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Aneurysm embolization

Jacques Sedat, Yves Chau, Jean Gaudart, Marina Sachet, Stephanie Beuil, Michel Lonjon
BACKGROUND: Thromboembolic complications are the main problem in stent-assisted coil embolization of unruptured intracranial aneurysms. The combination of aspirin and clopidogrel is generally used to decrease these complications, but some patients do not respond to clopidogrel and have a higher risk of stent thrombosis. In cardiology, clinical trials have shown that prasugrel reduced the incidence of ischaemic events in patients with acute coronary syndrome compared with clopidogrel but, according to several authors, prasugrel would produce an increased risk of cerebral haemorrhagic complications...
October 19, 2016: Interventional Neuroradiology
Francis Cloutier, Naim Khoury, Jimmy Ghostine, Behzad Farzin, Marc Kotowski, Alain Weill, Daniel Roy, Jean Raymond
BACKGROUND AND PURPOSE: Endovascular coil embolization of cerebral aneurysms is associated with suboptimal angiographic results in up to 20-30% of patients. Coil packing density has been used as an index of the success of the initial procedure. The trial sought to study the effects of using 15-caliber coils, as compared with 10-caliber coils, on packing density. METHODS: Does Embolization with Larger coils lead to better Treatment of Aneurysms (DELTA) is an investigator-initiated multicenter prospective, randomized, controlled clinical trial...
October 19, 2016: Interventional Neuroradiology
Amit Shrivastava, Jagadeesh Singh Rampal, D Nageshwar Reddy, Guduru Venkat Rao
BACKGROUND: Gastro-Intestinal bleeding remains a frequent clinical dilemma and common cause of hospitalization, morbidity and mortality. CASE REPORT: We report a case of pseudo aneurysm of splenic artery developed after an episode of acute on chronic pancreatitis which was treated by direct percutaneous puncture of pseudoaneurysm and embolization by coils. CONCLUSIONS: The aim was to preserve the main splenic artery and avoid the complications of splenic artery embolization like infarcts and abscess...
2016: Polish Journal of Radiology
Ji Yeon Lim, Yoon Hee Choi, Sun Hwa Lee
Epigastric pain is a common symptom in the emergency department. Most epigastric pain is not fatal, except in acute myocardial infarction, aortic dissection, and abdominal aneurysm rupture. Epigastric pain can also be the only symptom of isolated spontaneous gastric artery dissection. We report the case of a 51-year-old woman diagnosed with neurofibromatosis who initially presented with only epigastric pain. She was initially misdiagnosed with gastritis, treated conservatively, and discharged. Two hours later, she returned to the emergency department with persistent epigastric pain and rebound tenderness in the epigastric area...
June 2016: Clin Exp Emerg Med
Manoj Kumar Agarwala, Azeez Asad, Naveen Gummadi, Sundar Chidambaram, J Venkateswaralu
Carotid artery dissection (CAD) is a frequent cause of stroke, accounting for up to 25% of all ischemic strokes in young and middle-aged patients.(1,2) It may be traumatic or spontaneous, with multi-factorial etiology. A tear in the arterial wall causes intrusion of blood within its layers, producing intra-luminal stenosis, or aneurysmal dilatation.(3) Thrombo-embolism arising from this anatomic disruption has been postulated as the essential stroke mechanism in CAD.(4) Bilateral internal carotid artery dissection (ICAD) has been rarely reported...
September 2016: Indian Heart Journal
Jagdish C Mohan, Madhu Shukla, Vishwas Mohan, Arvind Sethi
Left atrial dissection is a very uncommon complication of cardiac surgery and usually causes significant hemodynamic compromise. Little is known about spontaneous dissection of the left atrium. Two patients, one middle-aged man and another elderly woman were evaluated following stroke. Routine trans-thoracic echocardiogram showed vertical division of the left atrium with both chambers communicating with each other through an orifice. Detailed trans-oesophageal echocardiographic study revealed dissection of the left atrium producing an additional false chamber (pseudo-aneurysm) placed posterior to the left atrial appendage and above the postero-lateral aspect of mitral annulus...
September 2016: Indian Heart Journal
Toshinari Kawasaki, Kazumichi Yoshida, Takayuki Kikuchi, Akira Ishii, Yasushi Takagi, Susumu Miyamoto
BACKGROUND: Concerning traumatic aneurysms, those of the superficial temporal artery (STA) have been frequently reported in the literature, whereas those of the occipital artery (OA) are extremely rare. CASE DESCRIPTION: A 30-year-old man had been followed at another hospital for meningoencephalocele associated with his congenital occipital bone defect. He was admitted to our hospital with a chief complaint of neck swelling and pain during a football game. CT and MRI showed a hematoma in his right neck along with the meningoencephalocele...
October 11, 2016: World Neurosurgery
Jian Liu, Linkai Jing, Ying Zhang, Ying Song, Yang Wang, Chuanhui Li, Yanmin Wang, Shiqing Mu, Nikhil Paliwal, Hui Meng, Italo Linfante, Xinjian Yang
BACKGROUND: Intracranial vertebral artery dissecting aneurysms (VADAs) tend to recur despite successful stent-assisted coil embolization (SACE). Hemodynamics is useful in evaluating aneurysmal formation, growth and rupture. Our aim was to evaluate the hemodynamic patterns of VADA's recurrence. METHODS: Between September 2009 and November 2013, all consecutive patients with recurrent VADAs after SACE in our institutions were enrolled. Recurrence was defined as recanalization and/or regrowth...
October 11, 2016: World Neurosurgery
Tibor Becske, Matthew B Potts, Maksim Shapiro, David F Kallmes, Waleed Brinjikji, Isil Saatci, Cameron G McDougall, István Szikora, Giuseppe Lanzino, Christopher J Moran, Henry H Woo, Demetrius K Lopes, Aaron L Berez, Daniel J Cher, Adnan H Siddiqui, Elad I Levy, Felipe C Albuquerque, David J Fiorella, Zsolt Berentei, Miklós Marosföi, Saruhan H Cekirge, Peter K Nelson
OBJECTIVE The long-term effectiveness of endovascular treatment of large and giant wide-neck aneurysms using traditional endovascular techniques has been disappointing, with high recanalization and re-treatment rates. Flow diversion with the Pipeline Embolization Device (PED) has been recently used as a stand-alone therapy for complex aneurysms, showing significant improvement in effectiveness while demonstrating a similar safety profile to stent-supported coil treatment. However, relatively little is known about its long-term safety and effectiveness...
October 14, 2016: Journal of Neurosurgery
Daniel R Felbaum, Kyle Mueller, Ai-Hsi Liu, Rocco A Armonda
Preoperative embolization of meningiomas can be safely performed using a variety of embolic agents. Most commonly, the vascular supply from branches of the external carotid artery is the target of embolization. In our report, we detail the treatment of a patient with a parafalcine meningioma that received its supply via branches of the anterior cerebral artery. One of the feeder vessels appeared to contain a dysplastic aneurysmal dilatation of the vessel. Due to patient circumstances, embolization was performed using standard microcatheterization techniques to minimize intraoperative blood loss...
September 11, 2016: Curēus
Tatsushi Onzuka, Yasuhisa Oishi, Hikaru Uchiyama, Yoshie Ochiai, Atsuhiro Nakashima, Kenji Shinozaki
Aberrant right subclavian artery embolization is problematic in debranching thoracic endovascular aortic repair, because concomitant bypass grafting to the right upper arm may hinder complete embolization. We report a case of a thoracic aortic aneurysm with aberrant right subclavian artery successfully treated with debranching thoracic endovascular aortic repair and bypass grafting. Although endoleakage was found from aberrant right subclavian artery after single use of Amplatzer vascular plug, additional deployment of Amplatzer vascular plug II completely eliminated residual endoleakage...
2016: Annals of Vascular Diseases
Edgar Gerardo Ordónez-Rubiano, Christian Von-Diemling, William Cortes-Lozano, Nelson Oswaldo Lobelo-Garcia
Giant aneurysms have been treated with endovascular approaches like general, balloon-assisted and stent-assisted coiling, and flow diverter stent-assisted techniques. Few cases have been reported to be treated with both normal and large coils. Despite the mass effect, an adequate revascularization has been reported. An initial use of these coils is being reported in the current study. This is a case which has been successfully treated using a stent-assisted coiling with both small and large coils i.e., Penumbra Coil 400 (Penumbra, Inc...
August 31, 2016: Curēus
J Scott Pannell, David R Santiago-Dieppa, Arvin R Wali, Brian R Hirshman, Jeffrey A Steinberg, Vincent J Cheung, David Oveisi, Jon Hallstrom, Alexander A Khalessi
This study establishes performance metrics for angiography and neuroendovascular surgery procedures based on longitudinal improvement in individual trainees with differing levels of training and experience. Over the course of 30 days, five trainees performed 10 diagnostic angiograms, coiled 10 carotid terminus aneurysms in the setting of subarachnoid hemorrhage, and performed 10 left middle cerebral artery embolectomies on a Simbionix Angio Mentor™ simulator. All procedures were nonconsecutive. Total procedure time, fluoroscopy time, contrast dose, heart rate, blood pressures, medications administered, packing densities, the number of coils used, and the number of stent-retriever passes were recorded...
August 29, 2016: Curēus
Luca Ferretto, Sandro Irsara
PURPOSE: To describe a sac embolization technique modification for type II endoleak prevention that makes a totally percutaneous approach feasible during endovascular aneurysm repair (EVAR) using the Excluder stent-graft. TECHNIQUE: Percutaneous access of the common femoral arteries is obtained and 2 suture-mediated closure systems are placed on each side. A 16-F or 18-F sheath is placed for delivery of the Excluder stent-graft main body and a 16-F sheath is used on the contralateral side...
October 12, 2016: Journal of Endovascular Therapy
Jiro Kimura, Kenji Okumura, Hideki Katagiri, Alan Kawarai Lefor, Ken Mizokami, Tadao Kubota
INTRODUCTION: Omental hemorrhage results from rupture of the omental vessels. There are many causes of omental hemorrhage including trauma, aneurysm, and vasculitis. Idiopathic omental hemorrhage is a rare cause of an acute abdomen, which is potentially life-threatening. We report a patient with idiopathic omental hemorrhage, which may have been caused by overeating. CASE PRESENTATION: A 29-year-old man without a history of trauma, bleeding disorders, or other significant medical history, presented with left upper quadrant pain, which began after overeating the previous evening...
October 4, 2016: International Journal of Surgery Case Reports
Xavier Chaufour, Julien Gaudric, Yann Goueffic, Réda Hassen Khodja, Patrick Feugier, Sergei Malikov, Guillaume Beraud, Jean-Baptiste Ricco
OBJECTIVE: Endovascular aneurysm repair (EVAR) is widely used with excellent results, but its infectious complications can be devastating. In this paper, we report a multicenter experience with infected EVAR, symptoms, and options for explantation and their outcome. METHODS: We have reviewed all consecutive endograft explants for infection at 11 French university centers following EVAR, defined as index EVAR, from 1998 to 2015. Diagnosis of infected aortic endograft was made on the basis of clinical findings, cultures, imaging studies, and intraoperative findings...
October 5, 2016: Journal of Vascular Surgery
Christoph J Griessenauer, Matthew R Fusco, Lucy He, Michelle Chua, Sarah Sieber, Abd A Mazketly, Arra S Reddy, Christopher S Ogilvy, Ajith J Thomas
BACKGROUND: The configuration of the anterior communicating artery (AcomA) complex is important in the endovascular treatment of AcomA complex aneurysms. In cases of codominant anterior cerebral arteries (ACA), coil embolization may result in inadvertent occlusion of the contralateral ACA due to poor visualization. A second diagnostic catheter in the contralateral carotid artery may help with visualization of this angiographic blind spot. To our knowledge, the safety and efficacy of this dual diagnostic catheter technique have never been assessed...
2016: Surgical Neurology International
Shinya Terada, Masaki Tabuchi, Akihiko Yamauchi
A 52-years-old man, who had undergone coil embolization of saccular aneurysm of the brachiocephalic artery, presented with right back discomfort. Diagnosis by computed tomography was difficult because of an artifact from the coils. Angiography, on the other hand, revealed a rupture of the aneurysm, and emergency surgery was performed. A Y-shaped graft was anastomosed to the ascending aorta under partial clamp. Then, one of its branches was anastomosed to the common carotid artery also under partial clamp in an end-to-side fashion...
October 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Sophia F Shakur, Victor A Aletich, Sepideh Amin-Hanjani, Ahmed E Hussein, Fady T Charbel, Ali Alaraj
BACKGROUND: Pipeline embolization devices (PEDs) are commonly used for endovascular treatment of cerebral aneurysms but can be associated with delayed ipsilateral intraparenchymal hemorrhage. Although intra-aneurysmal hemodynamic changes have been studied, parent vessel and intracranial hemodynamics after PED use are unknown. We examine the impact of flow diversion on parent artery and distal intracranial hemodynamics. METHOD: Patients with internal carotid cerebral aneurysms treated with PED who had flow volume rate, flow velocities, pulsatility index, resistance index, Lindegaard ratio, and wall shear stress (WSS) obtained after treatment using quantitative magnetic resonance angiography were reviewed...
October 4, 2016: Interventional Neuroradiology
Kimihiro Igari, Toshifumi Kudo, Takahiro Toyofuku, Yoshinori Inoue
Juxtarenal aortic aneurysms (JRAAs) are challenging to treat by endovascular aneurysm repair (EVAR) procedures. The chimney technique with EVAR (Ch-EVAR) is one of the feasible and less invasive treatments for JRAAs. However, the main concern of Ch-EVAR is the potential risk of "gutters," which can lead to type Ia endoleak (EL). Most type Ia ELs after Ch-EVAR procedures occurred intraoperatively, and these ELs could be treated using an endovascular technique. However, late-onset type Ia ELs could be extremely rare, which might have a fear of conservative treatment...
2016: Case Reports in Vascular Medicine
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