Objective: Carotid artery stenting (CAS) in highsurgicalrisk patients is considered as an effective alternative to carotid endarterectomy (CEA). Since the occurrence of distal embolization with CAS is still a major concern, an embolus protection device is usually employed during the procedure. We examined the debris in the embolic protection filter and compared the characteristics of the debris with the characteristics of CEA specimens.
Materials and Methods: CAS was performed for 27 patients with carotid artery stenosis (28 lesions). After completing CAS, each filter membrane was stained with HematoxylinEosin (HE) solution, removed from the filter strut, mounted onto a glass slide, and evaluated under a microscope. Fortynine patients (49 lesions) were treated with CEA. Histopathological examination was performed with HE stain, Azan stain, and Elastica van Gieson stain. The characteristics of the debris were compared with those of the CEA specimens.
Results: HE stain facilitated the characterization of the debris. Microscopically, thrombotic debris, calcified debris, lipid-rich debris, fibrous debris, cellular debris, and strips of endothelium were observed.
Conclusion: Carotid plaque debris captured during carotid stenting with a protection filter can be visualized on the filter by HE staining. Almost all components of the carotid plaque are identifiable as debris.

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Objective: Recanalization of cerebral aneurysms after coil embolization remains a serious problem that influences treatment outcomes. Matrix2^TM is bioactive, bioabsorbable detachable coil that was developed for the purpose of reducing recanalization. However, the efficacy and safety of the Matrix2^TM coil remains controversial. This study compared the safety and efficacy of the Matrix2^TM coil with that of bare platinum coils.
Methods: We performed 99 endovascular embolizations of cerebral aneurysms between January 2007 and December 2009. The present study included 51 aneurysms for which followup angiography was performed within 1 year after coil embolization. Initial and followup occlusion status, the appearance of highintensity spots (HIS) on magnetic resonance imaging, and the appearance of the white collar sign (suggesting the formation of a neointimal layer) were evaluated.
Results: Initial occlusion status did not differ significantly between the bare coil (BC) group and the bioactive coil (BAC) group. However, the rate of further thrombosis was 9.38% in the BC group and 15.8% in the BAC group. In small or medium size aneurysm cases, a tendency toward higher rates of neointimal formation in the aneurysm neck (white collar sign) was seen for the BAC group (BC group: 6.3%, BAC group: 26.3%, p=0.11). However, the rate of appearance of HIS was significantly higher in the BAC group, but was associated with no discernible impact on clinical outcomes.
Conclusion: Compared with bare platinum coils, bioactive coils increase the frequency of further thrombosis and provide more durable results following coil embolization of cerebral aneurysms, especially in small or medium size aneurysm cases. However, due consideration must be given to the occurrence of embolic complications.

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Objective: We report a case with acute cerebral sinus thrombosis treated by a sliding balloon technique combined with local thrombolysis.
Case presentation: A 21yearold man presented at our outpatient clinic with headache, followed by rapidly progressing consciousness disturbance and respiratory failure. Angiography revealed occlusion of the superior sagittal and bilateral transverse sinuses. We immediately performed mechanical thrombectomy using a sliding balloon and local infusion of urokinase. The occlusive sinuses were rapidly recanalized, and the patient recovered remarkably.
Conclusion: Mechanical thrombectomy using a sliding dilated balloon with local infusion of urokinase is an effective method to treat acute, severe sinus thrombosis.

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Objective: We report a case of acute internal carotid artery (ICA) occlusion completely recanalized using a stent placement and the Merci retrieval system.
Case presentation: A 70yearold man presented with sudden onset of left hemiplegia and hemispatial neglect. MRI showed early ischemic changes in the right insular cortex and frontal cortex along with right ICA occlusion. Carotid ultrasonography and cerebral angiography demonstrated occlusion at the origin of the right ICA with atheromatous plaque and arterytoartery embolism to the distal intracranial artery. The occluded artery was successfully recanalized by stent placement at the origin of ICA and thrombectomy using a Merci retriever, resulting in neurological improvement.
Conclusion: It is important to diagnose the location and pathogenesis of acute ICA occlusion and then choose the appropriate method and devices for recanalization.

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Background: RenduOslerWeber disease (Hereditary Hemorrhagic Telangiectasia; HHT) is a cause of refractory epistaxis. Several treatments have been established for HHT epistaxis, but there are few reports about the use of superselective embolization for its treatment. We report a case of frequent epistaxis because of HHT in a patient whose condition was treated by superselective embolization with nbutyl 2cyanoacrylate (NBCA) using a triple coaxial system.
Case report: A 51yearold male, who had HHT, has been suffering from epistaxis in spite of several treatments by otorhinolaryngologist. The site of bleeding was visualized by angiography, and the superselective catheterization was applied to the branch of the sphenopalatine artery just proximal to the lesion. Complete embolization was achieved successfully with NBCA.
Discussion: Endovascular treatment appears to be effective for refractory HHT epistaxis. Superselective embolization may be essential so as to secure the access route to the lesion for repeated treatments because the epistaxis from HTT recurs frequently.
Conclusion: Superselective embolization may be a new option for HTT epistaxis.

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Objective: A case of posterior epistaxis treated using transarterial embolization with detachable coils is presented.
Case: A 54yearold man presented with continuous bleeding from the posterior turbinate despite packing with inflatable balloons and endoscopic cauterization. A presurgical angiography failed to indicate the bleeding site. Thus, the tip of a pair of forceps was attached to the bleeding site while an external carotid angiography was performed. This maneuver accurately revealed that the bleeding was from the proximal portion of the left posterolateral branch of the sphenopalatine artery. Then, the bifurcation of the left sphenopalatine artery was tightly packed with detachable coils. After the endovascular treatment and additional nasal packing, a complete cure was obtained.
Conclusion: Targeted embolization of the sphenopalatine artery with platinum coils is effective for cases with intractable posterior epistaxis.

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Objective: We present a new technique for measurement of cerebral blood volume (Neuro PBV) and visualization of the colorcoded digital subtraction image (iFlow) using a Carm flat detector angiographic system.
Techniques: The Neuro PBV data acquisition protocol consists of 2 rotations: an initial rotation (mask run) followed by a second rotation after injection of the appropriate contrast medium (fill run). The iFlow was performed with a routinely used digital subtraction angiography method using the following parameters: 15 frames/s, 15 s of data acquisition. The data acquired with the Neuro PBV technique and iFlow techniques were loaded on a workstation to evaluate image quality and compare images before interventional neuroendovascular treatment with those just after.
Result: No complications occurred during the examination. The Neuro PBV technique with intraarterial contrast medium was technically successful and provided feasible cerebral blood volume information. The iFlow images were also useful for identifying the changes in vascular velocity from before treatment to just after the treatment.
Conclusion: While further work is required to define its ultimate clinical utility, Neuro PBV and iFlow imaging may provide important information for the management of patients receiving interventional neuroendovascular treatment.

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