Stent-assisted coiling in ruptured cerebral aneurysms: multi-center experience in acute phase.

INTRODUCTION: The purpose of this study is to report on a multi-center experience of ruptured intracranial aneurysms treated in acute phase with stent-assisted coil embolization, including primary success rates and midterm follow-up results. MATERIALS AND METHODS: Retrospective analysis was performed on a sample of 40 patients (14 men, 26 women, mean age 59.7 years) affected by ruptured saccular aneurysms and treated by stent-assisted coiling in acute phase; double antiplatelet therapy with clopidogrel bisulphate and acetylsalicylic acid was started after the procedure. Angiographic follow-up at 1 year was recorded. RESULTS: 20 % of the aneurysms were located in the posterior circulation, and 85 % presented a wide neck. Mean size of the sac was 7 mm (range 3-22 mm). Complete sac exclusion was obtained in 92.5 % and neck remnant in 7.5 %. The overall complications rate was 15 %. In 7.5 %, stent occlusion occurred intra-procedurally. In 12.5 %, re-bleeding was detected within 3 weeks after the procedure. Ischemic area related to the procedure was observed at follow-up in 7.5 %. Hydrocephalus developed in 15 %. 7.5 % presented with sac re-bleeding between 1 and 5 months after the procedure. In 15 %, the 3-6 months of follow-up revealed aneurysm refilling. 25 % of the patients presented vessel stenosis at the 1-year DSA of control. 33 % of the patients reported sensory-motor deficits. 82.5 % had a favorable outcome (GOS: IV-V), while 17.5 % presented a poor score (GOS: I-III). CONCLUSIONS: Stent-assisted coil embolization is a feasible endovascular treatment option for ruptured intracranial aneurysms, which is difficult to approach with simple coiling; however, neurointerventionalists need to consider a mild increase of post-procedural complications rate.

Basilar vascular system supplied by only right proatlantal intersegmentary artery type 1 with aneurysm and left internal carotid occlusion: a case report and review from the literature.

Persistence of proatlantal artery (PA) is a rare condition. More than 40 cases were described in the literature. Aneurysm may involve the PA itself in approximately 2% of cases, most arising from the internal carotid artery (ICA) side of PA. This case was particular because the PA showed a saccular aneurysm on the posterior wall, probably due to atherosclerosis disease and other alterations: plaque ulcerative of ICA, occlusion of left ICA, and aberrant right VA.

Vertebroplasty Using Calcium Triglyceride Bone Cement (Kryptonite™) for Vertebral Compression Fractures. A Single-Centre Preliminary Study of Outcomes at One-Year Follow-up.

This study assessed the one-year clinical and radiographic outcomes, in terms of pain-relief, vertebral re-fracture and complications, after vertebroplasty (VP) using a new osteoconductive cement (calcium triglyceride bone cement - Kryptonite™ bone cement, Doctors Research Group Inc., Southbury, CT, USA) to treat osteoporotic vertebral compression fractures. Sixteen consecutive osteoporotic patients (12 women and four men, mean age 68+/-10.5) were treated with VP using Kryptonite™ bone cement for a total of 20 vertebral fractures. All the patients complained of a pain syndrome resistant to medical therapy and all procedures were performed under fluoroscopy control with neuroleptoanalgesia using a monopedicular approach in 12 patients and bipedicular approach in four patients. All patients were studied by MR and MDCT and were evaluated with the visual analogue scale (VAS) and the Oswestry disability index (ODI) before treatment and at one and 12 months after the procedure. A successful outcome was observed in 80% of patients, with a complete resolution of pain. Differences in pre and post treatment VAS and ODI at one-year follow-up were significant (P<0.0001). We observed a disk and venous leakage in 66% of patients but only in one case did an asymptomatic pulmonary embolism occur during cement injection. Two cases of vertebral re-fractures at distant metamers were observed during follow-up. VP using Kryptonite bone cement is a helpful procedure that allows complete and long-lasting resolution of painful vertebral symptoms. The cost of the material is very high and the rate of disk and venous leakage is too high compared to standard cement.

Percutaneous treatment of symptomatic aneurysmal bone cyst of L5 by percutaneous injection of osteoconductive material (Cerament).

We present a case report of a 33-year-old woman with back pain for several months which was resistant to medical treatment. Thoracolumbar MRI and multidetector CT showed an aneurysmal bone cyst intersecting the body and pedicles of L5. Minimally invasive treatment was performed with percutaneous injection of osteoconductive cement (Cerament) to induce sclerosis and bone remodeling of the bone cyst lesion with an analgesic effect. Before treatment, spinal angiography was performed to exclude arterial afferents. No bone biopsy was done. Under general anesthesia and fluoroscopic guidance, a first vertebroplasty was performed by a bilateral transpedicular approach using the osteoconductive cement followed 2 months later by a second treatment with CT-fluoro-guided direct injection of Cerament. No complications occurred during the procedure. At 4 and 6 months follow-up the MRI/CT showed sclerotic bone remodeling of the walls of the aneurysmal cyst with clinical improvement.

Percutaneous treatment of symptomatic aneurysmal bone cyst of L5 by percutaneous injection of osteoconductive material (Cerament).

We present a case report of a 33-year-old woman with back pain for several months which was resistant to medical treatment. Thoracolumbar MRI and multidetector CT showed an aneurysmal bone cyst intersecting the body and pedicles of L5. Minimally invasive treatment was performed with percutaneous injection of osteoconductive cement (Cerament) to induce sclerosis and bone remodeling of the bone cyst lesion with an analgesic effect. Before treatment, spinal angiography was performed to exclude arterial afferents. No bone biopsy was done. Under general anesthesia and fluoroscopic guidance, a first vertebroplasty was performed by a bilateral transpedicular approach using the osteoconductive cement followed 2 months later by a second treatment with CT-fluoro-guided direct injection of Cerament. No complications occurred during the procedure. At 4 and 6 months follow-up the MRI/CT showed sclerotic bone remodeling of the walls of the aneurysmal cyst with clinical improvement.