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Endovascular embolization

A R Podgorsak, A C Venkataraman, S V Setlur Nagesh, D R Bednarek, S Rudin, A Siddiqui, C N Ionita
The imaging of endovascular devices during neurovascular procedures such as the coiling of aneurysms guided with CBCT imaging may be challenging due to the presence of highly attenuating materials such as platinum in the coil and stent marker, nickel-titanium in the stent, iodine in the contrast agent, and tantalum in the embolization agent. The use of dual-energy imaging followed by a basis material decomposition image processing-scheme may improve the feature separation and recognition. Two sets of testing were performed to validate this concept...
February 2018: Proceedings of SPIE
S V Setlur Nagesh, A Shankar, J Krebs, J Hinaman, D R Bednarek, S Rudin
Real-time visualization of fine details ranging to 100 um or less in neuro-vascular imaging guided interventions is important. A separate high-resolution detector mounted on a standard flat panel detector (FPD) was previously reported. This device had to be rotated mechanically into position over the FPD for high resolution imaging. Now, the new detector reported here has a high definition (Hi-Def) zoom capability along with the FPD built into one unified housing. The new detector enables rapid switching, by the operator between Hi-Def and FPD modes...
February 2018: Proceedings of SPIE
Zeferino Demartini Junior, Luana A Maranha Gatto, Gelson Luis Koppe, Tatiana F von Hertwig de Oliveira, Alexandre Novicki Francisco
Thromboembolism is the most frequent complication in endovascular treatment of intracranial aneurysms, causing disability and death. As stent retrievers have achieved high rates of arterial recanalization in the management of ischemic stroke, these devices were tested as rescue therapy of thromboembolism during aneurysm embolization. We retrospectively analyzed 10 consecutive patients with transprocedural arterial occlusion, treated with mechanical thrombectomy at a single center. Good angiographic recanalization was achieved in eight cases, mTICI 3, 2b and 2a in five, three and two patients, respectively, without additional complications or any deaths...
May 2018: Arquivos de Neuro-psiquiatria
Ahmed F Elmahrouk, Abdelmonem Helal, Mohamed F Ismail, Tamer Hamouda, Mohammed Mashali, Ahmed A Jamjoom, Jameel A Al-Ata
BACKGROUND: Isolated right Superior Vena Cava drainage into the left atrium in the absence of other cardiac anomalies is an extremely rare condition. The vein of Galen aneurysmal malformation is a congenital vascular malformation. It comprises 1% of all pediatric congenital anomalies. The association vein of Galen aneurysmal malformation, with congenital heart disease has been described. CASE PRESENTATION: We describe a 16-months old toddler presenting at 7-months of age with respiratory distress and cyanosis...
June 13, 2018: Journal of Cardiothoracic Surgery
Juan Parodi, Mark C Bates, Takao Ohki, Claudio Schönholz
Innovation in medicine is often driven by the observations of imaginative physicians who are blessed with insatiable curiosity, coupled with the inability to accept technical boundaries, the status quo of patient care, or the acceptance of procedural morbidity. Few examples illustrate this truism better than the physician-originated clinical research that transformed the safety of carotid stent angioplasty over the last 2 decades. Initial clinical application of carotid stenting suggested that proximal protection may be a better approach to prevent embolic stroke during the angioplasty procedure...
March 2018: Seminars in Vascular Surgery
Karel Novotný, Míla Roček, Radek Pádr, Radim Pavlík, Michal Polovinčák, Theodor Adla, Petra Zimolová, Jana Choi-Širůčková, Martin Weis, Simon Jirát, Vilém Rohn
BACKGROUND: Treating great and small saphenous vein trunk insufficiency with cyanoacrylate glue is the least taxing treatment method of all available techniques. Due to long-term unavailability of commercial kits with n-butyl-2-cyanoacrylate (histoacryl) in the Czech Republic, we used a modified technique. PATIENTS AND METHODS: Fifty-six limbs in 49 patients suffering from great saphenous vein or small saphenous vein insufficiency in combination with symptomatic chronic venous insufficiency and complicating comorbidities were treated with a modified endovascular cyanoacrylate glue application technique...
June 12, 2018: VASA. Zeitschrift Für Gefässkrankheiten
Yuki Yamamoto, Nobuaki Yamamoto, Junichiro Satomi, Izumi Yamaguchi, Masaaki Korai, Yasuhisa Kanematsu, Yasushi Takagi, Ryuji Kaji
Background: Dural arteriovenous fistulas (dAVFs) are extremely rare in the superior orbital fissure, and they exhibit ocular symptoms similar to the dAVF in the cavernous sinus because of the intraorbital venous congestion. Hence, the distinction of these conditions is imperative because of some inherent differences in endovascular treatment techniques. Case Description: A 58-year-old woman presented with a gradually worsening left eyeball protrusion and conjunctival congestion...
2018: Surgical Neurology International
Michael P DeWane, Wassim H Fares, Cassius Iyad Ochoa Chaar
Aneurysms associated with arteriovenous fistulas (AVF) are rare but can cause significant morbidity. They are often diagnosed after rupture, pain, or embolization. We describe a unique case of a 35-year-old woman with a large iliac vein aneurysm related to an acquired AVF incidentally discovered on ultrasound during pregnancy. She had a diagnosis of "idiopathic" pulmonary hypertension for several years. This report details the diagnosis and treatment with an arterial stent graft that was effective in decreasing the size of the venous aneurysm and reversing the systemic changes associated with the disease...
June 7, 2018: Annals of Vascular Surgery
Konstantinos G Moulakakis, Vangelis G Alexiou, Georgios Karaolanis, George S Sfyroeras, George Theoharopoulos, Andreas Lazaris, John Kakisis, George Geroulakos
AIM: Spinal cord ischemia (SCI) following endovascular abdominal aortic aneurysm (AAA) repair (EVAR) is a rare but devastating complication. The mechanism underlying the occurrence of SCI following EVAR seems to be multifactorial and is underreported and not fully elucidated. The aim of the study was to investigate the clinical outcomes in patients with this serious complication. MATERIAL-METHODS: A systematic review of the current literature, as per PRISMA statement guidelines, to evaluate the incidence of SCI following elective EVAR was performed...
June 6, 2018: Annals of Vascular Surgery
Daniel Umansky, Benjamin W Corn, Ido Strauss, Natan Shtraus, Shlomi Constantini, Vladimir Frolov, Shimon Maimon, Andrew A Kanner
PURPOSE: Treatment of cerebral arteriovenous malformations (AVM)-the most common cause of stroke in the pediatric population-can be challenging due to the complexity of size, morphology, and location. There is a significant risk in comparison to AVM treatment among adults. Thus, AVM treatment in the pediatric population imposes unique challenges. Recent improvements include optimized catheter techniques and better embolization materials, such as Onyx, a non-adhesive liquid embolic agent used in the adult population...
June 7, 2018: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
N Adeeb, C J Griessenauer, A A Dmytriw, H Shallwani, R Gupta, P M Foreman, H Shakir, J Moore, N Limbucci, S Mangiafico, A Kumar, C Michelozzi, Y Zhang, V M Pereira, C C Matouk, M R Harrigan, A H Siddiqui, E I Levy, L Renieri, T R Marotta, C Cognard, C S Ogilvy, A J Thomas
BACKGROUND AND PURPOSE: Flow diversion with the Pipeline Embolization Device is increasingly used for endovascular treatment of intracranial aneurysms due to high reported obliteration rates and low associated morbidity. While obliteration of covered branches in the anterior circulation is generally asymptomatic, this has not been studied within the posterior circulation. The aim of this study was to evaluate the association between branch coverage and occlusion, as well as associated ischemic events in a cohort of patients with posterior circulation aneurysms treated with the Pipeline Embolization Device...
June 7, 2018: AJNR. American Journal of Neuroradiology
Zi-Qiang Cai, Shi-Hong Chai, Xiang-Lei Wei, Ke-Zeng You, Jiang Li, Ding-Mei Zhang
The technique of stent-assisted coil embolization has been widely used in the clinic, while its efficacy and safety have yet to be evaluated. This study investigates the values of computed tomography angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA) in evaluating the Enterprise stent-assisted coil embolization in the treatment of intracranial wide-necked aneurysm.A total of 578 intracranial wide-necked aneurysm patients confirmed by MRA + CTA + DSA examinations were included and treated with Enterprise stent-assisted coil embolization in this study...
June 2018: Medicine (Baltimore)
Rosa Marie Andersen, Daniel P Henriksen, Hossein Mohit Mafi, Sten Langfeldt, Jacob Budtz-Lilly, Ole Graumann
PURPOSE: The aim of this study was to evaluate the incidence, risk factors, and outcome of endoleaks related to endovascular aneurysm repair (EVAR) procedure at a single center with up to 10 years' surveillance. MATERIALS AND METHODS: All patients treated with EVAR for an abdominal aorta or iliac aneurysm in a 10-year period at a single cardiovascular center in Denmark were included. Data were collected from a national database and patient journals. Follow-up computed tomography angiography and plain abdominal X-ray reports were reviewed...
January 1, 2018: Vascular and Endovascular Surgery
Kazushi Maeda, Ryota Motoie, Satoshi Karashima, Ryosuke Otsuji, Nice Ren, Shintaro Nagaoka, Yoshiaki Ikai, Junji Uno, Hidefuku Gi
Intraprocedural coil migration during endovascular treatment for an aneurysm that might carry serious ischemic complications is well known. On the other hand, delayed coil migration after endovascular treatment for an aneurysm is very rare. A 77-year-old woman was incidentally diagnosed with unruptured aneurysm associated with distal azygos anterior cerebral artery (ACA). The aneurysm was located at the distal bifurcation of the azygos ACA and was wide necked (approximately 7 mm in diameter). Endovascular coil embolization was selected and the aneurysm was occluded successfully, but 29 days after endovascular therapy, follow-up computed tomography (CT) and magnetic resonance (MR) angiography revealed distal coil migration in the peripheral portion of the ACA...
January 1, 2018: Interventional Neuroradiology
Fiona Rohlffs, Nikolaos Tsilimparis, Constantin Trepte, Jarin Kratzberg, John Mogensen, Eike Sebastian Debus, Tilo Kölbel
PURPOSE: To investigate the influence of (1) an additional side port for flushing the hollow pusher in Zenith thoracic stent-graft delivery systems and (2) additional carbon dioxide flushing on the amount of air released during stent-graft deployment. METHODS: Twenty thoracic stent-grafts with an additional flush port to fill the hollow pusher were separated into 2 equal groups (C and D). Both groups were flushed with 20 mL of normal saline through the extra side port connected to the pusher and with 60 mL of saline through the regular flushing port...
June 1, 2018: Journal of Endovascular Therapy
Chae Wook Huh, Jae Il Lee, Chang Hwa Choi, Tae Hong Lee, Jae Young Choi, Jun Kyeung Ko
Objective: Very large (20-25 mm) and giant (≥25 mm) intracranial aneurysms have an extremely poor natural course, and treatment of these aneurysms remains a challenge for endovascular and surgical strategies. This study was undertaken to describe our experiences of endosaccular treatment of very large and giant intracranial aneurysms with parent artery preservation. Methods: From January 2005 to October 2016, twenty-four very large or giant aneurysms in 24 patients were treated by endosaccular coil embolization with parent artery preservation...
June 5, 2018: Journal of Korean Neurosurgical Society
Daphne Li, Daniel M Heiferman, Brian D Rothstein, Hasan R Syed, Ali Shaibani, Tadanori Tomita
Scalp arteriovenous malformations (AVM), also known as cirsoid aneurysms, are rare lesions that are congenital, traumatic or post-infectious in nature. These lesions may be found incidentally or due to the signs and symptoms that they produce, such as an enlarging pulsatile mass, headache, tinnitus or bleeding. Treatment of these lesions usually consists of endovascular embolization followed by surgical resection. These lesions often constitute high flow arterial blood from the superficial temporal or occipital arteries with venous outflow into extracranial venous structures...
June 1, 2018: World Neurosurgery
Peixian Gao, Dianning Dong, Le Yang, Hai Yuan, Mo Wang, Jingyong Zhang, Zhenyue Zhong, Shiyi Zhang, Xing Jin, Xuejun Wu
Purpose Isolated iliac artery aneurysms are the relatively uncommon condition. This study aims to evaluate the technical issues and clinical outcomes of endovascular repair in a cohort of isolated iliac artery aneurysms treated. Methods We retrospectively reviewed 22 consecutive patients with isolated iliac artery aneurysms between December 2006 and September 2016. Iliac artery aneurysms were treated in one of the three ways: (1) standard bifurcated aortic stent graft placement with limb extension; (2) coverage of iliac artery aneurysms with covered stent grafts; and (3) embolization of the arterial branches distal to the aneurysms with coils or vascular plugs...
January 1, 2018: Vascular
Alejandro Berenstein, Srinivasan Paramasivam, Michelle Sorscher, Walter Molofsky, Dan Melia, Saadi Ghatan
BACKGROUND: Vein of Galen aneurysmal malformation (VGAM) is a rare congenital vascular malformation representing <1% of all arteriovenous malformations. The knowledge and strategies in the management are constantly evolving. OBJECTIVE: To review our series of postneonatal VGAM patients treated over 11-yr period. METHODS: Retrospective analysis of 113 VGAM treated between January 2004 and April 2015. After exclusions, 45 patients were included: 33 choroidal and 12 mural types...
June 1, 2018: Neurosurgery
Agustin Sibona, Jason C Smith, Daniel P Srikureja, Rahul Sharma, Carin Mascetti, Anees J Razzouk, David G Rabkin
Pulmonary embolization of a missile is a rare phenomenon. Localization after embolization can be confounding and there is no consensus on management. We report a case of a gunshot wound to the chest with preoperative and initial intraoperative imaging localizing the bullet to the right ventricle but a negative intraoperative exploration of the right-sided cardiac chambers. Intraoperative fluoroscopy allowed for immediate localization of the bullet to the hilum of the left lung with subsequent endovascular retrieval...
May 30, 2018: Annals of Thoracic Surgery
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