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Interventional Neuroradiology

Zhen Yu Jia, Yun Sun Song, Jae Jon Sheen, Joong Goo Kim, Deok Hee Lee
OBJECTIVE: Symptomatic non-acute intracranial arterial occlusion (NAICO) is not uncommon. We report a single-center experience of the feasibility and safety of endovascular treatment of anterior circulation NAICO and summarize the outcomes of patient groups with successful or failed recanalization. METHODS: Patients who underwent endovascular therapy for intracranial arterial stenosis between January 2010 and May 2017 were retrospectively reviewed. Thirty-eight patients with symptomatic NAICO (symptom onset > 24 hours) in the anterior circulation were identified...
February 27, 2019: Interventional Neuroradiology
Changchun Jiang, Wei Wang, Baojun Wang, Yuechun Li, Guorong Liu, Tianyou Zhang, Yu Fan, Junfeng Yang, Xia Li, Xiwa Hao, Fei Hao, Junmei Zhao, Shuguang Wang, Chuhan Jiang
BACKGROUND: Rupture of cerebral aneurysm is an inevitable complication during embolization, followed by subsequent acute subarachnoid hemorrhage or intracranial hematoma, and results in the aggravation of a patient's condition. In particular, for patients who have had a ruptured aneurysm, urgent treatment strategies are required during operation. The most common hemostatic methods seen in clinical practices are as follows: after lowering the blood pressure, we continue to embolize the aneurysms with detachable coils as soon as possible or inject with Glubran/Onyx embolization liquids, as well as use a balloon catheter to temporarily block the blood supply...
February 25, 2019: Interventional Neuroradiology
Konstantinos Lagios, Michalis Mantatzis
In many cases, an intra-arterial microcatheter loop is necessary to bypass the neck of wide-necked giant aneurysms for the placement of a stent across it. The removal of this loop is usually challenging, and many techniques have been described to achieve it. We describe a simple novel technique for straightening the microcatheter across the aneurysm's neck, without the need for additional products/devices or complex exchanging techniques. The method has been successfully applied in two cases. We named this novel maneuver the "Lagman vacuum" technique...
February 25, 2019: Interventional Neuroradiology
Eric S Nussbaum, Collin M Torok, Jason Carroll, Allicia M Gunderman
A 50-year-old female patient with hyperimmunoglobulin E syndrome (HIES) presented initially at the age of 48 years with subarachnoid hemorrhage (SAH) from a ruptured left middle cerebral artery (MCA) bifurcation aneurysm, which was treated successfully with coiling and microsurgical clipping. Angiography and cross-sectional imaging did not indicate evidence of any additional intracranial aneurysm. However, the patient presented two years later with SAH secondary to a new ruptured right MCA bifurcation aneurysm, which was treated successfully with microsurgical clipping...
February 25, 2019: Interventional Neuroradiology
Joong-Goo Kim, Dongwhane Lee, Jay Chol Choi, Yunsun Song, Deok Hee Lee, Dae Chul Suh
BACKGROUND AND PURPOSE: The prognosis of patients with acute basilar arterial occlusion after endovascular reperfusion therapy with diffusion-weighted imaging - posterior circulation-Alberta Stroke Program Early Computed Tomography Score (DWI-pc-ASPECTS) of 6 or less remains unclear. We aimed to assess the characteristics and prognosis of endovascular reperfusion therapy in patients with acute basilar arterial occlusion and DWI-pc-ASPECTS of 6 or less. METHODS: We analysed data collected from 1 January 2012 to 31 January 2018 in a prospective neuro-interventional registry of consecutive patients treated with endovascular reperfusion therapy...
February 25, 2019: Interventional Neuroradiology
Katsunari Namba, Ayuho Higaki, Naoki Kaneko, Shigeru Nemoto, Kensuke Kawai
BACKGROUND: Inventing an optimal curve on a microcatheter is required for successful intracranial aneurysm coiling. Shaping microcatheters for vertebrobasilar artery aneurysm coiling is difficult because of the vessel's long, tortuous and mobile anatomy. To overcome this problem, we devised a new method of shaping the microcatheter by using the patient's specific vessel anatomy and the highly shapable microcatheter. We report our preliminary results of treating posterior circulation aneurysms by this method...
February 25, 2019: Interventional Neuroradiology
Ljubisa Borota, Ehab Mahmoud, Christoffer Nyberg
AIM OF THE STUDY: To present our experience in the treatment of iatrogenic dissections of extracranial internal carotid and vertebral arteries with the Neuroform Atlas stent. MATERIALS AND METHODS: Between January 2017 and February 2018 we treated iatrogenic dissections of three internal carotid arteries and three vertebral arteries. These iatrogenic dissections occurred during the endovascular treatment of ruptured and unruptured intracranial aneurysms. The indication for stenting was haemodynamically significant, flow-limiting dissection with threatening flow arrest...
February 25, 2019: Interventional Neuroradiology
Ryushi Kondo, Toshihiro Kumabe, Daisuke Yamamoto, Hiroyuki Koizumi, Hiroki Kuroda, Kazuhiro Miyasaka
BACKGROUND: Although the abnormal venous drainage into the superior ophthalmic vein (SOV) is a well-known entity responsible for ocular symptoms, it remains unclear to what degree it affects the visual function. The purpose of this study was to evaluate the incidence, characteristics and outcomes of the visual disorders in patients with intracranial arteriovenous fistula (AVF) with venous drainage into the SOV. METHODS: This retrospective study involved eight patients diagnosed with intracranial AVFs with abnormal venous drainage into the SOV between January 2014 and December 2016...
February 25, 2019: Interventional Neuroradiology
Leonard Ll Yeo, Tommy Andersson, Åke Holmberg, Anastasios Mpotsaris, Michael Söderman, Staffan Holmin, Pervinder Bhogal, Yang Cunli, Anil Gopinathan, Benjamin Yq Tan, Vamsi Gontu, Jens Kolloch, Åsa KuntzeSöderqvist, Patrick A Brouwer, Sandra Cornelissen
BACKGROUND: Collateral blood flow is known to be an important factor that sustains the penumbra during acute stroke. We looked at both the leptomeningeal collateral circulation and the presence of anterior and posterior communicating arteries to determine the factors associated with good outcomes and mortality. METHODS: We included all patients with acute ischaemic stroke in the anterior circulation, who underwent thrombectomy with the same thrombectomy device from 2013 to 2016...
February 25, 2019: Interventional Neuroradiology
Şükrü Oğuz, Hasan Dinc
INTRODUCTION: The effectiveness and reliability of flow-diverter stents, which are commonly used in aneurysms of the anterior circulation, have been demonstrated previously. However, the use of these devices is associated with higher rates of perforator and branch ischemia following the treatment of aneurysms of the posterior circulation. METHODS: This work involved a single-center; retrospective study reviewing eight patients who had aneurysms related to the posterior inferior cerebellar artery (PICA) and who were treated with flow-diverter stents from September 2013 to May 2017...
February 25, 2019: Interventional Neuroradiology
James K Goddard, Eric S Nussbaum, Michael Madison, Jeff Lassig, Collin Torok, Dimitrios Giannakidis, Sandra Hanson, William McDonald, Kevin M Kallmes, Leslie A Nussbaum
Although cardiac myxomas have been known to cause acute ischemic stroke and other cerebrovascular complications, intracranial embolization of metastatic tumor fragments is rare. This is likely because venous emboli generally cause pulmonary embolism. Pulmonary vein metastases and patent foramen ovales have previously shown to propagate intracranial embolic carcinomas, but these events are very uncommon, and are not well characterized. We report a rare case of large-cell, high-grade neuroendocrine lung cancer embolus occluding the basilar artery, which likely detached into the bloodstream from the lung after intruding into a pulmonary vein...
February 20, 2019: Interventional Neuroradiology
Pervinder Bhogal, Joseph Lansley, Ken Wong, Sundip D Udani, Chris Uff, John Wadley, Atul Kumar, Charles C Matouk, Hegoda Ld Makalanda
Ruptured arteriovenous malformations are a frequently encountered pathology with significant associated morbidity and mortality. Identifying and securing the rupture point is mandatory; however, this can often be difficult. Black blood vessel wall magnetic resonance imaging is a promising technique for identifying ruptured saccular aneurysms and has been used in cases of multiple aneurysms. Here we describe a case of using this imaging technique to identify the rupture point in a ruptured arteriovenous malformation with histopathological correlation...
February 14, 2019: Interventional Neuroradiology
Marion Boulanger, Bertrand Lapergue, Francis Turjman, Emmanuel Touzé, René Anxionnat, Serge Bracard, Michel Piotin, Benjamin Gory
BACKGROUND: In acute ischemic stroke patients with large-artery occlusion, uncertainties remain about whether clinically important outcomes are comparable between first-line contact aspiration and stent-retriever thrombectomy, although two trials have investigated whether one strategy should be preferred over another. PURPOSE: The purpose of this article is to compare the efficacy and safety of first-line contact aspiration and stent-retriever thrombectomy in stroke patients with anterior circulation large-artery occlusion...
February 4, 2019: Interventional Neuroradiology
Robert Fahed, Tim E Darsaut, Charbel Mounayer, René Chapot, Michel Piotin, Raphaël Blanc, Vitor Mendes Pereira, Daniel G Abud, Dana Iancu, Alain Weill, Daniel Roy, Lorena Nico, Suzanne Nolet, Guylaine Gevry, Jean Raymond
BACKGROUND: Transvenous embolisation is a promising technique but the benefits remain uncertain. We hypothesised that transvenous embolisation leads to a higher rate of arteriovenous malformation angiographic occlusion than transarterial embolisation. METHODS: The Transvenous Approach for the Treatment of cerebral Arteriovenous Malformations (TATAM) is an investigator initiated, multicentre, prospective, phase 2, randomised controlled clinical trial. To test the hypothesis that transvenous embolisation is superior to transarterial embolisation for arteriovenous malformation obliteration, 76 patients with arteriovenous malformations considered curable by up to two sessions of endovascular therapy will be randomly allocated 1:1 to treatment with either transvenous embolisation (with or without transarterial embolisation) (experimental arm) or transarterial embolisation alone (control arm)...
February 4, 2019: Interventional Neuroradiology
Hans Kortman, Issam Boukrab, Menno Sluzewski, Willem Jan van Rooij, Jo Pp Peluso, Charles Majoie
BACKGROUND AND PURPOSE: Dural arteriovenous fistulas (DAVFs) with direct antegrade sinus drainage have a benign natural history but bruit can be disabling. Disconnection of the draining sinus is considered curative. We present the treatment results of 14 patients with a dural arteriovenous fistula with antegrade sinus return with emphasis on functionality of the involved sinus and the need for sinus patency. MATERIALS AND METHODS: Between January 2009 and January 2018, 14 patients with a DAVF with direct antegrade sinus drainage were treated in our institution...
February 4, 2019: Interventional Neuroradiology
Iacopo Valente, Sergio Nappini, Leonardo Renieri, Alessandro Pedicelli, Emilio Lozupone, Cesare Colosimo, Salvatore Mangiafico, Nicola Limbucci
INTRODUCTION: We report our experience with the novel stent-type clot-retrieval device EmboTrap II for the revascularization of large artery occlusions in acute ischaemic stroke. MATERIALS AND METHODS: Twenty-nine patients with acute ischaemic stroke due to large artery occlusion underwent mechanical thrombectomy with the new EmboTrap II in two Italian centres. Clinical, procedural and radiological data were collected. Angiographic results and neurological outcomes were analysed...
February 4, 2019: Interventional Neuroradiology
Jun-Soo Byun, Patrick Nicholson, Christopher A Hilditch, Anderson Chun On Tsang, Vitor Mendes Pereira, Timo Krings, Yibin Fang, Waleed Brinjikji
BACKGROUND AND PURPOSE: Recent studies suggest that thrombus imaging characteristics such as Hounsfield unit (HU) and perviousness assessed on noncontrast computed tomography (NCCT) and CT angiography (CTA) can predict successful recanalization. We assessed whether these thrombus imaging characteristics could predict successful first-pass recanalization. METHODS: We retrospectively reviewed cases of mechanical thrombectomy over a three-year period in which patients received a multiphase CTA and were treated with a stent retriever on first pass...
February 4, 2019: Interventional Neuroradiology
Shailesh Male, Tapan Mehta, Huseyin Tore, Coridon Quinn, Andrew W Grande, Ramachandra P Tummala, Bharathi D Jagadeesan
INTRODUCTION: Mechanical thrombectomy in the setting of acute ischemic stroke (AIS) requires cerebral digital subtraction angiography (DSA), typically performed with iodinated contrast medium. We present a case of emergent cerebral DSA and mechanical thrombectomy using gadolinium-based contrast for cerebral DSA in a patient with a history of anaphylaxis to iodinated contrast agents (ICs). CASE REPORT: A 72-year-old man developed left ventricle assist device thrombus while on anticoagulation...
December 19, 2018: Interventional Neuroradiology
Heinrich P Mattle, Carl Scarrott, Mairsil Claffey, John Thornton, Juan Macho, Christian Riedel, Michael Söderman, Alain Bonafé, Michel Piotin, John Newell, Tommy Andersson
BACKGROUND AND PURPOSE: The goal of the analysis of revascularisation in ischaemic stroke with EmboTrap study (ARISE I) was to demonstrate the effectiveness of EmboTrap. METHODS: ARISE I was an open label, single arm, multicentre, prospective study for the treatment of acute stroke due to large vessel occlusion. The primary outcome was revascularisation of the target vessel as measured by the modified thrombolysis in cerebrovascular infarction (mTICI) score of at least 2b following thrombectomy with EmboTrap...
December 18, 2018: Interventional Neuroradiology
Xuelei Zhang, Gang Luo, Baixue Jia, Dapeng Mo, Ning Ma, Feng Gao, Jingyu Zhang, Zhongrong Miao
BACKGROUND: Therapeutic strategies and outcomes vary with stroke subtypes for patients with acute vertebrobasilar occlusion (VBAO). This study aimed to compare characteristics and outcomes of VBAO due to intracranial atherosclerotic disease (ICAD) and embolisms and identify baseline predictors of ICAD. METHODS: Patients with VBAO who received endovascular therapy (EVT) were retrospectively analyzed. Participants fulfilling the criteria were classified as the ICAD group (focal stenosis of >70%, or fixed stenosis >50% in addition to either flow and perfusion impairment on angiography or an evident reocclusion tendency) and the embolism group (defined as no evidence of focal significant stenosis after thrombolysis or thrombectomy)...
December 4, 2018: Interventional Neuroradiology
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