Spontaneous Migration of a Ventriculoperitoneal Shunt into the Venous System: A Multidisciplinary Approach.

Ventriculoperitoneal shunt catheter migration is a rare but documented complication. The exact mechanism of this occurrence is not well understood. We report the case of an 81-year-old male who initially presented with symptoms consistent with normal pressure hydrocephalus.

Tandem Short-length Multi-stent Construct for Emergent Revascularization of Occlusive Long-segment Left Middle Cerebral Artery In-stent Stenosis.

Endovascular stenting and balloon angioplasty is a feasible although controversial option for intracranial atherosclerotic stenosis refractory to maximize medical management. High rates of symptomatic in-stent restenosis (ISR) have been identified with Wingspan stent (Stryker, Fremont, CA, USA) placement. Revascularization of ISR by way of re-stenting is often attempted, albeit with high risk and low durability.

Traumatic Pseudoaneurysm of the Ascending Cervical Artery Treated with N-butyl Cyanoacrylate Embolization: A Case Report and Review of the Literature.

Pseudoaneurysms of the thyrocervical trunk and its branches are commonly iatrogenic in nature; however, trauma is often an inciting mechanism. Open surgical repair was considered the main treatment modality until recent advances in endovascular therapy proved to be a viable treatment option. We report a case of a traumatic pseudoaneurysm arising from the ascending cervical artery with an associated arteriovenous fistula (AVF) that was treated using n-butyl cyanoacrylate (NBCA) embolization.

Acute Formation of a Blunt Trauma-induced Vertebral Artery Arteriovenous Fistula Treated with Endovascular Occlusion of Vertebral Artery.

Fistulous cerebrovascular injuries can occur spontaneously, iatrogenically following surgical procedures, or can result as a consequence of penetrating trauma. To our knowledge, this is only the second reported case of blunt-trauma induced cervical vertebral artery arteriovenous fistula (AVF) formation in a 55-year-old male. This was successfully occluded with N-butyl cyanoacrylate (NBCA) embolization of the recipient vein and endovascular coil ligation of the vertebral artery.

Clinical Outcomes of Endovascular Thrombectomy in Tissue Plasminogen Activator versus Non-Tissue Plasminogen Activator Patients at Primary Stroke Care Centers.

Background: The effect of intravenous tissue plasminogen activator (IV tPA) administration before endovascular intervention as compared to without at thrombectomy-capable low-volume centers on procedural aspects and patient outcomes has not been investigated.

Methods: Retrospective chart review was performed in all consecutive large vessel cerebrovascular accident patients treated with endovascular therapy at two select rural primary stroke centers between 2011 and 2015. Patients' data regarding age, sex, and medical history, as well as thrombus location by catheter-based cerebral angiography, postprocedural reperfusion status, and clinical outcomes were reviewed.

Symptomatic Post Endarterectomy Common Carotid Artery Pseudoaneurysm Treated with Combination of Flow Diverter Implantation and Carotid Stenting.

A 74-year-old male developed cervical carotid artery psuedoaneurysm 8 months after carotid endarterectomy. The patient was successfully managed with dual implantation of flow-diverter and conventional carotid stent. Flow-diverter was placed across the neck of pseudoaneurysm to provide flow diversion while carotid stent was implanted within the lumen of the expanded flow-diverter to approximate and hold the flow diverter proximal and distal to the pseudoaneurysm.

Endovascular management of symptomatic cerebral aneurysm thromboembolism due to pre-aneurysmal arterial stenosis.

Background: Pre-aneurysmal internal carotid steno-occlusive disease resulting in cerebral intra-aneurysmal thrombosis and subsequent embolic infarction has not been previously described.

Conclusion: Antithrombotic treatment for dissolution of the thrombus and pre-aneurysmal stent angioplasty followed by Pipeline embolization flow diverter placement through the aneurysm is a safe and feasible management option.

Congenital Bilateral C2 Transverse Foramina Stenosis Causing Adult-Onset Vertebrobasilar Insufficiency and Posterior Circulation Stroke.

Vertebrobasilar insufficiency leading to posterior circulation infarcts caused by congenital hypoplasia of the bilateral transverse foramina at the C2 level, affecting the caliber and flow of the bilateral distal cervical vertebral arteries in an adult, has not been previously reported. A 41-year-old male presented with episodic dizziness for a period of 1 year prior to consultation. Computed tomography angiography of the head and neck demonstrated congenital hypoplasia of the bilateral C2 transverse foramina, with absence of the vertebral arteries in each of the foramina and collateral reconstitution of diminutive intracranial vertebral artery segments.

Dual Stent-Assisted Coil Embolization for Fusiform Aneurysm Arising From Persistent Trigeminal Artery.

Aneurysms of the persistent trigeminal artery (PTA) trunk are exceptionally rare and have a high risk for rupture. Dual stent placement through each internal carotid and basilar artery for endovascular coil embolization of a fusiform aneurysm arising from the PTA has not been described in the literature. A 44-year-old female with a history of chronic headache was identified to have a fusiform aneurysm arising from medially coursing adult type, Saltzman type 3 PTA trunk.

Intra-operative N-butyl cyanoacrylate embolization arrest of uncontrollable hemorrhage during meningioma resection.

During the surgical resection of a convexity meningioma in a 63-year-old woman, an uncontrollable active hemorrhage from the operative bed was arrested with microcatheter N-butyl cyanoacrylate (NBCA) embolization after superselective angiography. To date, an uncontrollable neurosurgical intraprocedural hemorrhage terminated by NBCA embolization has not been previously reported. The embolization risk relative to the benefit needs to be carefully considered prior to the surgical removal of a meningioma.

Trans-femoral thromboaspiration for upper extremity ischemia.

Introduction: Endovascular trans-femoral access catheter aspiration of thrombus within the proximal subclavian, brachial, radial and ulnar arteries for symptomatic upper extremity ischemic pain has not been previously reported. We describe a case in which a successful clinical outcome was achieved using long length neuro-endovascular aspiration catheters.

Presentation Of Case: A 45 year old female presented with diffuse left upper limb pain.

Chronic innominate artery occlusion with hyperacute intracranial thromboembolism: Revascularization with simultaneous local thromboaspiration and mechanical thrombectomy.

Chronic innominate artery occlusion with acute right internal carotid terminus thromboembolism and successful revascularization using simultaneous local thromboaspiration and mechanical thrombectomy has not been previously described. A 51-year-old male presented with transient left hemiparesis. A CT angiogram of the head and neck demonstrated chronic occlusion of the right innominate artery with no intracranial thromboembolism.

Acute watershed infarcts with global cerebral hypoperfusion in symptomatic CADASIL.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common form of hereditary cerebral angiopathy. We present a case in which a pattern of diffusion signal change compatible with bihemispheric acute watershed infarcts occurred in a symptomatic patient demonstrating global hypoperfusion. To our knowledge, watershed infarcts in the clinical presentation of CADASIL have not been previously described.

Management of hemorrhagic pseudoaneurysmal arteriovenous fistula of the sphenopalatine artery.

n-Butyl cyanoacrylate (n-BCA) embolization of a hemorrhagic pseudoaneurysmal arteriovenous fistula of the sphenopalatine artery in a patient with paranasal sinus squamous cell carcinoma treated with regional surgery and radiation has, to our knowledge, not been previously reported.

WITHDRAWN: Onyx embolization of high flow spontaneous cervical vertebral arteriovenous fistula.

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Onyx embolization of high-flow spontaneous cervical vertebral arteriovenous fistula.

Background And Importance: High-flow spontaneous vertebral arteriovenous shunts in patients with fibromuscular disease (FMD) are rare. Onyx embolization of the recipient veins with shunt disconnection and preservation of the affected vertebral artery in a patient with FMD has not been reported.

Clinical Presentation: A 59-year-old female presented with progressive dizziness, pre-syncopal episodes, and tinnitus.

Profound hypoglycemia presents with reversible symmetrical ADC signal changes isolated to eloquent cortex of the parietal lobe.

MRI diffusion/ADC signal change with reversal, symmetrically isolated to the cortex of the precentral gyri in profound hypoglycemia has not been previously described. We present a case in which minimal cortical signal change without deep gray matter involvement and subsequent reversal occurred without significant clinical improvement. Correlation of the reversal of diffusion/ADC signal to findings by EEG evaluation has been described in animal studies and not in humans before.

Endovascular cerebral protection and revascularization of innominate artery stenosis through single-site access, with device entrapment and rescue: technical case report.

We describe a novel technique for cerebral embolic device placement with inadvertent entrapment and subsequent rescue in the endovascular treatment of innominate artery stenosis. A 62-year-old female presented with symptomatic right-sided subclavian steal syndrome. Single-site access for revascularization of critical innominate artery stenosis with simultaneous cerebral embolic protection performed for this diagnosis has not been previously reported.

Endovascular treatment of cerebral aneurysms at a low-volume community hospital practice: management strategies, complications, and outcomes.

Background And Purpose: Our institution serves a population of 160,000 and performed 14.4 endovascular cerebral aneurysm interventions annually, averaged over a 5-year period. The purpose of this study was to examine the safety and efficacy of endovascular treatment of cerebral aneurysms at a lowvolume center.

Microcatheter neck bridging and incorporated branch vessel protection for coil embolization of a wide-neck ruptured aneurysm: technical case report.

Background And Importance: A novel technique in which microcatheter neck bridging of a ruptured wide-neck posterior communicating artery aneurysm was performed by intra-aneurysmal catheter navigation into a fetal configuration posterior cerebral artery (PCA) branch vessel arising from the sac.

Clinical Presentation: An 88-year-old woman with a Hunt and Hess grade 1 and Fisher grade 4 subarachnoid hemorrhage was identified as having a wide-neck posterior communicating artery aneurysm and an isolated fetal configuration PCA with origins from the aneurysm sac. Delivery of a bare platinum Guglielmi detachable coil within the aneurysm lumen resulted in persistent coil prolapse into the parent vessel with occlusion of the incorporated vital PCA origin.

Pediatric holohemispheric developmental venous anomaly: definitive characterization by 3D susceptibility weighted magnetic resonance angiography.

We present a case of an incidentally discovered holohemispheric developmental venous anomaly (DVA) in a 12 year old, conclusively characterized by 3D T2* multi-echo sequence susceptibility weighted angiographic imaging (SWAN). For the evaluation of head trauma, abnormal right intraparenchymal and periventricular vascularity was identified by a non contrast head CT scan. Conventional MRI sequences revealed prominent veins with findings suspicious of a DVA.