Flow diversion treatment of anterior communicating artery region aneurysms.

Background And Purpose: Reports on flow diversion treatment of aneurysms beyond the Circle of Willis are limited, with few series dedicated to anterior communicating artery region aneurysms. The purpose of this study is to evaluate the safety and effectiveness of the pipeline embolization device in the treatment of anterior communicating artery region aneurysms.

Materials And Methods: The neuro-interventional database of a single institution was retrospectively reviewed for anterior communicating artery aneurysms treated with the pipeline embolization device between November 2016 and December 2018.

Isolated Intraventricular Hemorrhage Associated with Cerebral Vasospasm and Delayed Cerebral Ischemia following Arteriovenous Malformation Rupture.

Background: Although it is well characterized in aneurysmal subarachnoid hemorrhage, vasospasm is exceedingly rare following cerebral arteriovenous malformation (AVM) rupture. Subsequently, this complication is poorly characterized with regard to delayed cerebral ischemia (DCI). We review cases of ruptured AVM to assess the frequency and severity of vasospasm on cerebral angiography, and DCI.

Acute Ischemic Stroke due to Common Carotid Ostial Disease with Tandem Intracranial Occlusions Treated with Thrombectomy and Staged Retrograde Stenting.

Background: Acute ischemic stroke due to tandem occlusive lesions of the anterior circulation involves an intracranial large vessel occlusion as well as a concurrent occlusion or high-grade stenosis of the proximal carotid system. The vast majority of proximal lesions in tandem occlusive cases involve the extracranial internal carotid artery, although the lesion can theoretically exist anywhere along the carotid artery pathway, including the common carotid ostium.

Summary: To the best of our knowledge, only 1 report describes common carotid artery ostial lesions in the setting of acute ischemic stroke due to tandem occlusions, in which the authors describe an anterograde treatment paradigm.

Endovascular intervention of acute ischemic stroke due to occlusion of fetal posterior cerebral artery.

A fetal posterior cerebral artery (FPCA) is an anatomic variant in which the posterior cerebral artery is an embryological derivative of the internal carotid artery. Although most cases of ischemic strokes in patients with FPCAs involve embolic infarcts, emergent large vessel occlusion of a FPCA is extremely rare. We present two cases of successful endovascular intervention for emergent occlusion of a FPCA, one of which is only the second reported case of a mechanical thrombectomy of a FPCA.

Endovascular Retrieval of Migrated Coil within the Distal Middle Cerebral Artery Using Stentriever Device.

Background: Displacement of endovascular coils during endovascular embolization of an intracranial aneurysm is a potentially life-threatening complication. Several methods for coil retrieval have been described, including the use of microsnares and microforceps retrieval devices. With the recent surge of stentriever implementation in the treatment of ischemic stroke, some operators are now using such devices in the retrieval of migrated coils.

Mechanical Thrombectomy of Acute Middle Cerebral Artery Occlusion Using Trans-Anterior Communicating Artery Approach.

Background: A cross-circulation technique involves gaining access to a cerebral vessel through a patent anterior or posterior communicating artery. This technique may be used in patients with emergent large-vessel occlusions and an unfavorable direct route to the occlusion. While few previous reports have demonstrated a successful cross-circulation technique for treatment of emergent large-vessel occlusions, we present the first 2 cases of transanterior communicating artery stent retriever thrombectomy.

Rotational Vertebral Artery Dissection Secondary to Anomalous Entrance into Transverse Foramen.

Background: Rotational vertebral artery occlusion is a rare syndrome characterized by vertebrobasilar insufficiency secondary to position-dependent occlusion of the vertebral artery. Most cases reported in the literature have been attributed to osteophytic compression, either from the occipital condyle or within the transverse foramen. However, vertebral artery dissection secondary to motion in the setting of anomalous anatomy has not been reported.

Barbiturate withdrawal following Internet purchase of Fioricet.

Background: The Internet enables businesses to advertise their pharmaceutical products and services without medical supervision. The Internet also allows for the unsupervised purchase of medications that may have neurologic consequences.

Objective: To describe acute withdrawal delirium following the abrupt discontinuation of Fioricet.