Pub Date : 2019-02-07DOI: 10.5797/JNET.CR.2018-0083
Y. Sagara, H. Kiyosue, M. Okahara, M. Oga, A. Kaga, Yosuke Kamenofuchi
Objective: We report a patient in whom encephalopathy developed after coil embolization of an unruptured basilar artery aneurysm and stent placement for vertebral artery stenosis. Case Presentation: A 69-year-old female. When the unruptured basilar artery aneurysm was treated with coil embolization, a balloon-expandable stent was placed for left vertebral artery stenosis, and treatment was completed without complication. Loss of appetite and lightheadedness developed from 2 weeks after discharge, and multiple FLAIR highintensity areas, and nodular contrast enhancement in the left vertebral artery territory were observed on MRI. Steroid pulse therapy was performed suspecting metal allergy and foreign body granuloma, and symptoms improved. Conclusion: Encephalopathy associated with foreign body granuloma and metal allergy may be caused by coil and stent placement. Patients should be sufficiently interviewed, and when allergies are suspected, reconsideration of the treatment method may be necessary in advance.
{"title":"A Patient with Encephalopathy Following Coil Embolization of Cerebral Aneurysm and Extracranial Stent Placement","authors":"Y. Sagara, H. Kiyosue, M. Okahara, M. Oga, A. Kaga, Yosuke Kamenofuchi","doi":"10.5797/JNET.CR.2018-0083","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0083","url":null,"abstract":"Objective: We report a patient in whom encephalopathy developed after coil embolization of an unruptured basilar artery aneurysm and stent placement for vertebral artery stenosis. Case Presentation: A 69-year-old female. When the unruptured basilar artery aneurysm was treated with coil embolization, a balloon-expandable stent was placed for left vertebral artery stenosis, and treatment was completed without complication. Loss of appetite and lightheadedness developed from 2 weeks after discharge, and multiple FLAIR highintensity areas, and nodular contrast enhancement in the left vertebral artery territory were observed on MRI. Steroid pulse therapy was performed suspecting metal allergy and foreign body granuloma, and symptoms improved. Conclusion: Encephalopathy associated with foreign body granuloma and metal allergy may be caused by coil and stent placement. Patients should be sufficiently interviewed, and when allergies are suspected, reconsideration of the treatment method may be necessary in advance.","PeriodicalId":34768,"journal":{"name":"JNET","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/JNET.CR.2018-0083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48248416","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 : 2019-02-07DOI: 10.5797/JNET.OA.2018-0112
T. Wada, K. Takayama, K. Myouchin, M. Kotsugi, I. Nakagawa, Toshihiko Tanaka, S. Kurokawa, H. Nakase, K. Kichikawa
Objective: Patients who undergo stent-assisted cerebral aneurysm coiling require long-term antiplatelet therapy (AT). Recently, the low-profile visualized intraluminal support (LVIS) stent (LS) has been available for cerebral aneurysm treatment in Japan as a new design braided stent with excellent wall apposition due to manipulation even if the parent artery is tortuous, like the carotid siphon. The aim of this study was to evaluate whether AT could be terminated without increasing the risk of ischemic events among patients who have undergone LS-assisted cerebral aneurysm coiling. Methods: In all, 15 consecutive patients with 15 unruptured aneurysms who underwent LS-assisted cerebral aneurysm coiling and were confirmed to have neointimal formation by follow-up angiography at 3 months were evaluated in this study. All aneurysms were located in the internal carotid artery (ICA). Dual AT was given for 1 month, and then a single antiplatelet agent was given for 2 months until confirmation of neointimal formation. After confirmation of neointimal formation, AT was terminated. The incidences of ipsilateral ischemic events and stent occlusion, as evaluated by angiography or contrast-enhanced MRA, after termination of AT were prospectively assessed. Results: During follow-up, no ipsilateral ischemic events (mean, 10.3 months; range, 3.1–19.8 months) occurred, and no stent occlusion (mean, 8.0 months; range, 1–17.5 months) was observed in any cases. Conclusion: Termination of the antiplatelet drugs 3 months after the procedure may be safe who underwent LS-assisted
{"title":"Investigation of Safe Termination of Antiplatelet Therapy after LVIS Stent-assisted Cerebral Aneurysm Coiling","authors":"T. Wada, K. Takayama, K. Myouchin, M. Kotsugi, I. Nakagawa, Toshihiko Tanaka, S. Kurokawa, H. Nakase, K. Kichikawa","doi":"10.5797/JNET.OA.2018-0112","DOIUrl":"https://doi.org/10.5797/JNET.OA.2018-0112","url":null,"abstract":"Objective: Patients who undergo stent-assisted cerebral aneurysm coiling require long-term antiplatelet therapy (AT). Recently, the low-profile visualized intraluminal support (LVIS) stent (LS) has been available for cerebral aneurysm treatment in Japan as a new design braided stent with excellent wall apposition due to manipulation even if the parent artery is tortuous, like the carotid siphon. The aim of this study was to evaluate whether AT could be terminated without increasing the risk of ischemic events among patients who have undergone LS-assisted cerebral aneurysm coiling. Methods: In all, 15 consecutive patients with 15 unruptured aneurysms who underwent LS-assisted cerebral aneurysm coiling and were confirmed to have neointimal formation by follow-up angiography at 3 months were evaluated in this study. All aneurysms were located in the internal carotid artery (ICA). Dual AT was given for 1 month, and then a single antiplatelet agent was given for 2 months until confirmation of neointimal formation. After confirmation of neointimal formation, AT was terminated. The incidences of ipsilateral ischemic events and stent occlusion, as evaluated by angiography or contrast-enhanced MRA, after termination of AT were prospectively assessed. Results: During follow-up, no ipsilateral ischemic events (mean, 10.3 months; range, 3.1–19.8 months) occurred, and no stent occlusion (mean, 8.0 months; range, 1–17.5 months) was observed in any cases. Conclusion: Termination of the antiplatelet drugs 3 months after the procedure may be safe who underwent LS-assisted","PeriodicalId":34768,"journal":{"name":"JNET","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41851459","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 : 2019-01-09DOI: 10.5797/JNET.CR.2018-0121
E. Abe, T. Mitsuhashi, K. Nishioka, Munetaka Yamamoto, R. Ikemura, K. Kudo, J. Tokugawa, M. Hishii, K. Fukuda, H. Oishi, H. Arai
Objective: Reperfusion by endovascular mechanical thrombectomy has been proven effective for patients with acute ischemic stroke. Although most embolization sources are thrombi, other types of clots could also be embolic sources. We report a sporadic case of acute ischemic stroke caused by mobilization of cardiac papillary fibroelastoma (CPF). Case Presentation: A 79-year-old man presented was hospitalized with chronic heart failure due to disdialysis syndrome. He developed sudden consciousness disturbance and was diagnosed with basilar artery occlusion. Mechanical thrombectomy with only one pass of the Penumbra 5MAX ACE (Penumbra Inc., Alameda, CA, USA) was successful with a direct aspiration first-pass technique. Histopathological examination of the papilla-shaped fragile clot with white granular surface, revealed papillary fibroelastoma. Slight improvement in his clinical symptoms was seen after thrombectomy, but the patient died of deterioration of the disdialysis syndrome. CPF diagnosis was based on the pathological findings of the embolus, not on transesophageal echocardiography (TEE) or open heart surgery due to disdialysis syndrome in our patient. In addition, the presence of cardiac tumor could not be confirmed in the autopsy. Conclusion: CPF is a rare benign cardiac tumor, which might cause cerebral infarction either directly or through thrombus formed by platelets and fibrin. While mechanical thrombectomy is safe and effective, but histopathological diagnosis of the aspirated clot can be recommended, especially if the appearance of the embolic material is unusual.
{"title":"Mechanical Thrombectomy for Acute Ischemic Stroke Caused by Cardiac Papillary Fibroelastoma: A Case Report","authors":"E. Abe, T. Mitsuhashi, K. Nishioka, Munetaka Yamamoto, R. Ikemura, K. Kudo, J. Tokugawa, M. Hishii, K. Fukuda, H. Oishi, H. Arai","doi":"10.5797/JNET.CR.2018-0121","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0121","url":null,"abstract":"Objective: Reperfusion by endovascular mechanical thrombectomy has been proven effective for patients with acute ischemic stroke. Although most embolization sources are thrombi, other types of clots could also be embolic sources. We report a sporadic case of acute ischemic stroke caused by mobilization of cardiac papillary fibroelastoma (CPF). Case Presentation: A 79-year-old man presented was hospitalized with chronic heart failure due to disdialysis syndrome. He developed sudden consciousness disturbance and was diagnosed with basilar artery occlusion. Mechanical thrombectomy with only one pass of the Penumbra 5MAX ACE (Penumbra Inc., Alameda, CA, USA) was successful with a direct aspiration first-pass technique. Histopathological examination of the papilla-shaped fragile clot with white granular surface, revealed papillary fibroelastoma. Slight improvement in his clinical symptoms was seen after thrombectomy, but the patient died of deterioration of the disdialysis syndrome. CPF diagnosis was based on the pathological findings of the embolus, not on transesophageal echocardiography (TEE) or open heart surgery due to disdialysis syndrome in our patient. In addition, the presence of cardiac tumor could not be confirmed in the autopsy. Conclusion: CPF is a rare benign cardiac tumor, which might cause cerebral infarction either directly or through thrombus formed by platelets and fibrin. While mechanical thrombectomy is safe and effective, but histopathological diagnosis of the aspirated clot can be recommended, especially if the appearance of the embolic material is unusual.","PeriodicalId":34768,"journal":{"name":"JNET","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47382257","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 : 2019-01-01DOI: 10.5797/JNET.CR.2018-0042
K. Mizutani, K. Nakabayashi, Y. Aimi, Mitsuhiro Yoshida, Daimon Shiraishi, Tomoki Nawashiro, Y. Ito
Objective: In this study, we report a patient in whom a dural arteriovenous fistula (dAVF) developed after mechanical thrombectomy for acute ischemic stroke, and embolization was performed. Case Presentation: The patient was a 44-year-old male. He was brought to the emergency room of our hospital by ambulance with cervical pain. Head MRI revealed ischemic stroke related to right internal carotid artery occlusion. Mechanical thrombectomy was performed and thrombolysis in cerebral infarction (TICI) 2b recanalization was achieved. Middle cerebral artery (M2) occlusion and internal carotid artery dissection were observed. Follow-up was conducted. The postoperative course was favorable, and he was referred to another hospital for rehabilitation. However, cerebral angiography 4 months after surgery showed a dAVF. Transarterial embolization was performed. The postoperative course was uneventful and she was discharged. Conclusion: In the present case, dissection-related dilation/elevation of the internal carotid artery may have resulted in venous compression, leading to the development of a dAVF. We could confirm these serial changes in images before and after its development.
{"title":"Hypoglossal Canal Dural Arteriovenous Fistula Induced after Mechanical Thrombectomy for Acute Ischemic Stroke","authors":"K. Mizutani, K. Nakabayashi, Y. Aimi, Mitsuhiro Yoshida, Daimon Shiraishi, Tomoki Nawashiro, Y. Ito","doi":"10.5797/JNET.CR.2018-0042","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0042","url":null,"abstract":"Objective: In this study, we report a patient in whom a dural arteriovenous fistula (dAVF) developed after mechanical thrombectomy for acute ischemic stroke, and embolization was performed. Case Presentation: The patient was a 44-year-old male. He was brought to the emergency room of our hospital by ambulance with cervical pain. Head MRI revealed ischemic stroke related to right internal carotid artery occlusion. Mechanical thrombectomy was performed and thrombolysis in cerebral infarction (TICI) 2b recanalization was achieved. Middle cerebral artery (M2) occlusion and internal carotid artery dissection were observed. Follow-up was conducted. The postoperative course was favorable, and he was referred to another hospital for rehabilitation. However, cerebral angiography 4 months after surgery showed a dAVF. Transarterial embolization was performed. The postoperative course was uneventful and she was discharged. Conclusion: In the present case, dissection-related dilation/elevation of the internal carotid artery may have resulted in venous compression, leading to the development of a dAVF. We could confirm these serial changes in images before and after its development.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"88 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/JNET.CR.2018-0042","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71055596","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 : 2019-01-01DOI: 10.5797/jnet.cr.2018-0143
Masato Naraoka, N. Shimamura, Naoya Matsuda, Takeshi Katagai, Nozomi Fujiwara, H. Ohkuma
Objective: We report two cases of folding deformation of open-cell stents that occurred during carotid artery stenting (CAS) for internal carotid artery (ICA) stenosis. Case Presentations: Case 1: A 64-year-old man was diagnosed with asymptomatic right ICA severe stenosis. The stenosis was eccentric, comprising soft plaque with calcification. CAS was performed by standard procedure under protection with MOMA (Medtronic, Minneapolis, MN, USA) and GuardWire (Medtronic). We attempted post-dilation two times because PRECISE (Cordis, Miami, FL, USA) stent did not sufficiently dilate. Cone-beam CT showed a folding deformation of the stent. Case 2: A 60-year-old man was diagnosed with asymptomatic left carotid artery severe stenosis 5 years after radiation therapy for esophageal carcinoma. The stenosis was long, comprising soft plaque without calcification. CAS was performed under protection with MOMA and GuardWire. A PROTÉGÉ (Covidien, Irvine, CA, USA) stent was placed in the etiologic portion. After post-dilation, intravascular ultrasound (IVUS) examination showed suspected in-stent plaque protrusion, but cone-beam CT revealed a folding deformation of the PROTÉGÉ. We did not try any additional treatment. Both patients had no ischemic complications after the procedure and no infarction was detected on MRI. Conclusion: We reported two cases of folding deformation with PRECISE or PROTÉGÉ. In addition to careful attention to not using an oversized stent, it is important to select a protection device and a balloon as a device to avoid deformation. It is difficult to predict or repair stent deformity. Continuation of antiplatelet therapy and long-term follow-up are required.
{"title":"Stent Folding Deformation of PRECISE and PROTÉGÉ during Carotid Artery Stenting: Two Case Reports","authors":"Masato Naraoka, N. Shimamura, Naoya Matsuda, Takeshi Katagai, Nozomi Fujiwara, H. Ohkuma","doi":"10.5797/jnet.cr.2018-0143","DOIUrl":"https://doi.org/10.5797/jnet.cr.2018-0143","url":null,"abstract":"Objective: We report two cases of folding deformation of open-cell stents that occurred during carotid artery stenting (CAS) for internal carotid artery (ICA) stenosis. Case Presentations: Case 1: A 64-year-old man was diagnosed with asymptomatic right ICA severe stenosis. The stenosis was eccentric, comprising soft plaque with calcification. CAS was performed by standard procedure under protection with MOMA (Medtronic, Minneapolis, MN, USA) and GuardWire (Medtronic). We attempted post-dilation two times because PRECISE (Cordis, Miami, FL, USA) stent did not sufficiently dilate. Cone-beam CT showed a folding deformation of the stent. Case 2: A 60-year-old man was diagnosed with asymptomatic left carotid artery severe stenosis 5 years after radiation therapy for esophageal carcinoma. The stenosis was long, comprising soft plaque without calcification. CAS was performed under protection with MOMA and GuardWire. A PROTÉGÉ (Covidien, Irvine, CA, USA) stent was placed in the etiologic portion. After post-dilation, intravascular ultrasound (IVUS) examination showed suspected in-stent plaque protrusion, but cone-beam CT revealed a folding deformation of the PROTÉGÉ. We did not try any additional treatment. Both patients had no ischemic complications after the procedure and no infarction was detected on MRI. Conclusion: We reported two cases of folding deformation with PRECISE or PROTÉGÉ. In addition to careful attention to not using an oversized stent, it is important to select a protection device and a balloon as a device to avoid deformation. It is difficult to predict or repair stent deformity. Continuation of antiplatelet therapy and long-term follow-up are required.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/jnet.cr.2018-0143","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71056049","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 : 2019-01-01DOI: 10.5797/JNET.CR.2018-0144
Akikazu Nakamura, A. Kawashima, M. Hayashi, Kazutoshi Hashimoto, Ayumi Nagahara, T. Arai, T. Kawamata
Objective: Acute large vessel occlusion is treated with endovascular thrombectomy. We encountered a patient in whom the internal carotid artery (ICA) was injured by direct aspiration through a balloon guide catheter (BGC). Case Presentation: The patient was an 82-year-old woman being treated with oral warfarin for atrial fibrillation. Endovascular thrombectomy was performed for right ICA occlusion presented with left hemiplegia when direct aspiration was applied through BGC which placed into the right ICA, extravasation was noted on imaging immediately after its application. Hemostasis was acquired by coil embolization, but extensive subarachnoid hemorrhage was noted on postoperative CT and the patient died after 3 days. Conclusion: The direct aspiration technique through BGC should be carefully performed because it may have a risk of vascular injury.
{"title":"Internal Carotid Artery Injury due to Aspiration Technique from Balloon Guide Catheter on Acute Thrombectomy: A Case Report","authors":"Akikazu Nakamura, A. Kawashima, M. Hayashi, Kazutoshi Hashimoto, Ayumi Nagahara, T. Arai, T. Kawamata","doi":"10.5797/JNET.CR.2018-0144","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0144","url":null,"abstract":"Objective: Acute large vessel occlusion is treated with endovascular thrombectomy. We encountered a patient in whom the internal carotid artery (ICA) was injured by direct aspiration through a balloon guide catheter (BGC). Case Presentation: The patient was an 82-year-old woman being treated with oral warfarin for atrial fibrillation. Endovascular thrombectomy was performed for right ICA occlusion presented with left hemiplegia when direct aspiration was applied through BGC which placed into the right ICA, extravasation was noted on imaging immediately after its application. Hemostasis was acquired by coil embolization, but extensive subarachnoid hemorrhage was noted on postoperative CT and the patient died after 3 days. Conclusion: The direct aspiration technique through BGC should be carefully performed because it may have a risk of vascular injury.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71056101","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 : 2019-01-01DOI: 10.5797/jnet.cr.2019-0010
Azusa Yonezawa, H. Neki, S. Mizuhashi, Toshihiro Otsuka, Eisuke Tsukagoshi, F. Yamane, S. Kohyama
Objective: To examine a case of basilar artery (BA) occlusion caused by traumatic vertebral artery (VA) dissection after incomplete endovascular therapy. Case Presentation: A 32-year-old man who got caught sustained injuries in a truck accident wherein he was stuck between two trucks was transported to a nearby hospital. Stenting was performed for the left common carotid artery (CCA). For left VA dissection, coil embolization of the VA was performed to prevent thromboembolic infarction because floating thrombus was found at the V3 segment. On postoperative day 1, he exhibited conscious disturbance. MRA revealed BA occlusion. Upon transfer to our hospital, thrombectomy was performed. After revascularization, the patient was alert. Conclusion: Although optimal treatment of traumatic VA injury is still debated, proximal coil occlusion is regarded as an effective preventive treatment for thromboembolic stroke. In case of VA dissection with floating thrombus, proximal VA occlusion is insufficient to prevent thromboembolic stroke, and thrombus capture should be considered.
{"title":"Case of a Patient Who Developed Basilar Artery Occlusion after Treatment of Traumatic Vertebral Artery Dissection with Proximal Coil Occlusion","authors":"Azusa Yonezawa, H. Neki, S. Mizuhashi, Toshihiro Otsuka, Eisuke Tsukagoshi, F. Yamane, S. Kohyama","doi":"10.5797/jnet.cr.2019-0010","DOIUrl":"https://doi.org/10.5797/jnet.cr.2019-0010","url":null,"abstract":"Objective: To examine a case of basilar artery (BA) occlusion caused by traumatic vertebral artery (VA) dissection after incomplete endovascular therapy. Case Presentation: A 32-year-old man who got caught sustained injuries in a truck accident wherein he was stuck between two trucks was transported to a nearby hospital. Stenting was performed for the left common carotid artery (CCA). For left VA dissection, coil embolization of the VA was performed to prevent thromboembolic infarction because floating thrombus was found at the V3 segment. On postoperative day 1, he exhibited conscious disturbance. MRA revealed BA occlusion. Upon transfer to our hospital, thrombectomy was performed. After revascularization, the patient was alert. Conclusion: Although optimal treatment of traumatic VA injury is still debated, proximal coil occlusion is regarded as an effective preventive treatment for thromboembolic stroke. In case of VA dissection with floating thrombus, proximal VA occlusion is insufficient to prevent thromboembolic stroke, and thrombus capture should be considered.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71056547","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 : 2019-01-01DOI: 10.5797/JNET.TN.2018-0110
T. Terakado, Y. Nakai, Kazuaki Tsukada, Takahito Nishihira, H. Kohzuki, T. Konishi, M. Shiigai, K. Uemura
Objective: Transarterial embolization (TAE) for dural arteriovenous fistula (dAVF) is sometimes risky because of dangerous anastomosis. We successfully treated orbital apex dAVF by blocking back-flow to the internal carotid artery and ophthalmic artery with coil and balloon. Case Presentation: A 51-year-old man had red right eye and exophthalmos, and was diagnosed with right orbital apex dAVF. TAE using n-butyl-2-cyanoacrylate (NBCA)/lipiodol mixture via the artery of the superior orbital fissure was performed under flow control of the internal carotid artery and ophthalmic artery with balloon microcatheter and temporary placing of detachable coil. After the treatment, the shunt disappeared and the symptoms were improved. Conclusion: A proper understanding of dangerous anastomosis is important for safe and effective use of TAE for dAVF.
{"title":"A Case of Orbital Dural Arteriovenous Fistula with Exophthalmos Treated by Transarterial Embolization","authors":"T. Terakado, Y. Nakai, Kazuaki Tsukada, Takahito Nishihira, H. Kohzuki, T. Konishi, M. Shiigai, K. Uemura","doi":"10.5797/JNET.TN.2018-0110","DOIUrl":"https://doi.org/10.5797/JNET.TN.2018-0110","url":null,"abstract":"Objective: Transarterial embolization (TAE) for dural arteriovenous fistula (dAVF) is sometimes risky because of dangerous anastomosis. We successfully treated orbital apex dAVF by blocking back-flow to the internal carotid artery and ophthalmic artery with coil and balloon. Case Presentation: A 51-year-old man had red right eye and exophthalmos, and was diagnosed with right orbital apex dAVF. TAE using n-butyl-2-cyanoacrylate (NBCA)/lipiodol mixture via the artery of the superior orbital fissure was performed under flow control of the internal carotid artery and ophthalmic artery with balloon microcatheter and temporary placing of detachable coil. After the treatment, the shunt disappeared and the symptoms were improved. Conclusion: A proper understanding of dangerous anastomosis is important for safe and effective use of TAE for dAVF.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/JNET.TN.2018-0110","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71061720","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 : 2019-01-01DOI: 10.5797/jnet.oa.2019-0030
K. Hoya, Kazuya Nakamura, H. Nishido, Akihiro Nishikawa, Kenta Ohara, S. Miyamoto, K. Wakui
Objective: A method to create a microcatheter with a short and acute-angled tip using an Excelsior SL-10 pre-shaped S catheter (Stryker, Kalamazoo, MI, USA) by straightening its proximal curve is described. Its clinical application, in which a guidewire and a microcatheter are led into a distal artery branching sharply to prepare stent deployment, is presented. Methods: The proximal curve of a catheter was introduced into a disposable 18-gauge blunt needle. The needle was heated using a heat gun so as to heat and straighten only the proximal curve and to preserve the original shape and firmness of the distal curve. The catheter was then used to lead a guidewire to a sharply branching distal artery and subsequently to navigate itself into the artery. In each case, the angle formed by the vector of the proximal parent artery and that of the distal artery was measured to evaluate the technical difficulty. The usefulness of the catheter was assessed by whether stenting was completed. Results: The microcatheter was used in 10 cases. The average angle between the distal artery and the proximal parent artery was 144 ° . In two cases where the angle was over 180 ° , the guidewire could not enter the orifice of the distal artery directly. The guidewire could directly enter the orifice of the distal branch in eight cases, with angles of 108 ° –151 ° . In seven of the eight, the guidewire and microcatheter could go further into the distal artery, and stenting was achieved. Conclusion: A short and acutely angled catheter tip made from an Excelsior SL-10 pre-shaped S catheter with preservation of the distal curve is stable in shape. It is often useful when leading a guidewire to an artery branching at a sharp angle to prepare for stent-assisted coiling.
{"title":"Usefulness of a Microcatheter with a Short and Acute Angled Tip Made from an Excelsior SL-10 Pre-shaped S Catheter Preserving Its Distal Curve","authors":"K. Hoya, Kazuya Nakamura, H. Nishido, Akihiro Nishikawa, Kenta Ohara, S. Miyamoto, K. Wakui","doi":"10.5797/jnet.oa.2019-0030","DOIUrl":"https://doi.org/10.5797/jnet.oa.2019-0030","url":null,"abstract":"Objective: A method to create a microcatheter with a short and acute-angled tip using an Excelsior SL-10 pre-shaped S catheter (Stryker, Kalamazoo, MI, USA) by straightening its proximal curve is described. Its clinical application, in which a guidewire and a microcatheter are led into a distal artery branching sharply to prepare stent deployment, is presented. Methods: The proximal curve of a catheter was introduced into a disposable 18-gauge blunt needle. The needle was heated using a heat gun so as to heat and straighten only the proximal curve and to preserve the original shape and firmness of the distal curve. The catheter was then used to lead a guidewire to a sharply branching distal artery and subsequently to navigate itself into the artery. In each case, the angle formed by the vector of the proximal parent artery and that of the distal artery was measured to evaluate the technical difficulty. The usefulness of the catheter was assessed by whether stenting was completed. Results: The microcatheter was used in 10 cases. The average angle between the distal artery and the proximal parent artery was 144 ° . In two cases where the angle was over 180 ° , the guidewire could not enter the orifice of the distal artery directly. The guidewire could directly enter the orifice of the distal branch in eight cases, with angles of 108 ° –151 ° . In seven of the eight, the guidewire and microcatheter could go further into the distal artery, and stenting was achieved. Conclusion: A short and acutely angled catheter tip made from an Excelsior SL-10 pre-shaped S catheter with preservation of the distal curve is stable in shape. It is often useful when leading a guidewire to an artery branching at a sharp angle to prepare for stent-assisted coiling.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71059000","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 : 2019-01-01DOI: 10.5797/JNET.OA.2019-0015
Takehiro Katano, Genki Usui, Hirotsugu Hashimoto, T. Morikawa, S. Okubo, A. Ishii, S. Miyamoto, K. Kimura
Objective: We pathologically examined thrombi collected by mechanical thrombectomy in Embolic Stroke of Undetermined Source (ESUS). Methods: We examined the thrombi of acute ischemic stroke patients who underwent mechanical thrombectomy from January 2017 to June 2018. We histopathologically investigated the thrombi in ESUS patients, and performed a comparison with the thrombi of cardioembolic stroke. Results: Mechanical thrombectomy was performed in 35 patients, and the thrombus were obtained from five patients diagnosed as ESUS. The thrombus in one patient consisted of neutrophils and nuclear crush cells not only the red blood cells, and another one was included atheroma which was different from the typical clot in one patient. In the 25 cardioembolic stroke patients in this study, the thrombi were all constructed of fibrin, red blood cells, and platelets. Conclusion: In this pathological study, a difference was recognized in the clot components of ESUS. The results suggest that a pathological examination of thrombi obtained by mechanical thrombectomy is useful because there is a possibility that we can recognize the etiology of ESUS, and choose the best treatment for prevention of recurrence of stroke.
{"title":"Histological Examination of Thrombi in Patients with Cerebral Infarction in Embolic Stroke of Undetermined Source","authors":"Takehiro Katano, Genki Usui, Hirotsugu Hashimoto, T. Morikawa, S. Okubo, A. Ishii, S. Miyamoto, K. Kimura","doi":"10.5797/JNET.OA.2019-0015","DOIUrl":"https://doi.org/10.5797/JNET.OA.2019-0015","url":null,"abstract":"Objective: We pathologically examined thrombi collected by mechanical thrombectomy in Embolic Stroke of Undetermined Source (ESUS). Methods: We examined the thrombi of acute ischemic stroke patients who underwent mechanical thrombectomy from January 2017 to June 2018. We histopathologically investigated the thrombi in ESUS patients, and performed a comparison with the thrombi of cardioembolic stroke. Results: Mechanical thrombectomy was performed in 35 patients, and the thrombus were obtained from five patients diagnosed as ESUS. The thrombus in one patient consisted of neutrophils and nuclear crush cells not only the red blood cells, and another one was included atheroma which was different from the typical clot in one patient. In the 25 cardioembolic stroke patients in this study, the thrombi were all constructed of fibrin, red blood cells, and platelets. Conclusion: In this pathological study, a difference was recognized in the clot components of ESUS. The results suggest that a pathological examination of thrombi obtained by mechanical thrombectomy is useful because there is a possibility that we can recognize the etiology of ESUS, and choose the best treatment for prevention of recurrence of stroke.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5797/JNET.OA.2019-0015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71059080","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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