Purpose: To report the use of the Parodi Anti-Emboli System (PAES) for cerebral protection during emergent vertebral artery recanalization.
Case Report: A 56-year-old chimney sweep was referred with recurrent episodes of vertigo and gait ataxia. Left vertebral artery (LVA) flow was barely detectable on duplex Doppler, and brain computed tomography revealed a small infarct in the posterior inferior cerebellar artery territory. Angiography showed subtotal ostial stenosis of the LVA with poor distal flow and possible thrombus. Due to a high risk of distal embolization with percutaneous treatment, anticoagulation was initiated, and the lesion was to be re-evaluated in 2 to 3 weeks. However, 2 days later, the patient developed severe, aggravating headache, gait and left-limb ataxia, horizontal nystagmus, and vomiting. Emergent angiography showed a total ostial LVA occlusion. The PAES was employed to elicit a temporary subclavian steal during percutaneous LVA recanalization, thus protecting the brain from embolization. The ostial LVA was successfully recanalized and stented, with immediate symptom cessation.
Conclusions: The PAES can be successfully applied in the subclavian artery to prevent distal embolization during emergent vertebral artery recanalization. Since a significant proportion of vertebral strokes are embolic, PAES may play a novel role in the treatment of acute cerebellar stroke.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1583/04-1203.1 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Malpositioning of a Central Venous Catheter in the Vertebral Vein Through the Cervical Transverse Foramen: A Case Report.
Cureus
December 2024
Department of Neurosurgery, Kohka Public Hospital, Kohka, JPN.
Central venous catheters (CVCs) are commonly used for multiple clinical purposes. The internal jugular vein (IJV) is preferred among the most frequently used insertion sites due to its higher success rates and lower complication risks. Although CVC placement is generally considered a safe procedure, several complications have been reported.
View Article and Find Full Text PDFPerformance of the CT-Guided C1-C2 Facet (Lateral Atlantoaxial Joint) Injection.
AJNR Am J Neuroradiol
January 2025
University of Utah Department of Radiology and Imaging Sciences (D.A., T.A.H., L.M.S., M.E.P.), Salt Lake City, Utah.
CT-guided C1-C2 facet joint injections are a valuable tool for managing cervicogenic headaches caused by degenerative and inflammatory conditions of the atlantoaxial joint. This video article presents the procedural technique for a CT-guided C1-C2 facet joint injection in a patient with left-sided cervicogenic headache. Despite concerns regarding potential complications such as vascular injury to the vertebral artery and nerve injury to the C2 dorsal root ganglion, careful anatomic planning and imaging guidance allows safe and effective treatment.
View Article and Find Full Text PDFNovel Fusion Imaging of Muscle, Plaque, Arteries, and Bone Using MR Imaging for Carotid Endarterectomy Patients.
World Neurosurg
January 2025
Department of Neurosurgery, Ken-o-Tokorozawa Hospital, Tokorozawa, Saitama, Japan.
Background: Indications for carotid endarterectomy (CEA) and reduction of complications require evaluation of the plaque properties and location of the distal end of the plaque. High cervical location can be predicted from the anatomy of the vertebral body and mandibular bones, and the locations of the posterior belly of the digastric muscle and stylohyoid muscle. Magnetic resonance (MR) imaging without contrast medium is useful for preoperative evaluation of the plaque, arteries, and bone characterization.
View Article and Find Full Text PDFC2 Vertebra: An Enigma for Young Spine/Neurosurgeons.
J Neurol Surg B Skull Base
February 2025
Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Instrumentation of C2 vertebra is considered the most difficult for young neurosurgeons and trainees due to its complex anatomical structures, variety of surgical approaches and techniques, and proximity to important neurovascular structures. Key points from a surgical perspective for midline posterior approach is described in the era of neuroradiological advancements. Computed tomography angiographies (CTAs) of a total of 92 patients were evaluated with special attention to the key findings for insertion of screws for craniovertebral junction (CVJ) fixations.
View Article and Find Full Text PDFUse of Preoperative Spinal Angiography in Severe Spinal Deformity Patients Who Require Thoracic 3 Column Osteotomy: A Case Series and Review of the Literature.
Oper Neurosurg (Hagerstown)
January 2025
Department of Neurosurgery, NYU Langone Health, New York, New York, USA.
Background And Objectives: Three-column osteotomy (3CO) offers substantial spinal deformity correction. Thoracic neurovascular bundle sacrifice is often required, and anterior spinal artery (ASA) perfusion can be compromised. Spinal angiography allows localization of variable ASA vascular contribution.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!