A Comparison between Mechanical Thrombectomy and Intra-arterial Fibrinolysis in Acute Basilar Artery Occlusion: Single Center Experiences.

Background And Purpose: Recent advances in intra-arterial techniques and thrombectomy devices lead to high rate of recanalization. However, little is known regarding the effect of the evolvement of endovascular revascularization therapy (ERT) in acute basilar artery occlusion (BAO). We compared the outcome of endovascular mechanical thrombectomy (EMT) versus intra-arterial fibrinolysis (IAF)-based ERT in patients with acute BAO.

The Difficulties and Risks of Y-Stent-Assisted Coiling: A Comparison of First and Second Stenting Procedures.

Objective: Y-stent-assisted coiling (YSAC) requires multiple device accesses for double stenting. The purpose of this study was to test the hypothesis that second stenting procedures are riskier than first stenting procedures.

Methods: We retrospectively reviewed the medical records of 19 patients with 20 aneurysms undergoing YSAC.

Will Fluoroscopic Follow-up after Stent-Assisted Coiling of Cerebral Aneurysms Provide Information on Recanalization?

Fluoroscopic images for comparison (FICs) can be easily obtained for follow-up on an outpatient basis. This study retrospectively assessed the diagnostic performance of a set of FICs for evaluation of recanalization after stent-assisted coiling, with digital subtraction angiography (DSA) as the reference standard. A total of 124 patients harboring 144 stent-assisted coiled aneurysms were included.

Reappraisal of anatomic outcome scales of coiled intracranial aneurysms in the prediction of recanalization.

Objective: Several scales are currently used to assess occlusion rates of coiled cerebral aneurysms. This study compared these scales as predictors of recanalization.

Methods: Clinical data of 827 patients harboring 901 aneurysms treated by coiling were retrospectively reviewed.

Bilateral Approach for Stent-assisted Coiling of Posterior Inferior Cerebellar Artery Aneurysms - Two Cases.

Aneurysms of the posterior inferior cerebellar artery (PICA) are rarely encountered. In particular, due to frequent anatomic complexity and the presence of nearby critical structures, PICA origin aneurysms are difficult to treat. However, recent reports of anecdotal cases using advanced endovascular instruments and skills have made the results of endovascular treatment rather outstanding.

Endovascular Treatment of Wide-necked Cerebral Aneurysms with an Acute Angle Branch Incorporated into the Sac: Novel methods of Branch Access in 8 Aneurysms.

Purpose: The optimal management of geometrically complex aneurysms remains challenging. The aim of this retrospective study was to evaluate the safety and feasibility of branch-selective technique (BT) in wide-necked aneurysms with an acute angle branch incorporated into the sac.

Materials And Methods: Eight consecutive patients harboring wide-necked cerebral aneurysms with an incorporated, acute angle branch (mean, 30.

Evidence-based changes in devices and methods of endovascular recanalization therapy.

The devices and methods of endovascular recanalization therapy (ERT) have been rapidly developed and changed since PROACT II trial. Emerging as a treatment option in addition to intravenous or intra-arterial thrombolysis, mechanical thrombectomy is currently being further developed and investigated as a potential first-line and stand-alone treatment. This review highlights and summarizes the recent clinical series and trials of the available devices and methods of ERT focusing on the multimodal approach.

Subarachnoid hemorrhage from a dissecting aneurysm of the posterior cerebral artery in a child : rebleeding after stent-assisted coiling followed by stent-within-stent technique.

Pediatric patients with dissecting aneurysms usually present with ischemia rather than bleeding. We report a case of a 15-year-old boy with a dissecting aneurysm of the posterior cerebral artery (PCA) presenting with hemorrhage. He was first treated with stent-assisted coil embolization, in an attempt to avoid trapping of the PCA and preserve the perforators.

Clinical and angiographic factors related to the prognosis of cavernous sinus dural arteriovenous fistula.

Introduction: Endovascular occlusion of the fistula has been the most widely accepted treatment for cavernous sinus dural arteriovenous fistula (CS-dAVF). Although the CS-dAVF prognosis is generally good, physicians have noted poor recoveries, paradoxical worsening, or recurrences in some cases. In this study, we sought to identify factors that influence the prognoses of CS-dAVF patients.

Technical strategy in endovascular treatment of proximal anterior cerebral artery aneurysms.

Purpose: There have been few reports on the endovascular treatment of aneurysms arising from A1 due to their rarity. We report the angiographic results, clinical outcomes, and technical aspects of endovascular treatment for 13 A1 aneurysms in 12 patients.

Methods: From January 2002 to November 2007, 12 patients (9 females and 3 males) with 13 A1 aneurysms underwent endovascular treatment.

Is clopidogrel premedication useful to reduce thromboembolic events during coil embolization for unruptured intracranial aneurysms?

Background: Thromboembolism is a common complication related to coil embolization of intracranial aneurysms.

Objective: To identify factors related to thromboembolic events during coil embolization for unruptured intracranial aneurysms and to evaluate the role of clopidogrel premedication to prevent thromboembolisms.

Methods: Since March 2006, clopidogrel has been administered to patients with unruptured aneurysms before coil embolization (the clopidogrel group) in our institution.

Shaping and navigating methods of microcatheters for endovascular treatment of paraclinoid aneurysms.

Objective: To determine whether the use of a specific shape and a navigating method of microcatheters are suitable for placement at paraclinoid aneurysms.

Methods: The clinical data from 122 patients with 132 paraclinoid aneurysms that underwent endovascular treatments during a 2.5-year period were retrospectively reviewed.

Coil-based endovascular treatment of single-hole cerebral arteriovenous fistulae: experiences in 11 patients.

Background: An SHF is rare pial arteriovenous shunt with no nidal component, of which the feeder drains directly into a single venous channel. Casting with NBCA was described previously, but its control demands operator to accumulate a considerable learning curve. We are to present our experiences of coil-based endovascular treatment of SHF.

Muslinoma and muslin-induced foreign body inflammatory reactions after surgical clipping and wrapping for intracranial aneurysms: imaging findings and clinical features.

Object: Reinforcement of aneurysms with additional wrapping is an alternative procedure if the aneurysm cannot be completely clipped. Wrapping with muslin (cotton gauze) rarely incites foreign body inflammatory reactions. In this study, the authors describe the clinical and radiological features of muslinomas or muslin-induced foreign body reactions that can develop after treatment of intracranial aneurysms.

Endovascular treatment of largely thrombosed saccular aneurysms: follow-up results in ten patients.

Introduction: Partially thrombosed aneurysms are known to be vulnerable to recanalization after coiling. However, concerns about the extent or age of intra-aneurysmal thrombosis have not been addressed in relation to the recanalization. We evaluated the follow-up results in ten patients with largely thrombosed (>or=80% in volume) saccular aneurysms treated by coil embolization.

Endovascular coil embolization of anterior choroidal artery aneurysms. Clinical article.

Object: Anterior choroidal artery (AChA) aneurysms are difficult to treat, and the clinical outcome of patients is occasionally compromised by ischemic complications after clipping operations. The purpose of this study was to document the outcome and follow-up results of endovascular coil embolization in patients with AChA aneurysms.

Methods: Between July 1999 and March 2008, 88 patients with 90 AChA aneurysms (31 ruptured and 59 unruptured aneurysms) were treated with endovascular coil embolization in 91 sessions.

Spinal dural arteriovenous fistulas: clinical experience with endovascular treatment as a primary therapeutic modality.

Objective: The aim of this study was to evaluate the efficacy of endovascular therapy as a primary treatment for spinal dural arteriovenous fistula (DAVF).

Methods: The authors reviewed 18 patients with spinal DAVFs for whom endovascular therapy was considered as an initial treatment at a single institute between 1993 and 2006. NBCA embolization was considered the primary treatment of choice, with surgery reserved for patients in whom endovascular treatment failed.

Intracranial aneurysm perforation during endosaccular coiling: impact on clinical outcome, initial occlusion, and recanalization rates.

Objective: The aim of this study was to evaluate the acute and follow-up outcomes of cerebral aneurysms that perforated during endovascular treatment.

Methods: Nine hundred ten patients harboring 1056 intracranial aneurysms received 1164 endovascular treatments over 11 years at our institution. Intraprocedural aneurysm perforation occurred in 20 cases (1.

Intra-arterial tirofiban infusion for thromboembolism during endovascular treatment of intracranial aneurysms.

Objective: Thromboembolism is one of the most common and serious complications associated with the endovascular embolization of intracranial aneurysms. We report our clinical experiences with intra-arterial tirofiban infusion during aneurysm embolization.

Methods: The clinical, radiological, and laboratory data of 24 patients harboring 25 aneurysms (25 procedures) who underwent intra-arterial tirofiban infusion for thromboembolism during the endovascular treatment of intracranial aneurysms were reviewed retrospectively.

Venous-predominant parenchymal arteriovenous malformation: a rare subtype with a venous drainage pattern mimicking developmental venous anomaly.

Object: Considerable confusion exists in the literature regarding the classification of cerebrovascular malformations and their clinical significance. One example is provided by the atypical developmental venous anomaly (DVA) with arteriovenous shunt, because it remains controversial whether these lesions should be classified as DVAs or as atypical cases of other subtypes of cerebrovascular malformations. The purpose of this study was to clarify the classification of these challenging vascular lesions in an effort to suggest an appropriate diagnosis and management strategy.

Intraarterial abciximab for treatment of thromboembolism during coil embolization of intracranial aneurysms: outcome and fatal hemorrhagic complications.

Object: Experience with intraarterial abciximab for the treatment of thromboembolism during endovascular coil embolization is limited. The authors report the outcome of intraarterial abciximab use, with an emphasis on fatal hemorrhagic complications.

Methods: Between March 2003 and May 2006, the authors treated 606 aneurysms by using endovascular coil embolization, and in 32 (5.

Transcutaneous temporary cardiac pacing in carotid stenting: noninvasive prevention of angioplasty-induced bradycardia and hypotension.

Purpose: To evaluate the feasibility, safety, and effectiveness of prophylactically placed noninvasive transcutaneous temporary pacemakers (NTP) to prevent angioplasty-induced bradycardia and hypotension during carotid angioplasty and stenting (CAS).

Methods: The preventive use of NTPs was evaluated in 31 CAS procedures performed at 3 institutions in 30 patients considered to be at high risk for developing angioplasty-induced bradycardia. Twenty-four cases in 23 patients (20 men; mean age 72 years, range 56-85) requiring intraprocedural pacing due to angioplasty-induced bradycardia were included in this study.

Double origin of the posteroinferior cerebellar artery: angiographic anatomy and endovascular treatment of concurrent vertebrobasilar dissection.

Objective: The aim of this study was to evaluate the anatomic details and therapeutic implications of the double origin of the posteroinferior cerebellar artery (DOPICA).

Methods: A total of 131 patients with intracranial posterior circulation aneurysms were consecutively treated using endovascular techniques during an 8-year period. We retrospectively searched the angiographies of these patients for evidence of DOPICA and evaluated its anatomic and treatment details and outcomes in cases of concurrent vertebral artery dissection.

CT angiography of stented carotid arteries: comparison with Doppler ultrasonography.

Purpose: To determine whether computed tomographic angiography (CTA) is a feasible modality for assessing stented carotid arteries and whether in-stent restenosis based on CTA concurs with ultrasonography (US).

Methods: A retrospective review was conducted of 37 follow-up CTA and US images from 27 patients (23 men; median age 70 years, range 56-77) who received 34 nitinol carotid stents. CTA and US images were compared with respect to assessability and percent stenosis.