Double-Balloon-Assisted Coiling for Wide-Necked Posterior Communicating Artery Aneurysms with a Fetal-Type Variant of the Posterior Cerebral Artery: A Case Series

Endovascular treatment for wide-necked posterior communicating artery (PcomA) aneurysms with a fetal-type variant of the posterior cerebral artery (PCA) is often challenging. Since the complete occlusion rates achieved with the currently available treatment methods are unsatisfactory, we aimed to study the effectiveness of a double-balloon-assisted technique for these aneurysms. From September 2014 to August 2020, 6 consecutive patients with PcomA aneurysms with fetal-type PCAs and no previous treatment were treated with this technique at our institution (3 ruptured cases and 3 unruptured cases). The indication for this technique is that the neck of the aneurysm should significantly and broadly incorporate both the internal carotid artery and fetal-type PCA, such that a single-balloon remodeling and single stent would be inadequate to protect both the arteries. In all patients, the fetal-type PCAs were preserved without a stent and with adequate occlusion status. This double-balloon technique can be effective in the treatment of these aneurysms

Transvenous embolisation via an occluded inferior petrosal sinus for cavernous sinus dural arteriovenous fistulas

Aim of the study: We retrospectively searched for cases of transvenous embolisation for cavernous sinus dural arteriovenous fistulas.Materials and methods: Twenty-five cases underwent transvenous embolisation via the inferior petrosal sinus (IPS). IPS was probed using a standard 0.035-inch guidewire for microcatheter navigation, which was successful in all cases.Results: IPS was occluded in 17 cases (68%). Only one case experienced a complication, where the approach was changed to the contralateral side because of internal jugular vein injury. The relationship between the external auditory canal and the IPS route was reviewed in 18 cases using digital angiography (lateral view). The guidewire passed across, above, or below the external auditory canal in 10 (56%), six (33%), and two (11%) cases, respectively.Clinical implications: No previous reports have analysed the relationship between the external auditory canal and the IPS route. We present a safe and successful technique for approaching the cavernous sinus via the IPS

Second-stage pipeline embolization device treatment with coil embolization for large cerebral aneurysm prevents silent diffusion-weighted image ischemic infarction: a retrospective study

Abstract Background Second-stage flow diversion with coil embolization may improve occlusion outcomes and reduce periprocedural complications in patients with cerebral aneurysm. However, the actual cause behind this is unclear. In this study, we aimed to compare the efficacy and safety of second-stage pipeline embolization device (PED) and single-stage PED with coil embolization. Results Of the 22 treated patients with aneurysm, 10 and 12 were treated with second-stage PED and single-stage PED with coil embolization, respectively. The mean follow-up duration was 29.6 months. The mean numbers of diffusion-weighted image (DWI)-positive spots on day 1 post-procedure were 4.9 and 10.8 in the second-stage and single-stage PED with coil embolization groups, respectively (P = 0.01). Deterioration of the modified Rankin scale score was not ≥ 2 in any patient during follow-up in the second-stage PED group but was observed in 16.7% of cases (2/12) in the single-stage PED with coil embolization group (P = 0.48). On follow-up angiography, complete occlusion was observed in all patients (10/10) in the second-stage PED group and 66.7% (8/12) in the single-stage PED with coil embolization group (P = 0.09). Conclusions The second-stage PED strategy significantly reduces the number of DWI high-intensity spots, leading to the prevention of ischemic complications. This strategy may help to prevent complications and reduce morbidity

Dose measurement on both patients and operators during neurointerventional procedures using photoluminescence glass dosimeters

BACKGROUND AND PURPOSE: Although radiation skin injuries associated with interventional radiology have been known as a critical issue, there are few reports mentioning direct measurement of the entrance skin dose (ESD). Thus, the purpose of this study was to clarify the regional distributions of ESDs in neurointervention. \nMATERIALS AND METHODS: Using photoluminescence glass dosimeters (PLDs), we measured the ESDs in 32 patients with a median age of 61.5 years. Angiographic parameters, including exposure time, dose-area product (DAP), and the number of digital subtraction angiography (DSA) studies and frames, were recorded. The ESDs of operators were analyzed by the same method. \nRESULTS: The maximum ESD of 28 therapeutic procedures was 1.8 +/- 1.3 Gy. Although the averaged ESD on the right temporo-occipital region was higher than that in other regions, disease-specific patterns were not observed. Statistically positive correlations were found between the maximum ESD and exposure time (r = 0.5283, P = .005), DAP (r = 0.7917, P < .001), the number of DSA studies (r = 0.5636, P = .002), and the number of DSA frames (r = 0.8583, P < .001). As for operators, ESDs to the left upper extremity were significantly higher than those to other regions. However, most of the ESDs were <0.2 mGy. Lead protective garments reduced the exposure doses to approximately one half to one tenth. \nCONCLUSION: It was shown that the regional ESD could be measured by applying the PLD. This method should contribute to reducing the dose accumulation in patients as well as in operators

Treatment results and long-term outcomes of endovascular treatment of 96 unruptured anterior communicating artery aneurysms: A large single-center study

Objective: Data on endovascular treatment of unruptured anterior communicating artery (AcomA) aneurysms remain limited. Therefore, to clarify the outcomes of treatment for unruptured AcomA aneurysms, we retrospectively analyzed a single-center series of 96 unruptured AcomA aneurysms treated endovascularly. Methods: Endovascular treatment of 100 unruptured AcomA aneurysms was performed at our institution between May 2009 and May 2019; of these, 96 consecutive aneurysms (95 patients) were included in this retrospective study. Recanalization and retreatment rates were investigated for 76 aneurysms through follow-up using time-of-flight magnetic resonance angiography or digital subtraction angiography for ≥ 2 years after treatment. Results: The rate of total procedure-related complications was 19.8%. The rates of thromboembolic complications, hemorrhagic complications, and intraprocedural aneurysm bleeding were 12.5%, 6.3%, and 3.1%, respectively, with no poor outcomes (modified Rankin Scale score 2–6) resulting from thromboembolic and hemorrhagic complications at 180 days after treatment. The permanent morbidity rate was 1.0%. Multivariate analysis revealed that maximum diameter (>10 mm), neck size (>4 mm), and stent use were independently associated with symptomatic cerebral infarction. Endovascular retreatment was conducted for two aneurysms (2.6%), and the cumulative recanalization rate was 5.3% (4/76) over a mean follow-up period of 48.2 ± 23.7 months. Conclusion: This study indicates that although there is a relatively high possibility of overall procedure-related complications with endovascular treatment for unruptured AcomA aneurysms, most complications are temporary and mild, with a permanent morbidity rate of approximately 1.0%

Endovascular Treatment for Basilar Artery Occlusion Caused by Radiation-induced Vertebral Artery Stenosis: Case Report

Objective: We report endovascular treatment of a patient with acute basilar artery occlusion considered to be due to an embolus from radiation-induced vertebral artery stenosis.Case Presentation: The patient was a 46-year-old male with a history of neck irradiation. He developed basilar artery occlusion. Temporary recanalization achieved by intravenous alteplase therapy and revascularization was followed by relapse. The origin of the vertebral artery was stenosed, and basilar artery was considered to have been embolized by a thrombus formed on the proximal side of the vertebral artery, where blood flow was stagnated due to reduced antegrade flow from the distal side of the stenotic vertebral artery and the increased collateral flow from the deep cervical artery. Recurrence of cerebellar infarction could be prevented by revascularization and occlusion of the parent artery.Conclusion: Acute basilar artery occlusion considered to be due to an embolus from radiation-induced vertebral artery stenosis is a rare condition, but it must be recognized as a possible cause of posterior circulation infarction