Progressive headache and neck pain associated with neck rotation due to a congenital external carotid-jugular arteriovenous fistula: illustrative case.

Background: Congenital external carotid-jugular arteriovenous fistulas (AVFs) are often diagnosed based on a pulsatile neck mass. Patients rarely complain of headaches or neck pain.

Observations: A 45-year-old woman with no history of trauma had been diagnosed with a congenital cervical external carotid AVF 10 years earlier.

Progressive T1 high-intensity plaques in carotid stenosis: Comparative MRI analyses in asymptomatic and symptomatic phases of low-grade stenosis.

Background And Purpose: Carotid artery stenosis, particularly the progression from asymptomatic to symptomatic lesions, is a key factor in cerebrovascular events. This study identifies predictors of symptom development in low-grade carotid stenosis (<50%), focusing on intraplaque hemorrhage (IPH) and dynamic plaque changes.

Materials And Methods: We conducted a retrospective study analyzing 30 cases of symptomatic low-grade carotid stenosis, using carotid MRI before and after symptom onset.

Learning Curve Effect of Combined Technique Thrombectomy as First-Line Attempt for Acute Ischemic Stroke: A Single-Center Retrospective Study.

Objectives: We retrospectively examined the initial experience and learning curve after the introduction of thrombectomy with the combined technique using an aspiration catheter and a stent retriever as first-line attempt for acute ischemic stroke.

Methods: Consecutive patients undergoing thrombectomy for acute ischemic stroke at our institution between January 2020 and December 2022 were divided into 3 groups according to the year of thrombectomy. Patient characteristics and procedural, safety, and clinical outcomes were compared between the three year periods to determine predictors of favorable clinical outcome.

Factors related to vessel displacement due to stent retriever retraction: An in vitro study.

Background: Thrombectomy with a stent retriever (SR) may lead to intracranial hemorrhage due to vessel displacement. We aimed to explore factors related to vessel displacement using an in vitro vessel model.

Methods: A vessel model mimicking two-dimensional left internal carotid angiography findings was used in this study.

Aortogenic calcified cerebral embolism diagnosed with an embolus retrieved by thrombectomy: illustrative case.

Background: Calcified cerebral embolism has been reported as a cause of acute cerebral infarction, but an aortogenic origin has rarely been identified as the embolic source. The authors describe a case of aortogenic calcified cerebral embolism in a patient with other embolic sources.

Observations: In a patient with cerebral infarction and atrial fibrillation, a white hard embolus was retrieved by mechanical thrombectomy.

Basilar artery occlusion due to vertebral artery injury treated with thrombectomy and distal vertebral artery embolization through the unaffected side.

Background: There is no established opinion regarding embolization of asymptomatic traumatic vertebral artery injuries that do not require cervical spine repair and fixation.

Case Description: A 78-year-old man fell backward from a height of about 1 m and was rushed to his previous hospital. He had a fracture of the left transverse process of the 6 cervical vertebra.

Anterior condylar arteriovenous fistula mainly fed by peripheral branches of the bilateral internal maxillary arteries: illustrative case.

Background: The main feeding artery of an anterior condylar arteriovenous fistula (AC-AVF) is the ascending pharyngeal artery and rarely the internal maxillary artery.

Observations: A 58-year-old male with a history of sinusitis since adolescence presented with a 5-year history of bilateral pulsatile tinnitus and a 2-month history of right ocular symptoms. Angiography showed that the peripheral branches of the bilateral internal maxillary arteries were the main feeding arteries of the AC-AVF and that they gathered in the clivus with a relatively large shunted pouch in the left jugular tubercle.

Parent artery occlusion for cerebral infarction after spontaneous recanalization in traumatic vertebral artery: A case report.

Background: There is no established treatment strategy for traumatic vertebral artery occlusion that does not require cervical spine repair surgery.

Case Description: A 49-year-old man was brought to our hospital with traffic trauma. Fractures were observed in the left lateral mass and transverse process of Atlas and the left vertebral artery was occluded at the level of the foramen transversum of Atlas.

Disconnection of a stent retriever's pushwire caught by an accordion-like deformed aspiration catheter during mechanical thrombectomy: illustrative case.

Background: In mechanical thrombectomy for acute large vessel occlusion, a combined technique of using both a stent retriever and an aspiration catheter has been widely used. The authors report a case in which a stent retriever's pushwire and a microcatheter were caught and disconnected by an accordion-like deformed aspiration catheter.

Observations: A 74-year-old man underwent mechanical thrombectomy for a left M1 occlusion.

Cavernous sinus dural arteriovenous fistula embolized through an occluded superior petrosal sinus: illustrative case.

Background: Transvenous embolization for cavernous sinus (CS) dural arteriovenous fistulas (CS-DAVFs) with limitations of the major access routes to the CS is challenging.

Observations: A 74-year-old woman presented with left-sided conjunctival injection and exophthalmos. Cerebral angiography showed a left CS-DAVF draining into the left uncal vein and superior ophthalmic vein, with the fistulous point located in the posterosuperior compartment of the left CS.

De novo expansion formation in the outer curvature of the internal carotid artery after flow diverter deployment for an infectious cavernous carotid aneurysm: illustrative case.

Background: Infectious aneurysms very rarely occur in the cavernous carotid artery. Recently, treatment by flow diverter implantation with preservation of the parent artery has been the treatment of choice.

Observations: A 64-year-old woman presented with stenosis at the C5 segment of the left internal carotid artery (ICA), followed by ocular symptoms within 2 weeks, with a de novo aneurysm in the left cavernous carotid artery and wall irregularity with stenosis from the C2 to C5 segments of the left ICA.

Factors for failure of ultrasound-guided compression repair for femoral pseudoaneurysms after neuroendovascular therapy.

Objective: Pseudoaneurysms are a serious complication of neuroendovascular therapy with femoral artery puncture, for which ultrasound-guided compression repair (UGCR) is often the first choice of radical therapy. We sought to retrospectively investigate the factors for failure of UGCR for pseudoaneurysm at the femoral artery puncture site.

Methods: Among patients undergoing neuroendovascular therapy with femoral artery puncture at our hospital between January 2018 and April 2021, those who received a diagnosis of pseudoaneurysm and underwent UGCR were enrolled.

Dilation of proximal internal carotid artery collapse due to severe distal stenosis after angioplasty for distal stenosis: A case report.

Background: We report a case of proximal internal carotid artery (ICA) collapse due to severe distal stenosis that dilated after angioplasty for distal stenosis.

Case Description: A 69-year-old woman underwent thrombectomy for the left ICA occlusion due to stenosis of C3 portion and was discharged home with a modified Rankin Scale score of 0. One year later, she developed cerebral infarction due to progressive stenosis of the C3 portion of the left ICA with proximal ICA collapse and underwent emergency percutaneous transluminal angioplasty (PTA) for distal stenosis.

White Embolus-induced Basilar Artery Occlusion Due to Pulmonary Vein Invasion of a Metastasis of a Malignant Melanoma.

An 80-year-old woman presented with impaired consciousness after malignant melanoma resection. Magnetic resonance angiography showed basilar artery occlusion, which was subjected to mechanical thrombectomy for recanalization. A pathological analysis of the retrieved embolus revealed that it was derived from a metastasis of malignant melanoma.

Factors related to white thrombi in acute ischemic stroke in cancer patients.

Objectives: Thrombi in cerebral large vessel occlusion associated with active cancer are often fibrin and platelet-rich white thrombi. However, evaluating the thrombus composition in a short time before thrombectomy is often ineffective. We sought to determine factors related to white thrombi in acute ischemic stroke due to large vessel occlusion in cancer patients.

Analysis of Factors Influencing Delayed Presentation in Japanese Patients with Subarachnoid Hemorrhage.

Objective: Some aneurysmal subarachnoid hemorrhage (SAH) patients are delayed in their presentation. This can cause a washout of the subarachnoid hematoma and a potential misdiagnosis. As a result, they may suffer rerupture of the aneurysm and preventable deterioration.

Short-term aneurysm formation and rupture due to septic embolism diagnosed with a thrombus retrieved from another occluded artery.

Background: In rare cases, septic embolism is diagnosed on the basis of pathological findings of retrieved thrombi. Infected aneurysms can rapidly form and rupture after septic embolism, leading to a poor prognosis. We report a case of subcortical hemorrhage due to an infected aneurysm forming shortly after septic embolism in the left anterior cerebral artery.

Intraoperative identification of the lateral spinal artery in a case of craniocervical junction dural arteriovenous fistula surgically obliterated.

Background: The formation of a dural arteriovenous fistula (DAVF) at the craniocervical junction is rare. Such a fistula can be fed by the branches of the vertebral and external carotid arteries. The lateral spinal artery can branch from the vertebral artery.

Predicting the growth of middle cerebral artery bifurcation aneurysms using differences in the bifurcation angle and inflow coefficient.

Objective: Growing intracranial aneurysms (IAs) are prone to rupture. Previous cross-sectional studies using postrupture morphology have shown the morphological or hemodynamic features related to IA rupture. Yet, which morphological or hemodynamic differences of the prerupture status can predict the growth and rupture of smaller IAs remains unknown.

Clinical features and long-term outcomes of symptomatic low-grade carotid stenosis.

Objective: In symptomatic low-grade stenosis, most of the reports did not clarify the long-term outcome. This study aims to clarify the clinical features and long-term outcomes of symptomatic low-grade stenosis cases.

Materials And Methods: We included 123 symptomatic patients with low-grade (<50%) carotid stenosis.

Aneurysm Perforation Due to Advancement of the Coil Delivery Wire During Stent-Assisted Embolization.

We report a case of intraprocedural aneurysm rupture during coil embolization caused by a coil delivery wire. A 68-year-old woman underwent stent-assisted coil embolization for an unruptured aneurysm in the internal carotid artery (ICA). A low profile visible intraluminal support device was deployed at the aneurysm neck.

The bifurcation angle is associated with the progression of saccular aneurysms.

The role of the bifurcation angle in progression of saccular intracranial aneurysms (sIAs) has been undetermined. We, therefore, assessed the association of bifurcation angles with aneurysm progression using a bifurcation-type aneurysm model in rats and anterior communicating artery aneurysms in a multicenter case-control study. Aneurysm progression was defined as growth by ≥ 1 mm or rupture during observation, and controls as progression-free for 30 days in rats and ≥ 36 months in humans.

Correlation of Scoring Systems with the Requirement of an External Ventricular Drain in Intraventricular Hemorrhage.

Background: External ventricular drainage (EVD) is required to resolve acute hydrocephalus associated with intraventricular hemorrhage (IVH). The correlation of scoring systems of IVH with indications for EVD for acute hydrocephalus related to IVH is currently unknown.

Methods: We identified 213 hypertensive patients with IVH and divided them into 2 groups according to treatment method: 187 patients receiving blood pressure control alone and 26 patients undergoing EVD.

Removal of a central venous catheter penetrating the vertebral artery: A case report on endovascular treatment for blunt cerebrovascular injury.

Background: Anticoagulation and endovascular therapy are commonly used treatment methods for blunt cerebrovascular injury (BCVI). However, in certain cases, the perforating objects damaging the blood vessels need to be removed. In such cases, stenting and coil embolization have been reported to be useful.