Rapid ventricular pacing for flow control during transarterial Onyx embolization of tentorial dural arteriovenous fistulas.

We report transarterial Onyx embolization with flow control using rapid ventricular pacing (RVP) in a middle-aged male patient with tentorial dural arteriovenous fistulas (TDAVFs). The patient completed angiographic obliteration in one session without any complications, and the 6-month postangiographic obliteration follow-up showed no evidence of residual or recurrent dural arteriovenous fistulas. RVP may be a novel treatment option of flow control to facilitate the embolic agent penetrating into the venous side and to achieve complete cure in transarterial embolization of TDAVFs.

T-Stent or Half T-Stent-Assisted Embolization of Wide-Necked Aneurysms at the Internal Carotid-Posterior Communicating Artery Bifurcation.

Objective: We report the usefulness and pitfalls of coil embolization using the T or half T-stent technique for aneurysms located at internal carotid artery-posterior communicating artery (ICA-P-com) bifurcation in which the neck is wide and the P-com must be kept patent due to it being the fetal-type with a hypoplastic P1 segment.

Case Presentations: Two cases were treated using the T-stent technique and two were treated using the half T-stent technique. The average age of the patients was 70.

Evaluation of the Intracranial Flow Alteration during Manual Syringe and Continuous Pump Aspiration.

Goals: While mechanical thrombectomy (MT) has been shown to be effective in the treatment of acute large vessel occlusions, adjunctive measures, such as balloon guide catheters (BGC) and aspiration techniques, are utilized heterogeneously. Clarifying the effects of aspiration applied to the anterior cerebral circulation with proximal flow arrest can shed light on embolic protection during MT.

Materials And Methods: Manual and pump aspiration were applied through a BGC in a synthetic cerebrovascular model with a 60 ml syringe and a Penumbra pump, respectively.

Usefulness of preoperative cone beam computed tomography and intraoperative digital subtraction angiography for dural arteriovenous fistula at craniocervical junction: Technical case report.

Background: Direct surgery is commonly selected for the treatment of cranio-cervical junction dural arteriovenous fistula and its outcome is more satisfactory than that of embolization. Intraoperative treatment evaluation is relatively easy in embolization, whereas in direct surgery it can be difficult.

Case Description: A 67-year-old male suffered a subarachnoid hemorrhage.

Assessment of human placenta as an ex-vivo vascular model for testing of liquid embolic agent injections with adjunctive techniques.

Purpose: This project sought to test the utility of post-delivery human placenta (HP) as a vascular model for liquid embolic agent (LEA) simulation, along with adjunctive techniques.

Materials And Methods: Twelve LEA injections were performed under fluoroscopy in HP with two reflux control methods: dual lumen 'mini' balloon-catheter (n=9); and injection after proximal nBCA plug formation through a second microcatheter ('pressure cooker') (n=3). Measured outcomes included liquid embolic agent (LEA) advancement and reflux.

An Onyx tunnel: reconstructive transvenous balloon-assisted Onyx embolization for dural arteriovenous fistula of the transverse-sigmoid sinus.

Transvenous embolization is an effective method for treating dural arteriovenous fistulas (DAVFs) of the transverse-sigmoid sinus (TSS). However, in cases of complicated DAVFs, it is difficult to preserve the patency of the dural sinus. The authors describe the technical details of a new reconstructive technique using transvenous balloon-assisted Onyx embolization as another treatment option in a patient with an extensive and complex DAVF of the left TSS.

A case of a cerebral cavernous malformation of the third ventricle that caused the syndrome of inappropriate secretion of antidiuretic hormone.

Background: Cerebral cavernous malformations (CCMs, also known as cavernous hemanigiomas) of the third ventricle are uncommon. Here, we present a rare case of a CCM that caused the syndrome of inappropriate secretion of antidiuretic hormone (SIADH).

Case Description: A 68-year-old man presented with acute-onset cognitive and memory disturbance.

Utility of a Y-configured stentriever technique as a rescue method of thrombectomy for an intractable rooted thrombus located on the middle cerebral artery bifurcation: technical note.

Mechanical thrombectomy with stentriever and/or aspiration is the new gold standard for the treatment of acute strokes with large-vessel occlusion. As many as 20% of cases remain refractory to current stentriever and/or aspiration devices. "Saddle clots" obstructing a bifurcation may be a particular challenge for recanalization with conventional techniques and devices.

Novel balloon-and-aspiration method for cerebral venous sinus thrombosis: dental-floss technique.

Cerebral venous sinus thrombosis is sometimes fatal. The standard treatment for sinus thrombosis is anticoagulation, but endovascular intervention must be considered when medical treatment fails. Mechanical thrombectomy is usually required when a large clot burden exits.

Removal of a malignant cystic brain tumor utilizing pyoktanin blue and fibrin glue: Technical note.

Background: The leakage of cystic fluid during metastatic cystic brain tumor resection may cause tumor dissemination. When the cyst wall is thin, excision without removing the wall is often difficult.

Methods: We were able to perform an en bloc resection of a cystic malignant brain tumor after aspirating the cystic fluid, injecting pyoktanin blue into the cyst to stain the cyst walls, and solidifying the empty cyst cavity by filling it with fibrin glue.

Multiple Thromboembolic Cerebral Infarctions from the Aorta in a Patient with Churg-Strauss Syndrome.

Background: Ischemic stroke is a rare complication of Churg-Strauss syndrome (CSS) and its pathogenesis has not been well clarified yet. We report a case of cerebral infarction in a patient with CSS due to embolism from a thrombus on the wall of the aorta.

Case: A 39-year-old man had multiple cerebral infarctions with symptoms of mild left hemiparesis and reduced vision.

Angiographic Characteristics of Pseudo-occlusion of the Internal Carotid Artery Before and After Stenting.

Background: Various definitions of pseudo-occlusion and clinical outcomes after various treatments have been reported, but reports discussing the stenotic characteristics of pseudo-occlusion are rare.

Objective: To analyze the angiographic characteristics of pseudo-occlusion of the internal carotid artery (ICA) before and after carotid artery stenting (CAS).

Methods: We retrospectively reviewed the angiographic characteristics of 56 patients with pseudo-occlusion of the ICA treated with CAS.

[A Ruptured Vertebral Artery Dissecting Aneurysm Involving the Anterior Spinal Artery:A Case Report].

A 50-year-old woman presented with a subarachnoid hemorrhage caused by a ruptured vertebral artery dissecting aneurysm(VADA)involving the anterior spinal artery(ASA). The ASA branched at the proximal component of the dissecting aneurysm. The rupture point was presumed to be the distal region of the dissecting aneurysm.

Reappraisal of primary balloon angioplasty without stenting for patients with symptomatic middle cerebral artery stenosis.

There is a controversy regarding the safety and efficacy of intracranial stenting. We describe our experience with primary balloon angioplasty without stenting for symptomatic middle cerebral artery (MCA) stenosis. All patients who underwent balloon angioplasty without stenting for MCA stenosis between 1996 and 2010 were retrospectively reviewed.

Iatrogenic pneumothorax after ventriculoperitoneal shunt: an unusual complication and a review of the literature.

A patient received a ventriculoperitoneal shunt operation for hydrocephalus after subarachnoid hemorrhage. Postoperative computed tomography incidentally revealed asymptomatic pneumothorax caused by a shunt tube passing through the thoracic space. The patient was observed without removal of the tube or chest drainage, with the expectation of spontaneous recovery.

High cervical arteriovenous fistulas fed by dural and spinal arteries and draining into a single medullary vein: report of 3 cases.

Object: The authors previously reported a case of complex arteriovenous fistula (AVF) at C-1 with multiple dural and spinal feeders that were linked with a common medullary venous channel. The purpose of the present study was to collect similar cases and analyze their angioarchitecture to gain a better understanding of this malformation.

Methods: Three such cases, affecting 2 males and 1 female in their 60s who had presented with hematomyelia (2) or progressive myelopathy (1), were treated surgically, and the operative findings from all 3 cases were compared using digital subtraction angiography (DSA) to determine the angioarchitecture.

Stent-assisted coil embolization for cavernous carotid artery aneurysms.

Internal carotid artery (ICA) occlusion with or without a bypass surgery is the traditional treatment for cavernous sinus (CS) aneurysms with cranial nerve (CN) dysfunction. Coil embolization without stents frequently requires retreatment because of the large size of CS aneurysms. We report the mid-term results of six unruptured CS aneurysms treated with stent-assisted coil embolization (SACE).

A novel neck-sealing balloon technique for distal access through a giant aneurysm.

Background And Importance: In endovascular treatment for cerebral aneurysms using balloons, stents, or flow diverters, a microguidewire or microcatheter needs to be navigated distally across the neck of the aneurysm. However, this is sometimes difficult when there is a wide-neck or large aneurysm with a tortuous or atherosclerotic parent vessel. In this case report, we describe a new technique for navigating a microcatheter into a distal vessel.

Triple antiplatelet therapy with addition of cilostazol to aspirin and clopidogrel for Y-stent-assisted coil embolization of cerebral aneurysms.

Background: Dual antiplatelet therapy for stent-assisted coiling of cerebral aneurysms is essential to prevent thromboembolic complications. There is concern that Y-stent-assisted coiling may increase thromboembolic complications compared with coiling with a single stent. Several reports have demonstrated that cilostazol may improve clopidogrel responsiveness.

Preoperative simulations of endovascular treatment for a cerebral aneurysm using a patient-specific vascular silicone model.

Silicone models of cerebral aneurysms are used for evaluation of devices, training, or hemodynamic studies. We report preoperative simulations of endovascular treatment for a case with an unruptured wide-neck aneurysm of the anterior communicating artery using a patient-specific silicone model. Using a rapid prototyping system, we created a silicone model based on the vascular image obtained by three-dimensional rotational angiogram.

Endovascular recanalization of the completely occluded internal carotid artery using a flow reversal system at the subacute to chronic stage.

Object: The efficacy and pitfalls of endovascular recanalization were evaluated in cases of internal carotid artery (ICA) occlusion in the subacute to chronic stage.

Methods: Fourteen cases (15 lesions) of symptomatic ICA occlusion with hemodynamic compromise or recurrent symptoms were treated at the subacute to chronic stage using an endovascular technique. The Parodi embolic protection system was used during the recanalization procedure to prevent embolic stroke by reversing the flow from the distal ICA to the common carotid artery.

[Carotid artery stenting via a transbrachial artery: techniques and problems].

Recently, carotid artery stenting (CAS) has been reported to be an alternative of carotid endarterectomy (CEA) for internal carotid artery (ICA) stenosis due to the improvement of protection devices. In general, the transfemoral approach has been chosen for CAS because of the sizes of the devices. However, the transfemoral route seems to be unavailable or at high risk, in cases of severe atherosclerotic changes or aneurysm of the femoral, iliac artery or aorta, or after bypass graft placement.