Purpose: This retrospective research aimed to compare the efficacy of endovascular therapy (EVT) versus microsurgical treatment (MST) for elderly patients with aneurysmal subarachnoid hemorrhage (aSAH).

Methods: Elderly (>70 years) patients with aSAH who underwent aneurysm obliteration during 2007–2017 were selected from our hospital database and enrolled in this retrospective study. We reviewed each patient’s background, the severity of the aSAH, and aneurysmal characteristics that compelled EVT or microsurgery treatment and then compared the two treatment groups. A favorable primary outcome was defined by a modified Rankin scale (mRS) score of 0–3 at hospital discharge. The 78 patients formed two cohorts (39 patients each) based on their propensity scores for EVT or MST. We estimated the adjusted odds ratio, followed by a sensitivity analysis of the original 201 patients (118 with EVT and 83 with MST).

Results: In the propensity score-matched cohorts, favorable outcomes were observed in 33.3% and 7.7% of patients in the EVT and MST groups, respectively (p = 0.01). Results of the sensitivity analysis were similar to the main results.

Conclusion: The clinical outcomes for the elderly aSAH patients were better in the EVT group than in MST group.

Objective: We describe a male patient with covert sustained cognitive impairment who underwent endovascular treatment for severe stenosis in the left intracranial internal carotid artery (ICA).

Case Presentation: A 64-year-old man presented with transient dysarthria and dysphagia. Although he was alert, a cognitive evaluation revealed significant dysgraphia and a remarkable reduction in cognitive function. Diffusion-weighted imaging (DWI) revealed scattered high-intensity regions in the watershed area of the left cerebral hemisphere and severe stenosis in the C2 portion of the left ICA. Percutaneous transluminal angioplasty (PTA) was performed; a detailed examination revealed significantly improved cognitive function. One year later, the patient demonstrated further cognitive improvement, without any recurrent stroke.

Conclusions: We consider that patients with severe intracranial stenosis, who have covert cognitive decline without apparent sustained symptoms, might be promising candidates for revascularization. Higher brain function in patients with severe intracranial arterial stenosis should be carefully screened because cognitive decline might not be evident at the time of initial presentation.

Objective: We report a patient with intracranial hypertension associated with venous sinus stenosis due to tumor compression. Embolization of tumor feeding blood vessels reduced the tumor volume, improved venous sinus stenosis, and alleviated the symptoms of intracranial hypertension.

Case Presentation: The patient was a 46-year-old woman with chronic headache and blurred vision. Magnetic resonance venography (MRV) revealed stenosis of the right transverse-sigmoid sinus. Intracranial hypertension was diagnosed by lumbar puncture. A high-intensity 2-cm tumor was detected on T2-weighted magnetic resonance imaging (MRI), and the homogenously enhanced tumor was adjacent to the right transverse-sigmoid sinus. Cerebral angiography demonstrated tumor staining mainly from the right occipital artery (OA). Collateral venous flow was minimal. In such cases, resection and reconstruction of the involved sinus segment have a high risk of venous infarction. Accordingly, percutaneous transluminal angioplasty (PTA) was performed, but dilation of the stenosis was poor. Thus, feeder occlusion of the tumor was added and lumboperitoneal (LP) shunt was placed, alleviating the headache and blurred vision. Ten months later, reduction of the tumor volume and improvement of sinus stenosis were observed, and the LP-shunt system was removed. A decrease in tumor volume via feeder occlusion may lead to partial sinus decompression and increased venous flow, resulting in long-term clinical remission.

Conclusion: Transverse-sigmoid sinus stenosis can be a cause of intracranial hypertension, albeit rare. Embolization of the tumor is considered to be a treatment option for patients who cannot undergo resection.

Objective: Hereditary hemorrhagic telangiectasia (HHT) may be associated with paradoxical cerebral embolism caused by pulmonary arteriovenous malformation (PAVM). We present a case of HHT diagnosed by progressive anemia during anticoagulant therapy following mechanical thrombectomy.

Case Presentation: The patient was a 59-year-old woman who presented with acute stroke due to intracranial large vessel occlusion. Mechanical thrombectomy was successfully performed and the thrombus was retrieved. Postoperatively, anticoagulant therapy was started; however, she developed progressive anemia, which was associated with marked weakness, although no bleeding source was detected. Thorough postoperative imaging studies revealed PAVMs, which may be a source of cerebral embolism. It was noted that she frequently had episodes of epistaxis and a family history of PAVM. Embolization of PAVMs was performed to prevent the recurrence of embolic disorders. After this procedure, anticoagulant therapy was safely discontinued, which resulted in the improvement of anemia.

Conclusion: Physicians need to consider the possibility of HHT associated with PAVM which can cause paradoxical cerebral embolism.

Object: We report a case of endovascular surgery for subarachnoid hemorrhage (SAH) that developed in early pregnancy.

Case Presentations: An 8-week pregnant 35-year-old female was admitted to our hospital with severe headache and loss of consciousness. Cephalic computed tomography (CT) revealed SAH (Hunt and Hess grade II). Digital subtraction angiography (DSA) demonstrated a 2.7 mm aneurysm at the right internal carotid artery-posterior communicating artery (IC-PC) bifurcation. We prioritized maternal treatment. Cerebral aneurysm coil embolization was performed on the 1st day under general anesthesia. During the operation, we tried to avoid irradiating the fetus by limiting the irradiation range and time. She was discharged on the 36th day of illness and gave birth to a 2532-g baby at 36 weeks of gestation.

Conclusion: If SAH develops in early pregnancy, it is necessary to prioritize maternal treatment. Endovascular surgery should be considered as a treatment option.

Objective: We aimed to investigate the efficacy of the insertion-support guiding catheter (ISGC) for approaching target lesions during endovascular therapy in patients with severe atherosclerotic or tortuous arteries.

Case Presentations: The ISGC is an 8 Fr, JB2 shape, stiff-type, short guiding catheter. We used ISGC for 52 patients between April 2007 and March 2018, microcatheters or therapeutic devices were delivered to target lesions via ISGC in 46 (88.4%) of the 52 patients, and none of them developed associated complications. Herein, we present three representative cases.

Conclusions: An ISGC is useful for vascular intervention in patients with atherosclerotic or tortuous arteries.