Pub Date : 2019-01-01DOI: 10.5797/JNET.OA.2018-0090
Y. Nishikawa, Kentaro Tanaka, T. Kitamura, Teishiki Shibata, H. Yamada, M. Oomura, Noriaki Aihara, H. Katano, S. Osaga, M. Mase
Objective: Occasions to administer endovascular treatment to the elderly have increased, for which rapid and safe guiding catheter (GC) placement even in a lesion with seve re arteriosclerosis is required. We investigated an index to easily evaluate the degree of diffi culty before treatment. Methods: In all, 83 consecutive patients who received carotid artery stenting (CAS) through the transfemoral approach at our institution between May 2010 and December 2016 were divided into those in whom GC could be placed using the JB2-type inner catheter (IC) (JB2 group) and those who required the Simmon s type or Goose neck snare (SM/GS group). Vascular anatomy of the cervicothoracic region was evaluated and an index to select IC was investigated. Results: The JB2 and SM/GS groups consisted of 68 and 15 patients, respectively. The distributions of the following fi ve items were diff erent between the two groups: The level of the origin of the selected artery from the lesser curvature of t he aortic arch, aorta type, tortuosity of the common carotid artery, selected artery, and location of the lesion. On decision tree analysis of these factors, a fl owchart was prepared in which a lower level of the origin of the selected artery than the level of the lesser curvature of the aortic arch was the fi rst layer. Conclusion: IC selection can be more accurately evaluated based on whether the level of the origin of the selected artery is lower than the level of the lesser curvature of the aortic arch compared with evaluation of the aorta type III.
{"title":"Selection of Appropriate Inner Catheter for Placement of Guiding Catheter","authors":"Y. Nishikawa, Kentaro Tanaka, T. Kitamura, Teishiki Shibata, H. Yamada, M. Oomura, Noriaki Aihara, H. Katano, S. Osaga, M. Mase","doi":"10.5797/JNET.OA.2018-0090","DOIUrl":"https://doi.org/10.5797/JNET.OA.2018-0090","url":null,"abstract":"Objective: Occasions to administer endovascular treatment to the elderly have increased, for which rapid and safe guiding catheter (GC) placement even in a lesion with seve re arteriosclerosis is required. We investigated an index to easily evaluate the degree of diffi culty before treatment. Methods: In all, 83 consecutive patients who received carotid artery stenting (CAS) through the transfemoral approach at our institution between May 2010 and December 2016 were divided into those in whom GC could be placed using the JB2-type inner catheter (IC) (JB2 group) and those who required the Simmon s type or Goose neck snare (SM/GS group). Vascular anatomy of the cervicothoracic region was evaluated and an index to select IC was investigated. Results: The JB2 and SM/GS groups consisted of 68 and 15 patients, respectively. The distributions of the following fi ve items were diff erent between the two groups: The level of the origin of the selected artery from the lesser curvature of t he aortic arch, aorta type, tortuosity of the common carotid artery, selected artery, and location of the lesion. On decision tree analysis of these factors, a fl owchart was prepared in which a lower level of the origin of the selected artery than the level of the lesser curvature of the aortic arch was the fi rst layer. Conclusion: IC selection can be more accurately evaluated based on whether the level of the origin of the selected artery is lower than the level of the lesser curvature of the aortic arch compared with evaluation of the aorta type III.","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.2018-0090","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71058394","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.2019-0009
Toshinori Takagi, Y. Matsumoto, R. Itabashi, Kenichi Sato, S. Yoshimura
Objective: The purpose of this study was to investigate the current status of treatment for intracranial artery stenosis (ICAS) in Japan. Methods: A questionnaire was administered to a member of the Japanese Society for Neuroendovascular Therapy (JSNET), and data regarding the number of treatments for ICAS and the treatment strategies employed were collected via e-mail. Results: Responses were received from 261 hospitals (25.8%) with JSNET members. From January 1 to December 31, 2017, the number of endovascular treatments for ICAS was 783. Among them, symptomatic lesions were seen in 89.8% of the cases, and 30.3% of ICAS cases were diagnosed after the reperfusion of an acute occlusion. Among the treatment strategies for ICAS detected after the reperfusion of an acute large-vessel occlusion (ALVO), antiplatelet therapy was utilized in 23.8% of cases and endovascular therapy was utilized in 70.4% of cases, in addition to antiplatelet therapy. In cases involving symptomatic severe ICAS resistant to medical treatment with cerebral blood flow (CBF) impairment, 97.8% of physicians suggested intervention. However, in cases without CBF impairment, the percentage of physicians who suggested intervention decreased to 53.1%. In contrast, for asymptomatic ICAS without CBF impairment, more than 95% of physicians selected medical treatment. Conclusion: In cases involving symptomatic ICAS resistant to medical treatment with CBF impairment, the rate of physicians who suggested intervention was quite high in Japan. Thirty percent of ICAS cases were diagnosed after the reperfusion of an ALVO.
{"title":"Current Status of Endovascular Therapy for Intracranial Artery Stenosis from the Results of a Nationwide Survey","authors":"Toshinori Takagi, Y. Matsumoto, R. Itabashi, Kenichi Sato, S. Yoshimura","doi":"10.5797/jnet.oa.2019-0009","DOIUrl":"https://doi.org/10.5797/jnet.oa.2019-0009","url":null,"abstract":"Objective: The purpose of this study was to investigate the current status of treatment for intracranial artery stenosis (ICAS) in Japan. Methods: A questionnaire was administered to a member of the Japanese Society for Neuroendovascular Therapy (JSNET), and data regarding the number of treatments for ICAS and the treatment strategies employed were collected via e-mail. Results: Responses were received from 261 hospitals (25.8%) with JSNET members. From January 1 to December 31, 2017, the number of endovascular treatments for ICAS was 783. Among them, symptomatic lesions were seen in 89.8% of the cases, and 30.3% of ICAS cases were diagnosed after the reperfusion of an acute occlusion. Among the treatment strategies for ICAS detected after the reperfusion of an acute large-vessel occlusion (ALVO), antiplatelet therapy was utilized in 23.8% of cases and endovascular therapy was utilized in 70.4% of cases, in addition to antiplatelet therapy. In cases involving symptomatic severe ICAS resistant to medical treatment with cerebral blood flow (CBF) impairment, 97.8% of physicians suggested intervention. However, in cases without CBF impairment, the percentage of physicians who suggested intervention decreased to 53.1%. In contrast, for asymptomatic ICAS without CBF impairment, more than 95% of physicians selected medical treatment. Conclusion: In cases involving symptomatic ICAS resistant to medical treatment with CBF impairment, the rate of physicians who suggested intervention was quite high in Japan. Thirty percent of ICAS cases were diagnosed after the reperfusion of an ALVO.","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.2019-0009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71059114","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.2018-0093
H. Itokawa, Noriyoshi Okamoto, M. Fujimoto, M. Moriya, Y. Tsuge, K. Yamamoto, J. Sasanuma
Objective: A newly developed application for cerebral C-arm computed tomography perfusion imaging (C-arm CTP) using an angiography system was investigated. Case Presentation: C-arm CTP protocol continuously collects X-ray projection images during 10 back and forth C-arm rotations. From the collected data, cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP) images and multiphase vascular images are reconstructed. C-arm CTP images acquired in patients with acute and chronic major artery occlusion are presented. Conclusion: C-arm CTP using an angiography system is capable of evaluating perfusion parameters in real time, similar to conventional evaluation using multi-detector row CT perfusion (MD-CTP), suggesting its usefulness for examination of ischemic stroke in the angiographic suite.
{"title":"C-arm CT Perfusion Study Using Angiography System","authors":"H. Itokawa, Noriyoshi Okamoto, M. Fujimoto, M. Moriya, Y. Tsuge, K. Yamamoto, J. Sasanuma","doi":"10.5797/JNET.TN.2018-0093","DOIUrl":"https://doi.org/10.5797/JNET.TN.2018-0093","url":null,"abstract":"Objective: A newly developed application for cerebral C-arm computed tomography perfusion imaging (C-arm CTP) using an angiography system was investigated. Case Presentation: C-arm CTP protocol continuously collects X-ray projection images during 10 back and forth C-arm rotations. From the collected data, cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP) images and multiphase vascular images are reconstructed. C-arm CTP images acquired in patients with acute and chronic major artery occlusion are presented. Conclusion: C-arm CTP using an angiography system is capable of evaluating perfusion parameters in real time, similar to conventional evaluation using multi-detector row CT perfusion (MD-CTP), suggesting its usefulness for examination of ischemic stroke in the angiographic suite.","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.2018-0093","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71061679","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.2018-0124
T. Kinkori, Ken-ichi Watanabe
Objective: We report a fi rst case of stent-assisted coiling for the left vertebral artery aneurysm via the left distal radial approach. Case Presentation: The patient was a 47-year-old male with unruptured left vertebral artery aneurysm. Transfemoral approach was infeasible because of the history of thoracoabdominal aortic dissection, the left distal radial approach was selected. Distal radial artery in the left anatomical snuff box was punctured and a 4 Fr guiding sheath was introduced to the left vertebral artery, followed by successful coil embolization with stent. Conclusion: The left distal radial approach via the anatomical snuff box is a feasible method for left vertebral artery lesions.
{"title":"Left Distal Radial Approach for Stent-assisted Coiling of Left Vertebral Artery Aneurysm","authors":"T. Kinkori, Ken-ichi Watanabe","doi":"10.5797/JNET.TN.2018-0124","DOIUrl":"https://doi.org/10.5797/JNET.TN.2018-0124","url":null,"abstract":"Objective: We report a fi rst case of stent-assisted coiling for the left vertebral artery aneurysm via the left distal radial approach. Case Presentation: The patient was a 47-year-old male with unruptured left vertebral artery aneurysm. Transfemoral approach was infeasible because of the history of thoracoabdominal aortic dissection, the left distal radial approach was selected. Distal radial artery in the left anatomical snuff box was punctured and a 4 Fr guiding sheath was introduced to the left vertebral artery, followed by successful coil embolization with stent. Conclusion: The left distal radial approach via the anatomical snuff box is a feasible method for left vertebral artery lesions.","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":"71061772","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.2018-0049
K. Tokuyama, H. Kiyosue, Yuzo Hori, H. Nagatomi, Y. Wakugawa, S. Ide
Objective: To describe a case of dural arteriovenous fistulas (DAVFs) involving the isolated transverse sinus (TS) treated by transvenous embolization (TVE) via the mastoid emissary vein (MEV) with the femoral venous approach. Case Presentation: An 86-year-old woman presented with cerebral hemorrhage. Angiography showed DAVFs involving the left isolated TS with retrograde cortical venous drainage. Transvenous approach through the occluded sigmoid sinus into the affected sinus failed; however, we could easily advance a microcatheter into the isolated sinus via the MEV. The DAVFs were completely occluded by selective TVE combined with transarterial embolization, and reconstruction of antegrade cerebral venous drainage from the vein of Labbe’ to the MEV was obtained. Conclusion: The MEV can be an alternative approach route for TVE of transverse-sigmoid sinus DAVFs when an approach through the occluded sinus is difficult or failed.
{"title":"A Case of Transverse Sinus Dural Arteriovenous Fistula Treated by Transvenous Embolization via the Mastoid Emissary Vein with Femoral Venous Approach","authors":"K. Tokuyama, H. Kiyosue, Yuzo Hori, H. Nagatomi, Y. Wakugawa, S. Ide","doi":"10.5797/JNET.CR.2018-0049","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0049","url":null,"abstract":"Objective: To describe a case of dural arteriovenous fistulas (DAVFs) involving the isolated transverse sinus (TS) treated by transvenous embolization (TVE) via the mastoid emissary vein (MEV) with the femoral venous approach. Case Presentation: An 86-year-old woman presented with cerebral hemorrhage. Angiography showed DAVFs involving the left isolated TS with retrograde cortical venous drainage. Transvenous approach through the occluded sigmoid sinus into the affected sinus failed; however, we could easily advance a microcatheter into the isolated sinus via the MEV. The DAVFs were completely occluded by selective TVE combined with transarterial embolization, and reconstruction of antegrade cerebral venous drainage from the vein of Labbe’ to the MEV was obtained. Conclusion: The MEV can be an alternative approach route for TVE of transverse-sigmoid sinus DAVFs when an approach through the occluded sinus is difficult or failed.","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.2018-0049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71055282","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.2019-0008
M. Goto, Hirokuni Hashikata, H. Toda, K. Iwasaki
Objective: A rare case of parent artery stenosis and visual disturbance after balloon-assisted coil embolization for an unruptured cerebral aneurysm is reported. Case Presentation: A 63-year-old woman underwent successful coil embolization of an incidental cerebral aneurysm using a balloon-assisted technique. The aneurysm was located in the right internal carotid artery. Her treatment course was uneventful, and she was discharged without any neurological deficits. Follow-up angiography after 9 months showed severe parent artery stenosis without aneurysm recurrence. However, she had a visual disturbance, and MRI showed edema around the treated aneurysm at the same time. Judging from the results of several metal patch tests, the platinum coils caused this pathology, and oral steroids and antihistamines were administered. This treatment improved her parent artery stenosis, but her visual disturbance persisted. Conclusion: Although parent artery stenosis after coil embolization using balloon-assisted technique of a cerebral aneurysm in the chronic phase is rare, we should consider the possibility of metal allergy.
{"title":"Parent Artery Stenosis and Visual Disturbance after Balloon-assisted Coil Embolization of an Unruptured Cerebral Aneurysm: A Case Report","authors":"M. Goto, Hirokuni Hashikata, H. Toda, K. Iwasaki","doi":"10.5797/JNET.CR.2019-0008","DOIUrl":"https://doi.org/10.5797/JNET.CR.2019-0008","url":null,"abstract":"Objective: A rare case of parent artery stenosis and visual disturbance after balloon-assisted coil embolization for an unruptured cerebral aneurysm is reported. Case Presentation: A 63-year-old woman underwent successful coil embolization of an incidental cerebral aneurysm using a balloon-assisted technique. The aneurysm was located in the right internal carotid artery. Her treatment course was uneventful, and she was discharged without any neurological deficits. Follow-up angiography after 9 months showed severe parent artery stenosis without aneurysm recurrence. However, she had a visual disturbance, and MRI showed edema around the treated aneurysm at the same time. Judging from the results of several metal patch tests, the platinum coils caused this pathology, and oral steroids and antihistamines were administered. This treatment improved her parent artery stenosis, but her visual disturbance persisted. Conclusion: Although parent artery stenosis after coil embolization using balloon-assisted technique of a cerebral aneurysm in the chronic phase is rare, we should consider the possibility of metal allergy.","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":"71055792","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.2018-0075
Y. Kuranari, T. Akiyama, Kaoru Yanagisawa, Dai Kamamoto, Katsuhiro Mizutani, Satoshi Takahashi, Shin Saito, Hiroyuki Ozawa, K. Ogawa, Kazunari Yoshida
Objective: Pseudoaneurysms of the internal carotid artery (ICA) and sphenopalatine artery (SPA) are recognized as sources of arterial epistaxis following head and face trauma. However, epistaxis involving pseudoaneurysm of the anterior ethmoidal artery (AEA) is extremely rare. Case Presentation: A 25-year-old man experienced massive epistaxis due to a ruptured traumatic pseudoaneurysm of the AEA. The patient had suffered head and face trauma in a car accident. CT showed fractures of the frontal, ethmoidal, and maxillary bones, and he was managed conservatively. Nine days after the injury, he had sudden, massive epistaxis. Angiography showed a right AEA aneurysm, which was treated successfully with transarterial embolization using n-butyl2-cyanoacrylate (NBCA). Conclusion: Although pseudoaneurysm of the AEA is a rare cause of epistaxis, it is important to consider this diagnosis, in addition to pseudoaneurysm of the SPA and ICA, when a patient has massive arterial epistaxis following a traumatic skull base fracture, especially if the fracture is adjacent to the ethmoid sinus. Transarterial embolization using glue is a feasible therapeutic option for this condition.
{"title":"Traumatic Anterior Ethmoidal Artery Pseudoaneurysm with Repeated Epistaxis Treated by Transarterial Embolization: A Case Report","authors":"Y. Kuranari, T. Akiyama, Kaoru Yanagisawa, Dai Kamamoto, Katsuhiro Mizutani, Satoshi Takahashi, Shin Saito, Hiroyuki Ozawa, K. Ogawa, Kazunari Yoshida","doi":"10.5797/JNET.CR.2018-0075","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0075","url":null,"abstract":"Objective: Pseudoaneurysms of the internal carotid artery (ICA) and sphenopalatine artery (SPA) are recognized as sources of arterial epistaxis following head and face trauma. However, epistaxis involving pseudoaneurysm of the anterior ethmoidal artery (AEA) is extremely rare. Case Presentation: A 25-year-old man experienced massive epistaxis due to a ruptured traumatic pseudoaneurysm of the AEA. The patient had suffered head and face trauma in a car accident. CT showed fractures of the frontal, ethmoidal, and maxillary bones, and he was managed conservatively. Nine days after the injury, he had sudden, massive epistaxis. Angiography showed a right AEA aneurysm, which was treated successfully with transarterial embolization using n-butyl2-cyanoacrylate (NBCA). Conclusion: Although pseudoaneurysm of the AEA is a rare cause of epistaxis, it is important to consider this diagnosis, in addition to pseudoaneurysm of the SPA and ICA, when a patient has massive arterial epistaxis following a traumatic skull base fracture, especially if the fracture is adjacent to the ethmoid sinus. Transarterial embolization using glue is a feasible therapeutic option for this condition.","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.2018-0075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71055874","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.2018-0041
T. Asai, Kazunori Shintai, Takahiro Oyama, M. Ikezawa, Takuma Miyazawa, Kinya Yokoyama, T. Kawaguchi, Masasuke Ohno, N. Susaki, Y. Kajita, Tatsuo Takahashi
Objective: While the effectiveness of thrombectomy for anterior circulation proximal intracranial arterial occlusions has been established, there is no solid evidence concerning its therapeutic effect on acute ischemic stroke due to middle cerebral artery M2 occlusion. In this study, we evaluated the efficacy and safety of a direct aspiration first pass technique (ADAPT) using the Penumbra 4MAX aspiration catheters (4MAX; Medico’s Hirata Inc., Osaka, Japan) for M2 occlusion. Methods: Of the 17 patients with acute ischemic stroke who underwent thrombectomy for M2 occlusion between January 2016 and December 2017 at our institution, 12 patients in whom ADAPT using the 4MAX was performed as the first-line procedure were evaluated. The stent retriever (SR) was used concomitantly in patients in whom recanalization could not be achieved by ADAPT using the 4MAX only. The retrospective evaluation was performed according to effective recanalization (thrombolysis in cerebral infarction [TICI] scale 2b-3) and independence in daily activities (modified Rankin Scale [mRS] score 0-2 after 3 months) as the efficacy endpoints and symptomatic intracranial hemorrhage as a safety endpoint. Results: The median age of the 12 subjects was 77 (interquartile range [IQR] 69–80) years, 9 (75.0%) were males, and the median preprocedural National Institutes of Health Stroke Scale (NIHSS) score was 19.5 (IQR: 16–24.5). The 4MAX reached the clot in 11 (91.7%), and effective recanalization was obtained by ADAPT alone in 8 (66.7%). Effective recanalization was achieved in 11 (91.7%) at the end of all procedures, the outcome was favorable in 8 (66.7%), and no symptomatic intracranial hemorrhage was observed. Conclusion: In M2 occluded region, a high recanalization rate could be achieved by ADAPT using the 4MAX without causing symptomatic intracranial hemorrhage, and the results suggested high efficacy and safety of the technique.
{"title":"Therapeutic Results of a Direct Aspiration First Pass Technique Using the Penumbra 4MAX Aspiration Catheter for Middle Cerebral Artery M2 Occlusion","authors":"T. Asai, Kazunori Shintai, Takahiro Oyama, M. Ikezawa, Takuma Miyazawa, Kinya Yokoyama, T. Kawaguchi, Masasuke Ohno, N. Susaki, Y. Kajita, Tatsuo Takahashi","doi":"10.5797/JNET.OA.2018-0041","DOIUrl":"https://doi.org/10.5797/JNET.OA.2018-0041","url":null,"abstract":"Objective: While the effectiveness of thrombectomy for anterior circulation proximal intracranial arterial occlusions has been established, there is no solid evidence concerning its therapeutic effect on acute ischemic stroke due to middle cerebral artery M2 occlusion. In this study, we evaluated the efficacy and safety of a direct aspiration first pass technique (ADAPT) using the Penumbra 4MAX aspiration catheters (4MAX; Medico’s Hirata Inc., Osaka, Japan) for M2 occlusion. Methods: Of the 17 patients with acute ischemic stroke who underwent thrombectomy for M2 occlusion between January 2016 and December 2017 at our institution, 12 patients in whom ADAPT using the 4MAX was performed as the first-line procedure were evaluated. The stent retriever (SR) was used concomitantly in patients in whom recanalization could not be achieved by ADAPT using the 4MAX only. The retrospective evaluation was performed according to effective recanalization (thrombolysis in cerebral infarction [TICI] scale 2b-3) and independence in daily activities (modified Rankin Scale [mRS] score 0-2 after 3 months) as the efficacy endpoints and symptomatic intracranial hemorrhage as a safety endpoint. Results: The median age of the 12 subjects was 77 (interquartile range [IQR] 69–80) years, 9 (75.0%) were males, and the median preprocedural National Institutes of Health Stroke Scale (NIHSS) score was 19.5 (IQR: 16–24.5). The 4MAX reached the clot in 11 (91.7%), and effective recanalization was obtained by ADAPT alone in 8 (66.7%). Effective recanalization was achieved in 11 (91.7%) at the end of all procedures, the outcome was favorable in 8 (66.7%), and no symptomatic intracranial hemorrhage was observed. Conclusion: In M2 occluded region, a high recanalization rate could be achieved by ADAPT using the 4MAX without causing symptomatic intracranial hemorrhage, and the results suggested high efficacy and safety of the technique.","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.2018-0041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71058174","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.2019-0052
Bikei Ryu, Shinsuke Sato, Tatsuki Mochizuki, S. Shima, Tatsuya Inoue, K. Kuwamoto, Y. Okada, Y. Niimi
Objective: The usefulness of endovascular treatment for cavernous sinus (CS)-dural arteriovenous fistula (dAVF) has been established. As the first choice of endovascular intervention for CS-dAVF, transvenous embolization (TVE) is generally performed, and the inferior petrosal sinus (IPS) is usually selected as the main access route to the affected CS because of its accessibility. However, the angiographical pattern of the CS varies among individuals. In some cases, it is difficult to access the affected CS via the ipsilateral IPS because of thrombosis, hypoplasia, or aplasia. Therefore, in some cases, alternative venous access routes are needed for TVE. Methods: A retrospective study was performed with 27 patients diagnosed with intracranial dAVF who underwent endovascular embolization at our institution. Among these, the data of nine patients with CS-dAVF treated by endovascular intervention were analyzed retrospectively in this study. We reviewed the endovascular access routes for CS-dAVF treatment based on anatomical and embryological considerations. Results: The most common complaint was diplopia, followed by exophthalmos and chemosis. There was no hemorrhagic onset. Cortical venous reflux (CVR) was recognized angiographically in six patients. The IPS on the affected side was angiographically occluded in four patients. TVE was attempted first in all patients. In five patients where the ipsilateral IPS was patent, TVE was successfully performed via the ipsilateral IPS. In four patients where the ipsilateral IPS was occluded, microcatheter access to the affected CS via the ipsilateral IPS was unsuccessful. The following alternative approach routes were selected: the superficial temporal vein, facial vein, direct puncture of the superficial middle cerebral vein (SMCV), and ascending pharyngeal artery (APA) for transarterial intravenous embolization (TAIV). The CS-dAVF had disappeared in all patients at the final follow-up examination. In the case of difficult access, compartment formations of the intracavernous sinus were recognized. Compartment formation due to the anatomical and embryological differences of the intracavernous structure may have influenced the ability of the catheter to reach the affected shunted pouch. Conclusions: In cases where the approach via the ipsilateral IPS was difficult, alternative access routes were effective for the required embolization. It is extremely important to fully understand the angioarchitecture, location of the shunted pouch, and compartments of the CS for successful endovascular treatment. Anatomical and developmental CS considerations may be useful for better access route selection.
{"title":"Assessment of Therapeutic Access Routes for Endovascular Therapy of Cavernous Sinus-dural Arteriovenous Fistula","authors":"Bikei Ryu, Shinsuke Sato, Tatsuki Mochizuki, S. Shima, Tatsuya Inoue, K. Kuwamoto, Y. Okada, Y. Niimi","doi":"10.5797/JNET.OA.2019-0052","DOIUrl":"https://doi.org/10.5797/JNET.OA.2019-0052","url":null,"abstract":"Objective: The usefulness of endovascular treatment for cavernous sinus (CS)-dural arteriovenous fistula (dAVF) has been established. As the first choice of endovascular intervention for CS-dAVF, transvenous embolization (TVE) is generally performed, and the inferior petrosal sinus (IPS) is usually selected as the main access route to the affected CS because of its accessibility. However, the angiographical pattern of the CS varies among individuals. In some cases, it is difficult to access the affected CS via the ipsilateral IPS because of thrombosis, hypoplasia, or aplasia. Therefore, in some cases, alternative venous access routes are needed for TVE. Methods: A retrospective study was performed with 27 patients diagnosed with intracranial dAVF who underwent endovascular embolization at our institution. Among these, the data of nine patients with CS-dAVF treated by endovascular intervention were analyzed retrospectively in this study. We reviewed the endovascular access routes for CS-dAVF treatment based on anatomical and embryological considerations. Results: The most common complaint was diplopia, followed by exophthalmos and chemosis. There was no hemorrhagic onset. Cortical venous reflux (CVR) was recognized angiographically in six patients. The IPS on the affected side was angiographically occluded in four patients. TVE was attempted first in all patients. In five patients where the ipsilateral IPS was patent, TVE was successfully performed via the ipsilateral IPS. In four patients where the ipsilateral IPS was occluded, microcatheter access to the affected CS via the ipsilateral IPS was unsuccessful. The following alternative approach routes were selected: the superficial temporal vein, facial vein, direct puncture of the superficial middle cerebral vein (SMCV), and ascending pharyngeal artery (APA) for transarterial intravenous embolization (TAIV). The CS-dAVF had disappeared in all patients at the final follow-up examination. In the case of difficult access, compartment formations of the intracavernous sinus were recognized. Compartment formation due to the anatomical and embryological differences of the intracavernous structure may have influenced the ability of the catheter to reach the affected shunted pouch. Conclusions: In cases where the approach via the ipsilateral IPS was difficult, alternative access routes were effective for the required embolization. It is extremely important to fully understand the angioarchitecture, location of the shunted pouch, and compartments of the CS for successful endovascular treatment. Anatomical and developmental CS considerations may be useful for better access route selection.","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":"71059093","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.RA.2018-0105
Katsuhiro Mizutani, T. Akiyama, Kazunari Yoshida
The anterior condylar arteriovenous fi stula (AC-AVF) is a relatively rare AVF that aff ects the vasculatures adjacent to the hypoglossal canal. We aimed to discuss the etiology and defi nition of the AC-AVF from the viewpoint of the osseous venous anatomy. Our recent study, which used modern imaging technology (CT digital subtraction venography and cone beam CT reconstructed from 3D rotational angiography), elucidated the intraosseous venous anatomy in this region and the precise fi stulous locations of AC-AVFs. Those fi ndings suggest that the AC-AVF is a group of “osseous” AVF that involves the anterior condylar vein and jugular tubercle venous complex (JTVC), and the osseous veins connected to them. The AC-AVF develops in osseous veins adjacent to the hypoglossal canal, and it is one of the most common subtypes of osseous AVFs. The angioarchitectures and etiology of AC-AVFs discussed herein are essential to understand this clinical entity.
{"title":"The Anterior Condylar Arteriovenous Fistula from the Viewpoint of the Osseous Venous Anatomy","authors":"Katsuhiro Mizutani, T. Akiyama, Kazunari Yoshida","doi":"10.5797/JNET.RA.2018-0105","DOIUrl":"https://doi.org/10.5797/JNET.RA.2018-0105","url":null,"abstract":"The anterior condylar arteriovenous fi stula (AC-AVF) is a relatively rare AVF that aff ects the vasculatures adjacent to the hypoglossal canal. We aimed to discuss the etiology and defi nition of the AC-AVF from the viewpoint of the osseous venous anatomy. Our recent study, which used modern imaging technology (CT digital subtraction venography and cone beam CT reconstructed from 3D rotational angiography), elucidated the intraosseous venous anatomy in this region and the precise fi stulous locations of AC-AVFs. Those fi ndings suggest that the AC-AVF is a group of “osseous” AVF that involves the anterior condylar vein and jugular tubercle venous complex (JTVC), and the osseous veins connected to them. The AC-AVF develops in osseous veins adjacent to the hypoglossal canal, and it is one of the most common subtypes of osseous AVFs. The angioarchitectures and etiology of AC-AVFs discussed herein are essential to understand this clinical entity.","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.RA.2018-0105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71059700","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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