Objective: The purpose of this study was to compare the clinical outcome of transarterial embolization for isolated sinus type dural arteriovenous fistula (iDAVF) using n-butyl-cyanoacrylate (NBCA) and Onyx.
Methods: Seventeen lesions of iDAVF in 17 patients who underwent transarterial embolization between March 2008 and February 2015 were retrospectively analyzed. They were treated by embolization using NBCA in 10 patients, Onyx in 5 patients, and combination of NBCA and Onyx in 2 patients. We compared the results between embolization with NBCA and Onyx as follows: complete occlusion rate, number of embolized vessels, procedure-related complications, treatment time, dose of radiation exposure, amount of contrast agent, and total cost of the devices.
Results: The complete occlusion rate of iDAVF was significantly higher in the Onyx group: 4 of 10 (40%) in NBCA and 5 of 5 (100%) in Onyx (P = 0.04). The number of treated vessels (5.1 ± 1.2 in NBCA, 1 in Onyx [P <0.001]), the maximum skin entrance dose (NBCA: 5030 ± 1646 [mGy], Onyx: 1670 ± 564 [mGy] in Onyx [P <0.01]), and total cost of the devices (601,265 ± 15,749 [yen] in NBCA, 374,210 ± 122,142 [yen] in Onyx [P <0.01]) were significantly higher in the NBCA. No significant difference was observed in the treatment time and contrast agent dose.
Conclusion: In transarterial embolization of iDAVF, a higher complete occlusion rate was obtained with Onyx, which was also advantageous for reducing the exposure dose and cost of the devices.
Objective: In mechanical thrombectomy for acute ischemic stroke, a positive outcome depends on short workflow time and successful recanalization. In this study, we retrospectively compared the recanalization times and rates in our initial experience of mechanical thrombectomy with stent retrievers and the old-type aspiration catheter system.
Methods: We retrospectively reviewed patients who underwent mechanical thrombectomy in author's hospital from November 2012 to April 2015, and compared parameters between patients treated with each device.
Results: Thirty patients who underwent mechanical thrombectomy in the following order were divided into three chronologically sequential groups (n = 10 patients in each) for evaluating interval trends: the first group of patients underwent thrombectomy using the old aspiration catheter system; second, first stent retrievers; and third, second stent retrievers. Although successful recanalization rates (thrombolysis in cerebral infarction score ≥2b) were not significantly different among the three groups (p = 0.122), puncture-to-recanalization duration or duration of final digital subtraction angiography was significantly longer for patients recanalized using the old aspiration catheter system compared with that of patients recanalized using stent retrievers (143, 59.5, and 51.5 min, respectively; p = 0.004).
Conclusion: Although both thrombectomy systems showed no significant differences in successful recanalization rates, the stent system permitted more rapid recanalization than the old aspiration catheter system.
Objective: Optical coherence tomography (OCT) has recently been applied for the characterization of carotid plaques, but few studies have compared OCT findings with findings from histopathologic examination of carotid plaques. We consider the accuracy, problems, and limitation of OCT findings by comparing OCT findings of carotid artery stenosis and pathological specimen of removed carotid plaque, and confirm that the interpretation of coronary artery findings of OCT can be applied to OCT findings of carotid artery plaque.
Case Presentation: A 63-year-old man with asymptomatic left carotid stenosis underwent carotid endarterectomy (CEA). Findings for histopathologic assessment of excised plaque were compared with those from preoperative OCT images at the same section levels. Preoperative OCT findings of carotid artery stenosis were similar to histopathologic examination of carotid plaques removed by CEA. This suggests that OCT has great ability to visualize pathological fibrous cap and ulceration and to visualize the structure of neovascularization in the neointima. However, OCT was unable to differentiate between lesions that were visualized in histopathological examination as lipid component, hemorrhagic transformation, and necrotic transformation.
Conclusion: The high resolution of OCT enables real-time acquisition of carotid plaque data. Although OCT is invasive examination, it may contribute to the evaluation of carotid plaque characterization.
Objective: A case of contrast-induced encephalopathy, a complication of intracranial endovascular treatment, in which the measurement of the iodine concentration in cerebrospinal fluid (CSF) was effective for the diagnosis is reported.
Case Presentations: An 85-year-old woman underwent coil embolization of an unruptured aneurysm at the left internal carotid artery-posterior communicating artery bifurcation. Since recurrence was noted after one year, additional coil embolization was performed. After the procedure, she presented with right hemiplegia and aphasia, and head CT scans immediately after the procedure showed high-density areas in the cortex and sulci of the left cerebral hemisphere. On the day after the procedure, the high-density areas disappeared, and the symptoms were resolved by conservative treatment. Since CSF analysis after the procedure demonstrated marked elevation of the iodine concentration, a diagnosis of contrast-induced encephalopathy was made on the basis of this finding along with the CT findings and symptomatic course.
Conclusion: Measurement of the iodine concentration in CSF immediately after endovascular treatment is useful for the diagnosis of contrast-induced encephalopathy.
Objective: We report a case in which coil embolization was selected for an aneurysm that caused subarachnoid hemorrhage but was difficult to judge whether it was true or false.
Case Presentations: A 78-year-old woman presented with severe subarachnoid hemorrhage. A wide-necked aneurysm was observed in the dilated internal carotid artery. We suspected senile atherosclerotic change, but blood blister-like aneurysm was also considered possible from the aneurysm morphology and dilation of the parent artery. Conservative treatment was initially selected, but as enlargement was noted in part of the aneurysm, coil embolization was performed as an emergency procedure, resulting in a stable postoperative course.
Conclusion: In case of urgency, endovascular treatment may be a permissible option when the judgment of whether the aneurysm is true or false is difficult.
Objective: Arterial fenestration is an unusual anatomic variation and is often associated with aneurysms. Aneurysm arising from the fenestration of the horizontal segment of the anterior cerebral artery (A1) is considered to be rare.
Case Presentation: We report a case of a 61-year-old man who presented with a subarachnoid hemorrhage secondary to a ruptured aneurysm of fenestrated A1 segment of the anterior cerebral artery. Cerebral angiogram revealed an aneurysm at right A1 fenestration. The aneurysm was embolized by coils, leading to complete occlusion, while preserving both channels of the fenestration. On the 11th postoperative day, the patient suffered cerebral embolic stroke due to paroxysmal atrial fibrillation and his left proximal middle cerebral artery was occluded. He is doing rehabilitation for right hemiparesis and aphasia but remains severely disabled.
Conclusion: Considering that dissection of fenestrated A1 aneurysms is sometimes difficult, and there are several branches from one or both channels of fenestration, endovascular therapy would have some advantages over the neck clipping.
Objective: Endovascular treatment of a patient with acute embolism of the brachiocephalic artery (BCA) is reported.
Case Presentations: A 70-year-old woman presenting with weakness of the right upper extremity was transferred to our hospital due to acute embolism of the BCA. After the right brachial artery was secured by direct cardiovascular surgery, a balloon guidewire was inserted through the femoral artery and advanced near the thrombus in the BCA, and the balloon at its tip was inflated in the right internal carotid artery. Immediately after this, the thrombus in the BCA migrated to the right common carotid artery and right subclavian artery. The two vessels could be recanalized by endovascular treatment via a guide catheter and via the right brachial artery, respectively.
Conclusion: In endovascular treatment for acute embolization of the BCA, the methods for thrombus retrieval and distal protection have not been established, and the concurrent direct surgery and cooperation by a cardiologist are indispensable.
Objective: The authors report a case treated using the Penumbra system for in-stent reocclusion after revascularization with stent for acute intracranial artery occlusion.
Case Presentations: The patient was a 37-year-old woman. Endovascular treatment was performed for acute occlusion of the M1 segment of the left middle cerebral artery, and recanalization was achieved eventually by placing an Enterprise Vascular Reconstruction Device (VRD). In-stent reocclusion was noted 9 hours after the procedure, and revascularization was achieved by aspirating the thrombus at the site of occlusion using the Penumbra system. Treatment using the Penumbra system was possible without interference by the stent.
Conclusion: Thrombectomy using the Penumbra system is an option for in-stent reocclusion after stent placement for acute intracranial large vessel occlusion.