...an Amplatzer vascular plug (St. Jude) was delivered at the most proximal end of the vertebral artery to provide a durable occlusion Figure 3. ...a careful evaluation of the angiographic findings ...in patients with an extradural AVF in the thoracolumbar region should be performed to look for the presence of an intradural drainage, as purely extradural AVFs are very uncommon in that region.
Abstract The emergence of dabigatran, rivaroxaban and apixaban has changed the approach to anticoagulation for patients worldwide. Continued approval of novel oral anticoagulants (NOAC) for ...non-valvular atrial fibrillation and venous thromboembolism will result in increasing use of these medications over warfarin. Morbidity and mortality of anticoagulant related intracranial hemorrhage (ICH) is relatively high and there is concern that outcomes may be worse with NOAC as there is a lack of specific antidotes for these agents with a greater risk for hematoma expansion. Unfortunately, the evidence supporting effective reversal strategies is lacking. Therefore, to gain further insight into the outcome after the management of NOAC related ICH, we present our experience with two patients with NOAC-induced ICH.
Onyx HD 500 (eV3, Irvine, CA) is a high-viscosity liquid embolic agent that has recently been approved in the United States as a humanitarian use device for the treatment of wide-neck sidewall ...intracranial aneurysms. Preliminary evidence suggest that liquid embolic agents can provide improved angiographic results with a lower incidence of recanalization compared to coil embolization.
To report unstable Onyx casts and how to deal with them.
We report 4 cases of intracranial aneurysms treated with Onyx HD 500 in which, after the aneurysm was successfully obliterated, the Onyx cast was noted to have 1 of 2 types of embolic cast instability. In all 4 cases, an intracranial stent or vascular reconstruction device (VRD) was placed across the Onyx cast at the aneurysm orifice and the cast was stabilized.
This series is the first published description of Onyx HD 500 aneurysm cast instability. It is also the first report of using a stent or vascular reconstruction device rescue technique to secure an unstable Onyx cast and represents a new indication for these devices.
“Contrast-Less” Stent-Assisted Coiling of an A1 Aneurysm Munich, Stephan A., MD; Theessen, Heike, RT; Johnson, Andrew K., MD ...
Journal of stroke and cerebrovascular diseases,
10/2014, Letnik:
23, Številka:
9
Journal Article
Recenzirano
Background Iodine-based contrast medium used in diagnostic and therapeutic cerebrovascular imaging may cause renal toxicity, especially in patients with underlying renal impairment. Contrast dilution ...may impede efforts of the neurointerventionalist to treat intracranial vascular pathology. Methods A 36-year-old man with renal impairment presented with an unruptured A1 segment anterior cerebral artery aneurysm. Previously obtained magnetic resonance angiography was fused with intraoperative noncontrast computed tomography and live 2-dimensional fluoroscopic images. The aneurysm was successfully treated with stent-assisted coil embolization without the use of contrast. Results Neurointervention without contrast was feasible, and although the presented case is one example, the imaging fusion techniques used in this case can substantially decrease the exposure to contrast and subsequent risk of renal injury during intracranial procedures. Conclusions Further development of and experience with this technique is needed to improve its safety and efficacy.
INTRODUCTION Flow-diverters have revolutionized the endovascular treatment of intracranial aneurysms, offering a durable solution to aneurysms with high recurrence rates after conventional ...stent-assisted coiling. Events that occur after treatment with flow-diversion, such as in-stent stenosis (ISS) are not well understood and require further assessment. METHODS Six Pipeline Flex embolization devices (PED-Flex), six PED with Shield technology (PED-Shield), and four Solitaire AB devices were implanted in the carotid arteries (two stents per vessel) of four pigs. Intravascular optical coherence tomography (OCT) and digital subtraction angiography (DSA) images obtained on day 21 were compared to histological specimens. RESULTS A case of ISS in a PED-Flex device was assessed with OCT imaging. Neointima with asymmetrical topography completely covering the PED struts was observed. Histological preparations of the stenotic area demonstrated thrombus on the surface of device struts, covered by neointima. CONCLUSION This study provides evidence that endothelized thrombus is an underlying mechanism for ISS in flow-diverters. We postulate that similar cases of ISS are related to thrombus presence underneath endothelization, providing an explanation for stenosis occurrence and its reversibility.
Cerebral arteriovenous malformations (AVMs) have an estimated 2-4% annual risk of hemorrhage. Treatment options for AVMs include microsurgical resection, stereotactic radiosurgery, and endovascular ...embolization. As endovascular technology and techniques continue to advance and mature, endovascular embolization is becoming an increasingly vital component of AVM treatment not only as a presurgical treatment to reduce microsurgical risks, but also as a stand-alone curative method in some cases. This case illustrates the successful and curative transarterial embolization of a right frontal AVM in a 17-year-old boy with ethylene-vinyl alcohol copolymer (Onyx). The video can be found here: http://youtu.be/L4hE1MvCZCY .
Y-stent-assisted coiling is a technique used by neuroendovascular surgeons to treat complex, wide-necked, bifurcation aneurysms in locations such as basilar tip and middle cerebral artery ...bifurcation. Several recent studies have demonstrated low complication rate and favorable clinical and angiographic outcomes. The Y-stent technique is illustrated here in detail and the intraoperative nuances are also discussed to minimize potential complications associated with technique. The video can be found here: http://youtu.be/77pEmqx_fyQ .
Until recently, wide-necked aneurysms were not considered amenable to treatment with coil embolization. The recent introduction of intracranial stents has provided a method of preventing coil ...migration out of wide-necked aneurysms. The Neuroform2 Treo is a modification of the Neuroform stent; the new version has a higher metal/artery ratio. The authors' initial experience with the use of this stent in combination with coil embolization to treat widenecked intracranial aneurysms is reported and technical considerations are discussed.
The authors' first 10 consecutive patients with wide-necked intracranial aneurysms were included in this study. Inclusion criteria restricted the group to adult patients with wide-necked intracranial aneurysms (ruptured and unruptured lesions). A wide neck was defined as a dome/neck ratio of less than 2 or a neck that was 4 mm or wider as measured on angiograms. Immediate postprocedure angiography studies were performed to determine successful coil occlusion of the aneurysm as well as patency of the parent vessel. Six-month follow-up angiograms were obtained in all patients. Ten aneurysms with poor dome/neck ratios (< 2) were studied in 10 patients. In all cases the stent was delivered to the aneurysm site and positioned without difficulty. No branch artery compromise was observed. A technical difficulty occurred in one case, with prolapse of a coil into the parent vessel, which was successfully corrected with no adverse clinical effects. There were no clinical or neurological complications associated with endovascular treatment of aneurysms in this series. One patient required further coil embolization because of findings on the 6-month follow-up cerebral angiogram.
The Neuroform2 Treo navigates similarly to the Neuroform2, with the advantage of increased aneurysm neck coverage. This feature may lower the retreatment rates for wide-necked cerebral aneurysms.
The primary correlate to survival and preservation of neurologic function in patients suffering from an acute ischemic stroke is time from symptom onset to initiation of therapy and reperfusion. ...Communication and coordination among members of the stroke team are essential to maximizing efficiency and subsequently early reperfusion. In this work, we aim to describe our preliminary experience using the Join mobile application as a means to improve interdisciplinary team communication and efficiency.
We describe our pilot experience with the initiation of the Join mobile application between July 2015 and July 2016. With this application, a mobile beacon is transported with the patient on the ambulance. Transportation milestone timestamps and geographic coordinates are transmitted to the treating facility and instantly communicated to all treatment team members. The transport team / patient can be tracked en route to the treating facility.
During our pilot study, 62 patients were triaged and managed using the Join application. Automated time-stamping of critical events, geographic tracking of patient transport and summary documents were obtained for all patients. Treatment team members had an overall favorable impression of the Join application and recommended its continued use.
The Join application is one of several components of a multi-institutional, interdisciplinary effort to improve the treatment of patients with acute ischemic stroke. The ability of the treatment team to track patient transport and communicate with the transporting team may improve reperfusion time and, therefore, improve neurologic outcomes.
PDF
