Purpose: In recent years, shortening the time from onset to recanalization has been shown to markedly affect the outcome of acute ischemic stroke. In our hospital, in order to shorten the time to recanalization at night hours with staff shortage, stroke care unit (SCU) nurses supported the outpatient clinic nurses during endovascular treatment from preparation to introduction. We hereby report the contents and results of the training we conducted toward the SCU staff.
Materials and Methods: The following methods were used to educate 12 SCU nurses with the knowledge and skills necessary to provide support in acute-phase cerebral endovascular treatment: 1) training in the catheterization laboratory, 2) manual production for acute-phase recanalization therapy, 3) simulation training, and 4) production of a digital video disc (DVD) as an audiovisual teaching material. The effects of these methods were evaluated using a questionnaire.
Results: By the end of the training, 11 of the 12 SCU nurses were able to perform the procedures of cerebral endovascular treatment from preparation to introduction. Results of the questionnaire showed that these educational methods reduced SCU nurses' anxiety, and the knowledge provided by these methods could be utilized in clinical setting. Following the given training methods, the time from the patient's arrival at the hospital to acupuncture could be reduced by 22 minutes.
Conclusion: The nurses were able to acquire the knowledge and skills necessary to participate in acute-phase cerebral endovascular treatment by gaining experience through training in the catheterization laboratory, simulation training, and repeated image training using the manual and DVD. As a result, their anxiety decreased and the nurses became able to participate in the actual operation. The results suggest the usefulness of these educational methods.
Purpose: The assessment of the cerebral perfusion volume using single photon emission computed tomography (SPECT) is performed for patients with ischemic cerebral disease. In this study, we evaluated the cerebral blood flow volume by computational fluid dynamics (CFD) analysis using normal blood vessels. This was compared with the cerebral perfusion volume measured on SPECT to evaluate the relationship between the two parameters.
Material and Methods: We investigated the normal-side blood vessels without lesions, such as stenosis/occlusion, in four patients with cerebrovascular disease in whom the cerebral perfusion volume was measured using SPECT. CFD analysis was conducted using the vascular geometry reconstructed from respective CTA images. The blood flow volume in the M2-anterior region as a percentage of the total middle cerebral artery blood flow volume was defined as the mass flow rate (MFR*) on CFD and perfusion rate (PR*) on SPECT. The two parameters were compared.
Results: In four patients with normal blood vessels, the MFR*/PR* ratio was ≤1. The MFR* was approximately 0.30, whereas the PR* was approximately 0.50; the results of measurements on SPECT were higher.
Conclusion: In normal blood vessels, the results of SPECT measurement were slightly higher than those of CFD analysis. In the future, the relationship between CFD and SPECT should be further investigated in a larger number of patients. CFD analysis may facilitate the estimation of the cerebral perfusion volume in cerebral metabolism on SPECT.
Objective: We report a case of embolic stroke due to a thrombosed cerebral aneurysm that underwent mechanical thrombectomy.
Case Presentation: A 39-year-old female was brought to our hospital by an ambulance with sudden left hemiparesis and dysarthria. Detailed examination revealed a partially thrombosed aneurysm of the right internal carotid artery and embolism of the right middle cerebral artery. Emergent mechanical thrombectomy was performed, and thrombolysis in cerebral infarction (TICI) 2b recanalization was achieved. There was no other potential source of cerebral embolism, and the thrombosed aneurysm was considered an etiology for the embolism. After the endovascular treatment, antiplatelet and anticoagulant therapies were conducted, leading to the disappearance of the intra-aneurysmal thrombus.
Conclusion: Mechanical thrombectomy is effective for embolic stroke due to an unruptured thrombosed cerebral aneurysm if devices are carefully manipulated in an area adjacent to the aneurysm.
Introduction: The authors report three patients with tiny aneurysms for whom coil embolization was performed, evaluating them as the source of hemorrhage on subsequent angiogram based on follow-up CT findings of residual hematomas although each aneurysm was not recognized as the site of rupture on imaging early after the onset of subarachnoid hemorrhage.
Case Presentations: Case 1: A 44-year-old female with a basilar-superior cerebellar artery aneurysm. The presence of an aneurysm was suspected, but it was very small, and it could not be concluded as the source of hemorrhage. Case 2: A 66-year-old male with an internal carotid artery aneurysm. A tiny aneurysm was detected, but it could not be concluded as the source of hemorrhage based on the distribution of hemorrhage. Case 3: A 58-year-old female with a basilar artery aneurysm. Initially, imaging did not reveal this aneurysm, and other aneurysms were treated. In all patients, these were evaluated as ruptured aneurysms during the course based on changes in CT and angiography findings, and coil embolization was performed. There has been no recurrence.
Conclusion: Angiography based on CT findings of residual hematomas is useful for estimating the rupture of tiny aneurysms.
Objective: We encountered a patient with chronic headache due to intracranial hypertension associated with venous sinus stenosis. The symptom was alleviated after stent placement at the site of stenosis.
Case Presentation: The patient was a 33-year-old man with chronic headache as a chief complaint. MRI revealed stenosis of the right transverse and occipital sinuses. Intracranial hypertension was diagnosed by a lumbar puncture. Although lumboperitoneal shunting was performed after conservative treatment, no symptomatic improvement was observed. The venous pressure was measured at the time of cerebral angiography. Since intracranial hypertension and a transstenotic venous pressure gradient were observed, stent placement was performed, resulting in alleviation of headache.
Discussion: Transverse sinus stenosis can be a cause of intracranial hypertension although rarely. Stent placement is considered to be a treatment worth attempting in patients who resist medical treatments or cerebrospinal fluid shunting.
Objective: We report a patient who underwent one-stage bilateral vertebral artery (VA) occlusion to prevent recurrent ischemic stroke after atlanto-axial fracture with traumatic bilateral VA injuries (VAIs).
Case Presentation: A 78-year-old male with cervical pain and horizontal nystagmus after head injury as he fell down at the stairs. Cervical CT revealed atlanto-axial fracture without severe dislocation. MRI showed acute ischemic stroke in bilateral cerebellar hemisphere. Emergent cerebral angiography revealed bilateral VAIs. Based on the findings of the balloon test occlusion, one-stage bilateral VA occlusion was performed without any complication. After the procedure, there was no new neurological symptom or ischemic lesion on MRI.
Conclusion: For patients with traumatic VAI, treatments should be considered based on both the presence of ischemic symptoms and angiographic morphologies of lesions.
Objective: We report a rare case of neurofibromatosis type 1 (NF-1) presenting with myelopathy due to the vertebral arteriovenous fistula (AVF), and major intracranial artery occlusions with moyamoya-like vessels.
Case Presentation: A 66-year-old woman of NF-1 suffered from neck pain, tetraparesis, and sensory disturbance of gradual onset. Cervical MRI showed a huge flow void, and the spinal cord was strongly compressed by the dilated vessels. Vertebral angiography revealed the AVF at the level of C4/5 fed by the left vertebral artery and drained into the dilated epidural spinal vein between C2 and C5 via the intervertebral veins. In addition, carotid angiography showed the occlusion of the right internal carotid artery and the left anterior cerebral artery associated with moyamoya-like vessels. She underwent endovascular treatment with careful attention to the intraoperative hypotension and the AVF was completely occluded. Her neurological symptoms were cured after the treatment.
Conclusion: We experienced a rare case of NF-1 coexisted with the vertebral AVF and moyamoya syndrome. In such a complicated condition, discreet attention for possible cerebral hypoperfusion during the perioperative period should be paid for the successful treatment.
Objective: The coil-assisted technique (CAT) for delivering the wire or catheter to the vessel distal to large wide-neck intracranial aneurysms is described.
Case Presentations: We present three cases treated with this technique. The first coil placed in the aneurysm without detaching is used as a support of the wire or catheter in its passing through the aneurysmal neck. This technique was used in order to deliver a guidewire and a balloon catheter in two cases, and to deploy neck-bridge stent in one case.
Conclusion: CAT can be performed simply by changing the order of procedure without any use of additional devices. We think this technique might be useful in treating wide-neck intracranial aneurysms in order to get the distal vessel safely.