Pub Date : 2023-06-01DOI: 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.
{"title":"Role of surgery in management of intracranial dural arteriovenous fistulas.","authors":"Young Sill Kang, Won-Sang Cho, Sung Ho Lee, Kangmin Kim, Hyun-Seung Kang, Jeong Eun Kim","doi":"10.7461/jcen.2023.E2022.10.006","DOIUrl":"https://doi.org/10.7461/jcen.2023.E2022.10.006","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":15359,"journal":{"name":"Journal of Cerebrovascular and Endovascular Neurosurgery","volume":"25 2","pages":"117-131"},"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/e4/b7/jcen-2023-e2022-10-006.PMC10318241.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9752427","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}
Pub Date : 2023-06-01DOI: 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.
{"title":"Efficacy of intraoperative neuromonitoring (IONM) and intraoperative indocyanine green videoangiography (ICG-VA) during unruptured anterior choroidal artery aneurysm clipping surgery.","authors":"Chanbo Eun, Seung Joo Lee, Jung Cheol Park, Jae Sung Ahn, Byung Duk Kwun, Wonhyoung Park","doi":"10.7461/jcen.2023.E2022.10.008","DOIUrl":"https://doi.org/10.7461/jcen.2023.E2022.10.008","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":15359,"journal":{"name":"Journal of Cerebrovascular and Endovascular Neurosurgery","volume":"25 2","pages":"150-159"},"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/0c/8c/jcen-2023-e2022-10-008.PMC10318233.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9753252","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}
Pub Date : 2023-06-01DOI: 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.
{"title":"Association between ischemic stroke and pyogenic spondylitis in Korea: Nationwide longitudinal cohort study.","authors":"Soo Hyun Lee, Hakyung Kim, In-Bo Han, Seung Hun Sheen, Je Beom Hong, Seil Sohn","doi":"10.7461/jcen.2023.E2022.09.001","DOIUrl":"https://doi.org/10.7461/jcen.2023.E2022.09.001","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>The risk rate of IS increased in patient with pyogenic spondylitis.</p>","PeriodicalId":15359,"journal":{"name":"Journal of Cerebrovascular and Endovascular Neurosurgery","volume":"25 2","pages":"143-149"},"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/a6/76/jcen-2023-e2022-09-001.PMC10318237.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10129602","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}
Pub Date : 2023-06-01DOI: 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。
{"title":"Long-term outcomes of carotid artery stenting in patients with carotid artery stenosis: A single-center 14-year retrospective analysis.","authors":"Beom Mo Kang, Seok Mann Yoon, Jae Sang Oh, Hyuk Jin Oh, Jae Min Ahn, Gi Yong Yun","doi":"10.7461/jcen.2023.E2022.07.007","DOIUrl":"https://doi.org/10.7461/jcen.2023.E2022.07.007","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":15359,"journal":{"name":"Journal of Cerebrovascular and Endovascular Neurosurgery","volume":"25 2","pages":"160-174"},"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/65/a6/jcen-2023-e2022-07-007.PMC10318231.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9743851","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}
Pub Date : 2023-06-01DOI: 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.
{"title":"An interesting case of survival to multiple ruptures of aneurysms, with persistent trigeminal artery, cranial nerve deficit, and evolutionary exposure of neurovascular treatment.","authors":"Héctor Lezcano, María Fernanda Solorzano","doi":"10.7461/jcen.2022.E2022.06.009","DOIUrl":"https://doi.org/10.7461/jcen.2022.E2022.06.009","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":15359,"journal":{"name":"Journal of Cerebrovascular and Endovascular Neurosurgery","volume":"25 2","pages":"189-195"},"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/f9/59/jcen-2022-e2022-06-009.PMC10318238.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10111828","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}
Pub Date : 2023-06-01DOI: 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.
{"title":"Helical coils augment embolization of the middle meningeal artery for treatment of chronic subdural hematoma: A technical note.","authors":"Arvin R Wali, Alexander Himstead, Javier Bravo, Michael G Brandel, Brian R Hirshman, J Scott Pannell, Andrew D Nguyen, David R Santiago-Dieppa","doi":"10.7461/jcen.2023.E2022.08.001","DOIUrl":"https://doi.org/10.7461/jcen.2023.E2022.08.001","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":15359,"journal":{"name":"Journal of Cerebrovascular and Endovascular Neurosurgery","volume":"25 2","pages":"214-223"},"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/b8/52/jcen-2023-e2022-08-001.PMC10318235.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9750017","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}
Pub Date : 2023-06-01DOI: 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.
{"title":"Alterations of vital signs as prognostic factors after intraprocedural rupture of intracranial aneurysms during endovascular treatment.","authors":"Keonhee Kim, Junhyung Kim, Sang Kyu Park, Keun Young Park, Joonho Chung","doi":"10.7461/jcen.2022.E2022.05.003","DOIUrl":"https://doi.org/10.7461/jcen.2022.E2022.05.003","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":15359,"journal":{"name":"Journal of Cerebrovascular and Endovascular Neurosurgery","volume":"25 2","pages":"182-188"},"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/bb/35/jcen-2022-e2022-05-003.PMC10318240.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9753208","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}
Pub Date : 2023-06-01DOI: 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.
{"title":"Discontinuation of antiplatelet therapy after stent-assisted coil embolization for cerebral aneurysms.","authors":"Tae Gon Kim","doi":"10.7461/jcen.2023.E2022.10.009","DOIUrl":"https://doi.org/10.7461/jcen.2023.E2022.10.009","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":15359,"journal":{"name":"Journal of Cerebrovascular and Endovascular Neurosurgery","volume":"25 2","pages":"132-142"},"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/8d/5f/jcen-2023-e2022-10-009.PMC10318236.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9755372","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}
Pub Date : 2023-06-01DOI: 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.
{"title":"Retreatment of a recurrent giant aneurysm of the internal carotid artery after treatment with a flow-diverting stent.","authors":"Ginam Kim, Junhyung Kim, Sang Kyu Park, Joonho Chung","doi":"10.7461/jcen.2022.E2022.06.007","DOIUrl":"https://doi.org/10.7461/jcen.2022.E2022.06.007","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":15359,"journal":{"name":"Journal of Cerebrovascular and Endovascular Neurosurgery","volume":"25 2","pages":"208-213"},"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/84/f2/jcen-2022-e2022-06-007.PMC10318234.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10129562","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}
Pub Date : 2023-06-01DOI: 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.
{"title":"Initial experience with Scepter Mini dual lumen balloon for embolization of cerebrovascular diseases.","authors":"Muhammad U Manzoor, Ibrahim A Almulhim, Abdullah A Alrashed, Shorog Althubait, Abdulrahman Y Alturki, 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}