Objective: We report a case in which mechanical thrombectomy was performed via a low-profile visualized intraluminal support (LVIS) stent placed in the intracranial internal carotid artery (ICA).

Case Presentation: A 50-year-old female was presented in this study. LVIS stent-assisted coil embolization was performed on a right ruptured internal carotid artery blood blister-like aneurysm. Ten months after treatment, right middle cerebral artery (MCA) cardiogenic embolism develops. We tried to recanalize with an aspiration catheter device via the LVIS stent. But we abandoned due to the interference between the aspiration catheter device and the LVIS stent. Then, stent retriever device was deployed in the occlusion site, and the aspiration catheter was advanced over the stent retriever wire to the MCA, and stent retriever was removed in the aspiration catheter under continuous aspiration. We achieved a complete recanalization.

Conclusion: Even with the stent is deployed in the ICA, mechanical thrombectomy via a stent is one of the treatment options.

Objective: We report a rare case of a cerebellar infarction caused by a vertebral artery (VA) dissection resulting from an anomalous osseous process.

Case presentation: A 37-year-old man presented at our hospital, with right-sided sensory disturbance, visual field defect, and posterior neck pain. Magnetic resonance image (MRI) showed a small infarction in the left cerebellar hemisphere and MR angiography failed to demonstrate the left VA. Angiography of the left VA showed a stenosis at the C6 vertebral body level, which was occluded upon head rotation to the left. The stenosis and occlusion were caused by an anomalous osseous process in the C6 transverse foramen. Repeated compression of the VA by the anomalous osseous process might have caused its dissection. Because of repetitive ischemic symptoms, we planned endovascular occlusion of the left VA. His postoperative course was uneventful, and he was discharged without neurological deficits.

Conclusion: In the case of posterior circulation infarctions or VA stenosis/occlusion of unknown cause, it is important to recognize abnormal bone lesions in the cervical spine as the cause of the disease.

Objective: Subarachnoid hemorrhage with intracerebral hematoma (ICH) is usually treated with concomitant surgical clipping and ICH evacuation. However, aneurysm rebleeding is the most preventable cause of poor outcome, demonstrating a treatment strategy that leads to more rapid aneurysm obliteration without increased risk is meaningful. We report a case of craniotomy and clot evacuation after coil embolization for the ruptured middle cerebral artery aneurysm with ICH.

Case Presentation: A 59-year-old man, with a past history of hypertension, presented with a deep coma. CT scan demonstrated subarachnoid hemorrhage with left frontal ICH about 12 × 8 × 8 mm. CT angiography demonstrated a ruptured aneurysm in the early bifurcation of the left middle cerebral artery. An aneurysm and perforating artery were surrounded with hematoma, it is difficult to protect the aneurysm by surgical clipping in safety. We performed the coil embolization followed by clot evacuation. The patient was transferred to the rehabilitation hospital on day 40 with mRS 4.

Conclusion: Aneurysm coiling followed by ICH evacuation allowed for faster and safety aneurysm protection in this case, and which can be an alternative treatment option as well as direct surgery.

Objective: We report a technique for antegrade stenting of internal carotid artery stenosis with common carotid artery ostial stenosis.

Methods: The right femoral artery was punctured under local anesthesia. A guiding catheter was guided to distal of common carotid artery stenosis. We performed carotid artery stenting under distal protection of internal carotid artery with carotid Guardwire (GW). Second GW was inserted to the external carotid artery through interspace of stent strut, and inflated. Balloon-expandable stent was deployed for common carotid artery along with two GWs. We performed the procedure for two cases. Guiding catheter was stable during procedure. There were no intraoperative ischemic symptom and perioperative complications.

Conclusion: This method provides stability of guiding catheter and protection from distal embolism in antegrade stenting for internal carotid artery stenosis with common carotid artery stenosis.

Objective: Although endovascular thrombectomy for acute large vessel occlusion is recommended by Japanese Guidelines, the regional differences about the number of cases or available physicians remained problematic. The purpose of this study was to survey the current situation and the efforts initiated for improvements in endovascular thrombectomy in Chubu area branch of the Japanese Society for Neuroendovascular Therapy.

Methods: With the data collected from the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism (RESCUE)-Japan Project, a nation-wide survey, the number of endovascular thrombectomy cases and board-certified physicians in the eight prefectures in Chubu area (Aichi, Ishikawa, Gifu, Shizuoka, Toyama, Nagano, Fukui, Mie) were assessed.

Result: The average number of endovascular thrombectomy cases and board-certified physicians were 4.99 cases and 0.53 physicians per 100 000 people, respectively, in Chubu area. Though both were less than the national averages, these regional averages contained big differences among secondary areas in each prefecture. To improve these averages, various regional efforts are being performed.

Conclusion: In 2016, Chubu area had slightly less treatments and board-certified physicians per population than the national averages. However, various programs have been initiated in each prefecture, and dramatic improvements are expected.