Cerebral air embolism treated with endovascular flow reversal and suction aspiration

Cerebral air embolism is a rare but potentially devastating complication of endovascular intervention. The treatment for cerebral air embolism is often limited to hyperbaric oxygen therapy, anticonvulsants, high-flow oxygen, and a wait-and-see approach. Endovascular aspiration has been reported recently as a possible treatment option for large-vessel occlusion. We present a case in which a different endovascular treatment approach was used to manage air embolism encountered during endovascular therapy of a cerebral aneurysm. In this patient, we used a combination of flow reversal and suction to remove the air embolus. Keywords: Cerebral air embolism, Endovascular, Flow reversal, Suctio

High-resolution magnetic resonance imaging of intracranial aneurysms treated by flow diversion

Object: Flow diverter treatment of intracerebral aneurysms is highly successful and has low rates of morbidity and mortality. Among the primary concerns after endovascular treatment are failure to achieve aneurysm obliteration and recurrence, and close imaging follow-up is required. High-resolution magnetic resonance imaging (HRMRI) is being employed in evaluation of an increasingly wide variety of pathological conditions, but investigations into its use after flow diversion for aneurysm treatment have been limited. We present a brief overview of the literature on the use of HRMRI as a follow-up tool after aneurysm treatment using flow diversion, along with a case series describing three patients in whom we used HRMRI to assess aneurysm treatment response. Case descriptions: Patient 1 presented with an ischemic stroke and was found to have an unruptured ophthalmic segment aneurysm. Patient 2 presented with subarachnoid hemorrhage from a ruptured vertebral artery pseudoaneurysm. Patient 3, on workup for possible metastatic melanoma, was found to have an unruptured posterior communicating aneurysm. All three were treated with flow diversion, and in all three cases HRMRI was used to evaluate aneurysm obliteration on outpatient follow-up. HRMRI offered excellent resolution of the parent vessel, aneurysm sac, and aneurysm wall, demonstrating decreased or loss of flow-related enhancement in the aneurysm lumen and development of aneurysm sac thrombosis. Conclusion: HRMRI is a useful tool to evaluate aneurysm treatment by flow diversion and may represent an alternative to repeat digital subtraction angiography. Keywords: High-resolution MRI, Flow diverter, Aneurys