Objectives: Although use of the small-sized catheters is less invasive for cerebral angiography (CA), difficult manipulability for tortuous vessels is a limitation. We report the clinical feasibility of a newly developed 3.3Fr catheter for CA in terms of manipulability.
Methods: The data of 80 consecutive patients who underwent CA via the femoral or radial arteries using the newly developed 3.3Fr catheter were analyzed retrospectively. The duration of the CA procedure and fluoroscopy procedure in patients who underwent CA using a 3.3Fr catheter were compared with those in patients who underwent CA using a 4Fr catheter. We also analyzed the data of 14 patients who underwent CA with the new 3.3Fr catheter and had previously undergone CA with a 4Fr catheter using the same procedures including access routes and selected vessels.
Results: CA was completed in all patients without any complications using the 3.3Fr catheter. The differences in the durations of CA and fluoroscopy were not statistically significant between the 3.3Fr and 4Fr catheter groups. There was also no significant difference in CA outcome in the 14 patients who underwent the same procedure using different sized catheters.
Conclusions: The newly developed 3.3Fr catheter is useful for CA and its manipulability is the same as that of the 4Fr catheter.

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Objective: We report the usefulness of magnetic resonance (MR) plaque imaging for treatment planning of cervical carotid artery stenosis. Carotid plaque lesions that show high-signal intensity on T1 weighted black-blood magnetic resonance imaging (BB-MRI) are regarded as high risk indicators for carotid artery stenting (CAS). We believe carotid endarterectomy (CEA) should be performed in such cases. We retrospectively examined the outcome of CAS in patients with plaques assessed by BB-MRI.
Methods: We electively performed CAS in 78 cases between September 2002 and March 2010. We also used BB-MRI to quantitate carotid artery stenosis, assess plaque characteristics before treatment, and evaluate the relative overall signal intensity (roSI), which we defined as the ratio of signal intensity in carotid plaques to that in sternocleidomastoid muscles.
Results: The average roSI was 1.20±0.31 and markedly higher (>1.5) in 7 lesions (9.0%). Ipsilateral diffusion-weighted imaging showed that lesions were new in 23 cases (37.1%). Within 30 days after surgery, 2 patients (2.7%) experienced stroke and myocardial infarction and eventually died.
Conclusions: Non-invasive preoperative MR plaque imaging is useful for screening patients with a high risk for CAS, and this screening can ensure safe outcomes after CAS.

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Objective: This study evaluates clinical outcome and magnetic resonance imaging (MRI) findings after carotid artery stenting (CAS) performed without post-dilatation.
Methods: Between January 2010 and April 2012, a total of 81 consecutive patients (57.6% symptomatic) underwent 85 CAS procedures performed with an embolic protection device (GuardWire; 25, FilterWire EZ; 60). All stents were deployed without post-dilatation. Periprocedural complications and mid-term outcome were analyzed.
Results: The stroke rate was 2.4% within 30 days after CAS (asymptomatic; 2.8%, symptomatic; 2.0%). Cerebral infarction occurred in one (2.8%) asymptomatic patient. Intracranial hemorrhage occurred in one (2.0%) symptomatic patient. Diffusion-weighted imaging (DWI) obtained after CAS showed a high-intensity area in 12 (14.1%) of 85 procedures. Ipsilateral stroke after 31 days occurred in one patient (1.2%). Restenosis occurred in 3.4% of patients. A comparison of the embolic protection devices showed no difference in stroke occurrence within 30 days and in DWI high-intensity area after CAS procedure.
Conclusions: Our CAS procedure without post-dilatation is feasible, safe, and associated with a low rate of stroke and restenosis.

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Objective: The applicability of virtual reality (VR) simulation to objective assessment of endovascular skills has been suggested. The aim of this study was to assess the role of a virtual reality simulator of interventional vascular procedures (VIST; Vascular Interventional Simulation Trainer, Mentice Corporation, Gothenburg, Sweden) in the assessment of endovascular skills required for coil embolization of cerebral aneurysms.
Methods: A study was conducted in 22 trainees with various levels of expertise in basilar tip aneurysm treatment. They were divided into two groups according to experience with the coil embolization procedure either as operators or assistants: <20 cases (beginners, n=12) and >21 cases (non-beginners, n=10). Quantitative (procedure and fluoroscopy time) and qualitative (VER%) parameters were recorded and assessed by the simulator.
Results: The total procedure and fluoroscopy time and average contrast media usage were the same in both groups. The VER was more than 40% in non-beginners and less than 40% in beginners, indicating that the beginners were inexperienced in performing the coil deployment procedure.
Conclusion: The structured assessment correlates well with the assessment using the high-fidelity simulator. In addition to improving endovascular training, the simulators may help determine the procedural competency and credentialing standards for endovascular surgeons.

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Purpose: To present a case of coil embolization of an ophthalmic artery aneurysm in a patient with a double-origin ophthalmic artery.
Case presentation: A 74-year-old woman presented to our hospital with dizziness. MRI revealed a right ophthalmic artery aneurysm. The ophthalmic artery consisted of a primitive dorsal ophthalmic artery (PDOA) and primitive ventral ophthalmic artery (PVOA). We embolized the aneurysm by occluding the PVOA, and observed no complications.
Conclusion: An aneurysm in an ophthalmic artery with two origins is rare. An understanding of the anatomy and hemodynamics is important for preserving visual acuity and decreasing embolic complications.

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Objective: We report a case of severe memory impairment after coil embolization for multiple cerebral aneurysms including a ruptured internal carotid (IC)-anterior choroidal artery aneurysm with hypoplastic posterior communicating artery.
Case presentation: A 34-year-old right-handed man suffered a sudden headache and was admitted to our hospital. Subarachnoid hemorrhage due to a ruptured aneurysm was diagnosed. Coil embolization of three cerebral aneurysms including an IC-anterior choroidal artery aneurysm was performed. After surgery, he had neither motor paresis nor sensory disturbance, but showed disorientation and both retrograde and anterograde amnesia. Although immediate recall and remote memory were almost intact, his recent memory was moderately impaired and his verbal and non-verbal memories were completely impaired. Brain magnetic resonance imaging revealed cerebral infarcts in the genu of the right internal capsule and splenium of the corpus callosum, and so on. We believe that memory impairment was because of damage to the Papez circuit with temporary interruption of the anterior choroidal artery.
Conclusion: Coil embolization for IC-anterior choroidal artery aneurysm may cause memory impairment because the thalamotuberal artery arises from the anterior choroidal artery in this case, and because temporary interruption of this artery damaged the Papez circuit directly. Therefore, we should pay attention to temporary interruption of the posterior communicating artery and anterior choroidal artery caused by coils or thromboembolic events.

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