Pub Date : 2019-01-01DOI: 10.5797/JNET.CR.2018-0069
N. Shinoda, M. Mori, S. Tamura, K. Korosue, S. Kose, H. Imai, T. Enomoto, R. Tominaga, Toshio Masahira, T. Miki, Tomoya Hiura, Kentaro Shimoda, K. Suwa, J. Obata, Mutsuma Adachi, Y. Matsumoto, E. Kohmura
Objective: We report a patient in whom direct puncture of the superior ophthalmic vein for a cavernous sinus dural arteriovenous fistula led to rapidly progressing thrombosis and postoperative non-arteritic ischemic optic neuropathy (NA-ION), and review the pathogenesis. Case Presentation: A 74-year-old female. Detailed examination of diplopia and visual disorder suggested a cavernous sinus dural arteriovenous fistula. As approaching via a posterior route was difficult, transvenous embolization by direct puncture of the superior ophthalmic vein was performed. As drainage routes were aggregated around this vein, thrombosis of this vein occurred, inducing postoperative NA-ION through a rapid change in hemodynamics. Conclusion: When performing direct puncture of the superior ophthalmic vein, puncture methods and heparinization should be considered after sufficiently investigating drainage routes.
{"title":"A Patient with a Cavernous Sinus Dural Arteriovenous Fistula in Whom Direct Puncture of the Superior Ophthalmic Vein Led to Rapidly Progressing Thrombosis and Postoperative Non-arteritic Ischemic Optic Neuropathy: Pathogenesis with Respect to a Drainage Route","authors":"N. Shinoda, M. Mori, S. Tamura, K. Korosue, S. Kose, H. Imai, T. Enomoto, R. Tominaga, Toshio Masahira, T. Miki, Tomoya Hiura, Kentaro Shimoda, K. Suwa, J. Obata, Mutsuma Adachi, Y. Matsumoto, E. Kohmura","doi":"10.5797/JNET.CR.2018-0069","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0069","url":null,"abstract":"Objective: We report a patient in whom direct puncture of the superior ophthalmic vein for a cavernous sinus dural arteriovenous fistula led to rapidly progressing thrombosis and postoperative non-arteritic ischemic optic neuropathy (NA-ION), and review the pathogenesis. Case Presentation: A 74-year-old female. Detailed examination of diplopia and visual disorder suggested a cavernous sinus dural arteriovenous fistula. As approaching via a posterior route was difficult, transvenous embolization by direct puncture of the superior ophthalmic vein was performed. As drainage routes were aggregated around this vein, thrombosis of this vein occurred, inducing postoperative NA-ION through a rapid change in hemodynamics. Conclusion: When performing direct puncture of the superior ophthalmic vein, puncture methods and heparinization should be considered after sufficiently investigating drainage routes.","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":"71055401","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.2018-0022
M. Sunaga, T. Hashimoto, Daichi Kato, Hirofumi Okada, Yujiro Tanaka, H. Namatame, N. Nakajima, M. Kohno
Objective: In patients with infectious endocarditis requiring cardiac surgery, the presence of unruptured infectious intracranial aneurysms is an important issue. We report a patient in whom endovascular treatment for an unruptured infectious intracranial aneurysm was performed prior to cardiac surgery. Case Presentation: A 20-year-old woman was admitted with infectious endocarditis. During the assessment, a cerebellar abscess was noted and drainage was conducted. An infectious intracranial aneurysm was observed in the posterior cerebral artery and treatment with an antimicrobial drug was continued. Due to severe heart failure, cardiac surgery was required, but there was a slight increase in the aneurysmal size. Intra-aneurysmal embolization was performed while preserving the parent artery. Subsequently, valve plasty was conducted. The patient was discharged. Conclusion: If cardiac surgery is necessary, the treatment of infectious intracranial aneurysms should be performed in advance. If the heart failure is severe, endovascular treatment, which does not influence hemodynamics, may be useful.
{"title":"Endovascular Treatment for an Infectious Aneurysm Prior to Cardiac Surgery: A Case Report","authors":"M. Sunaga, T. Hashimoto, Daichi Kato, Hirofumi Okada, Yujiro Tanaka, H. Namatame, N. Nakajima, M. Kohno","doi":"10.5797/JNET.CR.2018-0022","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0022","url":null,"abstract":"Objective: In patients with infectious endocarditis requiring cardiac surgery, the presence of unruptured infectious intracranial aneurysms is an important issue. We report a patient in whom endovascular treatment for an unruptured infectious intracranial aneurysm was performed prior to cardiac surgery. Case Presentation: A 20-year-old woman was admitted with infectious endocarditis. During the assessment, a cerebellar abscess was noted and drainage was conducted. An infectious intracranial aneurysm was observed in the posterior cerebral artery and treatment with an antimicrobial drug was continued. Due to severe heart failure, cardiac surgery was required, but there was a slight increase in the aneurysmal size. Intra-aneurysmal embolization was performed while preserving the parent artery. Subsequently, valve plasty was conducted. The patient was discharged. Conclusion: If cardiac surgery is necessary, the treatment of infectious intracranial aneurysms should be performed in advance. If the heart failure is severe, endovascular treatment, which does not influence hemodynamics, may be useful.","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.2018-0022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71055477","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.2018-0106
M. Kugai, T. Suyama, T. Inui, Keisho Yamazato, M. Kitano, H. Hasegawa, Y. Tominaga, S. Tominaga
Objective: The authors report a rare case of symptomatic unruptured fusiform vertebral artery (VA) aneurysm causing hemifacial spasm, which was successfully treated by endovascular parent artery occlusion (PAO). Case Presentation: A 56-year-old man presented with left hemifacial spasm, and the symptom progressed rapidly over 3–4 weeks including difficulty of eye opening. Brain MRI showed a left fusiform VA aneurysm with a maximum diameter of approximately 10 mm, which compressed the root exit zone (REZ) of the left facial nerve. Endovascular PAO of the left VA was performed with coils. The hemifacial spasm disappeared immediately after PAO. The size of the aneurysm was markedly reduced on MRI on the next day. No recurrence of the hemifacial spasm and aneurysm was observed after half a year after PAO. Conclusion: This rare case suggested that endovascular PAO may be an effective treatment for hemifacial spasm caused by a relatively large aneurysm.
{"title":"A Case of Vertebral Artery Aneurysm Causing Hemifacial Spasm Rapidly Improved after Parent Artery Occlusion","authors":"M. Kugai, T. Suyama, T. Inui, Keisho Yamazato, M. Kitano, H. Hasegawa, Y. Tominaga, S. Tominaga","doi":"10.5797/JNET.CR.2018-0106","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0106","url":null,"abstract":"Objective: The authors report a rare case of symptomatic unruptured fusiform vertebral artery (VA) aneurysm causing hemifacial spasm, which was successfully treated by endovascular parent artery occlusion (PAO). Case Presentation: A 56-year-old man presented with left hemifacial spasm, and the symptom progressed rapidly over 3–4 weeks including difficulty of eye opening. Brain MRI showed a left fusiform VA aneurysm with a maximum diameter of approximately 10 mm, which compressed the root exit zone (REZ) of the left facial nerve. Endovascular PAO of the left VA was performed with coils. The hemifacial spasm disappeared immediately after PAO. The size of the aneurysm was markedly reduced on MRI on the next day. No recurrence of the hemifacial spasm and aneurysm was observed after half a year after PAO. Conclusion: This rare case suggested that endovascular PAO may be an effective treatment for hemifacial spasm caused by a relatively large 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":"71055818","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.2018-0130
K. Uchida, H. Hokaku, Chikashi Aoyagi, Yuushi Takuma, Ryutarou Furudate, N. Hirota
Objective: Dural arteriovenous fistula (DAVF) is classified as sinus type if it occurs in a venous sinus and as non-sinus type if it directly flows into a cortical vein. The latter is considered to have a high risk of hemorrhage because blood flow directly returns to the cerebral vein. Case Presentation: A 63-year-old man presenting with right hemiparesis and dysarthria was diagnosed with DAVF. We diagnosed transient ischemic attack (TIA) due to left internal carotid artery stenosis or cortical reflux of the DAVF. Treatment of DAVF was undertaken first, followed by carotid artery stenting (CAS) of the internal carotid artery stenosis. Conclusion: Transarterial embolization (TAE) can be used for the treatment of DAVF located on the wall of the superior sagittal sinus (SSS). Further studies with greater accumulation of case are required.
{"title":"Dural Arteriovenous Fistula on the Wall of the Superior Sagittal Sinus Treated with Transarterial Embolization with Onyx: A Case Report","authors":"K. Uchida, H. Hokaku, Chikashi Aoyagi, Yuushi Takuma, Ryutarou Furudate, N. Hirota","doi":"10.5797/JNET.CR.2018-0130","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0130","url":null,"abstract":"Objective: Dural arteriovenous fistula (DAVF) is classified as sinus type if it occurs in a venous sinus and as non-sinus type if it directly flows into a cortical vein. The latter is considered to have a high risk of hemorrhage because blood flow directly returns to the cerebral vein. Case Presentation: A 63-year-old man presenting with right hemiparesis and dysarthria was diagnosed with DAVF. We diagnosed transient ischemic attack (TIA) due to left internal carotid artery stenosis or cortical reflux of the DAVF. Treatment of DAVF was undertaken first, followed by carotid artery stenting (CAS) of the internal carotid artery stenosis. Conclusion: Transarterial embolization (TAE) can be used for the treatment of DAVF located on the wall of the superior sagittal sinus (SSS). Further studies with greater accumulation of case 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.2018-0130","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71055955","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.2018-0140
Etsuko Owashi, Takayuki Kato, J. Kokuzawa, Hirofumi Matsubara, T. Aki, S. Shirakami, S. Imai
Objective: We report a case of cavernous sinus dural arteriovenous fistula (CSdAVF) associated with Klippel-Trenaunay syndrome (KTS). Case Presentation: A 58-year-old woman was diagnosed with KTS with port-wine stain, overgrowth of tissues and bones, and venous malformation on the left upper limb. She was admitted to our hospital with the primary complain of ptosis and diplopia due to left oculomotor palsy, and her cerebral angiography revealed CSdAVF with retrograde leptomeningeal venous drainage. The shunt point was located at the posteromedial part of the left cavernous sinus (CS) on the angiogram. An enlarged subclavian vein and giant varix was detected in the left upper limb, and abnormality of the coagulation-fibrinolysis system caused by localized intravascular coagulation was confirmed. We performed transvenous coil embolization, and the symptoms improved after a few weeks with no new neurological deficits. However, the activation of coagulation-fibrinolysis system continued even after the surgery. Conclusion: The formation of dAVF occurrence in this case is unclear. If genetic abnormalities that cause angiogenesis are involved in KTS, follow-up is important in the future.
{"title":"A Patient with Cavernous Sinus Dural Arteriovenous Fistula Complicating Klippel-Trenaunay Syndrome","authors":"Etsuko Owashi, Takayuki Kato, J. Kokuzawa, Hirofumi Matsubara, T. Aki, S. Shirakami, S. Imai","doi":"10.5797/JNET.CR.2018-0140","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0140","url":null,"abstract":"Objective: We report a case of cavernous sinus dural arteriovenous fistula (CSdAVF) associated with Klippel-Trenaunay syndrome (KTS). Case Presentation: A 58-year-old woman was diagnosed with KTS with port-wine stain, overgrowth of tissues and bones, and venous malformation on the left upper limb. She was admitted to our hospital with the primary complain of ptosis and diplopia due to left oculomotor palsy, and her cerebral angiography revealed CSdAVF with retrograde leptomeningeal venous drainage. The shunt point was located at the posteromedial part of the left cavernous sinus (CS) on the angiogram. An enlarged subclavian vein and giant varix was detected in the left upper limb, and abnormality of the coagulation-fibrinolysis system caused by localized intravascular coagulation was confirmed. We performed transvenous coil embolization, and the symptoms improved after a few weeks with no new neurological deficits. However, the activation of coagulation-fibrinolysis system continued even after the surgery. Conclusion: The formation of dAVF occurrence in this case is unclear. If genetic abnormalities that cause angiogenesis are involved in KTS, follow-up is important in the future.","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":"71056033","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.2018-0068
Keisuke Kikuchi, Kazuma Matsumoto, T. Nasada, Yoshiaki Hagihara, Youko Ikeuchi, Takafumi Iizuka, Chiemi Mitsuie, Hiromi Kishida, R. Fujii, Shinya Nakano, N. Kotoura, K. Uchida, M. Shirakawa, S. Yoshimura
Purpose: It is difficult to predict lens radiation dose of the patients during neuroendovascular treatment due to various factors potentially affecting radiation dose such as a various working projection for individual procedures. The purpose of this study was to examine the association between the patient lens entrance dose (lens dose) during cerebral endovascular treatment and displayed dose on a system, as well as the influence of 3D imaging on lens exposure, and clarify factors influencing lens exposure. Methods: In patients who underwent cerebral endovascular treatment under general anesthesia between February and December 2017, the lens dose was measured using a real-time scintillation optical fiber dosimeter. The correlation between the lens dose and displayed dose on each system was analyzed. Furthermore, dose data were divided into fluoroscopy, DSA, and 3D imaging, and respective values as a percentage of the lens dose were calculated. Results: There was a strong correlation between the lens dose and Kerma Area Product (KAP) value. The lens dose was weakly correlated with the Air Kerma (AK) value and duration of fluoroscopy. 3D imaging for the visualization of a stent increased the value of 3D imaging as a percentage of the lens dose, and the lens dose increased with the frequency of imaging. In patients with a large field of irradiation after the establishment of a working angle, the lens dose increased. Conclusion: We evaluated the characteristics of the lens dose. In the future, the management of the lens dose should be examined.
{"title":"Measurement of Patient Lens Exposure during Cerebral Endovascular Treatment Using a Scintillation Optical Fiber Dosimeter","authors":"Keisuke Kikuchi, Kazuma Matsumoto, T. Nasada, Yoshiaki Hagihara, Youko Ikeuchi, Takafumi Iizuka, Chiemi Mitsuie, Hiromi Kishida, R. Fujii, Shinya Nakano, N. Kotoura, K. Uchida, M. Shirakawa, S. Yoshimura","doi":"10.5797/JNET.OA.2018-0068","DOIUrl":"https://doi.org/10.5797/JNET.OA.2018-0068","url":null,"abstract":"Purpose: It is difficult to predict lens radiation dose of the patients during neuroendovascular treatment due to various factors potentially affecting radiation dose such as a various working projection for individual procedures. The purpose of this study was to examine the association between the patient lens entrance dose (lens dose) during cerebral endovascular treatment and displayed dose on a system, as well as the influence of 3D imaging on lens exposure, and clarify factors influencing lens exposure. Methods: In patients who underwent cerebral endovascular treatment under general anesthesia between February and December 2017, the lens dose was measured using a real-time scintillation optical fiber dosimeter. The correlation between the lens dose and displayed dose on each system was analyzed. Furthermore, dose data were divided into fluoroscopy, DSA, and 3D imaging, and respective values as a percentage of the lens dose were calculated. Results: There was a strong correlation between the lens dose and Kerma Area Product (KAP) value. The lens dose was weakly correlated with the Air Kerma (AK) value and duration of fluoroscopy. 3D imaging for the visualization of a stent increased the value of 3D imaging as a percentage of the lens dose, and the lens dose increased with the frequency of imaging. In patients with a large field of irradiation after the establishment of a working angle, the lens dose increased. Conclusion: We evaluated the characteristics of the lens dose. In the future, the management of the lens dose should be examined.","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.2018-0068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71058596","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.2018-0113
K. Takai
Objective: The purpose of this study was to provide an update on recent developments in the diagnosis and treatment of arteriovenous fistulas at the craniocervical junction (CCJ AVFs). Methods: Associated literature published between 2009 and 2018 on the PubMed database was reviewed. Results: The systematic review identified 97 lesions in 92 cases of CCJ AVFs. These lesions were divided into three groups according to their angioarchitecture: 56 lesions of dural AVFs, 34 of intradural AVFs, and 7 of extradural AVFs. Clinical features, neuroimaging findings, treatments, and outcomes were compared among the three groups. Cases of dural AVFs were commonly associated with myelopathy and/or brainstem dysfunction due to venous congestion in the spinal cord (38%) and/or brainstem (21%). Cases of intradural AVFs had a more complex angioarchitecture than those of dural AVFs and were associated with a hemorrhagic presentation (83%). Of the 34 intradural AVFs, 25 lesions (74%) had a feeder aneurysm (n = 20) or varix (n = 5). The development of the aneurysm/varix may be attributed to hemodynamic and flow-related phenomena. The surgical obliteration of the intradural drainer and/or feeder was effective in most cases of dural and intradural AVFs. Endovascular embolization may be more effective in cases of extradural AVFs than in those of dural or intradural AVFs. No permanent neurologic complications occurred in 80 cases treated by surgery; however, brain infarction occurred in 2 (9%) of 22 cases treated by endovascular embolization. Good recovery was more frequently achieved in cases of intradural (79%) and extradural AVFs (100%) than in those of dural AVFs (61%) because cases with hemorrhagic presentation had fewer permanent neurologic deficits than those with venous congestion. Conclusion: A differential diagnosis among dural, intradural, and extradural AVFs is important because clinical features, neuroimaging findings, and treatment outcomes markedly differ among the three groups.
{"title":"Update on the Diagnosis and Treatment of Arteriovenous Fistulas at the Craniocervical Junction: A Systematic Review of 92 Cases","authors":"K. Takai","doi":"10.5797/JNET.OA.2018-0113","DOIUrl":"https://doi.org/10.5797/JNET.OA.2018-0113","url":null,"abstract":"Objective: The purpose of this study was to provide an update on recent developments in the diagnosis and treatment of arteriovenous fistulas at the craniocervical junction (CCJ AVFs). Methods: Associated literature published between 2009 and 2018 on the PubMed database was reviewed. Results: The systematic review identified 97 lesions in 92 cases of CCJ AVFs. These lesions were divided into three groups according to their angioarchitecture: 56 lesions of dural AVFs, 34 of intradural AVFs, and 7 of extradural AVFs. Clinical features, neuroimaging findings, treatments, and outcomes were compared among the three groups. Cases of dural AVFs were commonly associated with myelopathy and/or brainstem dysfunction due to venous congestion in the spinal cord (38%) and/or brainstem (21%). Cases of intradural AVFs had a more complex angioarchitecture than those of dural AVFs and were associated with a hemorrhagic presentation (83%). Of the 34 intradural AVFs, 25 lesions (74%) had a feeder aneurysm (n = 20) or varix (n = 5). The development of the aneurysm/varix may be attributed to hemodynamic and flow-related phenomena. The surgical obliteration of the intradural drainer and/or feeder was effective in most cases of dural and intradural AVFs. Endovascular embolization may be more effective in cases of extradural AVFs than in those of dural or intradural AVFs. No permanent neurologic complications occurred in 80 cases treated by surgery; however, brain infarction occurred in 2 (9%) of 22 cases treated by endovascular embolization. Good recovery was more frequently achieved in cases of intradural (79%) and extradural AVFs (100%) than in those of dural AVFs (61%) because cases with hemorrhagic presentation had fewer permanent neurologic deficits than those with venous congestion. Conclusion: A differential diagnosis among dural, intradural, and extradural AVFs is important because clinical features, neuroimaging findings, and treatment outcomes markedly differ among the three groups.","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":"71058757","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.2018-0145
S. Mizuhashi, Azusa Yonezawa, S. Kohyama
Objective: It is essential to improve the in-hospital system and arrangement to achieve recanalization as soon as possible in acute cerebral artery occlusion. In Saitama Prefecture, the stroke emergency transport system began to operate in January 2018 under the prefectural government initiative. At our hospital, also, a trial aiming at rapid, safe, and effective recanalization was initiated in August 2017 in a team consisting mainly of doctors and co-medical staff of the Stroke Center. In this report, the results of the 17-month trial are reviewed. Methods: In all, 127 patients with acute cerebral artery occlusion who underwent endovascular treatment between January 2016 and December 2018 (56 treated before and 71 treated after the initiation of the time-reducing trial) were compared. Interdepartmental conferences and simulations were frequently held with participation primarily by physicians, radiology technicians, and nurses, and information about treatments, operations by various professionals, and therapeutic approaches was shared. The diagnostic and therapeutic processes of the cases experienced were also promptly evaluated and modified for improvements. Results: The time from the arrival of the patient to the injection of recombinant tissue plasminogen activator (rt-PA) was significantly reduced from 90 to 75 minutes, time from the arrival to puncture from 99 to 74 minutes, procedure time from 63 to 50 minutes, and time from the arrival to eventual recanalization from 165 to 130 minutes. The rate of effective recanalization was higher after the initiation of the trial (62% vs. 76%), but the difference was not significant. The percentage of patients with a favorable outcome was also higher after the initiation of the trial (25% vs. 39%). Conclusion: The results of this study indicate that the time of emergency treatment for acute cerebral artery occlusion can be shortened even in a large-scale university hospital with many constraints by sharing of information among departments and making sure that the medical staff of stroke center is well-informed of the standardized therapeutic approach. stroke team approach, rapid recanalization, therapeutic time
{"title":"Strategy to Achieve Faster Recanalization for Acute Ischemic Stroke in a University Hospital with Many Constraints","authors":"S. Mizuhashi, Azusa Yonezawa, S. Kohyama","doi":"10.5797/jnet.oa.2018-0145","DOIUrl":"https://doi.org/10.5797/jnet.oa.2018-0145","url":null,"abstract":"Objective: It is essential to improve the in-hospital system and arrangement to achieve recanalization as soon as possible in acute cerebral artery occlusion. In Saitama Prefecture, the stroke emergency transport system began to operate in January 2018 under the prefectural government initiative. At our hospital, also, a trial aiming at rapid, safe, and effective recanalization was initiated in August 2017 in a team consisting mainly of doctors and co-medical staff of the Stroke Center. In this report, the results of the 17-month trial are reviewed. Methods: In all, 127 patients with acute cerebral artery occlusion who underwent endovascular treatment between January 2016 and December 2018 (56 treated before and 71 treated after the initiation of the time-reducing trial) were compared. Interdepartmental conferences and simulations were frequently held with participation primarily by physicians, radiology technicians, and nurses, and information about treatments, operations by various professionals, and therapeutic approaches was shared. The diagnostic and therapeutic processes of the cases experienced were also promptly evaluated and modified for improvements. Results: The time from the arrival of the patient to the injection of recombinant tissue plasminogen activator (rt-PA) was significantly reduced from 90 to 75 minutes, time from the arrival to puncture from 99 to 74 minutes, procedure time from 63 to 50 minutes, and time from the arrival to eventual recanalization from 165 to 130 minutes. The rate of effective recanalization was higher after the initiation of the trial (62% vs. 76%), but the difference was not significant. The percentage of patients with a favorable outcome was also higher after the initiation of the trial (25% vs. 39%). Conclusion: The results of this study indicate that the time of emergency treatment for acute cerebral artery occlusion can be shortened even in a large-scale university hospital with many constraints by sharing of information among departments and making sure that the medical staff of stroke center is well-informed of the standardized therapeutic approach. stroke team approach, rapid recanalization, therapeutic time","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":"71058836","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.2018-0054
Koichiro Shindo, T. Ogino, Tomoki Fuchizaki, Hideki Endo, Yohei Maruga, Toshiichi Watanabe, K. Kamiyama, T. Osato, Hirohiko Nakamura
Objective: We report a patient in whom thrombectomy for occlusion of the middle cerebral artery was performed, and a pial arteriovenous fistula (AVF) developed in the relevant vascular area. Case Presentation: The patient was a 72-year-old male. In 2011, thrombectomy with a Penumbra system for right M1 occlusion causing right cerebral infarction was performed. Recanalization was achieved (modified thrombolysis in cerebral infarction [TICI] 2b) although occlusion of the M2 anterior trunk remained. After 1 week, MRA confirmed complete recanalization. The course was favorable, and he was discharged. After 5 years, convulsion occurred, and he was brought to our hospital by ambulance. MRI showed subcortical hemorrhage of the right precentral gyrus. DSA confirmed an arteriovenous (AV) shunt between the right central artery and vein of Trolard, which had not been present. There was no nidus, leading to a diagnosis of a pial AVF. Under craniotomy, the shunt point was disconnected. Conclusion: Intraoperative findings suggested the involvement of cortical vein thrombosis after thrombectomy in the etiology.
{"title":"Hemorrhagic Acquired Pial Arteriovenous Fistula Occurring after Mechanical Thrombectomy: A Case Report","authors":"Koichiro Shindo, T. Ogino, Tomoki Fuchizaki, Hideki Endo, Yohei Maruga, Toshiichi Watanabe, K. Kamiyama, T. Osato, Hirohiko Nakamura","doi":"10.5797/JNET.CR.2018-0054","DOIUrl":"https://doi.org/10.5797/JNET.CR.2018-0054","url":null,"abstract":"Objective: We report a patient in whom thrombectomy for occlusion of the middle cerebral artery was performed, and a pial arteriovenous fistula (AVF) developed in the relevant vascular area. Case Presentation: The patient was a 72-year-old male. In 2011, thrombectomy with a Penumbra system for right M1 occlusion causing right cerebral infarction was performed. Recanalization was achieved (modified thrombolysis in cerebral infarction [TICI] 2b) although occlusion of the M2 anterior trunk remained. After 1 week, MRA confirmed complete recanalization. The course was favorable, and he was discharged. After 5 years, convulsion occurred, and he was brought to our hospital by ambulance. MRI showed subcortical hemorrhage of the right precentral gyrus. DSA confirmed an arteriovenous (AV) shunt between the right central artery and vein of Trolard, which had not been present. There was no nidus, leading to a diagnosis of a pial AVF. Under craniotomy, the shunt point was disconnected. Conclusion: Intraoperative findings suggested the involvement of cortical vein thrombosis after thrombectomy in the etiology.","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.2018-0054","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71055345","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.2018-0058
Ryosuke Tashiro, Masahiro Yoshida
Objective: After internal trapping for ruptured vertebral artery dissection (VAD), serious complications related to medullary infarction influence the prognosis. Methods: The subjects were 15 patients with ruptured VAD who had undergone internal trapping between 2004 and 2017. Targeted embolization of dilated segment was performed while neither adjacent stenotic sites nor normal segments were embolized. We retrospectively analyzed the incidence and extent of medullary infarctions, neurologic sequelae, and outcome. Results: In all patients, endovascular procedures were successful. There were no intraoperative complications. In two patients, embolization with the double-catheter method through bilateral approaches was performed. Postoperative medullary infarction was noted in two patients, but they had dorsolateral-type minor infracted foci. There were no serious sequelae in any patient, and there were no rebleedings during the follow-up period. Conclusion: The results suggest that internal trapping in which the extent of embolization is limited to the site of morbid dilation prevents rebleeding, reducing the risk of postoperative medullary infarctions. Tight packing of a dilated segment with the preservation of perforators from vertebral arteries (VAs) is extremely important. The double-catheter method through bilateral approaches may be useful for tight packing of the dilated segment of ruptured VAD.
{"title":"Targeted Internal Trapping to Dilated Portion for Ruptured Vertebral Artery Dissection","authors":"Ryosuke Tashiro, Masahiro Yoshida","doi":"10.5797/JNET.OA.2018-0058","DOIUrl":"https://doi.org/10.5797/JNET.OA.2018-0058","url":null,"abstract":"Objective: After internal trapping for ruptured vertebral artery dissection (VAD), serious complications related to medullary infarction influence the prognosis. Methods: The subjects were 15 patients with ruptured VAD who had undergone internal trapping between 2004 and 2017. Targeted embolization of dilated segment was performed while neither adjacent stenotic sites nor normal segments were embolized. We retrospectively analyzed the incidence and extent of medullary infarctions, neurologic sequelae, and outcome. Results: In all patients, endovascular procedures were successful. There were no intraoperative complications. In two patients, embolization with the double-catheter method through bilateral approaches was performed. Postoperative medullary infarction was noted in two patients, but they had dorsolateral-type minor infracted foci. There were no serious sequelae in any patient, and there were no rebleedings during the follow-up period. Conclusion: The results suggest that internal trapping in which the extent of embolization is limited to the site of morbid dilation prevents rebleeding, reducing the risk of postoperative medullary infarctions. Tight packing of a dilated segment with the preservation of perforators from vertebral arteries (VAs) is extremely important. The double-catheter method through bilateral approaches may be useful for tight packing of the dilated segment of ruptured VAD.","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.2018-0058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71058648","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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