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Thrombus in the Superior Sagittal Sinus Was Successfully Aspirated by Coaxial Catheter Technique: A Technical Case Report 同轴导管技术成功吸出上矢状窦血栓1例
Pub Date : 2019-01-01 DOI: 10.5797/JNET.TN.2018-0038
Shoko Fujii, M. Yoshimura, Shin Hirota, Juri Kiyokawa, Shinji Yamamoto
Objective: We report a case of superior sagittal sinus thrombosis, where aspiration of the thrombus using a 6 Fr coaxial catheter (CC) resulted in prompt and complete recanalization. Case Presentation: A 69-year-old female was brought to our hospital by ambulance due to headache and left hemiparesis. MRI images revealed superior sagittal sinus thrombosis. Endovascular treatment was performed in addition to anticoagulant therapy to prevent clinical deterioration and to achieve an early improvement. Unfortunately, neither intrasinus chemical thrombolysis nor mechanical thrombectomy with a balloon led to recanalization. Therefore, we used a CC, 6 Fr Cerulean catheter DD6 (Medikit co. ltd., Tokyo, Japan), as an aspiration catheter, which resulted in prompt and complete recanalization. Consequently, her symptoms disappeared shortly thereafter. Conclusion: As the endovascular treatment of venous sinus thrombosis, thrombus aspiration through a 6 Fr CC may be an effective option.
目的:我们报告一例上矢状窦血栓形成,其中使用6fr同轴导管(CC)吸入血栓导致及时和完全的再通。病例介绍:一名69岁女性因头痛、左偏瘫被救护车送至我院。MRI显示上矢状窦血栓形成。血管内治疗在抗凝治疗的基础上进行,以防止临床恶化并实现早期改善。不幸的是,无论是静脉内化学溶栓还是机械球囊取栓都不能导致再通。因此,我们使用CC, 6 Fr Cerulean导管DD6 (Medikit co. ltd, Tokyo, Japan)作为抽吸导管,导致及时和完全的再通。因此,她的症状不久就消失了。结论:作为静脉窦血栓形成的血管内治疗,通过6fr CC吸血栓可能是一种有效的选择。
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引用次数: 0
Scaffolding Technique: A New Double-catheter Technique for Coil Embolization of Wide-necked Aneurysms 支架技术:一种用于宽颈动脉瘤线圈栓塞的双导管新技术
Pub Date : 2019-01-01 DOI: 10.5797/JNET.TN.2018-0074
Jun Morioka, K. Murao, K. Miyake, H. Miwa
Objective: We herein report a new technique using double microcatheters to treat a wide-necked aneurysm in which the neck is incorporated with the parent artery. Case Presentations: Case 1: The patient was a 71-year-old woman with a large, wide-necked unruptured aneurysm of the basilar bifurcation area with the right posterior cerebral artery (PCA) incorporated in the aneurysm sac. We previously placed a scaffolding coil around the right PCA orifice via a microcatheter placed near the right PCA to avoid a framing coil via another microcatheter involving the right PCA orifice. After confirming that the framing coil did not obstruct the right PCA flow, the “scaffolding” coil was repositioned in the framing coil. Complete occlusion of the aneurysm was achieved with the stable frame of these two coils. Case 2: The patient was a 68-year-old woman who presented with subarachnoid hemorrhaging due to a ruptured aneurysm with a wide neck of the basilar bifurcation. Coiling with a conventional double-catheter technique failed to form suitable framing because the tips of both microcatheters faced the same direction (posterior) even after changing the shapes of the tips. After leading the tip of one microcatheter to face the anterior direction by inserting part of the first coil via the microcatheter, we placed the second coil via another microcatheter with its tip facing posteriorly. The second coil then came to functions as the scaffolding, holding the tip of the first catheter anteriorly. A stable frame was made when the remaining part of the first coil was deployed. Conclusion: We termed this method the “scaffolding technique.” This technique is an effective and safe option for treating wide-necked aneurysms.
目的:我们在此报告一种使用双微导管治疗颈部与载动脉合并的宽颈动脉瘤的新技术。病例介绍:病例1:患者是一名71岁的女性,在颅底分叉区有一个大的、宽颈的未破裂动脉瘤,右脑后动脉(PCA)合并在动脉瘤囊中。我们之前通过放置在右侧PCA附近的微导管在右侧PCA孔周围放置了一个支架线圈,以避免通过另一个微导管在右侧PCA孔周围放置框架线圈。在确认框架线圈没有阻碍正确的PCA流后,“脚手架”线圈在框架线圈中重新定位。通过这两个线圈的稳定框架实现了动脉瘤的完全闭塞。病例2:患者是一名68岁的女性,因颅底分叉处宽颈动脉瘤破裂而出现蛛网膜下腔出血。传统的双导管盘绕技术无法形成合适的框架,因为即使改变了尖端的形状,两个微导管的尖端也朝向相同的方向(后)。通过微导管插入第一个线圈的一部分,使一个微导管的尖端朝向前方向,我们通过另一个微导管放置第二个线圈,其尖端朝向后。然后第二个线圈起支架的作用,将第一个导管的尖端固定在前面。当第一个线圈的剩余部分被部署时,一个稳定的框架就完成了。结论:我们将这种方法称为“支架技术”。这项技术是治疗宽颈动脉瘤的有效和安全的选择。
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引用次数: 1
Overlapping Stent-assisted Coil Embolization for Ruptured Blood Blister-like Aneurysms of Basilar Trunk: Two Case Reports 重叠支架辅助线圈栓塞治疗基底干破裂血泡样动脉瘤2例报告
Pub Date : 2019-01-01 DOI: 10.5797/JNET.CR.2018-0047
Yusuke Morinaga, K. Nii, A. Eto, Hayatsura Hanada, Takafumi Mitsutake, Fumihiro Hiraoka, Ritsurou Inoue, K. Sakamoto, M. Tsutsumi
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引用次数: 1
A Case of High-grade Arteriovenous Malformation Manifesting as Trigeminal Neuralgia Successfully Treated by Embolization in Multimodal Treatment 以三叉神经痛为表现的高度动静脉畸形多模式栓塞治疗成功1例
Pub Date : 2019-01-01 DOI: 10.5797/JNET.CR.2019-0005
M. Kugai, T. Suyama, M. Kitano, H. Hasegawa, Y. Tominaga, S. Tominaga
Objective: The authors report a rare case of symptomatic cerebral arteriovenous malformation (AVM) manifesting as trigeminal neuralgia (TGN) that was successfully treated by a multimodal treatment. Case Presentation: A 68-year-old man presented with right TGN. The symptom progressed with lancinating pain. Brain MRI showed a right temporal lobe AVM with a maximum diameter of approximately 50 mm. A right ectatic tortuous vertebral artery (VA) compressed the root of the right trigeminal nerve. The TGN completely disappeared after the 4th embolization. After the 6th embolization, excision was performed. No recurrence of TGN was observed in the 6 months after its excision. Conclusion: The present case suggested that treatment of nidus may improve AVM-induced TGN. Embolization was considered to be an effective modality, especially in multimodal treatment for high-grade AVM.
目的:报告一例罕见的以三叉神经痛(TGN)为表现的症状性脑动静脉畸形(AVM),经多模式治疗成功。病例介绍:68岁男性,右侧TGN。症状加重,伴有剧烈疼痛。脑MRI显示右侧颞叶AVM,最大直径约50mm。右扩张弯曲椎动脉压迫右三叉神经根。第四次栓塞后TGN完全消失。第六次栓塞后,行手术切除。TGN切除后6个月无复发。结论:本病例提示病灶治疗可改善avm诱导的TGN。栓塞被认为是一种有效的方式,特别是在多模式治疗高级AVM中。
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引用次数: 1
Hyperperfusion Immediately after Reperfusion by Thrombectomy May Predict Hemorrhagic Transformation 取栓后再灌注后立即高灌注可预测出血转化
Pub Date : 2019-01-01 DOI: 10.5797/JNET.OA.2018-0046
T. Yoshihara, R. Kanazawa, H. Ohbuchi, T. Uchida, T. Higashida, Naoyuki Arai, Manabu Osakabe, Yuichi Takahashi
Objective: To evaluate cerebral blood fl ow immediately after reperfusion following thrombectomy for acute large vessel occlusion, and to examine whether cerebral blood fl ow after reperfusion is related to hemorrhagic transformation. Methods: The patients with acute large vessel occlusion in the anterior circulation who obtained reperfusion by thrombectomy were included. Cerebral blood fl ow was evaluated using single photon emission computed tomography (SPECT) within 6 hours after reperfusion. The patients were divided into two groups with or without hemorrhagic transformation, and basic characteristics, the ratio of cerebral blood fl ow (aff ected-side to unaff ected-side ratio) in the perfusion area of the middle cerebral artery (MCA asymmetry index), and functional prognosis were compared among two groups. Results: In all, 23 patients were included; 11 presented hemorrhagic transformation, and 12 did not. The hemorrhagic group exhibited signifi cantly higher MCA asymmetry index than the non-hemorrhagic group (median: 1.54 [1.30–1.83] vs. 1.12 [1.07–1.24], respectively, P = 0.02), and a lower rate tendency of modifi ed Rankin Scale (mRS): 0-2 after 3 months (1 patient [9%] vs. 6 patients [50%], respectively, P = 0.06). Conclusion: In patients with successful reperfusion by thrombectomy, hemorrhagic transformation is predisposed to occur when high MCA asymmetry index is presented. Care should be taken in periprocedural management of blood pressure and sedation for those with high MCA asymmetry index.
目的:评价急性大血管闭塞取栓术后立即再灌注脑血流量,探讨再灌注后脑血流量是否与出血转化有关。方法:选取经取栓术获得再灌注的急性前循环大血管闭塞患者为研究对象。再灌注后6小时内用单光子发射计算机断层扫描(SPECT)评估脑血流量。将患者分为有无出血转化两组,比较两组患者的基本特征、大脑中动脉灌注区脑血流量(受累侧与未受累侧之比)(MCA不对称指数)及功能预后。结果:共纳入23例患者;11例有出血转化,12例无。出血组MCA不对称指数明显高于非出血组(中位数分别为1.54[1.30-1.83]和1.12 [1.07-1.24],P = 0.02), 3个月后修正Rankin量表(mRS)的发生率趋势为0-2(1例[9%]比6例[50%],P = 0.06)。结论:取栓后再灌注成功的患者,MCA不对称指数高时易发生出血转化。对于MCA不对称指数高的患者,应注意围手术期的血压管理和镇静。
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引用次数: 1
Ultra-small Catheter Shaping Method with a Sheath Dilator: Usefulness for Coil Embolization of Cerebral Aneurysms 带鞘扩张器的超小导管成形方法:用于脑动脉瘤线圈栓塞
Pub Date : 2019-01-01 DOI: 10.5797/JNET.OA.2018-0018
H. Matsumoto, Hirokazu Nishiyama, Yoshiaki Tetsuo, Hideki Takemoto
Objective: We devised a method to readily create an ultra-small shape at the microcatheter tip using a sheath dilator. In the present study, we introduce the creation method and report its usefulness. Methods: For mandrel formation, 7 Fr. or 4 Fr. sheath dilators were used. 1) A small, round loop was prepared by rolling a mandrel on a sheath dilator. 2) The mandrel with an ultra-small loop was inserted into the tip of a straight-type microcatheter. 3) The microcatheter tip was heated using a heat gun. 4) The mandrel was removed from the microcatheter tip. Using the catheter which has ultra-small shaped tip, coil embolization was performed. Results: The mandrel loop diameter was 3 mm when a 7 Fr. sheath dilator was used. It was 2 mm when a 4 Fr. sheath dilator was used. It was possible to create various ultra-small shapes, such as J, S, and pigtail shapes, at the catheter tip. Ultra-small shaped catheters were used to treat 25 cerebral aneurysms. In all patients, catheters could be readily guided into the aneurysms, and their stability after insertion was favorable. Conclusion: The ultra-small catheter shaping method with a sheath dilator facilitated the creation of various ultra-small shapes measuring 2–3 mm in diameter at the microcatheter tip.
目的:我们设计了一种使用鞘扩张器在微导管尖端容易形成超小型形状的方法。在本研究中,我们介绍了创建方法并报告了它的实用性。方法:采用7fr或4fr鞘扩张器形成心轴。1)在鞘扩张器上滚动芯棒,形成一个小而圆的环。2)将带超细环的芯棒插入直筒式微导管的尖端。3)用热风枪加热微导管尖端。4)将芯棒从微导管尖端取出。采用尖端超小形状的导管进行线圈栓塞。结果:使用7fr鞘扩张器时,芯环直径为3mm。使用4fr鞘扩张器时为2mm。在导管尖端可以制造出各种超小形状,如J形、S形和辫子形。采用超小型导管治疗脑动脉瘤25例。在所有患者中,导管都可以很容易地引导到动脉瘤中,并且导管插入后的稳定性良好。结论:鞘扩张器的超小型导管成形方法有助于在微导管尖端形成直径2 ~ 3 mm的各种超小型形状。
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引用次数: 2
De Novo Multiple Dural Arteriovenous Fistulae Successfully Treated with Transarterial Embolization Using Low-concentration N-butyl-2-cyanoacrylate: A Case Report 低浓度N-丁基-2-氰基丙烯酸酯动脉栓塞治疗De Novo多发性硬脑膜动静脉瘘1例
Pub Date : 2018-09-12 DOI: 10.5797/JNET.CR.2017-0132
Daisuke Izawa, O. Masuo, Takumi Kawaguchi, Rie Yako, N. Nakao
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引用次数: 0
Transradial Neuroendovascular Treatment for Anterior Circulation Lesions: An Initial Experience with a 6 Fr Guiding Sheath 经桡神经血管内治疗前循环病变:6Fr导引鞘的初步经验
Pub Date : 2018-08-09 DOI: 10.5797/JNET.OA.2018-0055
Y. Hanaoka, J. Koyama, Alhusain Nagm, Toshiya Uchiyama, Takafumi Kiuchi, Keisuke Kamiya, Takaaki Kamijo, T. Ogiwara, T. Horiuchi, K. Hongo
Objective: To clarify the usefulness and safety of neuroendovascular treatment with a 6 Fr guiding sheath via the right radial artery for anterior circulation lesions. Methods: A total of 20 patients (carotid artery stenting: 11 patients, coil embolization of cerebral aneurysms: nine patients) who underwent neuroendovascular treatment via the right radial artery under general anesthesia, between September 2016 and June 2017, were included in this study. We retrospectively analyzed 1) the pertinent anatomy of the target-side common carotid artery and the aortic arch, 2) devices, 3) method to advance the guiding sheath into the common carotid artery, 4) hemostasis at the puncture site, and 5) outcome (success rate, perioperative complications, and complications at the site of puncture). Results: In all patients, a 6 Fr guiding sheath could be guided into the common carotid artery, and treatment was accomplished. Furthermore, there was no perioperative or puncture-site complication. Conclusion: Transradial neuroendovascular treatment is considered as a safe and successful choice for anterior circulation lesions.
目的:阐明经右桡动脉使用6Fr引导鞘进行神经血管内治疗前循环病变的有效性和安全性。方法:本研究共纳入20名患者(颈动脉支架置入术:11名患者,脑动脉瘤线圈栓塞术:9名患者),他们在2016年9月至2017年6月期间在全麻下通过右桡动脉接受神经血管内治疗。我们回顾性分析了1)目标侧颈总动脉和主动脉弓的相关解剖结构,2)装置,3)将引导鞘推进颈总动脉的方法,4)穿刺部位的止血,以及5)结果(成功率、围手术期并发症和穿刺部位的并发症)。结果:在所有患者中,6Fr引导鞘可以被引导进入颈总动脉,并完成了治疗。此外,无围手术期或穿刺部位并发症。结论:经桡神经血管内治疗前循环病变是一种安全、成功的选择。
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引用次数: 5
Two Patients with a Rapid Increase in the Ocular Pressure after Carotid Artery Stenting for Cervical Internal Carotid Artery Stenosis with Ocular Ischemic Syndrome 颈内动脉狭窄伴眼缺血综合征行颈动脉支架植入术后眼压快速升高2例
Pub Date : 2018-07-27 DOI: 10.5797/JNET.CR.2018-0039
Tomohiro Kawano, Kiyotaka Saito, Takako Hidaka, N. Kajihara, H. Chuman, H. Ohta, K. Yokogami, H. Takeshima
Objective: We report two patients with a rapid increase in the ocular pressure after carotid artery stenting (CAS) for cervical internal carotid artery stenosis with ocular ischemic syndrome. Case Presentations: Case 1 was a 67-year-old male. Case 2 was a 70-year-old male. In the two patients, a reduction in vision and transient hemiparesis had persisted for a few months, leading to a diagnosis of severe internal carotid artery stenosis. Furthermore, they were diagnosed with ocular ischemic syndrome and neovascular glaucoma. Panretinal photocoagulation was performed before CAS in the Department of Ophthalmology. In Case 1, ocular pain appeared 9 days after CAS. In Case 2, it appeared the day after CAS, and increased ocular pressure was noted. After conservative treatment, trabeculectomy was performed, but the visual prognosis was unfavorable. Conclusion: In patients with severe internal carotid artery stenosis and ocular ischemic syndrome, there may be a rapid increase in the ocular pressure after revascularization. Therefore, it is necessary to establish a cross-sectional treatment strategy in cooperation with ophthalmologists.
目的:报告2例颈动脉狭窄合并眼部缺血综合征颈动脉支架置入术(CAS)后血压迅速升高的患者。病例介绍:病例1为67岁男性。病例2为70岁男性。在这两名患者中,视力下降和短暂性偏瘫持续了几个月,导致诊断为严重的颈内动脉狭窄。此外,他们被诊断为眼部缺血性综合征和新生血管性青光眼。全视网膜光凝术在CAS眼科进行。在病例1中,CAS后9天出现眼部疼痛。在病例2中,它出现在CAS后的第二天,并注意到眼压升高。保守治疗后,行小梁切除术,但视力预后不良。结论:在严重颈内动脉狭窄和眼部缺血性综合征患者中,血运重建后眼压可能会迅速升高。因此,有必要与眼科医生合作,制定一种横断面治疗策略。
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引用次数: 1
Transradial Stenting with a 6 Fr Modified Simmonds Guiding Sheath for Stenosis of the Common Carotid Artery 6 Fr改良Simmonds导向鞘经桡动脉支架置入术治疗颈总动脉狭窄
Pub Date : 2018-07-18 DOI: 10.5797/JNET.TN.2018-0040
Y. Hanaoka, J. Koyama, Alhusain Nagm, Keisuke Kamiya, A. Chiba, Takaaki Kamijo, T. Ogiwara, T. Horiuchi, K. Hongo
Objective: Carotid artery stenting (CAS) for common carotid artery stenosis via the transfemoral approach might have a potential risk of iatrogenic distal embolism. In this study, we present a technique of transradial stenting with 6 Fr modified Simmonds guiding sheath for stenosis of the common carotid artery. Case Presentations: A 6 Fr modified Simmonds guiding sheath was introduced via the right radial artery and advanced to the common carotid artery without passing a guidewire or coaxial catheter through the stenotic lesions. Two cases with common carotid artery stenosis were treated successfully with this procedure. Conclusion: Transradial CAS with modified Simmonds guiding sheath provides a safe and durable alternative option for patients with common carotid artery stenosis having vulnerable plaques.
目的:经股动脉入路颈动脉支架术(CAS)治疗颈总动脉狭窄可能存在医源性远端栓塞的潜在风险。在这项研究中,我们提出了一种使用6Fr改良的Simmonds引导鞘进行颈总动脉狭窄的经桡动脉支架置入术。病例介绍:通过右桡动脉引入6 Fr改良的Simmonds引导鞘,并在不通过导丝或同轴导管穿过狭窄病变的情况下推进至颈总动脉。两例颈总动脉狭窄均采用该方法成功治疗。结论:改良Simmonds导引鞘经桡动脉CAS治疗颈总动脉狭窄伴易损斑块的患者是一种安全、耐用的替代选择。
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引用次数: 5
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