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Embolization flow

Jeremy J Heit, Greg Zaharchuk, Max Wintermark
Acute ischemic stroke (AIS) occurs when there is a sudden loss in cerebral blood flow due to embolic or thromboembolic occlusion of a cerebral or cervical artery. Patients with AIS require emergent neuroimaging to guide treatment, which includes intravenous thrombolysis and endovascular mechanical thrombectomy (EMT). Recent advances in AIS treatment by EMT has been driven in part by advances in computed tomography (CT) and MR imaging neuroimaging evaluation of ischemic penumbra and pial collateral vessels. The authors review advanced noninvasive brain imaging by CT and MR imaging for the evaluation of AIS focusing on penumbral and collateral imaging...
November 2018: Neuroimaging Clinics of North America
Patrick Meyer, Johann Otto Pelz
BACKGROUND: Complex blood flow patterns are a well-known phenomenon at the carotid bifurcation. However, unlike for the descending aorta, a blood flow reversal has not been detected at the carotid bifurcation, so far. METHODS: In 17 subjects, flow patterns with focus on blood flow reversal were examined at the carotid bifurcation with vector flow imaging. RESULTS: We found a blood flow reversal from the external carotid artery (ECA) into the internal carotid artery (ICA) in 13 of 25 (52%) carotid bifurcations...
October 12, 2018: Brain and Behavior
Hideki Ishimaru, Minoru Morikawa, Takayuki Sakugawa, Ichiro Sakamoto, Yasuhide Motoyoshi, Yohei Ikebe, Masataka Uetani
A male patient underwent conventional transcatheter chemoembolization for advanced recurrent hepatocellular carcinoma (HCC). Even after the injection of 7 mL of lipiodol followed by gelatin sponge particles, the flow of feeding arteries did not slow down. A repeat angiography revealed a newly developed vascular lake draining into systemic veins; however, embolization was continued without taking noticing of the vascular lake. The patient's level of consciousness deteriorated immediately after the procedure, and non-contrast computed tomography revealed pulmonary and cerebral lipiodol embolisms...
October 7, 2018: World Journal of Gastroenterology: WJG
Kei Takase
Recent introduction of multidetector-row computed tomography(MDCT) with more than 64 scanners enabled high-speed scanning in wide range of the body. Electrocardiogram (ECG) gated scanning and 4-dimensional imaging provides precise evaluation of cardiac and vascular diseases. Fine vascular structures such as the artery of Adamkiewicz can be visualized due to improved spatial and temporal resolution of CT and magnetic resonance imaging(MRI). Interventional radiology also plays important roles in combination with surgical treatment...
September 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Jin Soo Lee, Seong-Joon Lee, Joon Sang Yoo, Jeong-Ho Hong, Chang-Hyun Kim, Yong-Won Kim, Dong-Hun Kang, Yong-Sun Kim, Ji Man Hong, Jin Wook Choi, Bruce Ovbiagele, Andrew M Demchuk, Sung-Il Sohn, Yang-Ha Hwang
BACKGROUND AND PURPOSE: Little is known about prognosis after endovascular therapy (EVT) for acute large artery occlusion (LAO) caused by underlying intracranial atherosclerotic stenosis (ICAS). Therefore, we investigated the prognosis following EVT according to the underlying etiology of LAO. METHODS: Patients from the Acute Stroke due to Intracranial Atherosclerotic occlusion and Neurointervention-Korean Retrospective (ASIAN KR) registry (n=720) were included if their occlusion was in the intracranial anterior circulation and their onset-to-puncture time was <24 hours...
September 2018: Journal of Stroke
Ram Kishore Gurajala, Ehsan Fayazzadeh, Elie Nasr, Sankaran Shrikanthan, Shyam Srinivas, Karunakaravel Karuppasamy
OBJECTIVE: In acute gastrointestinal bleeding, despite positive dynamic phase 99 mTc-red blood cell scintigraphy, invasive catheter angiography (CA) is frequently negative. In this study, we investigated the value of flow phase scintigraphy in predicting extravasation on CA. METHODS: Institutional review board approval with a waiver of informed consent was obtained for this retrospective study. A total of 173 scintigraphy procedures performed in 145 patients with GIB between January 2013 and August 2014 were analysed...
October 11, 2018: British Journal of Radiology
Ajit Yadav, Gaurav Gangwani, Nitin Mishra, Arun Gupta
Occlusion of Portal Vein (PV) and Superior Mesenteric Vein (SMV) is a known effect of local infiltration by pancreatic or mesenteric neuroendocrine tumors. Venous occlusion leads to formation of collateral pathways to restore hepatopetal flow in main PV and these collateral pathways can be seen in the form of ectopic (duodenal or jejunal) varices. We present a case of bleeding duodenal varices secondary to SMV occlusion by a locally infiltrating pancreatic neuroendocrine tumor which was successfully treated by coil embolization of varices and SMV stenting of the occluded venous segment after failure of endoscopic glue injection...
September 2018: Journal of Clinical and Experimental Hepatology
Yoshiaki Katada, Shiro Onozawa, Shoichi Takahashi, Shigeru Suzuki
PURPOSE: To report an experimental study and clinical case using a coil packing technique that hastens occlusion of an Amplatzer Vascular Plug 1 (AVP1) in short-segment embolization of high-flow target vessels. TECHNIQUE: An experimental vascular stenosis model was made of 12-mm soft polyvinyl chloride tubing. Under continuous pulsatile flow, a 12-mm AVP1 was deployed in the 4-mm-diameter stenosis. Before detachment of the AVP1, a 2.2-F microcatheter was inserted into the AVP1 through its mesh via a 6-F delivery guiding sheath in parallel with the delivery wire...
October 10, 2018: Journal of Endovascular Therapy
Hidenori Oishi, Kosuke Teranishi, Kenji Yatomi, Takashi Fujii, Munetaka Yamamoto, Hajime Arai
Flow diverters (FDs) have been developed for intracranial aneurysms difficult to treat with conventional endovascular therapy and surgical clipping. We reviewed 94 patients with 100 large or giant unruptured internal carotid artery (ICA) aneurysms treated with Pipeline embolization device (PED) embolization from December 2012 to June 2017 at Juntendo University Hospital. The patients' mean age was 63.4 years (range, 19-88), and there were 90 women 89.4%. Aneurysm locations were: C4 (45), C3 (4), and C2 (51) in ICA segments...
October 6, 2018: Neurologia Medico-chirurgica
Laurent Pierot, Laurent Spelle, Jérôme Berge, Anne-Christine Januel, Denis Herbreteau, Mohamed Aggour, Michel Piotin, Alessandra Biondi, Xavier Barreau, Charbel Mounayer, Chrisanthi Papagiannaki, Jean-Paul Lejeune, Jean-Yves Gauvrit, Anne-Laure Derelle, Emmanuel Chabert, Vincent Costalat
BACKGROUND AND PURPOSE: Flow diversion is an innovative and increasingly used endovascular treatment for intracranial aneurysms. Its initial evaluation with the first devices available showed good efficacy of this treatment with variable safety results. The Flow Direction Endoluminal Device (FRED) has a specific design and was evaluated in a single-arm, multicenter, prospective, Good Clinical Practice study: SAFE (Safety and efficacy Analysis of FRED Embolic device in aneurysm treatment)...
October 8, 2018: Journal of Neurointerventional Surgery
Mao Qiang Wang, Jin Long Zhang, Hai Nan Xin, Kai Yuan, Jieyu Yan, Yan Wang, Guo Dong Zhang, Jin Xin Fu
PURPOSE: To evaluate the safety and efficacy of prostatic artery embolization (PAE) using the combination of 50-μm and 100-μm polyvinyl alcohol (PVA) particles versus 100-μm PVA particles alone in the treatment of patients with symptomatic benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Over a 5-year period, 120 patients treated with PAE for lower urinary tract symptoms (LUTS) secondary to BPH were randomized to undergo embolization with 50-μm plus 100-μm PVA particles (group A) or 100-μm PVA particles alone (group B)...
October 5, 2018: Journal of Vascular and Interventional Radiology: JVIR
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
Yan-Jie Cheng, Hui Xie, Shu-Xia Guo
OBJECTIVE: To explore the hematological and clinical features of patients with malignant lymphoma (ML) combined with venous thromboembolism (VTE). METHODS: Sixty patients with ML combined with VTE in our hospital from May 2014 to May 2016 were enrolled in ML+VTE group, out of them 42 patients were males and 18 patients with females; another 60 patients with ML alone were enrolled in control group, out of them 43 patients were males and 17 patients females. The hematological, coagulation and clinical datas of all the patients were collected and then retrospectively analyzed...
October 2018: Zhongguo Shi Yan Xue Ye Xue za Zhi
Valentin Zumstein, Patrick Betschart, Malte W Vetterlein, Luis A Kluth, Lukas Hechelhammer, Livio Mordasini, Daniel S Engeler, Thomas M Kessler, Hans-Peter Schmid, Dominik Abt
CONTEXT: Prostatic artery embolization (PAE) has been introduced into clinical practice for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH-LUTS) despite a lack of high-level evidence. OBJECTIVE: To perform a systematic review and meta-analysis of clinical trials comparing efficacy and safety of PAE versus established surgical therapies. EVIDENCE ACQUISITION: Medline, Embase, and York CRD were searched up to June 23, 2018...
October 3, 2018: European Urology Focus
Hunsoo Park, Ichiro Nakagawa, Shohei Yokoyama, Takeshi Wada, Yasushi Motoyama, Kimihiko Kichikawa, Hiroyuki Nakase
BACKGROUND: Recent reports have described that endovascular treatment of coil embolization of ophthalmic artery (OphA) aneurysms has a relative risk of visual disruption caused by thromboembolic infarction of the central retinal artery (CRA), especially the OphA when it originates within the body of the aneurysm. Patent microthrombus in the OphA might also cause retinal infarction that affects visual acuity. We describe stent-assisted coil embolization of an OphA aneurysm complicated with a severe visual disturbance although normal flow was scrupulously maintained in the OphA during the procedure...
October 3, 2018: World Neurosurgery
Christopher A Worgul, George Wu, Nikhil Kansal
INTRODUCTION: Internal iliac artery aneurysms (IIAAs) are rare, comprising 0.3% of all aortoiliac aneurysms. Endovascular management is associated with lower morbidity and mortality than open repair. We present a 91-year-old female with a rapidly expanding 8.2 cm IIAA who previously underwent incomplete endovascular treatment, using EVAR, to exclude the right internal iliac artery (IIA). Transarterial access to the IIAA was not possible secondary to the iliac limb of the endograft over the origin of the internal iliac artery...
October 1, 2018: Annals of Vascular Surgery
Anshu Mahajan, Gaurav Goel, Biplab Das, Karanjit Singh Narang
Ruptured vertebral artery (VA) dissecting aneurysm carries high risk of rerupture and mortality if not treated immediately. Dissecting aneurysm of the VA involving the posteroinferior cerebellar artery (PICA) origin is difficult to treat by surgical and endovascular route. With the availability of flow diversion device for reconstructive procedure, endovascular treatment has now become easy to treat difficult aneurysm while maintaining the patency of the PICA. However, instead of using flow diverter (FD) in our case, we successfully treated dissecting VA aneurysm involving the PICA origin with retrograde stent placement from distal right VA to the left PICA to maintain the patency of PICA and occlusion of dissecting aneurysm of VA with detachable coils instead of performing surgical bypass and FD placement...
July 2018: Asian Journal of Neurosurgery
Hideaki Ono, Tomohiro Inoue, Akira Iijima, Takeo Tanishima, Akira Tamura, Isamu Saito
Intracranial aneurysms may cause embolic stroke. Medical or surgical management is selected on an individual basis, as the optimal treatment strategy has not been established. A 79-year-old woman with a large cavernous carotid aneurysm suffered repeated embolic stroke after enlargement and partial thrombosis of the aneurysm, in spite of antiplatelet therapy. Coil embolization of the primitive trigeminal artery and ligation of the internal carotid artery (ICA) at the cervical portion followed by high-flow bypass from the cervical external carotid artery to the middle cerebral artery were performed...
July 2018: Asian Journal of Neurosurgery
Luca Sedran, Mila Bonaso, Arianna Mettus, Fabio Roccia
An epithelioid hemangioma is a very rare lesion arising from vascular structures. We encountered 2 cases in atypical locations, one in the orbital and the other in the nasal region. We performed preoperative angiography in addition to the diagnostic imaging recommended in the literature. Angiography highlighted the lesions well, and in one case, it was possible to embolize the arterial trunk of a high-flow lesion. Angiography underscored how such lesions may differ from the vascular perspective, emphasizing the importance of histology in correct diagnosis...
October 1, 2018: Journal of Craniofacial Surgery
Vijay M Ravindra, Julius Griauzde, Jonathan P Scoville, Craig J Kilburg, D Andrew Wilkinson, Clint Christensen, William T Couldwell, Philipp Taussky
OBJECTIVE: Flow diversion has been an important addition to endovascular neurosurgery, but its use in the posterior circulation remains controversial. Our goal is to describe the safety and efficacy of moderate sedation during flow diversion for posterior circulation lesions (aneurysms or dissecting pseudoaneurysms). METHODS: The authors retrospectively reviewed the medical records of all patients who underwent placement of a Pipeline embolization device for a posterior circulation lesion from August 2012 through November 2017...
September 28, 2018: World Neurosurgery
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