Pub Date : 2019-05-14DOI: 10.5797/JNET.CR.2018-0104
Seigo Kimura, Ryokichi Yagi, Ryo Tamaki, D. Ogawa, T. Manno, H. Taniguchi, T. Kuroiwa
Objective: We report a 73-year-old male in whom a traumatic pseudoaneurysm of the middle meningeal artery (PMMA) increased during conservative treatment for traumatic subarachnoid hemorrhage, an acute subdural hematoma, and brain contusion, leading to intracerebral hemorrhage related to its rupture. Case Presentation: During decommissioning operations, he fell down from the bed of a truck, and was brought to our hospital by ambulance. Head CT revealed traumatic subarachnoid hemorrhage, left acute subdural hematoma, and brain contusion. Conservative treatment was performed. Left temporal lobe hemorrhage related to the rupture of a traumatic pseudoaneurysm of the left middle meningeal artery (MMA) was observed 20 days after onset. Emergency endovascular treatment and hematoma removal under craniotomy were conducted. Conclusion: In cases of subarachnoid hemorrhage after head trauma, serial changes should be assessed using CTA and DSA, considering the possibility of a traumatic PMMA.
{"title":"A Patient with a Pseudoaneurysm of the Middle Meningeal Artery Who Developed Intracerebral Hemorrhage during Conservative Treatment for Traumatic Subarachnoid Hemorrhage","authors":"Seigo Kimura, Ryokichi Yagi, Ryo Tamaki, D. Ogawa, T. Manno, H. Taniguchi, T. Kuroiwa","doi":"10.5797/JNET.CR.2018-0104","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0104","url":null,"abstract":"Objective: We report a 73-year-old male in whom a traumatic pseudoaneurysm of the middle meningeal artery (PMMA) increased during conservative treatment for traumatic subarachnoid hemorrhage, an acute subdural hematoma, and brain contusion, leading to intracerebral hemorrhage related to its rupture. Case Presentation: During decommissioning operations, he fell down from the bed of a truck, and was brought to our hospital by ambulance. Head CT revealed traumatic subarachnoid hemorrhage, left acute subdural hematoma, and brain contusion. Conservative treatment was performed. Left temporal lobe hemorrhage related to the rupture of a traumatic pseudoaneurysm of the left middle meningeal artery (MMA) was observed 20 days after onset. Emergency endovascular treatment and hematoma removal under craniotomy were conducted. Conclusion: In cases of subarachnoid hemorrhage after head trauma, serial changes should be assessed using CTA and DSA, considering the possibility of a traumatic PMMA.","PeriodicalId":34768,"journal":{"name":"JNET","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/JNET.CR.2018-0104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48066397","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 : 2019-05-01DOI: 10.5797/JNET.OA.2018-0089
K. Sugiu, T. Hishikawa, M. Hiramatsu, S. Nishihiro, N. Kidani, Yu Takahashi, S. Murai, I. Date
Objective: To introduce our experience of endovascular treatment for craniofacial arteriovenous fistula/malformation (AVF/M). Methods: We retrospectively analyzed the medical records of 13 patients (7 females and 6 males) with craniofacial AVF/M who were treated between 2001 and 2017 in our institution. We classified into three categories including single AVF (sAVF), multiple AVF (mAVF), and arteriovenous malformation (AVM). Treatment plans included 1) curative embolization, 2) preoperative embolization, and 3) palliative embolization. These strategies were decided by the discussion with plastic surgeons in every individual case. Results: Complete cure by embolization alone was obtained in all six patients with sAVF, in two among three patients with mAVF, and in none among four patients with AVM. Curative embolization was aimed at in eight patients, and complete cure obtained in all eight patients. Preoperative embolization was aimed at in three patients, and three patients resulted in total resection by surgery after successful partial embolization. Palliative embolization was aimed at in two patients, and these patients were kept in a stable condition after partial embolization. No permanent complications related to embolization were counted. Conclusion: Endovascular treatment for craniofacial AVF/M is safe and effective treatment, especially in the case with sAVF.
{"title":"Endovascular Treatment for Craniofacial Arteriovenous Fistula/Malformation","authors":"K. Sugiu, T. Hishikawa, M. Hiramatsu, S. Nishihiro, N. Kidani, Yu Takahashi, S. Murai, I. Date","doi":"10.5797/JNET.OA.2018-0089","DOIUrl":"https://doi.org/10.5797/JNET.OA.2018-0089","url":null,"abstract":"Objective: To introduce our experience of endovascular treatment for craniofacial arteriovenous fistula/malformation (AVF/M). Methods: We retrospectively analyzed the medical records of 13 patients (7 females and 6 males) with craniofacial AVF/M who were treated between 2001 and 2017 in our institution. We classified into three categories including single AVF (sAVF), multiple AVF (mAVF), and arteriovenous malformation (AVM). Treatment plans included 1) curative embolization, 2) preoperative embolization, and 3) palliative embolization. These strategies were decided by the discussion with plastic surgeons in every individual case. Results: Complete cure by embolization alone was obtained in all six patients with sAVF, in two among three patients with mAVF, and in none among four patients with AVM. Curative embolization was aimed at in eight patients, and complete cure obtained in all eight patients. Preoperative embolization was aimed at in three patients, and three patients resulted in total resection by surgery after successful partial embolization. Palliative embolization was aimed at in two patients, and these patients were kept in a stable condition after partial embolization. No permanent complications related to embolization were counted. Conclusion: Endovascular treatment for craniofacial AVF/M is safe and effective treatment, especially in the case with sAVF.","PeriodicalId":34768,"journal":{"name":"JNET","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/JNET.OA.2018-0089","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43353564","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 : 2019-04-26DOI: 10.5797/JNET.CR.2018-0071
Soichiro Numa, Toshinori Takagi, S. Ono, Kyohei Fujita, Masatomo Miura, S. Yoshimura
Objective: We encountered the case of re-occlusion occurred within a short time after thrombectomy to the patient with acute cerebral embolism complicated by protein C deficiency. We have reported this case as its clinical presentation is rare and important for considering a treatment strategy for young adult-onset cerebral embolism in the future. Case Presentation: A 34-year-old male developed dysarthria, aphasia, and right hemiparesis and was diagnosed with cerebral infarction caused by left M1 occlusion. Mechanical thrombectomy was performed and achieved recanalization, but the same region was re-occluded after 7 hours and thrombectomy was repeated. The patient was diagnosed with protein C deficiency based on the blood test findings. Re-occlusion was considered due to epithelial damage by a stent retriever and a hypercoagulable state induced by protein C deficiency. Conclusion: Since young adult-onset cerebral embolism may be complicated by underlying disease, such as coagulopathy like this patient, the possibility of re-obstruction induced by epithelial damage should be considered.
{"title":"A Case Report of Re-occlusion after Mechanical Thrombectomy to the Patient with Protein C Deficiency-associated Cerebral Infarction","authors":"Soichiro Numa, Toshinori Takagi, S. Ono, Kyohei Fujita, Masatomo Miura, S. Yoshimura","doi":"10.5797/JNET.CR.2018-0071","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0071","url":null,"abstract":"Objective: We encountered the case of re-occlusion occurred within a short time after thrombectomy to the patient with acute cerebral embolism complicated by protein C deficiency. We have reported this case as its clinical presentation is rare and important for considering a treatment strategy for young adult-onset cerebral embolism in the future. Case Presentation: A 34-year-old male developed dysarthria, aphasia, and right hemiparesis and was diagnosed with cerebral infarction caused by left M1 occlusion. Mechanical thrombectomy was performed and achieved recanalization, but the same region was re-occluded after 7 hours and thrombectomy was repeated. The patient was diagnosed with protein C deficiency based on the blood test findings. Re-occlusion was considered due to epithelial damage by a stent retriever and a hypercoagulable state induced by protein C deficiency. Conclusion: Since young adult-onset cerebral embolism may be complicated by underlying disease, such as coagulopathy like this patient, the possibility of re-obstruction induced by epithelial damage should be considered.","PeriodicalId":34768,"journal":{"name":"JNET","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/JNET.CR.2018-0071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43324137","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 : 2019-04-01DOI: 10.5797/JNET.TN.2018-0136
R. Kimura, Kenji Fukutome, K. Fujimoto, Y. Okumura, I. Nakagawa, H. Nakase
Objective: The clinical course of extracranial internal carotid artery dissection (eICAD) treated with medical therapy alone is usually benign, but late embolism may cause intracranial large artery occlusion (iLAO). We report a new procedure to treat iLAO caused by eICAD. Case Presentation: A 47-year-old man patient presented with two episodes of transient right hemiparesis and mild neck pain. An emergent MRI detected a left internal carotid artery (ICA) occlusion but no new infarction. Because it was strongly suspected that eICAD was the cause, medical therapy was started, and the patient’s neurological condition was frequently checked to ensure prompt response if a late embolism developed. One day after onset, a follow-up MRI revealed recanalization of the ICA occlusion and eICAD without a new infarction. Unfortunately, a late embolism of the left middle cerebral artery occurred 2 days after onset. We started intravenous tissue plasminogen activator administration immediately after a CT scan. We performed a mechanical thrombectomy (MT), resulting in thrombolysis in cerebral infarction (TICI) score of 3. Subsequently, we performed carotid artery stenting (CAS) for eICAD. Ten days after the stroke, the patient’s National Institutes of Health Stroke Scale (NIHSS) score was 2. Conclusion: When treating iLAO due to eICAD by MT and CAS, further vascular injury and intracranial embolism must be prevented. We used proximal and distal protection in combination, employing an aspiration catheter to withdraw the stent retriever and deliver a distal embolic protection device before CAS. As a result, the patient’s condition improved.
{"title":"Late Embolism Following Recanalization of Occluded Extracranial Internal Carotid Artery Dissection","authors":"R. Kimura, Kenji Fukutome, K. Fujimoto, Y. Okumura, I. Nakagawa, H. Nakase","doi":"10.5797/JNET.TN.2018-0136","DOIUrl":"https://doi.org/10.5797/JNET.TN.2018-0136","url":null,"abstract":"Objective: The clinical course of extracranial internal carotid artery dissection (eICAD) treated with medical therapy alone is usually benign, but late embolism may cause intracranial large artery occlusion (iLAO). We report a new procedure to treat iLAO caused by eICAD. Case Presentation: A 47-year-old man patient presented with two episodes of transient right hemiparesis and mild neck pain. An emergent MRI detected a left internal carotid artery (ICA) occlusion but no new infarction. Because it was strongly suspected that eICAD was the cause, medical therapy was started, and the patient’s neurological condition was frequently checked to ensure prompt response if a late embolism developed. One day after onset, a follow-up MRI revealed recanalization of the ICA occlusion and eICAD without a new infarction. Unfortunately, a late embolism of the left middle cerebral artery occurred 2 days after onset. We started intravenous tissue plasminogen activator administration immediately after a CT scan. We performed a mechanical thrombectomy (MT), resulting in thrombolysis in cerebral infarction (TICI) score of 3. Subsequently, we performed carotid artery stenting (CAS) for eICAD. Ten days after the stroke, the patient’s National Institutes of Health Stroke Scale (NIHSS) score was 2. Conclusion: When treating iLAO due to eICAD by MT and CAS, further vascular injury and intracranial embolism must be prevented. We used proximal and distal protection in combination, employing an aspiration catheter to withdraw the stent retriever and deliver a distal embolic protection device before CAS. As a result, the patient’s condition improved.","PeriodicalId":34768,"journal":{"name":"JNET","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/JNET.TN.2018-0136","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43736185","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 : 2019-03-29DOI: 10.5797/JNET.CR.2018-0126
Karim Gaber, M. Ezura, A. Narisawa, Yusuke Takahashi, Takashi Inoue, H. Uenohara
Objective: A rare case of enlargement of asymptomatic dissecting aneurysm after its initial treatment with stent-assisted coiling with parent artery occlusion for the ruptured contra lateral side is reported. Case Presentation: A 52-year-old male patient presented with a subarachnoid hemorrhage resulting from a bilateral vertebral artery dissecting aneurysms. The patient was treated within 24 hours of the hemorrhage to prevent re-rupture by parent artery occlusion of the right vertebral artery and stent-assisted coiling of the left side. A 6-month follow-up showed an enlargement of the left side dissecting aneurysm. A second treatment was done to the left side also using stent-assisted coiling. The patient was discharged with no neurological deficit. Conclusion: To our knowledge, parent artery occlusion for ruptured vertebral artery dissecting aneurysms (VADA) may cause contra lateral VADA enlargement even after its initial treatment by stent-assisted coil embolization in the same setting.
{"title":"Enlargement of Asymptomatic VA Dissecting Aneurysm after Initial Treatment with Stent-assisted Coil Embolization with Contra Lateral Ruptured VA Dissecting Aneurysm Treated by Parent Artery Occlusion: A Case Report","authors":"Karim Gaber, M. Ezura, A. Narisawa, Yusuke Takahashi, Takashi Inoue, H. Uenohara","doi":"10.5797/JNET.CR.2018-0126","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0126","url":null,"abstract":"Objective: A rare case of enlargement of asymptomatic dissecting aneurysm after its initial treatment with stent-assisted coiling with parent artery occlusion for the ruptured contra lateral side is reported. Case Presentation: A 52-year-old male patient presented with a subarachnoid hemorrhage resulting from a bilateral vertebral artery dissecting aneurysms. The patient was treated within 24 hours of the hemorrhage to prevent re-rupture by parent artery occlusion of the right vertebral artery and stent-assisted coiling of the left side. A 6-month follow-up showed an enlargement of the left side dissecting aneurysm. A second treatment was done to the left side also using stent-assisted coiling. The patient was discharged with no neurological deficit. Conclusion: To our knowledge, parent artery occlusion for ruptured vertebral artery dissecting aneurysms (VADA) may cause contra lateral VADA enlargement even after its initial treatment by stent-assisted coil embolization in the same setting.","PeriodicalId":34768,"journal":{"name":"JNET","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43066597","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 : 2019-03-28DOI: 10.5797/JNET.CR.2018-0139
S. Kawada, K. Sugiu
Objective: We report a case of ruptured large thrombosed true posterior communicating artery (PCoA) aneurysm and consider its treatment. Case Presentation: A 71-year-old male patient had a left ruptured large thrombosed true PCoA aneurysm (maximum diameter 23 mm) with a small neck. Intra-aneurysmal coil embolization via the internal carotid artery was performed to preserve the premammillary artery (PMA). The adjunctive technique could not be used because the diameter of the PCoA was 1.5 mm. The result was a neck remnant and the aneurysm was recanalized. After 14 months, similar treatment was performed, and the aneurysm was recanalized again. The acute and twisted angle of the PCoA origin and the thinness of the PCoA were considered as factors for incomplete embolization. Because the distance between the origin of the PMA and aneurysmal neck was 5 mm, short-segment internal trapping of the aneurysm was performed 13 months after the second embolization. As a result, the PMA was no longer visualized on DSA; however, he had no neurologic deficit. The aneurysm remained obliterated after 7 months. Conclusion: Making a tight intra-aneurysmal coil embolization of a large thrombosed true PCoA aneurysm is difficult. If there is a certain distance between the PMA and the aneurysm neck, short-segment internal trapping might be useful to treat it.
{"title":"A Ruptured Large Thrombosed True Posterior Communicating Artery Aneurysm Treated with Endovascular Treatment Three Times","authors":"S. Kawada, K. Sugiu","doi":"10.5797/JNET.CR.2018-0139","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0139","url":null,"abstract":"Objective: We report a case of ruptured large thrombosed true posterior communicating artery (PCoA) aneurysm and consider its treatment. Case Presentation: A 71-year-old male patient had a left ruptured large thrombosed true PCoA aneurysm (maximum diameter 23 mm) with a small neck. Intra-aneurysmal coil embolization via the internal carotid artery was performed to preserve the premammillary artery (PMA). The adjunctive technique could not be used because the diameter of the PCoA was 1.5 mm. The result was a neck remnant and the aneurysm was recanalized. After 14 months, similar treatment was performed, and the aneurysm was recanalized again. The acute and twisted angle of the PCoA origin and the thinness of the PCoA were considered as factors for incomplete embolization. Because the distance between the origin of the PMA and aneurysmal neck was 5 mm, short-segment internal trapping of the aneurysm was performed 13 months after the second embolization. As a result, the PMA was no longer visualized on DSA; however, he had no neurologic deficit. The aneurysm remained obliterated after 7 months. Conclusion: Making a tight intra-aneurysmal coil embolization of a large thrombosed true PCoA aneurysm is difficult. If there is a certain distance between the PMA and the aneurysm neck, short-segment internal trapping might be useful to treat it.","PeriodicalId":34768,"journal":{"name":"JNET","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42883437","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 : 2019-03-19DOI: 10.5797/JNET.OA.2018-0095
Kazutoshi Tanaka, H. Takao, Tomoaki Suzuki, S. Fujimura, Takashi Suzuki, Y. Uchiyama, H. Ono, K. Otani, Hiroaki Ishibashi, M. Yamamoto, Y. Murayama
Objective: Thin-walled regions of cerebral aneurysms are areas of risk for rupture, particularly during surgical procedures. Prediction of thin-walled regions before surgery can lead to safer treatment, avoiding interactions with thinwalled regions. It is considered that blood flow influences aneurysm wall thickness reduction. The objective of this study was to establish a parameter to accurately identify thin-walled regions using computational fluid dynamics (CFD) analysis. Methods: The surgical field was photographed during craniotomy in 50 patients with unruptured middle cerebral artery aneurysms and red regions of the aneurysm wall were compared with the color of the parent vessel and defined as a thin-walled region. CFD analysis was performed and the distribution map of wall shear stress divergence (WSSD*) was compared to the surgical image of the cerebral aneurysms. Results: The WSSDmax region and thin-walled region were coinciding in 41 (82.0%) of the 50 patients. There was a significant difference (P = 0.00022) between the patients with and without coincidence between the WSSDmax and thinwalled regions, and the threshold, sensitivity, specificity, and area under the curve (AUC) on receiver operating characteristic (ROC) analysis of WSSDmax were 0.230, 0.900, 0.875, and 0.883, respectively. Conclusion: High-WSSD regions tended to be coinciding with thin-walled regions, suggesting that WSSDmax is useful to identify thin-walled regions of cerebral aneurysms.
{"title":"A Parameter to Identify Thin-walled Regions in Aneurysms by CFD","authors":"Kazutoshi Tanaka, H. Takao, Tomoaki Suzuki, S. Fujimura, Takashi Suzuki, Y. Uchiyama, H. Ono, K. Otani, Hiroaki Ishibashi, M. Yamamoto, Y. Murayama","doi":"10.5797/JNET.OA.2018-0095","DOIUrl":"https://doi.org/10.5797/JNET.OA.2018-0095","url":null,"abstract":"Objective: Thin-walled regions of cerebral aneurysms are areas of risk for rupture, particularly during surgical procedures. Prediction of thin-walled regions before surgery can lead to safer treatment, avoiding interactions with thinwalled regions. It is considered that blood flow influences aneurysm wall thickness reduction. The objective of this study was to establish a parameter to accurately identify thin-walled regions using computational fluid dynamics (CFD) analysis. Methods: The surgical field was photographed during craniotomy in 50 patients with unruptured middle cerebral artery aneurysms and red regions of the aneurysm wall were compared with the color of the parent vessel and defined as a thin-walled region. CFD analysis was performed and the distribution map of wall shear stress divergence (WSSD*) was compared to the surgical image of the cerebral aneurysms. Results: The WSSDmax region and thin-walled region were coinciding in 41 (82.0%) of the 50 patients. There was a significant difference (P = 0.00022) between the patients with and without coincidence between the WSSDmax and thinwalled regions, and the threshold, sensitivity, specificity, and area under the curve (AUC) on receiver operating characteristic (ROC) analysis of WSSDmax were 0.230, 0.900, 0.875, and 0.883, respectively. Conclusion: High-WSSD regions tended to be coinciding with thin-walled regions, suggesting that WSSDmax is useful to identify thin-walled regions of cerebral aneurysms.","PeriodicalId":34768,"journal":{"name":"JNET","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/JNET.OA.2018-0095","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43009314","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 : 2019-03-01DOI: 10.5797/JNET.CR.2018-0108
N. Yamamoto, Yuki Yamamoto, M. Korai, Kenji Shimada, Y. Kanematsu, Y. Izumi, J. Satomi, Y. Takagi, R. Kaji
Objective: For patients with tandem occlusion (TO), it is controversial whether an antegrade approach or retrograde approach should be undertaken. Here, we report our strategy for treating patients with TO by simultaneous approach. First, a microcatheter was advanced to the distal occlusion site along with a microwire. Second, a stent retriever (SR) was deployed as an anchor at the distal lesion, and percutaneous transluminal angioplasty (PTA) was performed at the proximal lesion using push wire of SR. After that, the microwire was removed and PTA balloon as well as the guiding catheter (GC) was advanced along the wire of SR. Finally, the SR was withdrawn with clot. Case Presentations: Cases 1 and 2, who were confi rmed as TO, were treated by the method described above. We could re-perfuse successfully. These two cases had favorable outcomes, indicating a modifi ed Rankin scale 2 at the time of discharge. Conclusion: Our therapeutic strategy for TO might be useful for early reperfusion of a distal occlusion site and associated with favorable outcome.
{"title":"Simultaneous Approach to Tandem Occlusion in Acute Ischemic Stroke Patients: Percutaneous Transluminal Angioplasty (PTA) Using Push Wire of Stent Retriever","authors":"N. Yamamoto, Yuki Yamamoto, M. Korai, Kenji Shimada, Y. Kanematsu, Y. Izumi, J. Satomi, Y. Takagi, R. Kaji","doi":"10.5797/JNET.CR.2018-0108","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0108","url":null,"abstract":"Objective: For patients with tandem occlusion (TO), it is controversial whether an antegrade approach or retrograde approach should be undertaken. Here, we report our strategy for treating patients with TO by simultaneous approach. First, a microcatheter was advanced to the distal occlusion site along with a microwire. Second, a stent retriever (SR) was deployed as an anchor at the distal lesion, and percutaneous transluminal angioplasty (PTA) was performed at the proximal lesion using push wire of SR. After that, the microwire was removed and PTA balloon as well as the guiding catheter (GC) was advanced along the wire of SR. Finally, the SR was withdrawn with clot. Case Presentations: Cases 1 and 2, who were confi rmed as TO, were treated by the method described above. We could re-perfuse successfully. These two cases had favorable outcomes, indicating a modifi ed Rankin scale 2 at the time of discharge. Conclusion: Our therapeutic strategy for TO might be useful for early reperfusion of a distal occlusion site and associated with favorable outcome.","PeriodicalId":34768,"journal":{"name":"JNET","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41720391","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 : 2019-02-21DOI: 10.5797/JNET.CR.2018-0122
Atsushi Uyama, A. Fujita, Y. Takaishi, T. Kondo, Atsushi Arai, M. Okada, Daigo Fujiwara, E. Kohmura
Objective: In transarterial embolization (TAE) of spinal epidural arteriovenous fistula (SEDAVF), it is essential to control the blood flow at the shunt point. We report a case of SEDAVF treated with TAE with occluding one of several segmental arteries (SAs) involved in the shunt using a balloon. Case Presentation: A 68-year-old male presented with gait disturbance and bladder bowel dysfunction. Lumbar spinal MRI showed a dilated and tortuous vein around the spinal conus. Spinal angiography revealed a SEDAVF with intradural venous reflux through the epidural venous plexus fed by the branches of the right 2nd and 3rd lumbar arteries (L2 and L3). We infused 14% n-buthyl-2-cyanoacrylate (NBCA) from the feeder of the L2 under the flow control by occluding L3 using a balloon and achieved complete obliteration of the arteriovenous shunt. Conclusion: In treatment of SEDAVF with feeders from several SAs, TAE with occluding one of the SAs using a balloon is a useful method.
{"title":"A Patient with Spinal Epidural Arteriovenous Fistula Cured by Balloon-assisted Transarterial Embolization under Flow Control","authors":"Atsushi Uyama, A. Fujita, Y. Takaishi, T. Kondo, Atsushi Arai, M. Okada, Daigo Fujiwara, E. Kohmura","doi":"10.5797/JNET.CR.2018-0122","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0122","url":null,"abstract":"Objective: In transarterial embolization (TAE) of spinal epidural arteriovenous fistula (SEDAVF), it is essential to control the blood flow at the shunt point. We report a case of SEDAVF treated with TAE with occluding one of several segmental arteries (SAs) involved in the shunt using a balloon. Case Presentation: A 68-year-old male presented with gait disturbance and bladder bowel dysfunction. Lumbar spinal MRI showed a dilated and tortuous vein around the spinal conus. Spinal angiography revealed a SEDAVF with intradural venous reflux through the epidural venous plexus fed by the branches of the right 2nd and 3rd lumbar arteries (L2 and L3). We infused 14% n-buthyl-2-cyanoacrylate (NBCA) from the feeder of the L2 under the flow control by occluding L3 using a balloon and achieved complete obliteration of the arteriovenous shunt. Conclusion: In treatment of SEDAVF with feeders from several SAs, TAE with occluding one of the SAs using a balloon is a useful method.","PeriodicalId":34768,"journal":{"name":"JNET","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46425053","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 : 2019-02-20DOI: 10.5797/JNET.CR.2018-0096
Shinya Sonobe, M. Ezura, Kazuhiko Sato, H. Uenohara, T. Tominaga
Dural arteriovenous fistula (dAVF) can develop brainstem dysfunction. Increased shunt flow is known as the mechanism,1) and no other mechanisms were mentioned. In addition, no study has clarified the influence on the A Case of Cavernous Sinus Dural Arteriovenous Fistula Presenting with Medulla Oblongata Dysfunction in Parallel to Thrombosis of a Varix on a Drainage Route after Transvenous Embolization
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