu Han, Danbi Park, Dae Chul Suh
Thromboembolism is one of the major complications of stent assisted coiling in treatment of cerebral aneurysm. Clopidogrel resistance is so common and prasugrel is more effective in its rapid and potent effect. We investigated changes in the value of P2Y12 resistance unit (PRU) when prasugrel was administered to patients with clopidogrel resistance. One hundred mg of aspirin and 75 mg of clopidogrel were administered for 5 days before the procedure, and PRU were examined. The resistance to clopidogrel was defined as the inhibition of PRU was less than 20%...
September 2018: Neurointervention
Zhen Yu Jia, Yuan Yuan Jiang, Jung Min Woo, Seon Moon Hwang, Ok Kyun Lim, Tae Il Kim, Jung Cheol Park, Hee Sun Lee, Eun Sang Kim, Deok Hee Lee
PURPOSE: Wide-neck aneurysms (WNAs) associated with a dilated parent artery (PA) are not uncommon morphological abnormalities and usually cause inappropriate wall apposition and incomplete neck coverage of a tubular stent in stent-assisted coiling of aneurysms. We aimed to introduce a fusiform-shaped stent (FSS) and test its effectiveness in treating intracranial WNAs associated with a dilated PA using a three-dimensional (3D) model. MATERIALS AND METHODS: Two FSS types were designed with the middle one-third segment dilated by 10% (FSS10) and 20% (FSS20) and were compared with the tubular-shaped stent (TSS)...
September 2018: Neurointervention
Kittipong Riabroi, Khanin Khanungwanitkul, Prasert Wattanapongpitak, Anchali Krisanachinda, Keerati Hongsakul
PURPOSE: Neurointerventional radiology procedures often require a long time to perform. Patient radiation dose is an important issue due to the hazards of ionizing radiation. The objective of this study was to measure the peak skin dose (PSD) and effective dose to estimate the deterministic and stochastic effects of a therapeutic interventional neuroradiologic procedure. MATERIALS AND METHODS: The cumulative dose (CD) and dose area product (DAP) were automatically recorded by a fluoroscopic machine and collected prospectively between April and November 2015...
September 2018: Neurointervention
Kevin Phan, Julian Maingard, Hong Kuan Kok, Adam A Dmytriw, Sourabh Goyal, Ronil Chandra, Duncan Mark Brooks, Vincent Thijs, Hamed Asadi
PURPOSE: The evidence for endovascular therapy and choice of technique in distal middle cerebral artery (MCA) M2 segment occlusions in acute ischemic stroke remains controversial. We aimed to conduct a systematic review and meta-analysis primarily comparing reperfusion rates of stent-retrieval versus contact aspiration for M2 occlusions. MATERIALS AND METHODS: Study selection included cohorts of patients with distal MCA occlusions in acute ischemic strokes treated with an endovascular approach including stent-retrieval or contact aspiration...
September 2018: Neurointervention
Hak Cheol Ko, Chang-Woo Ryu, Seong Jong Yun, Jun Seok Koh, Hee Sup Shin, Eui Jong Kim
PURPOSE: Characteristic signs - the susceptibility vessel sign (SVS) and the prominent hypointense vessel sign (PHVS) - on T2*-based magnetic resonance imaging (T2*MRI) can be seen for acute ischemic stroke with large artery occlusion. In this study, we investigated the evidence to support our hypothesis that these findings may help to predict outcomes after reperfusion therapy. MATERIALS AND METHODS: We searched for papers describing SVS and PHVS in patients treated with reperfusion therapy for acute ischemic stroke, and their functional/radiologic outcomes were systematically reviewed...
September 2018: Neurointervention
Kwon-Duk Seo, Sang Hyun Suh
PURPOSE: As endovascular therapy (EVT) has been approved as a treatment guideline for acute ischemic stroke (AIS), it has been increasing in Korea. We conducted a nationwide survey to evaluate the current status of EVT for patients with AIS in Korea. MATERIALS AND METHODS: An electronic survey was sent to a representative clinician at each hospital where EVT was available in Korea. A Google survey was used to distribute the questionnaires and receive responses from October 2017 to December 2017...
September 2018: Neurointervention
Keun-Hwa Jung
Cerebral aneurysm is a common cerebrovascular disease that is sometimes complicated by rupture or an enlarged mass. We are now aggressively evaluating and managing unruptured cerebral aneurysms based on a significant concern for the high morbidity and mortality related to its associated complications. However, the actual rupture rate is very low and the diagnostic and treatment modalities are expensive and invasive, which may lead to unnecessary costs and potential medical complications. This disproportionate situation is related to a poor understanding of the natural course and pathophysiology of cerebral aneurysms...
September 2018: Neurointervention
Sangil Suh, Byung Moon Kim
No abstract text is available yet for this article.
September 2018: Neurointervention
Volker Maus, Anastasios Mpotsaris, Jan Borggrefe, Nuran Abdullayev, Thomas Liebig, Franziska Dorn, Pantelis Stavrinou, De-Hua Chang, Christoph Kabbasch
No abstract text is available yet for this article.
September 2018: Neurointervention
Chun On Anderson Tsang, Wan Lung Ryo Yeung, Ka Fung Mak, Wai Man Lui
No abstract text is available yet for this article.
September 2018: Neurointervention
Anup Singh, Kapil Sikka, Nishchint Jain, Leve Joseph Devarajan
Endovascular treatment is a standard mode of treatment for traumatic cavernous internal carotid artery (ICA) pseudoaneurysms with good results and relatively low rates of complications. We describe a case of an unusual, potentially fatal, delayed postoperative event happening in a case of post-traumatic pseudoaneurysm of ICA, which had been previously managed with endovascular coiling.
March 2018: Neurointervention
Tsang Chun On Anderson, Yeung Wan Lung Ryo, Mak Ka Fung, Lui Wai Man
We report a case of unique location of an aneurysm at the atlanto-axial extradural segment of a unilateral aberrant vertebral artery. The MRI vessel wall imaging findings and possible mechanism of aneurysm formation were discussed. A 5 mm extracranial vertebral artery aneurysm located at the interlaminar space between C1 and C2 was diagnosed in a woman presenting with occipital headache. The index vertebral artery ran an aberrant course at the V3 segment, where it entered the dura between C1 and C2 instead of the usual atlanto-occipital space...
March 2018: Neurointervention
Soumik Das, Arun Kumar Gupta, Arvinda Hanumathapura Ramalingiah
We report here a rare complication in the form of kinking of flow diverter in a case of giant wide-necked supraclinoid internal carotid artery (ICA) aneurysm 48 hours after the procedure. This 28-year female presented with giant wide-necked right supraclinoid ICA aneurysm which was managed by flow diversion. On 2nd post-op day, patient developed weakness of left side with altered sensorium - angiography and CT showed kinking of flow diverter at the neck of the aneurysm with poor distal flow. Eventually, the patient developed right middle cerebral artery infarct for which decompressive hemicraniectomy was done...
March 2018: Neurointervention
Michael Young, Greg Imbarrato, Ajeet Gordhan
A 74-year-old male developed cervical carotid artery psuedoaneurysm 8 months after carotid endarterectomy. The patient was successfully managed with dual implantation of flow-diverter and conventional carotid stent. Flow-diverter was placed across the neck of pseudoaneurysm to provide flow diversion while carotid stent was implanted within the lumen of the expanded flow-diverter to approximate and hold the flow diverter proximal and distal to the pseudoaneurysm. Follow-up ultrasonography revealed complete resolution of the pseudoaneurysm...
March 2018: Neurointervention
Su-Hee Cho, Ji-Ye Lee, Kyeong-Hwa Ryu, Dae Chul Suh
Purpose: False positive diagnoses of cerebral aneurysm via magnetic resonance angiography (MRA) screening may increase unnecessary cerebral catheter angiography. The purpose of this study was to investigate the effects of medical liability on medical decision-making during radiologic interpretation. Materials and Methods: We included 56 consecutive patients who were referred with suspected aneurysm based on MRA or computed tomography angiography (CTA) and showed no aneurysm on subsequent digital subtraction angiography (DSA)...
March 2018: Neurointervention
Dong Joon Kim, Dae Chul Suh, Byung Moon Kim, Dong Ik Kim
Purpose: Adjuvant coils may offer advantages in flow control during glue embolization of high flow vein of Galen aneurysmal malformation (VGAM) patients but involves specific issues such as feasibility, durability and coil mass effect. The purpose of this study is to assess the outcome of adjuvant coils in addition to transarterial glue embolization for treatment of these patients. Materials and Methods: Five pediatric VGAM patients (age range; 11 weeks to 2 yrs 2 mos) with high flow fistulous angioarchitecture were treated with adjuvant coils 1) in the distal feeding artery and/or 2) in the vein of Galen followed by glue embolization of the shunt...
March 2018: Neurointervention
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