Objective: Patients who undergo stent-assisted cerebral aneurysm coiling require long-term antiplatelet therapy (AT). Recently, the low-profile visualized intraluminal support (LVIS) stent (LS) has been available for cerebral aneurysm treatment in Japan as a new design braided stent with excellent wall apposition due to manipulation even if the parent artery is tortuous, like the carotid siphon. The aim of this study was to evaluate whether AT could be terminated without increasing the risk of ischemic events among patients who have undergone LS-assisted cerebral aneurysm coiling.
Methods: In all, 15 consecutive patients with 15 unruptured aneurysms who underwent LS-assisted cerebral aneurysm coiling and were confirmed to have neointimal formation by follow-up angiography at 3 months were evaluated in this study. All aneurysms were located in the internal carotid artery (ICA). Dual AT was given for 1 month, and then a single antiplatelet agent was given for 2 months until confirmation of neointimal formation. After confirmation of neointimal formation, AT was terminated. The incidences of ipsilateral ischemic events and stent occlusion, as evaluated by angiography or contrast-enhanced MRA, after termination of AT were prospectively assessed.
Results: During follow-up, no ipsilateral ischemic events (mean, 10.3 months; range, 3.1–19.8 months) occurred, and no stent occlusion (mean, 8.0 months; range, 1–17.5 months) was observed in any cases.
Conclusion: Termination of the antiplatelet drugs 3 months after the procedure may be safe who underwent LS-assisted coil embolization.
Objective: To introduce our experience of endovascular treatment for craniofacial arteriovenous fistula/malformation (AVF/M).
Methods: We retrospectively analyzed the medical records of 13 patients (7 females and 6 males) with craniofacial AVF/M who were treated between 2001 and 2017 in our institution. We classified into three categories including single AVF (sAVF), multiple AVF (mAVF), and arteriovenous malformation (AVM). Treatment plans included 1) curative embolization, 2) preoperative embolization, and 3) palliative embolization. These strategies were decided by the discussion with plastic surgeons in every individual case.
Results: Complete cure by embolization alone was obtained in all six patients with sAVF, in two among three patients with mAVF, and in none among four patients with AVM. Curative embolization was aimed at in eight patients, and complete cure obtained in all eight patients. Preoperative embolization was aimed at in three patients, and three patients resulted in total resection by surgery after successful partial embolization. Palliative embolization was aimed at in two patients, and these patients were kept in a stable condition after partial embolization. No permanent complications related to embolization were counted.
Conclusion: Endovascular treatment for craniofacial AVF/M is safe and effective treatment, especially in the case with sAVF.
Objective: We report a patient in whom encephalopathy developed after coil embolization of an unruptured basilar artery aneurysm and stent placement for vertebral artery stenosis.
Case Presentation: A 69-year-old female. When the unruptured basilar artery aneurysm was treated with coil embolization, a balloon-expandable stent was placed for left vertebral artery stenosis, and treatment was completed without complication. Loss of appetite and lightheadedness developed from 2 weeks after discharge, and multiple FLAIR high-intensity areas, and nodular contrast enhancement in the left vertebral artery territory were observed on MRI. Steroid pulse therapy was performed suspecting metal allergy and foreign body granuloma, and symptoms improved.
Conclusion: Encephalopathy associated with foreign body granuloma and metal allergy may be caused by coil and stent placement. Patients should be sufficiently interviewed, and when allergies are suspected, reconsideration of the treatment method may be necessary in advance.
Objective: We report a patient in whom direct puncture of the superior ophthalmic vein for a cavernous sinus dural arteriovenous fistula led to rapidly progressing thrombosis and postoperative non-arteritic ischemic optic neuropathy (NA-ION), and review the pathogenesis.
Case Presentation: A 74-year-old female. Detailed examination of diplopia and visual disorder suggested a cavernous sinus dural arteriovenous fistula. As approaching via a posterior route was difficult, transvenous embolization by direct puncture of the superior ophthalmic vein was performed. As drainage routes were aggregated around this vein, thrombosis of this vein occurred, inducing postoperative NA-ION through a rapid change in hemodynamics.
Conclusion: When performing direct puncture of the superior ophthalmic vein, puncture methods and heparinization should be considered after sufficiently investigating drainage routes.
Objective: We report a case of cavernous sinus dural arteriovenous fistula (CSdAVF) presenting with medulla oblongata dysfunction in parallel to thrombosis of a varix on a drainage route after transvenous embolization (TVE).
Case Presentation: A 76-year-old male presented with deep sensory disturbance. Cerebral angiogram revealed a right CSdAVF with retrograde venous drainage refluxing to the anterior medullary vein. A varix arising from the vein was buried in the medulla oblongata, and an edematous change was shown in the nerve tissue around the varix. TVE was successfully performed and the shunt flow completely disappeared. The neurological symptoms improved immediately after TVE. The following day after TVE, medulla oblongata dysfunction appeared again, which was more severe than that before TVE. MRI showed thrombosis and a volume increase of the varix, and an enlargement of edematous change in the nerve tissue around the varix. Administration of corticosteroids gradually improved neurological and imaging findings.
Conclusion: A varix on a drainage route can cause brainstem dysfunction in CSdAVF. Thrombosis of the varix may exacerbate neurological symptoms.
Objective: In transarterial embolization (TAE) of spinal epidural arteriovenous fistula (SEDAVF), it is essential to control the blood flow at the shunt point. We report a case of SEDAVF treated with TAE with occluding one of several segmental arteries (SAs) involved in the shunt using a balloon.
Case Presentation: A 68-year-old male presented with gait disturbance and bladder bowel dysfunction. Lumbar spinal MRI showed a dilated and tortuous vein around the spinal conus. Spinal angiography revealed a SEDAVF with intradural venous reflux through the epidural venous plexus fed by the branches of the right 2nd and 3rd lumbar arteries (L2 and L3). We infused 14% n-buthyl-2-cyanoacrylate (NBCA) from the feeder of the L2 under the flow control by occluding L3 using a balloon and achieved complete obliteration of the arteriovenous shunt.
Conclusion: In treatment of SEDAVF with feeders from several SAs, TAE with occluding one of the SAs using a balloon is a useful method.