Preoperative Onyx embolization of a giant cavernous malformation involving the dural sinuses.

Cavernous malformations (CMs) or hemangiomas arising from within the dural sinuses are rare entities that differ from their parenchymal counterparts in that they are highly vascular lesions. While parenchymal CMs are typically angiographically occult, intrasinus malformations may have large, dural-based arterial feeding vessels that are amenable to preoperative embolization. The novel liquid embolic Onyx (ev3, Inc.

Delayed symptomatic coil migration after initially successful balloon-assisted aneurysm coiling: technical case report.

Objective: To describe delayed migration of a coil loop after adjunctive balloon remodeling of an anterior communicating artery aneurysm.

Methods: A 56-year-old man with a subarachnoid hemorrhage from a small anterior communicating artery aneurysm underwent successful coil embolization with adjunctive balloon remodeling.

Results: Eight days after the procedure, the patient returned with the acute onset of right lower extremity paralysis.

Curative reconstruction of a giant midbasilar trunk aneurysm with the pipeline embolization device.

Objective: To demonstrate the curative reconstruction of a giant circumferential basilar trunk aneurysm using the Pipeline embolization device (PED) (Chestnut Medical Technologies, Inc., Menlo Park, CA) alone, without embolization coils.

Methods: A 13-year-old female patient was referred for the treatment of a 4-cm, partially thrombosed, circumferential midbasilar trunk aneurysm.

Revascularization of symptomatic subacute cerebrovascular occlusions with a self-expanding intracranial stent system.

Objective: In some patients, collateral circulation may preserve the viability of brain parenchyma distal to an intracranial arterial occlusion for hours or days after the presenting event. These patients may be good candidates for revascularization, even when they present outside of the accepted 6-hour time window for stroke intervention.

Methods: Three patients were revascularized with the Wingspan stent system (Boston Scientific/Target, Fremont, CA) after presenting with subacute occlusions of intracranial arteries and progressive ischemic symptoms despite maximal medical therapy.

Double-balloon trapping technique for embolization of a large wide-necked superior cerebellar artery aneurysm: case report.

Objective: To describe a novel double-balloon trapping technique for endovascular embolization of a broad-based saccular aneurysm of the superior cerebellar artery.

Clinical Presentation: A 62-year-old man with a history of diabetes, coronary artery disease, and smoking presented with a syncopal episode. Catheter angiography revealed a large (11.

Treatment of intracranial aneurysms with the Enterprise stent: a multicenter registry.

Object: The development of self-expanding stents dedicated to intracranial use has significantly widened the applicability of endovascular therapy to many intracranial aneurysms that would otherwise have been untreatable by endovascular techniques. Recent Food and Drug Administration approval of the Enterprise Vascular Reconstruction Device and Delivery System (Cordis) has added a new option for self-expanding stent-assisted intracranial aneurysm coiling.

Methods: The authors established a collaborative registry across multiple institutions to rapidly provide largevolume results regarding initial experience in using the Enterprise in real-world practice.

Target lesion revascularization after wingspan: assessment of safety and durability.

Background And Purpose: In-stent restenosis (ISR) occurs in approximately one-third of patients after the percutaneous transluminal angioplasty and stenting of intracranial atherosclerotic lesions with the Wingspan system. We review our experience with target lesion revascularization (TLR) for ISR after Wingspan treatment.

Methods: Clinical and angiographic follow-up results were recorded for all patients from 5 participating institutions in our US Wingspan Registry.

Delayed visual deficits and monocular blindness after endovascular treatment of large and giant paraophthalmic aneurysms.

Objective: Paraophthalmic aneurysms may exert mass effect on the optic apparatus. Although surgical clipping and endovascular coiling of these aneurysms can be complicated by immediate postoperative visual deterioration, endovascular coil embolization has the unique risk of visual complications later (>24 h) in the perioperative period.

Methods: Six patients with a delayed onset of vision loss after technically successful coil embolization of paraophthalmic region aneurysms were identified.

Intracranial placement of a new, compliant guide catheter: technical note.

Objective: We describe our initial experience with the use of a novel, compliant guide catheter designed for placement within the cranial vasculature in a series of seven patients who were treated for various intracranial pathologies.

Clinical Presentation: Seven patients were deemed to have either tortuous supra-aortic, intracranial, and/or extracranial vasculature or to require additional microcatheter support as the result of lesion location.

Intervention: The patients were treated, in part, with the 6-French Neuron delivery catheter (Penumbra, Inc.

Monorail snare technique for the retrieval of an adherent microcatheter from an onyx cast: technical case report.

Objective: Microcatheters retained after Onyx (eV3 Neurovascular, Inc., Irvine, CA) embolization represent a potential source of thromboembolic complications. Catheter retention depends on the degree of Onyx reflux and vessel tortuosity.

Angiographic patterns of Wingspan in-stent restenosis.

Objective: A classification system developed to characterize in-stent restenosis (ISR) after coronary percutaneous transluminal angioplasty with stenting was modified and applied to describe the appearance and distribution of ISR occurring after Wingspan (Boston Scientific, Fremont, CA) intracranial percutaneous transluminal angioplasty with stenting.

Methods: A prospective, intention-to-treat, multicenter registry of Wingspan treatment for symptomatic intracranial atherosclerotic disease was maintained. Clinical and angiographic follow-up results were recorded.

Delayed migration of a self-expanding intracranial microstent.

A 43-year-old patient with a basilar apex aneurysm had a 4.5-mm x 14-mm Enterprise stent placed from the midbasilar artery to the left P1 segment of the posterior cerebral artery. The patient experienced vertigo 4 months after stent placement and 1 week after stopping clopidogrel.

Definitive reconstruction of circumferential, fusiform intracranial aneurysms with the pipeline embolization device.

Objective: The Pipeline embolization device (PED; Chestnut Medical, Menlo Park, CA) is a new endovascular construct designed to exclude aneurysms from the parent cerebrovasculature. We report the results of the first two human implantations of this device in North America.

Clinical Presentation: Two patients presenting with large, symptomatic, circumferential, fusiform intracranial vertebral artery aneurysms were treated with the PED.

Analyzer-based imaging of spinal fusion in an animal model.

Analyzer-based imaging (ABI) utilizes synchrotron radiation sources to create collimated monochromatic x-rays. In addition to x-ray absorption, this technique uses refraction and scatter rejection to create images. ABI provides dramatically improved contrast over standard imaging techniques.

Recanalization of an acute middle cerebral artery occlusion using a self-expanding, reconstrainable, intracranial microstent as a temporary endovascular bypass.

Background And Purpose: Although self-expanding intracranial microstents have been used to treat acute middle cerebral artery (MCA) stroke, there are disadvantages associated with placing a permanent endovascular implant. We describe a technique in which a reconstrainable stent was used to provide a temporary endovascular bypass to achieve MCA recanalization without permanent stent implantation.

Methods: A 55-year-old male presented with acute onset left hemiplegia (National Institutes of Health Stroke Score (NIHSS) of 20.

A Randomized Trial Comparing Platinum and Hydrogel-coated Coils in Patients Prone to Recurrence after Endovascular Treatment (The PRET Trial).

New coils have been designed to preserve the safety of coil embolization while improving on long-term efficacy. There is currently no scientific evidence that one type of coil material is better than another. The recurrence problem may be more pressing in certain types of patients, such as patients with large aneurysms or those already presenting with angiographic recurrences.

Stent reconstruction of wide-necked aneurysms across the circle of Willis.

Objective: To describe a novel technique for single stent reconstruction of wide-necked aneurysms arising from the circle of Willis.

Methods: Neuroform stents (Boston Scientific/Target, Fremont, CA) were placed across the basilar apex (right P1 to left P1) via the posterior communicating artery in two patients, across the left carotid terminus (left A1 to left M1) via the anterior communicating artery in two patients, and across the anterior communicating artery (left A1 to right A1) in one patient for stent-supported coil embolization.

Results: Five women underwent successful deployment of the Neuroform stent across the circle of Willis to support subsequent coil embolization of a wide-necked cerebral aneurysm.

Influence of patient age and stenosis location on wingspan in-stent restenosis.

Background And Purpose: Wingspan is a self-expanding, microcatheter-delivered microstent specifically designed for the treatment of symptomatic intracranial atherosclerotic disease. Our aim was to discuss the effect of patient age and lesion location on in-stent restenosis (ISR) rates after percutaneous transluminal angioplasty and stenting (PTAS) with the Wingspan system.

Materials And Methods: Clinical and angiographic follow-up results were recorded for all patients from 5 participating institutions.

Disc space-targeted angled axial MR images of the lumbar spine: a potential source of diagnostic error.

Objective: To compare the sensitivities of contiguous axial (CA) images and disc space-targeted angled axial (DSTAA) images of the lumbar spine for: (1) the detection of spondylolysis defects, and (2) the identification of disc material which has migrated away from the parent disc.

Materials And Methods: Prospective imaging of the lumbar spine was performed over a 22-month period in 103 patients. Imaging protocols included spin-echo T1- and fast spin-echo (FSE) T2-weighted images in the sagittal and axial planes.

Marginal sinus arteriovenous fistulas mimicking carotid cavernous fistulas: diagnostic and therapeutic considerations.

Marginal sinus fistulas (MSFs) are uncommon vascular anomalies. Occasionally, the dominant venous drainage is forced retrograde up the inferior petrosal sinus and into the cavernous sinus, causing chemosis, proptosis, and ocular hypertension, mimicking a carotid cavernous fistula. This atypical clinical presentation may lead to misdiagnosis and inappropriate hazardous treatment of an MSF.

Pregnancies complicated with antiphospholipid syndrome: the pathogenic mechanism of antiphospholipid antibodies: a review of the literature.

There are several possible mechanisms by which antiphospholipid antibodies (aPL) may have adverse effects on placental functions. Examination of placentas and first-trimester decidua from antiphospholipid syndrome-complicated pregnancies has found little evidence of specific thrombotic placental pathology. It is now generally accepted that the clinically relevant aPL bind to proteins with affinity for phospholipids.

CT angiographic appearance of in-stent restenosis of intracranial arteries treated with the Wingspan stent.

Four patients underwent angioplasty and stenting of medically refractory symptomatic intracranial atherosclerosis with the new Wingspan stent system. In all 4 patients, CT angiography (CTA) showed an abnormality within the stented segment that was suggestive of nonocclusive in-stent thrombus. However, subsequent conventional angiography findings were typical for in-stent restenosis.

Wingspan in-stent restenosis and thrombosis: incidence, clinical presentation, and management.

Objective: Wingspan (Boston Scientific, Fremont, CA) is a self-expanding stent designed specifically for the treatment of symptomatic intracranial atheromatous disease. The current series reports the observed incidence of in-stent restenosis (ISR) and thrombosis on angiographic follow-up.

Methods: A prospective, intent-to-treat registry of patients in whom the Wingspan stent system was used to treat symptomatic intracranial atheromatous disease was maintained at five participating institutions.