Pub Date : 2019-01-01DOI: 10.5797/JNET.OA.2018-0082
M. Hiramatsu, K. Sugiu, T. Yasuhara, T. Hishikawa, S. Nishihiro, N. Kidani, Yu Takahashi, S. Murai, I. Date
Objective: The purpose of this study is to retrospectively assess the differences between spinal dural arteriovenous fistulas (SDAVFs) and spinal epidural arteriovenous fistulas (SEAVFs). Methods: Subjects consisted of 18 patients with SDAVFs and 7 with SEAVFs admitted to our department between January 2007 and December 2017 exhibiting intradural drainage of shunt flow. Patient background, lesion characteristics, and treatment/follow-up results were compared. Results: Of the seven patients in the SEAVF group, six patients (86%) had been misdiagnosed with SDAVFs at the time of treatment. The rates of patients with a history of spinal surgery, lumbar vertebral lesions, involvement of a dorsal somatic branch (DSB), involvement of multiple segmental arteries, or involvement of bilateral segmental arteries were significantly higher in the SEAVF group. As for post-treatment course, there were significant difference in the recurrence rate after endovascular treatment (SDAVF group: 6%, SEAVF group: 50%, respectively, p < 0.05). Conclusion: Endovascular treatment may not be effective for SEAVFs if they are misdiagnosed as SDAVFs, and they may recur. For optimal treatment, accurate assessment of the angioarchitecture with the latest diagnostic imaging method may be necessary.
{"title":"Comparison between Spinal Dural Arteriovenous Fistula and Spinal Epidural Arteriovenous Fistula","authors":"M. Hiramatsu, K. Sugiu, T. Yasuhara, T. Hishikawa, S. Nishihiro, N. Kidani, Yu Takahashi, S. Murai, I. Date","doi":"10.5797/JNET.OA.2018-0082","DOIUrl":"https://doi.org/10.5797/JNET.OA.2018-0082","url":null,"abstract":"Objective: The purpose of this study is to retrospectively assess the differences between spinal dural arteriovenous fistulas (SDAVFs) and spinal epidural arteriovenous fistulas (SEAVFs). Methods: Subjects consisted of 18 patients with SDAVFs and 7 with SEAVFs admitted to our department between January 2007 and December 2017 exhibiting intradural drainage of shunt flow. Patient background, lesion characteristics, and treatment/follow-up results were compared. Results: Of the seven patients in the SEAVF group, six patients (86%) had been misdiagnosed with SDAVFs at the time of treatment. The rates of patients with a history of spinal surgery, lumbar vertebral lesions, involvement of a dorsal somatic branch (DSB), involvement of multiple segmental arteries, or involvement of bilateral segmental arteries were significantly higher in the SEAVF group. As for post-treatment course, there were significant difference in the recurrence rate after endovascular treatment (SDAVF group: 6%, SEAVF group: 50%, respectively, p < 0.05). Conclusion: Endovascular treatment may not be effective for SEAVFs if they are misdiagnosed as SDAVFs, and they may recur. For optimal treatment, accurate assessment of the angioarchitecture with the latest diagnostic imaging method may be necessary.","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.2018-0082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71058267","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.2018-0048
K. Hayashi, Y. Matsunaga, Yukishige Hayashi, K. Shirakawa, M. Iwanaga
Objective: Carotid artery stenting is performed using a device for preventing distal embolism because vasodilationrelated debris may cause cerebral infarction. Concerning filters for preventing embolism, membrane-type filters have been used, but mesh-type filters became commercially available. We have selected filter-assisted stenting as a first-choice procedure. We examined post-treatment filters under a microscope, and reviewed the pathogenesis of distal embolism. Methods: The subjects were 83 patients in whom carotid artery stenting with a filter was performed, and filters could be examined after surgery (Angioguard XP [AG; Cordis Corporation, Miami Lakes, FL, USA]: 25 patients, Filterwire EZ [FW; Boston Scientific, Natick MA, USA]: 32, and Spider FX [Spider; Covidien, Dublin, Ireland]: 26). After treatment, the filters were stained with hematoxylin and eosin (HE), separated from the struts, and embedded in preparations for microscopic observation. Debris was classified into plaque-derived and fibrin-formation types, and quantified as an area using computer software. Distal embolism was evaluated based on intraoperative flow impairment, postoperative symptoms, and perioperative diagnostic imaging findings. Results: Intraoperative flow impairment was noted in six patients (24%) in the AG group, five (15.6%) in the FW group, and one (3.8%) in the Spider group. Cerebral infarction was observed in three (12%), two (6.3%), and two (7.6%) patients, respectively. There were no differences in the volume of plaque-derived debris, but the volume of fibrin-formation-type debris was more in the AG group. As a result, the volume of debris collected was more. In the Spider group, the volume of fibrin-formation-type debris was minimum. Conclusion: Functions differed between the membrane-type and mesh-type filters. Considering their performance, these filters should be used.
目的:颈动脉支架植入术是一种防止远端栓塞的装置，因为血管扩张相关的碎片可能导致脑梗死。关于防止栓塞的过滤器，膜型过滤器已被使用，但网型过滤器已商品化。我们选择滤镜辅助支架置入术作为首选手术。我们在显微镜下检查了治疗后的过滤器，并回顾了远端栓塞的发病机制。方法:83例行过滤器颈动脉支架植入术的患者，术后可检查过滤器(Angioguard XP [AG;Cordis Corporation, Miami Lakes, FL, USA]: 25例患者，Filterwire EZ [FW;Boston Scientific, Natick MA, USA]: 32, Spider FX [Spider;柯维迪恩，都柏林，爱尔兰]:26)。处理后，用苏木精和伊红(HE)染色，将滤光片与支架分离，包埋在显微镜下观察。将碎片分为斑块衍生型和纤维蛋白形成型，并使用计算机软件将其量化为面积。远端栓塞是根据术中血流障碍、术后症状和围手术期诊断成像结果来评估的。结果:AG组6例(24%)、FW组5例(15.6%)、Spider组1例(3.8%)出现术中血流障碍。脑梗死患者分别为3例(12%)、2例(6.3%)和2例(7.6%)。斑块源性碎片的体积没有差异，但纤维蛋白形成型碎片的体积在AG组更多。因此，收集到的碎片数量更多。在蜘蛛组中，纤维蛋白形成型碎片的体积最小。结论:膜式过滤器与网状过滤器功能不同。考虑到它们的性能，应该使用这些过滤器。
{"title":"Review of Distal Embolism with Respect to Filters for Carotid Artery Stenting","authors":"K. Hayashi, Y. Matsunaga, Yukishige Hayashi, K. Shirakawa, M. Iwanaga","doi":"10.5797/JNET.OA.2018-0048","DOIUrl":"https://doi.org/10.5797/JNET.OA.2018-0048","url":null,"abstract":"Objective: Carotid artery stenting is performed using a device for preventing distal embolism because vasodilationrelated debris may cause cerebral infarction. Concerning filters for preventing embolism, membrane-type filters have been used, but mesh-type filters became commercially available. We have selected filter-assisted stenting as a first-choice procedure. We examined post-treatment filters under a microscope, and reviewed the pathogenesis of distal embolism. Methods: The subjects were 83 patients in whom carotid artery stenting with a filter was performed, and filters could be examined after surgery (Angioguard XP [AG; Cordis Corporation, Miami Lakes, FL, USA]: 25 patients, Filterwire EZ [FW; Boston Scientific, Natick MA, USA]: 32, and Spider FX [Spider; Covidien, Dublin, Ireland]: 26). After treatment, the filters were stained with hematoxylin and eosin (HE), separated from the struts, and embedded in preparations for microscopic observation. Debris was classified into plaque-derived and fibrin-formation types, and quantified as an area using computer software. Distal embolism was evaluated based on intraoperative flow impairment, postoperative symptoms, and perioperative diagnostic imaging findings. Results: Intraoperative flow impairment was noted in six patients (24%) in the AG group, five (15.6%) in the FW group, and one (3.8%) in the Spider group. Cerebral infarction was observed in three (12%), two (6.3%), and two (7.6%) patients, respectively. There were no differences in the volume of plaque-derived debris, but the volume of fibrin-formation-type debris was more in the AG group. As a result, the volume of debris collected was more. In the Spider group, the volume of fibrin-formation-type debris was minimum. Conclusion: Functions differed between the membrane-type and mesh-type filters. Considering their performance, these filters should be used.","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.2018-0048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71058429","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.2018-0053
H. Yamazaki, K. Imai, M. Hamanaka, M. Itsukage, K. Tsuto, A. Yamamoto, T. Ioku, Takehiro Yamada, Takuma Nakamura, H. Takezawa, N. Tokuda
Objective: This study was conducted to clarify the characteristics of preprocedural vascular images in patients with acute embolic occlusion of the carotid artery in whom the internal carotid artery (ICA) could be recanalized by manual suction with syringe via the balloon guiding catheter (SS-BGC) alone. Methods: The subjects were 64 consecutive patients who underwent SS-BGC for carotid artery embolic occlusion at our institution between May 2006 and September 2017. The subjects were classified into those who with recanalization (R-SS-BGC group) and no recanalization (N-SS-BGC) of ICA by SS-BGC alone, and the background factors including findings of preprocedural vascular imaging and outcomes were compared between the two groups. Results: The R-SS-BGC and N-SS-BGC groups consisted of 16 and 48 patients, respectively. In the R-SS-BGC/N-SS-BGC groups, the horizontal segment of the ipsilateral anterior cerebral artery (A1) was patent in 15/24 (94/50%) and the horizontal segment of the ipsilateral middle cerebral artery (M1) was patent in 6/16 (38/34%) on preprocedural MRA. The ipsilateral posterior communicating artery (PcomA) was patent in 3/14 (19/29%) and the ipsilateral ophthalmic artery (OphA) was patent in 1/14 (6/29%) on preprocedural angiography. The median duration of operation was 39/86.5 minutes, and complete recanalization could be achieved in 15/34 (94/71%). The outcome was favorable in 10/11 (63/23%). Conclusion: In the R-SS-BGC group, the percentages of patients with patent ipsilateral A1 and M1 were high, and the percentages of those with patent ipsilateral PcomA and OphA were low.
{"title":"Angiographical Features of Acute Stroke Patients with Carotid Artery Embolic Occlusion Recanalized by Suction with Syringe via Balloon Guiding Catheter","authors":"H. Yamazaki, K. Imai, M. Hamanaka, M. Itsukage, K. Tsuto, A. Yamamoto, T. Ioku, Takehiro Yamada, Takuma Nakamura, H. Takezawa, N. Tokuda","doi":"10.5797/JNET.OA.2018-0053","DOIUrl":"https://doi.org/10.5797/JNET.OA.2018-0053","url":null,"abstract":"Objective: This study was conducted to clarify the characteristics of preprocedural vascular images in patients with acute embolic occlusion of the carotid artery in whom the internal carotid artery (ICA) could be recanalized by manual suction with syringe via the balloon guiding catheter (SS-BGC) alone. Methods: The subjects were 64 consecutive patients who underwent SS-BGC for carotid artery embolic occlusion at our institution between May 2006 and September 2017. The subjects were classified into those who with recanalization (R-SS-BGC group) and no recanalization (N-SS-BGC) of ICA by SS-BGC alone, and the background factors including findings of preprocedural vascular imaging and outcomes were compared between the two groups. Results: The R-SS-BGC and N-SS-BGC groups consisted of 16 and 48 patients, respectively. In the R-SS-BGC/N-SS-BGC groups, the horizontal segment of the ipsilateral anterior cerebral artery (A1) was patent in 15/24 (94/50%) and the horizontal segment of the ipsilateral middle cerebral artery (M1) was patent in 6/16 (38/34%) on preprocedural MRA. The ipsilateral posterior communicating artery (PcomA) was patent in 3/14 (19/29%) and the ipsilateral ophthalmic artery (OphA) was patent in 1/14 (6/29%) on preprocedural angiography. The median duration of operation was 39/86.5 minutes, and complete recanalization could be achieved in 15/34 (94/71%). The outcome was favorable in 10/11 (63/23%). Conclusion: In the R-SS-BGC group, the percentages of patients with patent ipsilateral A1 and M1 were high, and the percentages of those with patent ipsilateral PcomA and OphA were low.","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.2018-0053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71058488","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.2018-0034
T. Fujii, H. Oishi, Kohsuke Teranishi, K. Yatomi, Munetaka Yamamoto
Objective: We report a patient in whom vascular straightening was achieved after stent-assisted coil embolization, leading to complete occlusion of an intracranial aneurysm after 1 year. Case Presentation: The patient was a 60-year-old female. A medical checkup of the brain showed a posterior inferior cerebellar artery (PICA) aneurysm. Under general anesthesia, coil embolization was performed. During surgery, a coil deviated onto the PICA side, and a stent was deployed so that the aneurysmal neck might be located at its center. Finally, incomplete occlusion of the aneurysm was achieved. Cerebral angiography 1 year after surgery indicated a sharper branching angle of the blood vessel in comparison with the preoperative angle and complete occlusion of the aneurysm. Conclusion: A braided stent inserted to a site where a thin parent vessel is not fixed by the peripheral structure may make the parent vessel straight, contributing to complete occlusion of an aneurysm.
{"title":"A Patient in Whom Straightening of a Parent Vessel Related to Insertion of a Braided Stent Contributed to Complete Occlusion of an Intracranial Aneurysm","authors":"T. Fujii, H. Oishi, Kohsuke Teranishi, K. Yatomi, Munetaka Yamamoto","doi":"10.5797/JNET.CR.2018-0034","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0034","url":null,"abstract":"Objective: We report a patient in whom vascular straightening was achieved after stent-assisted coil embolization, leading to complete occlusion of an intracranial aneurysm after 1 year. Case Presentation: The patient was a 60-year-old female. A medical checkup of the brain showed a posterior inferior cerebellar artery (PICA) aneurysm. Under general anesthesia, coil embolization was performed. During surgery, a coil deviated onto the PICA side, and a stent was deployed so that the aneurysmal neck might be located at its center. Finally, incomplete occlusion of the aneurysm was achieved. Cerebral angiography 1 year after surgery indicated a sharper branching angle of the blood vessel in comparison with the preoperative angle and complete occlusion of the aneurysm. Conclusion: A braided stent inserted to a site where a thin parent vessel is not fixed by the peripheral structure may make the parent vessel straight, contributing to complete occlusion of an aneurysm.","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":"71055681","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.2019-0064
Shunsuke Magami, H. Oishi, H. Mitsuoka, K. Suda, H. Arai
Objective: We herein describe a rare case of intraventricular hemorrhage (IVH) due to a distal anterior choroidal artery (AChA) aneurysm associated with an arteriovenous malformation (AVM) in the trigone of the lateral ventricle during early pregnancy. Case Presentation: At 8 weeks of pregnancy, a 36-year-old woman developed sensory aphasia and mild right hemiparesis due to a left lateral IVH. Digital subtraction angiography showed a peripherally located aneurysm branching from the medial perforating branch (MPB) of the plexal segment in the AChA associated with a micro-AVM in the trigone of the left lateral ventricle. Endovascular embolization was performed. A microcatheter was guided to a feeder branching out from the MPB. The aneurysm and the nidus, including the feeder, were occluded by 20% n-butyl-2cyanoacrylate (NBCA). However, right homonymous hemianopsia was apparent postoperatively, although the blood flow of the cisternal segment was preserved. Head MRI showed an acute infarction in the perfusion area of the AChA, including the internal capsule and optic radiation. Conclusion: We performed endovascular embolization to temporarily treat both the aneurysm and the nidus because the source of bleeding was unclear considering the hematoma position and angiographic features. Ischemic complications of the embolization for the aneurysm and the nidus with the preservation of the cisternal segment of the AChA are unusual.
{"title":"Intraventricular Hemorrhage due to a Distal Anterior Choroidal Artery Aneurysm Associated with an Arteriovenous Malformation in the Trigone","authors":"Shunsuke Magami, H. Oishi, H. Mitsuoka, K. Suda, H. Arai","doi":"10.5797/jnet.cr.2019-0064","DOIUrl":"https://doi.org/10.5797/jnet.cr.2019-0064","url":null,"abstract":"Objective: We herein describe a rare case of intraventricular hemorrhage (IVH) due to a distal anterior choroidal artery (AChA) aneurysm associated with an arteriovenous malformation (AVM) in the trigone of the lateral ventricle during early pregnancy. Case Presentation: At 8 weeks of pregnancy, a 36-year-old woman developed sensory aphasia and mild right hemiparesis due to a left lateral IVH. Digital subtraction angiography showed a peripherally located aneurysm branching from the medial perforating branch (MPB) of the plexal segment in the AChA associated with a micro-AVM in the trigone of the left lateral ventricle. Endovascular embolization was performed. A microcatheter was guided to a feeder branching out from the MPB. The aneurysm and the nidus, including the feeder, were occluded by 20% n-butyl-2cyanoacrylate (NBCA). However, right homonymous hemianopsia was apparent postoperatively, although the blood flow of the cisternal segment was preserved. Head MRI showed an acute infarction in the perfusion area of the AChA, including the internal capsule and optic radiation. Conclusion: We performed endovascular embolization to temporarily treat both the aneurysm and the nidus because the source of bleeding was unclear considering the hematoma position and angiographic features. Ischemic complications of the embolization for the aneurysm and the nidus with the preservation of the cisternal segment of the AChA are unusual.","PeriodicalId":34768,"journal":{"name":"JNET","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71056273","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.2019-0034
M. Arihara, K. Miyata, Satoshi Iihoshi, R. Yokoyama, Ayumu Yamaoka, Yuto Suzuki, T. Mikami, M. Wanibuchi, N. Mikuni
Objective: Clinical research demonstrating safety and security in subclavian artery stenting (SAS) is limited because treatment strategies for SAS vary greatly among institutions, operators, and clinical conditions, as no standard protocol exists. As stenotic lesions frequently occur in the proximal portion of the subclavian artery (SA), it is often difficult to stabilize the guiding catheter for stent delivery. Our purpose was to assess whether lesion location can be used to predict optimal procedural strategies. Methods: We performed a retrospective, single-center observational study on 26 consecutive patients who underwent SAS between 2004 and 2016. We categorized patients treated with SAS into two groups according to lesion location: those with lesions located less than 10 mm from the origin of the SA (Group P) and those with lesions in the distal portion (Group D). We defined a bidirectional approach via both brachial and femoral puncture as well as bilateral brachial puncture as combined access. In pull-through method, a guidewire was passed from one sheath to another. We compared Group P with Group D in terms of procedural strategy and efficacy. Results: All 26 cases were clinically successful. Asymptomatic cerebral embolism was found in 10 (48%) of 21 cases in which postoperative MRI was performed, and the number of spotty lesions was less than four in every patient. Arterial access-site complications were documented in eight patients. Two cases of late in-stent restenosis were retreated with balloon dilatation. Cases with retrograde ipsilateral vertebral artery (VA) blood flow and symptomatic lesions occurred more frequently in Group P than in Group D (79% vs. 42%; p = 0.06, 71% vs. 33%; p = 0.05, respectively). Patients in Group P were significantly more often treated with combined access (100% vs. 42%; p = 0.001), with the pull-through method (64% vs. 0%; p < 0.001) than those in Group D. The distal end of the stent was involved with the ipsilateral VA orifice more often in Group D than in Group P (50% vs. 7%; p = 0.02). Conclusion: These results demonstrate that our strategy is a safe and effective method of stenting for SA stenosis in the portion of the artery that is proximal to the aorta. We should pay special attention to the risk of arterial access-site complications.
目的:临床研究表明锁骨下动脉支架植入术(SAS)的安全性和安全性是有限的，因为SAS的治疗策略因机构、操作者和临床条件的不同而差异很大，没有标准的方案。由于狭窄病变常发生在锁骨下动脉(SA)近端，通常难以稳定支架置入的导管。我们的目的是评估病变位置是否可以用来预测最佳的手术策略。方法:我们对2004年至2016年间连续26例接受SAS治疗的患者进行了回顾性、单中心观察研究。我们根据病变位置将接受SAS治疗的患者分为两组:病变位于距SA起源小于10mm的患者(P组)和病变位于远端部分的患者(D组)。我们定义了通过肱和股动脉穿刺以及双侧肱动脉穿刺的双向入路作为联合入路。在拉通法中，导丝从一个护套传递到另一个护套。我们将P组与D组在手术策略和疗效方面进行比较。结果:26例临床均成功。21例患者术后行MRI检查，无症状脑栓塞10例(48%)，点状病灶少于4例。8例患者出现动脉通路并发症。2例晚期支架内再狭窄均经球囊扩张治疗。P组出现同侧椎动脉(VA)逆行血流和症状性病变的频率高于D组(79% vs. 42%;P = 0.06, 71% vs. 33%;P = 0.05)。P组患者更常接受联合治疗(100% vs. 42%;P = 0.001)，采用拉通法(64% vs. 0%;p < 0.001)，与D组相比，D组支架远端累及同侧VA口的频率更高(50% vs. 7%;P = 0.02)。结论:我们的方法是治疗主动脉近端SA狭窄的一种安全有效的方法。我们应特别注意动脉通路并发症的风险。
{"title":"Cerebral Ischemic Complications of Subclavian Artery Stenting: Relationship between Lesion Location and Procedural Strategy","authors":"M. Arihara, K. Miyata, Satoshi Iihoshi, R. Yokoyama, Ayumu Yamaoka, Yuto Suzuki, T. Mikami, M. Wanibuchi, N. Mikuni","doi":"10.5797/jnet.oa.2019-0034","DOIUrl":"https://doi.org/10.5797/jnet.oa.2019-0034","url":null,"abstract":"Objective: Clinical research demonstrating safety and security in subclavian artery stenting (SAS) is limited because treatment strategies for SAS vary greatly among institutions, operators, and clinical conditions, as no standard protocol exists. As stenotic lesions frequently occur in the proximal portion of the subclavian artery (SA), it is often difficult to stabilize the guiding catheter for stent delivery. Our purpose was to assess whether lesion location can be used to predict optimal procedural strategies. Methods: We performed a retrospective, single-center observational study on 26 consecutive patients who underwent SAS between 2004 and 2016. We categorized patients treated with SAS into two groups according to lesion location: those with lesions located less than 10 mm from the origin of the SA (Group P) and those with lesions in the distal portion (Group D). We defined a bidirectional approach via both brachial and femoral puncture as well as bilateral brachial puncture as combined access. In pull-through method, a guidewire was passed from one sheath to another. We compared Group P with Group D in terms of procedural strategy and efficacy. Results: All 26 cases were clinically successful. Asymptomatic cerebral embolism was found in 10 (48%) of 21 cases in which postoperative MRI was performed, and the number of spotty lesions was less than four in every patient. Arterial access-site complications were documented in eight patients. Two cases of late in-stent restenosis were retreated with balloon dilatation. Cases with retrograde ipsilateral vertebral artery (VA) blood flow and symptomatic lesions occurred more frequently in Group P than in Group D (79% vs. 42%; p = 0.06, 71% vs. 33%; p = 0.05, respectively). Patients in Group P were significantly more often treated with combined access (100% vs. 42%; p = 0.001), with the pull-through method (64% vs. 0%; p < 0.001) than those in Group D. The distal end of the stent was involved with the ipsilateral VA orifice more often in Group D than in Group P (50% vs. 7%; p = 0.02). Conclusion: These results demonstrate that our strategy is a safe and effective method of stenting for SA stenosis in the portion of the artery that is proximal to the aorta. We should pay special attention to the risk of arterial access-site complications.","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":"71059164","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.2018-0084
N. Hayashi, M. Kawanishi, S. Okubo, N. Osaka, K. Osaka, T. Tamiya
Objective: We report a very rare case of dural arteriovenous fistula (DAVF) involving the inferior petroclival vein (IPCV). Case Presentation : The patient was a 77-year-old woman. She suffered from right ophthalmalgia, pulsatile tinnitus, blepharedema, and chemosis, as well as right ptosis and diplopia (right oculomotor nerve palsy). Our imaging examinations demonstrated DAVF involving the IPCV. Since the proximal side of the right inferior petrosal sinus (IPS) was obstructed, the main venous drainage flow refluxed retrogradely from the IPS to the cavernous sinus (CS). Therefore, her clinical symptoms were similar to those of CS-DAVF. We successfully performed transvenous coil embolization (TVE) in the IPCV and IPS. Conclusion: We experienced a very rare case of DAVF involving the IPCV. We believe that it is important in each case to understand the 3D vascular anatomy by making full use of 3D-DSA and other modalities to accurately identify the shunt point and venous drainage structure.
{"title":"A Case of Dural Arteriovenous Fistula Involving the Inferior Petroclival Vein","authors":"N. Hayashi, M. Kawanishi, S. Okubo, N. Osaka, K. Osaka, T. Tamiya","doi":"10.5797/JNET.CR.2018-0084","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0084","url":null,"abstract":"Objective: We report a very rare case of dural arteriovenous fistula (DAVF) involving the inferior petroclival vein (IPCV). Case Presentation : The patient was a 77-year-old woman. She suffered from right ophthalmalgia, pulsatile tinnitus, blepharedema, and chemosis, as well as right ptosis and diplopia (right oculomotor nerve palsy). Our imaging examinations demonstrated DAVF involving the IPCV. Since the proximal side of the right inferior petrosal sinus (IPS) was obstructed, the main venous drainage flow refluxed retrogradely from the IPS to the cavernous sinus (CS). Therefore, her clinical symptoms were similar to those of CS-DAVF. We successfully performed transvenous coil embolization (TVE) in the IPCV and IPS. Conclusion: We experienced a very rare case of DAVF involving the IPCV. We believe that it is important in each case to understand the 3D vascular anatomy by making full use of 3D-DSA and other modalities to accurately identify the shunt point and venous drainage structure.","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.2018-0084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71056019","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.2019-0065
Yusuke Takahashi, Y. Suda, A. Saito, Ryosei Wakasa
Objective: Sinus thrombosis often deteriorates despite anticoagulation therapy. Early endovascular therapy may lead to a better outcome in such cases. We report a case of sinus thrombosis treated by mechanical thrombectomy as an initial treatment. Case Presentation: A 45-year-old female presented with headache and tonic seizure affecting the right arm. Computed tomography revealed subcortical hemorrhage at the right superior frontal gyrus. Occlusion of the superior sagittal sinus (SSS) was found on CTA and we diagnosed sinus thrombosis. Digital subtraction angiography demonstrated complete occlusion of the SSS and venous congestion at the middle third of the SSS. Immediately after diagnosis, we performed mechanical thrombectomy as an initial treatment. Partial recanalization was achieved after mechanical thrombectomy. Postoperative anticoagulation therapy was continued, and her symptom was improved. Conclusion: Mechanical thrombectomy as an initial treatment for sinus thrombosis may be a useful treatment option when aggravation of the symptoms is predicted.
{"title":"Mechanical Thrombectomy as an Initial Treatment for Sinus Thrombosis","authors":"Yusuke Takahashi, Y. Suda, A. Saito, Ryosei Wakasa","doi":"10.5797/jnet.cr.2019-0065","DOIUrl":"https://doi.org/10.5797/jnet.cr.2019-0065","url":null,"abstract":"Objective: Sinus thrombosis often deteriorates despite anticoagulation therapy. Early endovascular therapy may lead to a better outcome in such cases. We report a case of sinus thrombosis treated by mechanical thrombectomy as an initial treatment. Case Presentation: A 45-year-old female presented with headache and tonic seizure affecting the right arm. Computed tomography revealed subcortical hemorrhage at the right superior frontal gyrus. Occlusion of the superior sagittal sinus (SSS) was found on CTA and we diagnosed sinus thrombosis. Digital subtraction angiography demonstrated complete occlusion of the SSS and venous congestion at the middle third of the SSS. Immediately after diagnosis, we performed mechanical thrombectomy as an initial treatment. Partial recanalization was achieved after mechanical thrombectomy. Postoperative anticoagulation therapy was continued, and her symptom was improved. Conclusion: Mechanical thrombectomy as an initial treatment for sinus thrombosis may be a useful treatment option when aggravation of the symptoms is predicted.","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.2019-0065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71056320","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.2019-0025
Takeaki Totsuka, H. Hiramatsu, Tomoya Ohishi, Shusuke Matsui, M. Kamiya, H. Nanba
Objective: In this report, we describe a case of cervical vertebral arteriovenous fistula (AVF) associated with neurofibromatosis type 1(NF1) presented as radiculopathy. Case Presentation: A 65-year-old female patient diagnosed with left cervical vertebral artery lesion-like aneurysms and NF1 incidentally. After 5 years, she presented with neck pain and left upper weakness. Examinations revealed left vertebral AVF. Endovascular therapy was performed and her symptoms were improved. Conclusion: Endovascular therapy should be performed if asymptomatic cervical vertebral aneurysms associated with NF1 are growing or become symptomatic.
{"title":"A Patient with Cervical Vertebral Arteriovenous Fistula Which Manifested as Radiculopathy: A Case Complicated by Neurofibromatosis Type 1","authors":"Takeaki Totsuka, H. Hiramatsu, Tomoya Ohishi, Shusuke Matsui, M. Kamiya, H. Nanba","doi":"10.5797/jnet.cr.2019-0025","DOIUrl":"https://doi.org/10.5797/jnet.cr.2019-0025","url":null,"abstract":"Objective: In this report, we describe a case of cervical vertebral arteriovenous fistula (AVF) associated with neurofibromatosis type 1(NF1) presented as radiculopathy. Case Presentation: A 65-year-old female patient diagnosed with left cervical vertebral artery lesion-like aneurysms and NF1 incidentally. After 5 years, she presented with neck pain and left upper weakness. Examinations revealed left vertebral AVF. Endovascular therapy was performed and her symptoms were improved. Conclusion: Endovascular therapy should be performed if asymptomatic cervical vertebral aneurysms associated with NF1 are growing or become symptomatic.","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.2019-0025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71056594","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.2018-0044
Y. Matsumoto, Hayatsura Hanada, K. Nii, Yusuke Morinaga, M. Iko, Takafumi Mitsutake, A. Eto, H. Aikawa, K. Kazekawa, M. Tsutsumi
Objective: A direct aspiration technique using a 5MAX ACE catheter (Penumbra, Alameda, CA, USA) has been reported. However, recanalization has not been achieved in all cases with this technique alone. Additionally, Japan has a rapidly aging society, and differences in the condition of vessels, because of aging, can limit the approach of revascularization devices to the thrombus. We evaluated the accessibility of the 5MAX ACE (0.060-inch inner diameter) over the clinoid segment of the internal carotid artery (ICA). Methods: We conducted a retrospective and cross-sectional study of 28 patients who received intraarterial treatment for acute ischemic stroke between October 2014 and October 2016. We recorded the maximum distal arrival point of the distal edge of the 5MAX ACE during the procedure before the stent retriever was retrieved. Results: In 5 of the 28 patients, the distal edge of the 5MAX ACE catheter did not advance over the clinoid segment of the ICA. The mean age of patients for whom the 5MAX ACE catheter failed to advance over the clinoid segment of the ICA was significantly higher (non-advancement: 85 ± 3 years) than that of patients with advancement (76 ± 9 years, Mann–Whitney U-test: P = 0.04). Conclusion: Advanced age may limit successful revascularization using only a direct aspiration technique with the 5MAX ACE without a stent or balloon anchoring technique for lesions at the terminal portion of the ICA and more distal arteries, which suggests that different devices or approaches may be needed for clot removal.
{"title":"High Age Could Influence Large Thrombus Aspiration Catheter Advancement over the Carotid Siphon","authors":"Y. Matsumoto, Hayatsura Hanada, K. Nii, Yusuke Morinaga, M. Iko, Takafumi Mitsutake, A. Eto, H. Aikawa, K. Kazekawa, M. Tsutsumi","doi":"10.5797/JNET.OA.2018-0044","DOIUrl":"https://doi.org/10.5797/JNET.OA.2018-0044","url":null,"abstract":"Objective: A direct aspiration technique using a 5MAX ACE catheter (Penumbra, Alameda, CA, USA) has been reported. However, recanalization has not been achieved in all cases with this technique alone. Additionally, Japan has a rapidly aging society, and differences in the condition of vessels, because of aging, can limit the approach of revascularization devices to the thrombus. We evaluated the accessibility of the 5MAX ACE (0.060-inch inner diameter) over the clinoid segment of the internal carotid artery (ICA). Methods: We conducted a retrospective and cross-sectional study of 28 patients who received intraarterial treatment for acute ischemic stroke between October 2014 and October 2016. We recorded the maximum distal arrival point of the distal edge of the 5MAX ACE during the procedure before the stent retriever was retrieved. Results: In 5 of the 28 patients, the distal edge of the 5MAX ACE catheter did not advance over the clinoid segment of the ICA. The mean age of patients for whom the 5MAX ACE catheter failed to advance over the clinoid segment of the ICA was significantly higher (non-advancement: 85 ± 3 years) than that of patients with advancement (76 ± 9 years, Mann–Whitney U-test: P = 0.04). Conclusion: Advanced age may limit successful revascularization using only a direct aspiration technique with the 5MAX ACE without a stent or balloon anchoring technique for lesions at the terminal portion of the ICA and more distal arteries, which suggests that different devices or approaches may be needed for clot removal.","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.2018-0044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71058197","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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