Intravascular ultrasound (IVUS) provides endoluminal views and cross-sectional images of carotid arteries but lacks overview of vascular territory provided by angiography. Co-registration of IVUS ...with angiographic images may provide the potential to navigate both imaging modalities in a synchronous manner. The objective of this study is to evaluate the feasibility and accuracy of co-registering both imaging modalities in the carotid vasculature of the neck.
Fourteen patients with 15 cervical carotid artery lesions underwent angiography and subsequent treatment. In each case, an IVUS catheter was advanced to the target lesion and a reference angiography sequence was acquired. This was followed by an electrocardiography-triggered fluoroscopy sequence that was initiated upon IVUS catheter pullback. IVUS data collected during pullback were registered with fluoroscopy and evaluated for error and clinical usability.
A total of 32 landmarks were identified that demonstrated reasonable agreement during IVUS–angiography co-registration. There was a mean registration error distance of 3.36 mm (SD 2.82 mm) between targets. The longitudinal extent and severity of the disease through the target segment could be easily evaluated after co-registration.
Semiautomatic tracking and co-registration of angiography and IVUS is a new technology and has the potential to increase the use of IVUS in carotid disease and to proivde the opportunity to optimize procedural outcomes.
Endovascular therapy of cerebral venous thrombosis using modern approaches to intracranial recanalization, such as stent retrievers and aspiration thrombectomy, is not well described. We performed a ...retrospective review of data for consecutive patients with venous sinus thrombosis who underwent endovascular treatment between 1 January 2010 and 31 December 2013 at participating institutions. We identified a total of 13 patients with a diagnosis of cerebral venous thrombosis. The most frequently utilized type of endovascular intervention was the Penumbra aspiration system (Penumbra Inc., Alameda, California, USA) (nine cases), followed by local infusion of tissue plasminogen activator (bolus and/or drip in six cases) and stent retrievers (Solitaire FR (Covidien, Irvine, California, USA) in three cases and Trevo (Stryker, Kalamazoo, Michigan, USA) in one case). Overall, multimodality treatment (two or more different types of devices or approaches) was performed in 62% of cases. Follow-up data were available for 11 patients; of those, five had a favorable clinical outcome (defined as modified Rankin Scale score of 0–2) and three patients died. Various endovascular approaches are utilized in current clinical practice. A multimodal approach to endovascular therapy for the treatment of cerebral venous thrombosis resulted in partial or complete restoration of flow in all cases, yet the mortality rate of 27% indicates the need for improvement in recanalization strategies for this disorder.
Abstract
OBJECTIVE
To report an operative technique using 2 microcatheters placed in different arterial pedicles for Onyx (ev3 Neurovascular, Inc, Irvine, CA) embolization of cerebral arteriovenous ...malformations (AVMs).
TECHNIQUE
Two cases illustrate this approach to embolization of AVMs. Microcatheters are placed in 2 different arterial pedicles of the AVM. Subsequently, the embolic material is injected in an alternate fashion between the microcatheters until occlusion of the AVM.
CONCLUSION
The 2-microcatheter technique for embolization of AVMs with Onyx was performed safely. The technique allowed for less interruptions of injection and better control of the reflux of Onyx in the arterial pedicle during treatment. This technique presents an alternate approach to conventional AVM embolization.
Cerebrovascular lesions can have complicated abnormal anatomy that is not completely characterized by CT or MR angiography. Although 3D rotational angiography provides superior spatial and temporal ...resolution, catheter angiograms are not easily registered to the patient, limiting the use of these images as a source for neuronavigation. However, 3D digital subtraction angiography (DSA) contains not only vascular anatomy but also facial surface anatomy data. The authors report a novel technique to register 3D DSA images by using only the surface anatomy contained within the data set without having to fuse the DSA image set to other imaging modalities or use fiducial markers.
A cadaver model was first created to assess the accuracy of neuronavigation based on 3D DSA images registered by facial surface anatomy. A 3D DSA scan was obtained of a formalin-fixed cadaver head, with acquisitions of mask and contrast runs. The right common carotid artery was injected prior to the contrast run with a 45% contrast solution diluted with water-soluble red liquid latex. One week later, the head was registered to a neuronavigation system loaded with the 3D DSA images acquired earlier using facial surface anatomy. A right pterional craniotomy was performed and 10 different vascular landmarks were identified and measured for accuracy using the neuronavigation system. Neuronavigation based only on 3D DSA was then used to guide an open clipping procedure for a patient who presented with a ruptured distal lenticulostriate aneurysm.
The accuracy of the measurements for the cadaver model was 0.71 ± 0.25 mm (mean ± SE), which is superior to the 1.8-5 mm reported for neuronavigation. The 3D DSA-based navigation-assisted surgery for the distal lenticulostriate aneurysm aided in localization, resulting in a small craniotomy and minimal brain dissection.
This is the first example of frameless neuronavigation based on 3D catheter angiography registered by only the surface anatomy data contained within the 3D DSA image set. This is an easily applied technique that is beneficial for accurately locating vascular pathological entities and reducing the dissection burden of vascular lesions.
Giant vein of Galen malformation in an adult Kerolus, Mena G., MD; Tan, Lee A., MD; Lopes, Demetrius K., MD
Radiology case reports,
09/2017, Letnik:
12, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Abstract Vein of Galen malformations (VoGMs) are rare vascular malformations resulting from persistent shunting of primitive choroidal vessels into the median prosencephalic vein of Markowski. VoGMs ...are associated with poor clinical outcome with a reported 76.7% mortality if left untreated. We present an exceedingly rare case of a giant, untreated VoGM measuring 7.8 × 5.5 × 7 cm in a 42-year-old man. The embryologic origin, classification, clinical manifestations, and treatment options of VoGMs are discussed with a review of pertinent literature.
Highlights • The presence of intraventricular hemorrhage (IVH) is a known risk factor for poor clinical outcome with up to 80% mortality. • The Apollo vibration/suction system can be used for ...minimally invasive IVH evacuation with minimal procedure-related complication.
BACKGROUND:The promising results of the Solitaire Flow Restoration (FR) With the Intention for Thrombectomy (SWIFT) trial recently led to Food and Drug Administration (FDA) approval of the Solitaire ...FR stent retriever device for recanalization of cerebral vessels in patients with acute ischemic stroke.
OBJECTIVE:To report the early postmarket experience with this device since its FDA approval in the United States, which has not been previously described.
METHODS:We conducted a retrospective analysis of consecutive acute ischemic strokes cases treated between March 2012 and July 2012 at 10 United States centers where the Solitaire FR was used as a single device or in conjunction with other intraarterial endovascular approaches.
RESULTS:A total of 101 patients were identified (mean age, 64.7 years; mean admission National Institutes of Health Stroke Scale NIHSS score, 17.6). Intravenous thrombolysis was administered in 39% of cases; other endovascular techniques were utilized in conjunction with the Solitaire FR in 52%. Successful recanalization (Thrombolysis in Myocardial Infarction 2/3) was achieved in 88%. The rate of symptomatic intracranial hemorrhage within the first 24 hours was 15%. In-hospital mortality was 26%. At 30 days, 38% of patients had favorable functional outcome (modified Rankin scale score ≤2). Severity of NIHSS score on admission was a strong predictor of poor outcome.
CONCLUSION:Our study shows that a variety of other endovascular approaches are used in conjunction with Solitaire FR in actual practice in the United States. Early postmarket results suggest that Solitaire FR is an effective tool for endovascular treatment of acute ischemic stroke.
ABBREVIATIONS:ASPECTS, Alberta Stroke Program Early CT scoreECASS, European-Australasian Acute Stroke StudyFDA, Food and Drug AdministrationICH, intracranial hemorrhageIV, intravenousmRS, modified Rankin ScaleNIHSS, National Institutes of Health Stroke Scale ScoresICH, symptomatic intracranial hemorrhageSWIFT, Solitaire FR With the Intention for ThrombectomyTIMI, Thrombolysis in Myocardial InfarctiontPA, tissue plasminogen activator
Highlights • Natalizumab is a known risk factor for developing PML. • Discontinuation of natalizumab can cause IRIS with mortality up to 29.4%. • We report a rare case of PML-IRIS successfully ...treated with hemicraniectomy.
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