Pub Date : 2018-07-18DOI: 10.5797/JNET.TN.2018-0040
Y. Hanaoka, J. Koyama, Alhusain Nagm, Keisuke Kamiya, A. Chiba, Takaaki Kamijo, T. Ogiwara, T. Horiuchi, K. Hongo
Objective: Carotid artery stenting (CAS) for common carotid artery stenosis via the transfemoral approach might have a potential risk of iatrogenic distal embolism. In this study, we present a technique of transradial stenting with 6 Fr modified Simmonds guiding sheath for stenosis of the common carotid artery. Case Presentations: A 6 Fr modified Simmonds guiding sheath was introduced via the right radial artery and advanced to the common carotid artery without passing a guidewire or coaxial catheter through the stenotic lesions. Two cases with common carotid artery stenosis were treated successfully with this procedure. Conclusion: Transradial CAS with modified Simmonds guiding sheath provides a safe and durable alternative option for patients with common carotid artery stenosis having vulnerable plaques.
{"title":"Transradial Stenting with a 6 Fr Modified Simmonds Guiding Sheath for Stenosis of the Common Carotid Artery","authors":"Y. Hanaoka, J. Koyama, Alhusain Nagm, Keisuke Kamiya, A. Chiba, Takaaki Kamijo, T. Ogiwara, T. Horiuchi, K. Hongo","doi":"10.5797/JNET.TN.2018-0040","DOIUrl":"https://doi.org/10.5797/JNET.TN.2018-0040","url":null,"abstract":"Objective: Carotid artery stenting (CAS) for common carotid artery stenosis via the transfemoral approach might have a potential risk of iatrogenic distal embolism. In this study, we present a technique of transradial stenting with 6 Fr modified Simmonds guiding sheath for stenosis of the common carotid artery. Case Presentations: A 6 Fr modified Simmonds guiding sheath was introduced via the right radial artery and advanced to the common carotid artery without passing a guidewire or coaxial catheter through the stenotic lesions. Two cases with common carotid artery stenosis were treated successfully with this procedure. Conclusion: Transradial CAS with modified Simmonds guiding sheath provides a safe and durable alternative option for patients with common carotid artery stenosis having vulnerable plaques.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"12 1","pages":"573-579"},"PeriodicalIF":0.0,"publicationDate":"2018-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49068331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-07-16DOI: 10.5797/JNET.CR.2018-0025
K. Shimonaga, T. Matsushige, Masahiro Hosogai, T. Kawasumi, K. Kurisu, S. Sakamoto
Objective: Many vertebral arteriovenous (AV) fistulae are associated with trauma. Recently, a procedure to embolize a fistula and parent blood vessel by endovascular treatment has been performed as standard treatment. We report a patient in whom stent-assisted coil embolization with the preservation of the vertebral artery (VA) led to the disappearance of a fistula. Case Presentation: A 48-year-old male. He complained of pulsatile tinnitus 5 days after head bruise. Detailed examination showed a left extracranial vertebral AV fistula with reflux into the intracranial space. Dilation of the AV fistula was noted, with the venous pouch surrounding the VA. Stent-assisted coil embolization of the fistula through the venous side was performed, reducing blood flow. The disappearance of the AV fistula was confirmed 3 months after surgery. Conclusion: We encountered a patient in whom stent-assisted coil embolization of a traumatic vertebral AV fistula led to its disappearance. As a method to preserve a parent blood vessel, stent-assisted treatment may be effective.
{"title":"A Case of Traumatic Vertebral Arteriovenous Fistula Treated by Coil Embolization Using Braided-stent for Preservation of Parental Artery","authors":"K. Shimonaga, T. Matsushige, Masahiro Hosogai, T. Kawasumi, K. Kurisu, S. Sakamoto","doi":"10.5797/JNET.CR.2018-0025","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0025","url":null,"abstract":"Objective: Many vertebral arteriovenous (AV) fistulae are associated with trauma. Recently, a procedure to embolize a fistula and parent blood vessel by endovascular treatment has been performed as standard treatment. We report a patient in whom stent-assisted coil embolization with the preservation of the vertebral artery (VA) led to the disappearance of a fistula. Case Presentation: A 48-year-old male. He complained of pulsatile tinnitus 5 days after head bruise. Detailed examination showed a left extracranial vertebral AV fistula with reflux into the intracranial space. Dilation of the AV fistula was noted, with the venous pouch surrounding the VA. Stent-assisted coil embolization of the fistula through the venous side was performed, reducing blood flow. The disappearance of the AV fistula was confirmed 3 months after surgery. Conclusion: We encountered a patient in whom stent-assisted coil embolization of a traumatic vertebral AV fistula led to its disappearance. As a method to preserve a parent blood vessel, stent-assisted treatment may be effective.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"12 1","pages":"546-552"},"PeriodicalIF":0.0,"publicationDate":"2018-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/JNET.CR.2018-0025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49180825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-07-13DOI: 10.5797/JNET.TN.2017-0130
T. Ishibashi, K. Aoki, Ritsu Kakutou, I. Yuki, Y. Murayama
Objective: To increase procedure-related options for Pipeline Embolization Device (PED) insertion. Case Presentation: An 83-year-old female patient with a right internal carotid artery (ICA) cerebral aneurysm in the cavernous sinus being on follow-up showed subsequently an increase in the aneurysmal size and diplopia, and surgery was considered. Diagnostic cerebral angiography showed marked arteriosclerosis, and it was difficult to guide selectively a catheter into the ICA. Therefore, for treatment, we planned PED insertion by direct puncture of the carotid artery through direct cervical surgical exposure. Under general anesthesia, a cervical skin incision exposed the common carotid artery. Surgical vessel holding tapes were placed distal and proximal to the site to be punctured on the common carotid artery. Using a pediatric puncture kit, a 4 Fr sheath was inserted in the common carotid artery. Next, under fluoroscopy the ICA was entered using a 0.035-inch guidewire that was exchanged for a 6 Fr Destination 90-cm (Terumo Corporation, Tokyo, Japan) long. This was carefully guided into the ICA. Subsequently, a PED measuring 5 × 35 mm was inserted to the aneurysmal site using a 5 Fr Navien 115 cm (Marksman; Covidien, Irvine, CA, USA). Hemostasis by suture was performed at the site of arterial puncture. There were no intraoperative or postoperative complications. Conclusion: Direct puncture of the carotid artery can be an effective method for patients in whom it may be difficult to insert a PED due to arteriosclerosis.
{"title":"Pipeline Embolization Device Insertion Using a Direct Exposure Transcarotid Approach","authors":"T. Ishibashi, K. Aoki, Ritsu Kakutou, I. Yuki, Y. Murayama","doi":"10.5797/JNET.TN.2017-0130","DOIUrl":"https://doi.org/10.5797/JNET.TN.2017-0130","url":null,"abstract":"Objective: To increase procedure-related options for Pipeline Embolization Device (PED) insertion. Case Presentation: An 83-year-old female patient with a right internal carotid artery (ICA) cerebral aneurysm in the cavernous sinus being on follow-up showed subsequently an increase in the aneurysmal size and diplopia, and surgery was considered. Diagnostic cerebral angiography showed marked arteriosclerosis, and it was difficult to guide selectively a catheter into the ICA. Therefore, for treatment, we planned PED insertion by direct puncture of the carotid artery through direct cervical surgical exposure. Under general anesthesia, a cervical skin incision exposed the common carotid artery. Surgical vessel holding tapes were placed distal and proximal to the site to be punctured on the common carotid artery. Using a pediatric puncture kit, a 4 Fr sheath was inserted in the common carotid artery. Next, under fluoroscopy the ICA was entered using a 0.035-inch guidewire that was exchanged for a 6 Fr Destination 90-cm (Terumo Corporation, Tokyo, Japan) long. This was carefully guided into the ICA. Subsequently, a PED measuring 5 × 35 mm was inserted to the aneurysmal site using a 5 Fr Navien 115 cm (Marksman; Covidien, Irvine, CA, USA). Hemostasis by suture was performed at the site of arterial puncture. There were no intraoperative or postoperative complications. Conclusion: Direct puncture of the carotid artery can be an effective method for patients in whom it may be difficult to insert a PED due to arteriosclerosis.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"12 1","pages":"567-572"},"PeriodicalIF":0.0,"publicationDate":"2018-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42092917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-07-12DOI: 10.5797/JNET.OA.2018-0032
T. Ohashi, Y. Arai, Daichi Kato, S. Aoyagi, Hirofumi Okada, Tomoya Yokoyama, Megumi Ichikawa, Kenta Nagai, H. Namatame, A. Saida, T. Hashimoto, M. Kono
Objective: The purpose of this study was to investigate the preventive effects of an eicosapentaenoic acid (EPA) medication on restenosis after carotid artery stenting (CAS). Methods: Of 134 patients (144 episodes) who underwent CAS in our hospital or affiliated institutions between November 2005 and September 2017, the subjects were 123 who could be followed-up for ≥30 days after procedure by carotid ultrasonography with a mean age of 73.3 years (range: 55–90 years). Males accounted for 106 (86.2%) of the patients, 61 lesions (49.6%) were symptomatic. We retrospectively compared the incidence of restenosis between the two groups: EPA-treated group (n = 43) and non-EPA-treated group (n = 80). In addition, the serum levels of fatty acid compositions had been analyzed in 97 of the 123 patients, and the relationship of the EPA/arachidonic acid (AA) ratio with perioperative ischemic complications or restenosis was examined. Results: There was no restenosis in any of the 43 EPA-treated patients, whereas it occurred in 8 (10%) of the 80 patients in the non-EPA-treated group, and the incidence of restenosis in EPA-treated group was significantly lower (p = 0.043) than that of non-EPA-treated group. In addition, the incidences of restenosis and perioperative ischemic complications were slightly higher in patients with a low EPA/AA ratio. Conclusion: Although restenosis was more frequent in patients with a low EPA/AA ratio, the administration of an EPA medication may prevent restenosis in all patients who underwent CAS.
{"title":"Preventive Effects of an EPA Preparation on Restenosis after Carotid Artery Stenting","authors":"T. Ohashi, Y. Arai, Daichi Kato, S. Aoyagi, Hirofumi Okada, Tomoya Yokoyama, Megumi Ichikawa, Kenta Nagai, H. Namatame, A. Saida, T. Hashimoto, M. Kono","doi":"10.5797/JNET.OA.2018-0032","DOIUrl":"https://doi.org/10.5797/JNET.OA.2018-0032","url":null,"abstract":"Objective: The purpose of this study was to investigate the preventive effects of an eicosapentaenoic acid (EPA) medication on restenosis after carotid artery stenting (CAS). Methods: Of 134 patients (144 episodes) who underwent CAS in our hospital or affiliated institutions between November 2005 and September 2017, the subjects were 123 who could be followed-up for ≥30 days after procedure by carotid ultrasonography with a mean age of 73.3 years (range: 55–90 years). Males accounted for 106 (86.2%) of the patients, 61 lesions (49.6%) were symptomatic. We retrospectively compared the incidence of restenosis between the two groups: EPA-treated group (n = 43) and non-EPA-treated group (n = 80). In addition, the serum levels of fatty acid compositions had been analyzed in 97 of the 123 patients, and the relationship of the EPA/arachidonic acid (AA) ratio with perioperative ischemic complications or restenosis was examined. Results: There was no restenosis in any of the 43 EPA-treated patients, whereas it occurred in 8 (10%) of the 80 patients in the non-EPA-treated group, and the incidence of restenosis in EPA-treated group was significantly lower (p = 0.043) than that of non-EPA-treated group. In addition, the incidences of restenosis and perioperative ischemic complications were slightly higher in patients with a low EPA/AA ratio. Conclusion: Although restenosis was more frequent in patients with a low EPA/AA ratio, the administration of an EPA medication may prevent restenosis in all patients who underwent CAS.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"12 1","pages":"527-531"},"PeriodicalIF":0.0,"publicationDate":"2018-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41515330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-21DOI: 10.5797/JNET.TN.2018-0020
Y. Hanaoka, J. Koyama, Takafumi Kiuchi, Keisuke Kamiya, Haruki Kuwabara, Takaaki Kamijo, T. Horiuchi, K. Hongo
Objective: We report two patients for whom the proximal balloon protection (PBP) method was used during transradial carotid artery stenting (TR-CAS). Case Presentations: Case 1 was a 79-year-old male. TR-CAS for acute occlusion of the internal carotid artery was performed. A 6 Fr balloon guiding catheter was introduced into a 6 Fr guiding sheath, and CAS was conducted by passing through the lesion under PBP. Case 2 was an 83-year-old male. TR-CAS was performed to treat marked stenosis of the internal carotid artery. It was difficult to pass the catheter through the lesion, but PBP with a balloon guiding catheter enhanced the supporting power, facilitating lesion passage, and CAS was successful. Conclusion: No study has reported PBP during TR-CAS, but we were able to perform PBP during TR-CAS by adopting this method, and the support for lesion passage may be enhanced. This method may be useful for patients at risk of distal embolism or for those in whom lesion passage is difficult.
{"title":"Proximal Balloon Protection during Carotid Artery Stenting via the Transradial Approach","authors":"Y. Hanaoka, J. Koyama, Takafumi Kiuchi, Keisuke Kamiya, Haruki Kuwabara, Takaaki Kamijo, T. Horiuchi, K. Hongo","doi":"10.5797/JNET.TN.2018-0020","DOIUrl":"https://doi.org/10.5797/JNET.TN.2018-0020","url":null,"abstract":"Objective: We report two patients for whom the proximal balloon protection (PBP) method was used during transradial carotid artery stenting (TR-CAS). Case Presentations: Case 1 was a 79-year-old male. TR-CAS for acute occlusion of the internal carotid artery was performed. A 6 Fr balloon guiding catheter was introduced into a 6 Fr guiding sheath, and CAS was conducted by passing through the lesion under PBP. Case 2 was an 83-year-old male. TR-CAS was performed to treat marked stenosis of the internal carotid artery. It was difficult to pass the catheter through the lesion, but PBP with a balloon guiding catheter enhanced the supporting power, facilitating lesion passage, and CAS was successful. Conclusion: No study has reported PBP during TR-CAS, but we were able to perform PBP during TR-CAS by adopting this method, and the support for lesion passage may be enhanced. This method may be useful for patients at risk of distal embolism or for those in whom lesion passage is difficult.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"9 13","pages":"520-526"},"PeriodicalIF":0.0,"publicationDate":"2018-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/JNET.TN.2018-0020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41262022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-18DOI: 10.5797/JNET.OA.2018-0027
N. Shimizu, J. Suenaga, Hiromasa Abe, K. Nagao, Y. Arakaki, Yuko Gobayashi, Ryo Matsuzawa, R. Miyazaki, Taishi Nakamura, Mitsuru Sato, K. Tateishi, Hidetoshi Murata, Tetsuya Yamamoto
Objective: We retrospectively reviewed patients who had undergone preoperative embolization of cerebellar hemangioblastomas with a liquid embolic material, N-butyl cyanoacrylate (NBCA), by the plug and push technique. Methods: The subjects were six patients who had undergone preoperative embolization of cerebellar hemangioblastomas in our hospital between April 2016 and October 2017. In all patients, a microcatheter was selectively guided into a feeder, and tumor embolization with low-concentration NBCA, which had been diluted with oily contrast medium, was performed using the plug and push technique before tumor resection based on approval by the Ethics Review Board of our hospital. Results: The male-to-female ratio was 5:1. The mean age was 33.8 ± 10.7 years. The tumor type was evaluated as nodular in three patients and solid in three patients. The mean nodular size was 26 ± 8.9 mm. The mean interval from embolization until surgery was 1.3 days (1–4 days). In all patients, the procedure could be accomplished. The mean concentration of NBCA was 19.4% ± 1.4%. Concerning the embolization effects, cerebral angiography showed complete occlusion in four patients and partial occlusion in two patients. There was no embolization-related complication or adverse event. Under suboccipital craniotomy, total tumor resection was possible in five patients, whereas one patient required blood transfusion. Conclusion: Preoperative embolization of cerebellar hemangioblastomas with low-concentration NBCA by the plug and push technique may be useful for accomplishing tumor resection although catheter adhesion on infusion must be considered.
{"title":"Preoperative Embolization of Cerebellar Hemangioblastomas with a Liquid Embolic Material (NBCA) by the “Plug and Push” Technique","authors":"N. Shimizu, J. Suenaga, Hiromasa Abe, K. Nagao, Y. Arakaki, Yuko Gobayashi, Ryo Matsuzawa, R. Miyazaki, Taishi Nakamura, Mitsuru Sato, K. Tateishi, Hidetoshi Murata, Tetsuya Yamamoto","doi":"10.5797/JNET.OA.2018-0027","DOIUrl":"https://doi.org/10.5797/JNET.OA.2018-0027","url":null,"abstract":"Objective: We retrospectively reviewed patients who had undergone preoperative embolization of cerebellar hemangioblastomas with a liquid embolic material, N-butyl cyanoacrylate (NBCA), by the plug and push technique. Methods: The subjects were six patients who had undergone preoperative embolization of cerebellar hemangioblastomas in our hospital between April 2016 and October 2017. In all patients, a microcatheter was selectively guided into a feeder, and tumor embolization with low-concentration NBCA, which had been diluted with oily contrast medium, was performed using the plug and push technique before tumor resection based on approval by the Ethics Review Board of our hospital. Results: The male-to-female ratio was 5:1. The mean age was 33.8 ± 10.7 years. The tumor type was evaluated as nodular in three patients and solid in three patients. The mean nodular size was 26 ± 8.9 mm. The mean interval from embolization until surgery was 1.3 days (1–4 days). In all patients, the procedure could be accomplished. The mean concentration of NBCA was 19.4% ± 1.4%. Concerning the embolization effects, cerebral angiography showed complete occlusion in four patients and partial occlusion in two patients. There was no embolization-related complication or adverse event. Under suboccipital craniotomy, total tumor resection was possible in five patients, whereas one patient required blood transfusion. Conclusion: Preoperative embolization of cerebellar hemangioblastomas with low-concentration NBCA by the plug and push technique may be useful for accomplishing tumor resection although catheter adhesion on infusion must be considered.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"12 1","pages":"475-480"},"PeriodicalIF":0.0,"publicationDate":"2018-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/JNET.OA.2018-0027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44807887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-18DOI: 10.5797/JNET.OA.2018-0043
H. Minami, Shinichirou Yoshida, Hiroaki Hanayama, Hiroaki Matsumoto, Y. Sakurai, Atsushi Masuda, Shogo Tominaga, K. Miyaji, I. Yamaura, Y. Hirata, Yasuhisa Yoshida
{"title":"Efficacy of Heavily T2-weighted MRI to Diagnose Vessel Course Distal to Occluded Artery in Mechanical Thrombectomy for Acute Ischemic Stroke","authors":"H. Minami, Shinichirou Yoshida, Hiroaki Hanayama, Hiroaki Matsumoto, Y. Sakurai, Atsushi Masuda, Shogo Tominaga, K. Miyaji, I. Yamaura, Y. Hirata, Yasuhisa Yoshida","doi":"10.5797/JNET.OA.2018-0043","DOIUrl":"https://doi.org/10.5797/JNET.OA.2018-0043","url":null,"abstract":"","PeriodicalId":34768,"journal":{"name":"JNET","volume":"12 1","pages":"481-488"},"PeriodicalIF":0.0,"publicationDate":"2018-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49254389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-13DOI: 10.5797/JNET.CR.2017-0119
H. Nishi, A. Ishii, M. Itani, T. Kikuchi, Y. Takenobu, Y. Yamao, Hiroyuki Ikeda, Yu Abekura, S. Miyamoto
Objective: A case that suffered vessel perforation during flow diverter stent placement is reported. Case Presentation: The patient was a 65-year-old woman with an unruptured aneurysm 10 mm in maximum diameter at the paraclinoid portion of the left internal carotid artery. She developed disturbance of consciousness a few hours after elective flow diverter stent placement, and diffuse subarachnoid hemorrhage was noted on head CT. Although rupture of aneurysm was suspected, bleeding from the left angular artery was confirmed by emergent angiography. Trapping of the same site was carried out. Vessel perforation due to jump-up of the delivery wire was retrospectively estimated to be the cause of bleeding. Conclusion: Vessel perforation is a serious complication of intracranial endovascular treatment, and its cause and treatment are discussed with a review of the literature.
{"title":"A Case of Paraclinoid Internal Carotid Artery Aneurysm That Suffered Vessel Perforation during Pipeline Flex Placement","authors":"H. Nishi, A. Ishii, M. Itani, T. Kikuchi, Y. Takenobu, Y. Yamao, Hiroyuki Ikeda, Yu Abekura, S. Miyamoto","doi":"10.5797/JNET.CR.2017-0119","DOIUrl":"https://doi.org/10.5797/JNET.CR.2017-0119","url":null,"abstract":"Objective: A case that suffered vessel perforation during flow diverter stent placement is reported. Case Presentation: The patient was a 65-year-old woman with an unruptured aneurysm 10 mm in maximum diameter at the paraclinoid portion of the left internal carotid artery. She developed disturbance of consciousness a few hours after elective flow diverter stent placement, and diffuse subarachnoid hemorrhage was noted on head CT. Although rupture of aneurysm was suspected, bleeding from the left angular artery was confirmed by emergent angiography. Trapping of the same site was carried out. Vessel perforation due to jump-up of the delivery wire was retrospectively estimated to be the cause of bleeding. Conclusion: Vessel perforation is a serious complication of intracranial endovascular treatment, and its cause and treatment are discussed with a review of the literature.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"12 1","pages":"513-519"},"PeriodicalIF":0.0,"publicationDate":"2018-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/JNET.CR.2017-0119","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46248370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-06-01DOI: 10.5797/JNET.CR.2017-0115
I. Takano, Y. Matsumoto, Yoshiko Fujii, Y. Inoue, Y. Sugiura, Koji Hirata, Y. Kawamura, R. Suzuki, R. Nakae, Yoshihiro Tanaka, M. Nagaishi, T. Takigawa, A. Hyodo, Kensuke Suzuki
Objective: We report a patient with severe cerebral sinus thrombosis (CST) in whom mechanical thrombolysis with a balloon and thrombectomy with a stent retriever were effective. Case Presentation: The patient was a 32-year-old male. Headache occurred, and magnetic resonance venography (MRV) showed occlusion of the superior sagittal sinus. Transvenous anticoagulant therapy was performed, but consciousness disorder and paralysis progressed in a few days. Head CT revealed marked edema of the bilateral frontal lobes and cerebral hemorrhage. Cerebral angiography showed occlusion of the superior sagittal sinus, and endovascular treatment with a balloon and stent retriever was performed, leading to recanalization. Finally, the course was favorable. Conclusion: Endovascular treatment with a stent retriever may be safe and effective for severe CST.
{"title":"A Patient with Severe Cerebral Sinus Thrombosis in Whom Mechanical Thrombolysis with a Balloon and Thrombectomy with a Stent Retriever Were Effective","authors":"I. Takano, Y. Matsumoto, Yoshiko Fujii, Y. Inoue, Y. Sugiura, Koji Hirata, Y. Kawamura, R. Suzuki, R. Nakae, Yoshihiro Tanaka, M. Nagaishi, T. Takigawa, A. Hyodo, Kensuke Suzuki","doi":"10.5797/JNET.CR.2017-0115","DOIUrl":"https://doi.org/10.5797/JNET.CR.2017-0115","url":null,"abstract":"Objective: We report a patient with severe cerebral sinus thrombosis (CST) in whom mechanical thrombolysis with a balloon and thrombectomy with a stent retriever were effective. Case Presentation: The patient was a 32-year-old male. Headache occurred, and magnetic resonance venography (MRV) showed occlusion of the superior sagittal sinus. Transvenous anticoagulant therapy was performed, but consciousness disorder and paralysis progressed in a few days. Head CT revealed marked edema of the bilateral frontal lobes and cerebral hemorrhage. Cerebral angiography showed occlusion of the superior sagittal sinus, and endovascular treatment with a balloon and stent retriever was performed, leading to recanalization. Finally, the course was favorable. Conclusion: Endovascular treatment with a stent retriever may be safe and effective for severe CST.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"12 1","pages":"450-455"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48041096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-05-25DOI: 10.5797/JNET.CR.2017-0121
T. Yamanouchi, N. Matsubara, Fumiaki Kanamori, Naoki Koketsu
Objective: We report a case of internal carotid artery (ICA) dissection presenting acute intracranial occlusion and accompanied with simultaneous carotid cavernous fistula (CCF) treated by thrombectomy. Case Presentation: The patient was a 43-year-old male who presented with severe neurological symptoms. Imaging findings demonstrated acute ischemic stroke with occlusion of the left ICA. A retrospective review of angiogram showed ICA dissection-related occlusion with a fine CCF. However, dissection could not be recognized initially, and thrombus aspiration with Penumbra system was performed as revascularization therapy. Recanalization of the ICA was not achieved and the CCF deteriorated. Considering the risk of hemorrhagic complications and the treatment of CCF, parent artery occlusion of the ICA was conducted. The CCF disappeared; however, an extensive area of the left middle cerebral artery territory was infarcted. Conclusion: In revascularization for acute ischemic stroke, it is important to adequately evaluate the condition such as dissection and to select an appropriate therapeutic strategy.
{"title":"A Case of Internal Carotid Artery Dissection Presenting Acute Intracranial Occlusion and Accompanied with Simultaneous Carotid Cavernous Fistula Treated by Thrombectomy","authors":"T. Yamanouchi, N. Matsubara, Fumiaki Kanamori, Naoki Koketsu","doi":"10.5797/JNET.CR.2017-0121","DOIUrl":"https://doi.org/10.5797/JNET.CR.2017-0121","url":null,"abstract":"Objective: We report a case of internal carotid artery (ICA) dissection presenting acute intracranial occlusion and accompanied with simultaneous carotid cavernous fistula (CCF) treated by thrombectomy. Case Presentation: The patient was a 43-year-old male who presented with severe neurological symptoms. Imaging findings demonstrated acute ischemic stroke with occlusion of the left ICA. A retrospective review of angiogram showed ICA dissection-related occlusion with a fine CCF. However, dissection could not be recognized initially, and thrombus aspiration with Penumbra system was performed as revascularization therapy. Recanalization of the ICA was not achieved and the CCF deteriorated. Considering the risk of hemorrhagic complications and the treatment of CCF, parent artery occlusion of the ICA was conducted. The CCF disappeared; however, an extensive area of the left middle cerebral artery territory was infarcted. Conclusion: In revascularization for acute ischemic stroke, it is important to adequately evaluate the condition such as dissection and to select an appropriate therapeutic strategy.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"12 1","pages":"507-512"},"PeriodicalIF":0.0,"publicationDate":"2018-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46480522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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