Objective: The incidence of procedures for subarachnoid hemorrhage (SAH) in elderly people has increased recently as life expectancy has increased. We investigated clinical outcomes of SAH treatment with a coil-first strategy at our institution.

Methods: A total of 33 patients aged 80 or older who were treated for SAH between April 2010 and June 2017 were retrospectively reviewed (30 females, mean age 84.6 [80–93]) and divided according to the treatment method into a coil embolization group and a clipping group. Background and clinical outcome were compared between two groups, and cases that were difficult to treat were considered.

Results: The coil embolization group included 22 cases (66.7%), and the clipping group included 11 cases (33.3%). A good outcome, as defined by a Modified Rankin Scale score of 0-2 at discharge or 3-month follow-up, was more common in the coil embolization group (6/22; 27.3%) than in the clipping group (2/11; 18.2%), although there was no significant difference. Four of 11 cases in the clipping group (36.4%), however, had concurrent hematoma, which significantly affected outcome. In addition, some cases were difficult to treat because of advanced age.

Conclusion: The clinical outcome of coil-first SAH treatment involved few complications in elderly people, although a lower proportion of cases resulted in good outcome than in young people. Clipping, however, is necessary in some cases that are unsuitable for coil embolization. Tailored treatment and periprocedural general management might be also necessary due to multiple risks associated with advanced age.

Objective: To examine partially thrombosed intracranial aneurysm (PTIA) presenting as recurrence after treatment of ruptured aneurysm was examined.

Methods: Between April 2009 and June 2017, three patients with PTIA were treated with coil embolization.

Results: One patient underwent coil embolization at onset and recurred as PTIA, one patient underwent clipping at onset and coil embolization at recurrence and re-recurred as PTIA: one patient underwent clipping at onset and recurred as PTIA. The treatment procedures were as follows: The single microcatheter method using only one microcatheter was performed in one patient, and double microcatheter method was performed in two patients. Embolization results were as follows: one complete occlusion, two neck remnants. Asymptomatic cerebral infarction occurred in one patient. From 3 to 98 months, recanalization and bleeding episodes did not occur in any of the three cases.

Conclusion: Coil embolization could be one of the treatment options for PITA presenting as recurrence after treatment of ruptured aneurysm.

Objective: We report a case of carotid artery stenting (CAS) for stenosis associated with non-bifurcating cervical carotid artery.

Case Presentation: A 54-year-old man was presented with right frontal cortical infarction. On angiography, the right carotid artery appeared as a non-bifurcating cervical carotid artery, and 54% and 40% stenosis according to the North American Symptomatic Carotid Endarterectomy Trial method was observed at the second to third cervical vertebral level and fourth to fifth cervical vertebral level, respectively. CAS was performed using two occlusion balloons at the common carotid artery and distal internal carotid artery because of the findings of vulnerable plaque. No perioperative complications were encountered and the postoperative course was uneventful as of the 8-month follow-up.

Conclusion: Carotid artery stenosis associated with this anomaly is often seen near the bifurcation of the superior thyroid artery. CAS for non-bifurcating cervical carotid artery can be safely performed using a proper distal embolic protection device.

Objective: In this report, we describe a case of ruptured basilar artery fenestration aneurysm treated with double-barrel stenting.

Case Presentation: A 68-year-old female patient presented with subarachnoid hemorrhage. Examination revealed an unruptured small basilar artery tip aneurysm and a ruptured large basilar artery fenestration aneurysm. Double stenting was deployed from both basilar fenestration limbs into both distal vertebral arteries. Following stent deployment, the aneurysm was treated with coil embolization by using a jailed microcatheter.

Conclusion: A double-barrel stent-assisted technique is useful for the basilar artery fenestration aneurysm.

Objective: The radiation dose varies depending on fluoroscopic pulse per second (pps). When we got a new angio machine in 2014, fluoroscopic pps was set up only 12.5 pps in vessel protocol with cerebral angio machine. Moreover, reducing fluoroscopic pps might contribute to reducing patients' radiation dose and produces clinically useful images. Therefore, we preferred a company machine which created 6.25 fluoroscopic pps. To examine reduce of patients' radiation dose for reducing of fluoroscopic pps in cerebral angiography, we visually evaluated these phantom images (wire rotation phantom and low contrast).

Case Presentations: These images of 6.25 and 12.5 pps were equivalent quality for treating aneurysms of the basilar tip.

Conclusion: Results of comparison of exposure dose rates at interventional reference point show that the exposure dose rates using 6.25 pps were reduced more than 12.5 pps (maximum 51% and average 42%). These phantom images were equivalent quality. The method to use 6.25 pps fluoroscopic technique in neuroendovascular therapy is one of the effective radiation exposure reductions.

Objective: We report a mechanical thrombectomy strategy combined aspiration catheter with stent retriever without guiding catheter (GC) via transbrachial approach for a basilar artery (BA) occlusion.

Case Presentations: A 95-year-old female was transferred to our hospital because of impaired consciousness. BA occlusion was revealed on MRA. Because of type 3 arch on chest CT image, catheter access through transfemoral approach was thought to be difficult. A sheath was inserted into the right brachial artery. We did not use a GC to maintain antegrade blood flow to BA. An aspiration catheter was placed in the right vertebral artery. After a stent retriever was deployed across a clot, the aspiration catheter was advanced to the face of clot. We then removed the stent retriever and the aspiration catheter with pump-aspiration as a single unit into the sheath and complete recanalization was obtained.

Conclusion: The transbrachial approach mechanical thrombectomy is a useful option in patients who thought to be difficult to access through the transfemoral approach.