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Role of surgery in management of intracranial dural arteriovenous fistulas. 手术治疗颅内硬脑膜动静脉瘘的作用。
Pub Date : 2023-06-01 DOI: 10.7461/jcen.2023.E2022.10.006
Young Sill Kang, Won-Sang Cho, Sung Ho Lee, Kangmin Kim, Hyun-Seung Kang, Jeong Eun Kim

Intracranial dural arteriovenous fistulas (DAVF) are abnormal connections between intracranial arterial and venous systems within the dural layers. Intracranial DAVFs are rare but can occur wherever dural components exist. The pathogenesis of DAVFs is controversial. Venous hypertension is considered as a main cause of clinical symptoms which are subclassified into asymptomatic, benign and aggressive manifestations. To date, several classification schemes have been proposed to stratify the natural course and risks of DAVFs. Currently, endovascular therapy is the main treatment modality. Moreover, the use of radiosurgery and radiotherapy has been limited. Open surgery is also selectively performed as a main treatment modality for specific types of DAVFs and an adjunctive modality for the endovascular approach. Herein, we present a review of the general perspectives of intracranial DAVFs with an emphasis on the role of surgery.

颅内硬脑膜动静脉瘘(DAVF)是硬脑膜层内颅内动脉和静脉系统之间的异常连接。颅内davf是罕见的,但可以发生在任何存在硬脑膜成分的地方。davf的发病机制存在争议。静脉高压被认为是临床症状的主要原因,临床症状分为无症状、良性和侵袭性表现。迄今为止,已经提出了几种分类方案来对davf的自然过程和风险进行分层。目前,血管内治疗是主要的治疗方式。此外,放射外科和放射治疗的使用受到限制。开放手术也被选择性地作为特定类型davf的主要治疗方式和血管内入路的辅助治疗方式。在此,我们提出了颅内davf的一般观点的回顾,重点是手术的作用。
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引用次数: 1
Efficacy of intraoperative neuromonitoring (IONM) and intraoperative indocyanine green videoangiography (ICG-VA) during unruptured anterior choroidal artery aneurysm clipping surgery. 术中神经监测(IONM)和术中吲哚菁绿血管造影(ICG-VA)在未破裂前脉络膜动脉瘤夹闭术中的疗效。
Pub Date : 2023-06-01 DOI: 10.7461/jcen.2023.E2022.10.008
Chanbo Eun, Seung Joo Lee, Jung Cheol Park, Jae Sung Ahn, Byung Duk Kwun, Wonhyoung Park

Objective: The aim of this study was to investigate the efficacy of intraoperative indocyanine green videoangiography (ICG-VA) and intraoperative neuromonitoring (IONM) to prevent postoperative ischemic complications during microsurgical clipping of unruptured anterior choroidal artery (AChA) aneurysms.

Methods: We retrospectively reviewed the clinical and radiological records of all patients who had undergone microsurgical clipping for unruptured AChA aneurysms at our institution between April 2001 and December 2019. We compared the postoperative complication rate of the group for which intraoperative ICG-VA and IONM were utilized (group B; n=324) with that of the group for which intraoperative ICG-VA and IONM were not utilized (group A; n=72).

Results: There were no statistically significant differences in demographic data between the two groups. Statistically significant differences were observed in the rate of overall complications (p=0.014) and postoperative ischemic complications related to AChA territory (p=0.039). All the cases (n=4) in group B who had postoperative infarctions related to AChA territory showed false-negative results of intraoperative ICG-VA and IONM.

Conclusions: Preserving the patency of the AChA is essential to minimize postoperative complications. Intraoperative monitoring tools including ICG-VA and IONM can greatly contribute to lowering complication rates. However, their pitfalls and false-negative results should always be considered.

目的:探讨术中吲吲胺绿血管造影(ICG-VA)和术中神经监测(IONM)对显微手术夹持未破裂脉络膜前动脉(AChA)动脉瘤术后缺血性并发症的预防作用。方法:回顾性分析2001年4月至2019年12月在我院接受显微手术夹持治疗未破裂AChA动脉瘤的所有患者的临床和影像学记录。我们比较术中使用ICG-VA和IONM组的术后并发症发生率(B组;n=324)与术中未使用ICG-VA和IONM组(A组;n = 72)。结果:两组患者人口学资料差异无统计学意义。两组总并发症发生率(p=0.014)和AChA区域相关的术后缺血性并发症发生率(p=0.039)比较,差异均有统计学意义。B组术后发生AChA相关梗死的患者(n=4)术中ICG-VA、IONM均为假阴性。结论:保持AChA通畅对减少术后并发症至关重要。术中监测工具包括ICG-VA和IONM可以大大降低并发症发生率。然而,它们的缺陷和假阴性结果应始终予以考虑。
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引用次数: 2
Association between ischemic stroke and pyogenic spondylitis in Korea: Nationwide longitudinal cohort study. 韩国缺血性卒中与化脓性脊柱炎的关系:全国纵向队列研究。
Pub Date : 2023-06-01 DOI: 10.7461/jcen.2023.E2022.09.001
Soo Hyun Lee, Hakyung Kim, In-Bo Han, Seung Hun Sheen, Je Beom Hong, Seil Sohn

Objective: The purpose of this nationwide age- and sex- matched longitudinal study was to determine the pyogenic spondylitis (PS) increases the incidence of ischemic stroke (IS) in Korea.

Methods: From the National Health Insurance Service (NHIS), we collected the patient data for the period from January 1, 2004 to December 31, 2015. PS was classified according to the International Classification of Disease codes M46.2-M46.8, M49.2, and M49.3. By using a 1:5 age- and sex- stratified matching, a total of 628 patients and 3140 control subjects were included in the study. The IS incidence rates in PS and control group was calculated by using the Kaplan-Meier method. The outcome of hazard ratio of IS was estimated by Cox proportional hazards regression analyses. This study did not exclude PS as a result of postoperative complications.

Results: According to the study, 51 patients (8.12%) in the PS group and 201 patients (6.4%) in the control group experienced IS. The adjusted hazard ratio of IS in the PS group was 3.419 (95% CI: 2.473-4.729) after adjusting individual medical condition and demographics. Following the results of subgroup analysis, the risk ratio of IS was greater in most of the subgroup categories (male, female, age <65, age >65, non-diabetic, hypertensive, non-hypertensive, dyslipidemic and non-dyslipidemic subgroup). However, the risk of IS did not differ significantly in diabetic subgroup (95% CI: 0.953-4.360).

Conclusions: The risk rate of IS increased in patient with pyogenic spondylitis.

目的:这项全国年龄和性别匹配的纵向研究的目的是确定化脓性脊柱炎(PS)增加韩国缺血性卒中(IS)的发生率。方法:收集2004年1月1日至2015年12月31日期间国民健康保险服务(NHIS)的患者数据。PS按照国际疾病分类代码M46.2-M46.8、M49.2和M49.3进行分类。采用1:5年龄和性别分层匹配,共纳入628例患者和3140例对照受试者。采用Kaplan-Meier法计算PS组和对照组的IS发病率。采用Cox比例风险回归分析估计IS的风险比结果。本研究没有排除术后并发症导致的PS。结果:PS组51例(8.12%),对照组201例(6.4%)发生IS。在调整个人医疗状况和人口统计学因素后,PS组IS的校正风险比为3.419 (95% CI: 2.473-4.729)。根据亚组分析结果,大多数亚组类别(男性、女性、65岁、非糖尿病、高血压、非高血压、血脂异常和非血脂异常亚组)发生IS的风险比都较大。然而,糖尿病亚组发生IS的风险无显著差异(95% CI: 0.953-4.360)。结论:化脓性脊柱炎患者发生IS的风险增加。
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引用次数: 1
Long-term outcomes of carotid artery stenting in patients with carotid artery stenosis: A single-center 14-year retrospective analysis. 颈动脉狭窄患者颈动脉支架置入术的长期结果:一项单中心14年回顾性分析。
Pub Date : 2023-06-01 DOI: 10.7461/jcen.2023.E2022.07.007
Beom Mo Kang, Seok Mann Yoon, Jae Sang Oh, Hyuk Jin Oh, Jae Min Ahn, Gi Yong Yun

Objective: Carotid artery stenting (CAS) is currently widely used for the treatment of carotid artery stenosis. The objective of this study was to analyze the outcomes of CAS performed in a single institution.

Methods: We retrospectively analyzed 313 CAS cases from January 2007 to December 2020, including 206 (66%) symptomatic and 107 (34%) asymptomatic cases. Procedure-related morbidity and mortality were assessed. Rates of periprocedural (≤30 days after CAS) and postprocedural ipsilateral strokes (>30 days after CAS) were also assessed. Logistic regression analysis was used to identify risk factors for the periprocedural complication, in-stent restenosis (ISR), and ipsilateral stroke.

Results: The success rate of CAS was 98%. Among 313 cases, 1 patient died due to hyperperfusion-related intracerebral hemorrhage (ICH). The CAS-related mortality rate was 0.31%. The overall incidence of periprocedural complications is 5.1%. A risk factor for periprocedural complication was a symptomatic carotid artery stenosis (7.3% vs. 0.9%, p=0.016). Twenty cases of ISR occurred during 63.7±42.1 months of follow-up. The overall incidence of ISR was 10.2% (20/196). A risk factors for ISR were diabetes mellitus (17.6% vs. 5.7%, p=0.008) and patients who used Open-cell stents (19.6% vs. 6.9%, p=0.010). The overall incidence of ipsilateral stroke is 5.6%. A risk factors for ipsilateral stroke was ISR (95% CI, p=0.002).

Conclusions: CAS is a safe and effective procedure for carotid artery stenosis. Although the incidence of complications is low, fatal complication such as hyperperfusion- related ICH can occur. To prevent hyperperfusion-related ICH, several methods such as strict blood pressure (BP) control, intentional less widening of stenotic segment should be used. To prevent ISR or stroke occurrence, special attention should be paid to patients who have ISR or ipsilateral stroke risk factors.

目的:颈动脉支架植入术(CAS)是目前广泛应用于治疗颈动脉狭窄的一种方法。本研究的目的是分析在单一机构进行CAS的结果。方法:回顾性分析2007年1月至2020年12月313例CAS病例,其中有症状206例(66%),无症状107例(34%)。评估手术相关的发病率和死亡率。同时评估术中(术后≤30天)和术后同侧卒中(术后>30天)的发生率。采用Logistic回归分析确定围手术期并发症、支架内再狭窄(ISR)和同侧卒中的危险因素。结果:手术成功率98%。313例患者中,1例死于高灌注相关性脑出血(ICH)。cass相关死亡率为0.31%。围手术期并发症的总发生率为5.1%。围手术期并发症的危险因素是有症状的颈动脉狭窄(7.3% vs 0.9%, p=0.016)。随访63.7±42.1个月,共发生20例ISR。ISR的总发生率为10.2%(20/196)。糖尿病(17.6% vs. 5.7%, p=0.008)和使用开放细胞支架的患者(19.6% vs. 6.9%, p=0.010)是发生ISR的危险因素。同侧脑卒中的总发生率为5.6%。同侧卒中的危险因素是ISR (95% CI, p=0.002)。结论:颈动脉动脉栓塞术是一种安全有效的治疗颈动脉狭窄的方法。虽然并发症的发生率较低,但可发生致命性并发症,如高灌注相关性脑出血。为预防高灌注相关性脑出血,应采用严格控制血压、有意减少狭窄段加宽等方法。为了预防ISR或卒中的发生,应特别注意有ISR或同侧卒中危险因素的患者。
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引用次数: 1
An interesting case of survival to multiple ruptures of aneurysms, with persistent trigeminal artery, cranial nerve deficit, and evolutionary exposure of neurovascular treatment. 多发动脉瘤破裂,伴有持续性三叉动脉,颅神经缺损,并逐渐暴露于神经血管治疗的有趣病例。
Pub Date : 2023-06-01 DOI: 10.7461/jcen.2022.E2022.06.009
Héctor Lezcano, María Fernanda Solorzano

Subarachnoid hemorrhage secondary to rupture of an aneurysm is a severe condition, associated with a high rate of morbidity and mortality. There are few cases in the literature of rupture of an aneurysm of the persistent trigeminal artery. This is the case of a 62-year-old female who has suffered multiple ruptures of aneurysms, in different decades of her life, with the development of de novo aneurysm, been this the presented case, a rupture of aneurysm of the persistent trigeminal artery. This patient has survival to these conditions and remain without important morbidity. The case manifested with a clinical picture of third and seventh cranial nerve deficit, which this last one, there are not previous publications of cases with this deficit. This aneurysm was embolized with coils, and the postoperative condition was satisfactory, been discharged at 4 postoperative days.

继发于动脉瘤破裂的蛛网膜下腔出血是一种严重的疾病,具有很高的发病率和死亡率。文献中很少有三叉动脉持续性动脉瘤破裂的病例。这是一名62岁的女性在她生命的不同时期,经历了多次动脉瘤破裂,随着新生动脉瘤的发展,这是一个持续性三叉动脉动脉瘤破裂的病例。该患者在这些条件下存活,并且没有出现重要的发病率。该病例表现为第三和第七脑神经缺损的临床表现,这是最后一个,以前没有发表过这种缺损的病例。动脉瘤用线圈栓塞,术后情况满意,术后4天出院。
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引用次数: 0
Helical coils augment embolization of the middle meningeal artery for treatment of chronic subdural hematoma: A technical note. 螺旋线圈增强脑膜中动脉栓塞治疗慢性硬膜下血肿:技术说明。
Pub Date : 2023-06-01 DOI: 10.7461/jcen.2023.E2022.08.001
Arvin R Wali, Alexander Himstead, Javier Bravo, Michael G Brandel, Brian R Hirshman, J Scott Pannell, Andrew D Nguyen, David R Santiago-Dieppa

Embolization of the middle meningeal artery (MMA) is a safe and effective adjunct in the treatment of chronic subdural hematoma. While prior authors describe the use of coils to assist embolization by preventing reflux through eloquent collaterals, we de- scribe the use of coils to further open the MMA, allowing the administration of greater amounts of embolisate for a more robust embolization. The objective of this study was to demonstrate that helical coils can safely open the MMA following the administration of polyvinyl alcohol (PVA) particles. This allows for more embolisate to be administered into the MMA for more effective treatment. A retrospective review was conducted at our institution including intraoperative images and postoperative clinical and radiographic follow up. Failure rates using MMA embolization with PVA and helical coil augmentation were compared to failure rates in the literature of MMA embolization with PVA or ethylene vinyl-alcohol copolymer alone. A total of 8 cases were reviewed in which this technique was implemented. There were no immediate complications after treatment. All patients that underwent helical coil embolization following the administration of PVA had increased amount of embolisate delivered into the MMA. All patients at follow up had resolution of the subdural hematoma on outpatient imaging. Helical coil embolization allows for more embolisate administration into the MMA and provides a technical advantage for patients that fail traditional techniques of embolization. Case series are taking place to further test this hypothesis and identify the ideal patient population that may gain maximal yield from this novel technique.

脑膜中动脉栓塞是治疗慢性硬膜下血肿的一种安全有效的辅助手段。虽然先前的作者描述了使用线圈通过雄辩的侧支防止反流来辅助栓塞,但我们描述了使用线圈进一步打开MMA,允许更大量的栓塞管理,以实现更强大的栓塞。本研究的目的是证明螺旋线圈在聚乙烯醇(PVA)颗粒注入后可以安全地打开MMA。这允许更多的栓塞剂进入MMA以获得更有效的治疗。回顾性回顾在我院进行,包括术中图像和术后临床及影像学随访。将MMA栓塞与PVA和螺旋线圈增强的失败率与文献中单独使用PVA或乙烯-乙烯-醇共聚物的MMA栓塞的失败率进行比较。总共回顾了8例采用该技术的病例。治疗后无立即并发症。在给予PVA后,所有接受螺旋线圈栓塞的患者都增加了栓塞物进入MMA的量。所有患者在随访中均能在门诊显像上看到硬膜下血肿。螺旋线圈栓塞允许对MMA进行更多的栓塞管理,并为无法使用传统栓塞技术的患者提供技术优势。病例系列正在进行,以进一步验证这一假设,并确定可能从这种新技术中获得最大收益的理想患者群体。
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引用次数: 1
Alterations of vital signs as prognostic factors after intraprocedural rupture of intracranial aneurysms during endovascular treatment. 颅内动脉瘤术中破裂后生命体征改变与血管内治疗预后的关系。
Pub Date : 2023-06-01 DOI: 10.7461/jcen.2022.E2022.05.003
Keonhee Kim, Junhyung Kim, Sang Kyu Park, Keun Young Park, Joonho Chung

Objective: To report our experience with intraprocedural rupture (IPR) of intracranial aneurysms during endovascular treatment and evaluate alterations in vital signs as independent prognostic factors to predict the outcomes of IPR.

Methods: Between January 2008 and August 2021, 34 patients (8 ruptured and 26 unruptured) were confirmed to have IPR based on our dataset with 3178 endovascular coiling procedures. The patients who underwent additional surgeries related to IPR were classified as the OP group (n=9), while those who did not receive additional surgeries were classified as the non-OP group (n=25). Vital signs were recorded during the procedure by anesthesiologists and analyzed.

Results: Of the 34 patients included in this study, eight initially presented with subarachnoid hemorrhage due to a ruptured aneurysm. The clinical outcomes at discharge were significantly different between the two groups (p=0.046). In the OP group, five patients showed favorable outcomes at discharge, while four showed unfavorable outcomes. In the non-OP group, 23 patients showed favorable outcomes at discharge while two patients showed unfavorable outcomes. Maximal (MAX) systolic blood pressure (SBP) (odds ratio [OR] 1.520, 95% confidence interval [CI] 1.084-2.110; p=0.037) and higher differential value MAX-median blood pressure (MBP) (OR 1.322, 95% CI 1.029-1.607; p=0.044) remained independent risk factors for poor prognosis after IPR on multivariate logistic regression analysis.

Conclusions: The MAX SBP and the difference between the maximal and baseline values of MBP are key factors in predicting the prognosis of patients after IPR, as well as providing useful information for predicting the outcome. Further research is required to confirm the relationship between naive pressure and prognosis.

目的:报告颅内动脉瘤术中破裂(IPR)在血管内治疗中的经验,并评价生命体征改变作为预测IPR预后的独立预后因素。方法:2008年1月至2021年8月,34例患者(8例破裂,26例未破裂)经3178次血管内缠绕手术确认为IPR。将额外接受IPR相关手术的患者分为OP组(n=9),未接受额外手术的患者分为非OP组(n=25)。麻醉医师在手术过程中记录生命体征并进行分析。结果:在本研究纳入的34例患者中,8例最初因动脉瘤破裂而出现蛛网膜下腔出血。两组患者出院时临床结局比较,差异有统计学意义(p=0.046)。在OP组中,5例患者出院时预后良好,4例预后不良。在非op组中,23例患者出院时预后良好,2例患者出院时预后不良。最大(MAX)收缩压(SBP)(优势比[OR] 1.520, 95%可信区间[CI] 1.084-2.110;p=0.037)和更高的差值MAX-median blood pressure (MBP) (OR 1.322, 95% CI 1.029-1.607;多因素logistic回归分析显示,p=0.044)仍是IPR术后预后不良的独立危险因素。结论:最大收缩压及最大收缩压与基线值之差是预测IPR术后患者预后的关键因素,为预测预后提供有用信息。需要进一步的研究来证实初始压力与预后的关系。
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引用次数: 0
Discontinuation of antiplatelet therapy after stent-assisted coil embolization for cerebral aneurysms. 支架辅助线圈栓塞治疗脑动脉瘤后停止抗血小板治疗。
Pub Date : 2023-06-01 DOI: 10.7461/jcen.2023.E2022.10.009
Tae Gon Kim

Objective: Dual antiplatelet therapy (DAPT) is usually temporarily used after stent-assisted coil embolization (SACE), and is commonly converted to mono antiplatelet therapy (MAPT) for indefinitely. In this study, we aimed to find the possibility of discontinuing MAPT, and to determine the proper period of DAPT use.

Methods: We used the Standard Sample Cohort DB dataset from the National Health Insurance Sharing Service. Among approximately 1 million people in the dataset, SACE was performed in 214 patients whose data this study analyzed. The relationship between discontinuation of antiplatelet therapy and intracranial hemorrhage or cerebral infarction was analyzed using multiple logistic regression, considering all confounding variables. The survival rate according to the continuation of antiplatelet therapy was obtained using Kaplan-Meier analysis, and the difference in survival rate according to the continuation of antiplatelet therapy was verified using the log-rank test. The hazard ratio according to continuation of antiplatelet therapy was obtained using the Cox proportional hazards model. The analysis was conducted by applying the same statistical method to the duration of DAPT use.

Results: Among 214 patients who underwent SACE, 50, 159 and five patients continued, discontinued and did not use antiplatelet therapy (except at the time of procedure), respectively. In multiple logistic regression analysis, discontinuation of antiplatelet agents (including aspirin) and the period of DAPT use did not affect the occurrence of intracranial hemorrhage or cerebral infarction, considering various confounding factors. In the survival analysis according to the continuation of antiplatelet agents, patients who continued to use antiplatelet agents had a higher survival rate than those in other groups (p=0.00). The survival rate was higher in the rest of the group than in the group that received DAPT for three months (p=0.00).

Conclusions: Continuation of antiplatelet agents or the period of DAPT use did not affect the occurrence of intracranial hemorrhage or cerebral infarction. Considering the survival rate, it would be better to maintain at least three months of antiplatelet therapy and it might be recommended to continue DAPT use for 12 months.

目的:双重抗血小板治疗(DAPT)通常在支架辅助线圈栓塞(SACE)后暂时使用,并且通常转化为单抗血小板治疗(MAPT)无限期使用。在本研究中,我们的目的是寻找停用MAPT的可能性,并确定DAPT的适当使用时间。方法:我们使用来自国家健康保险共享服务的标准样本队列数据库数据集。在数据集中约100万人中,本研究分析了214名患者的数据。考虑所有混杂变量,采用多元logistic回归分析停止抗血小板治疗与颅内出血或脑梗死的关系。采用Kaplan-Meier分析获得持续抗血小板治疗的生存率,采用log-rank检验验证持续抗血小板治疗的生存率差异。采用Cox比例风险模型计算持续抗血小板治疗的风险比。采用与DAPT使用时间相同的统计方法进行分析。结果:在214例接受SACE治疗的患者中,分别有50例、159例和5例患者继续、停止和未使用抗血小板治疗(手术时除外)。在多元logistic回归分析中,考虑多种混杂因素,停用抗血小板药物(包括阿司匹林)和DAPT使用时间不影响颅内出血或脑梗死的发生。在持续使用抗血小板药物的生存分析中,持续使用抗血小板药物的患者生存率高于其他组(p=0.00)。其余组生存率高于DAPT组(p=0.00)。结论:抗血小板药物的持续使用或DAPT的使用时间对颅内出血或脑梗死的发生无影响。考虑到生存率,维持抗血小板治疗至少3个月为佳,建议继续DAPT治疗12个月。
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引用次数: 0
Retreatment of a recurrent giant aneurysm of the internal carotid artery after treatment with a flow-diverting stent. 血流转移支架治疗后复发的颈内动脉巨大动脉瘤的再治疗。
Pub Date : 2023-06-01 DOI: 10.7461/jcen.2022.E2022.06.007
Ginam Kim, Junhyung Kim, Sang Kyu Park, Joonho Chung

Flow-diverting stents (FDSs) have proven advantageous for the treatment of large, fusiform, and dissecting aneurysms that are otherwise difficult to treat. Retreatment strategies for recurrent large or giant aneurysms after FDSs are limited to overlapping implantation of an additional FDS or definitive occlusion of the parent vessel. We report a recurrent giant aneurysm that was initially treated with an FDS with coils and was successfully treated with an additional FDS. Visual symptoms due to the mass effect of the recurrent aneurysm were completely resolved, and follow-up digital subtraction angiography revealed complete obliteration of the aneurysm. Additional FDS implantation for the retreatment of incompletely occluded aneurysms after the initial FDS treatment may be feasible and safe. Further studies are required to validate these results.

血流转移支架(FDSs)已被证明对治疗大的梭状动脉瘤和夹层动脉瘤是有利的,否则这些动脉瘤很难治疗。FDS后复发的大或巨动脉瘤的再治疗策略仅限于重叠植入额外的FDS或最终闭塞母血管。我们报告了一例复发性巨大动脉瘤,最初使用带线圈的FDS治疗,并成功地使用额外的FDS治疗。复发动脉瘤的肿块效应导致的视觉症状完全消失,随后的数字减影血管造影显示动脉瘤完全闭塞。在初始FDS治疗后,对不完全闭塞的动脉瘤再治疗额外的FDS植入可能是可行和安全的。需要进一步的研究来验证这些结果。
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引用次数: 0
Initial experience with Scepter Mini dual lumen balloon for embolization of cerebrovascular diseases. 迷你双腔球囊用于脑血管疾病栓塞的初步经验。
Pub Date : 2023-06-01 DOI: 10.7461/jcen.2023.E2022.10.004
Muhammad U Manzoor, Ibrahim A Almulhim, Abdullah A Alrashed, Shorog Althubait, Abdulrahman Y Alturki, Sultan M Al-Qahtani

Objective: Endovascular treatment of cerebrovascular diseases is often challenging due to small caliber, tortuous distal vessels. Several devices and techniques have evolved to overcome these challenges. Recently, a low profile dual lumen microballoon catheter, specifically designed for distal navigation is employed for neurovascular procedures. Due to its recent advent, scarce data is available on clinical utility and safety of Scepter Mini. The aim of this case series is to report our initial experience with Scepter Mini in the management of various cerebrovascular diseases.

Methods: All interventional neurovascular cases performed using Scepter Mini between January 2020 till April 2021 were included. Data regarding patient demographics, procedural details and complications was retrospectively collected from patient's electronic medical record and procedure reports.

Results: Total twelve embolization procedures were performed in eleven patients, including six brain arteriovenous malformation, two dural arteriovenous fistula, one vein of Galen malformation and three hyper-vascular glomus tumor embolizations. All procedures were successfully performed with adequate penetration of the embolic agent. Complete embolization was performed in six procedures, while intended partial embolization was performed in the rest of procedures. Scepter Mini was solely used in ten procedures, however in the other two embolization procedures it was used as an additional conjunct tool to complete the intended embolization. No balloon related complication was observed in any procedure.

Conclusions: Scepter Mini dual lumen microballoon catheter is safe and feasible for delivery of liquid embolic agents for cerebrovascular embolization procedures.

目的:脑血管病的远端血管小口径、迂曲,常使血管内治疗具有挑战性。为了克服这些挑战,已经发展了几种设备和技术。最近,专门设计用于远端导航的低轮廓双腔微球囊导管被用于神经血管手术。由于其问世不久,关于迷你Scepter的临床效用和安全性的数据很少。本病例系列的目的是报告我们使用迷你权杖治疗各种脑血管疾病的初步经验。方法:纳入2020年1月至2021年4月期间使用Scepter Mini进行介入治疗的所有神经血管病例。从患者的电子病历和手术报告中回顾性收集有关患者人口统计、手术细节和并发症的数据。结果:11例患者共行12次栓塞术,其中脑动静脉畸形6例,硬脑膜动静脉瘘2例,盖伦静脉畸形1例,高血管球瘤栓塞3例。在栓塞剂充分渗透的情况下,所有手术均成功完成。在6例手术中进行了完全栓塞,而在其余手术中进行了预定的部分栓塞。Scepter Mini仅在10次手术中使用,但在其他两次栓塞手术中,它被用作额外的连接工具来完成预期的栓塞。所有手术均无球囊相关并发症。结论:Scepter迷你双腔微球囊导管用于输送液体栓塞剂用于脑血管栓塞手术是安全可行的。
{"title":"Initial experience with Scepter Mini dual lumen balloon for embolization of cerebrovascular diseases.","authors":"Muhammad U Manzoor,&nbsp;Ibrahim A Almulhim,&nbsp;Abdullah A Alrashed,&nbsp;Shorog Althubait,&nbsp;Abdulrahman Y Alturki,&nbsp;Sultan M Al-Qahtani","doi":"10.7461/jcen.2023.E2022.10.004","DOIUrl":"https://doi.org/10.7461/jcen.2023.E2022.10.004","url":null,"abstract":"<p><strong>Objective: </strong>Endovascular treatment of cerebrovascular diseases is often challenging due to small caliber, tortuous distal vessels. Several devices and techniques have evolved to overcome these challenges. Recently, a low profile dual lumen microballoon catheter, specifically designed for distal navigation is employed for neurovascular procedures. Due to its recent advent, scarce data is available on clinical utility and safety of Scepter Mini. The aim of this case series is to report our initial experience with Scepter Mini in the management of various cerebrovascular diseases.</p><p><strong>Methods: </strong>All interventional neurovascular cases performed using Scepter Mini between January 2020 till April 2021 were included. Data regarding patient demographics, procedural details and complications was retrospectively collected from patient's electronic medical record and procedure reports.</p><p><strong>Results: </strong>Total twelve embolization procedures were performed in eleven patients, including six brain arteriovenous malformation, two dural arteriovenous fistula, one vein of Galen malformation and three hyper-vascular glomus tumor embolizations. All procedures were successfully performed with adequate penetration of the embolic agent. Complete embolization was performed in six procedures, while intended partial embolization was performed in the rest of procedures. Scepter Mini was solely used in ten procedures, however in the other two embolization procedures it was used as an additional conjunct tool to complete the intended embolization. No balloon related complication was observed in any procedure.</p><p><strong>Conclusions: </strong>Scepter Mini dual lumen microballoon catheter is safe and feasible for delivery of liquid embolic agents for cerebrovascular embolization procedures.</p>","PeriodicalId":15359,"journal":{"name":"Journal of Cerebrovascular and Endovascular Neurosurgery","volume":"25 2","pages":"175-181"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ef/39/jcen-2023-e2022-10-004.PMC10318239.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10129618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
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Journal of Cerebrovascular and Endovascular Neurosurgery
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