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BACKGROUND: T1-weighted (T1W) magnetic resonance imaging (MRI) using the delay alternating with nutation for excitation-sampling perfection with application-optimized contrasts using different flip angle evolution (DANTE-SPACE) is the preferred imaging technique for evaluation of the vessel wall. PURPOSE: To evaluate the intra- and inter-rater reproducibility of carotid wall segmentation on T1W DANTE-SPACE in patients with symptomatic (acute stroke or transient ischemic attack) internal carotid artery (ICA) stenosis. MATERIAL AND METHODS: This prospective study included 25 patients with acute (≤3 months) stroke or transient ischemic attack and 50%-99% stenosis of the ICA. All patients underwent 3.0-T high-resolution carotid MRI. Two radiologists independently performed the manual segmentation of the vessel wall and inner lumen of the bilateral carotid artery on DANTE-SPACE. The intraclass correlation coefficient (ICC), Dice similarity coefficient (DSC), and Hausdorff distance (HD) were calculated. RESULTS: The ICCs for intra-rater reproducibility of carotid wall volume, inner lumen volume, and normalized wall index were 0.965, 0.990, and 0.962, respectively. The ICCs for inter-rater reproducibility of carotid wall volume, inner lumen, and normalized wall index were 0.856, 0.981, and 0.904. DSC and HD for intra- and inter-rater reproducibility of carotid wall segmentation were as follows: 0.873 and 0.809 (DSC); and 0.079 and 0.118 (HD), respectively. For evaluation of reproducibility only in the carotid artery with symptomatic stenosis, the ICCs for intra- and inter-rater reproducibility indicated all perfect agreement. CONCLUSION: T1W DANTE-SPACE is a reproducible sequence for evaluation of the carotid wall using carotid MRI in patients with symptomatic ICA stenosis.
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OBJECTIVE: In this preliminary study, we investigated the value of fusion techniques by flat detector computed tomography based dual volume rotational angiography (DVRA) for the evaluation of the anatomical relationship of cavernous sinus dural arteriovenous fistula (CSDAVF) and assessed the possibility of transvenous target segment embolization. METHODS: Twenty-six patients with CSDAVF supplied by multiple feeders underwent DVRA for each feeding large vessel separately. We assessed the anatomical relationship of feeders, fistula points, and venous drainage with 3 dual volume image fusion techniques. Transvenous embolization was targeted to the segment of fistulous point for preserving those not involved and reducing coil mass effect. RESULTS: Dual vessel multi-planar reconstruction fusion technique could show which segment of the cavernous sinus supplied by feeding arteries. In the dual vessel volume rendering fusion technique, the association between feeding arteries, fistula points, and draining veins of 2 different vessels could be accurately identified in 3 dimensions. In addition, we could visualize the exact anatomical relationship between the components of CSDAVF and skull anatomy with the single vessel fusion technique. Based on various fusion images, target segment embolization was successfully performed in 8 patients. In this group, we achieved complete or near complete occlusion without complications, including cranial nerve palsy. CONCLUSIONS: Detailed anatomical information including accurate fistula point, specific feeding arteries, and draining veins could be obtained with various dual volume image fusion techniques. In addition, the target segment embolization of CSDAVF could be possible with understanding of the precise CSDAVF architectures.
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OBJECTIVE: We aimed to investigate risk factors for the recurrence of distal anterior cerebral artery (DACA) aneurysms after endovascular treatment (EVT). METHODS: The clinical and radiologic outcomes of DACA aneurysms treated with endovascular methods at a single tertiary hospital from September 2008 to December 2021 were retrospectively reviewed. We measured the angle between 2 distal branches of DACA aneurysms and categorized the angle as follows: 1) wide-angle (≥180°), and 2) narrow-angle type configuration (<180°). Univariate and multivariate analyses were performed to demonstrate the relationships between characteristics of DACA aneurysm and recurrence risk. RESULTS: In total, 132 DACA aneurysms were treated in our institution. Among these, 47 DACA aneurysms after EVT were included in this study. Forty patients underwent coil embolization without stent, 7 for stent-assisted coil embolization. At the last follow-up (mean 30.2 ± 24.2 months), overall recurrence rate was 23.4% (n = 11). Recurrence rate of the wide-angle type (9 of 23, 39.1%) was significantly greater than narrow-angle type (2 of 24, 8.3%) (P = 0.041; odds ratio 8.174, 95% confidence interval 1.094-61.066). Irregular shape of the DACA aneurysm also showed significantly greater recurrence rate (P = 0.011; odds ratio 10.663, 95% confidence interval 1.701-66.838) after endovascular treatment. CONCLUSIONS: The wide-angle between 2 distal branches of DACA aneurysm and irregular shape might be independent risk factors for the recurrence after endovascular treatment for DACA aneurysms.
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Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Recidiva , Humanos , Feminino , Masculino , Aneurisma Intracraniano/cirurgia , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Pessoa de Meia-Idade , Fatores de Risco , Procedimentos Endovasculares/métodos , Estudos Retrospectivos , Idoso , Embolização Terapêutica/métodos , Adulto , Artéria Cerebral Anterior/cirurgia , Artéria Cerebral Anterior/diagnóstico por imagem , Stents , Resultado do TratamentoRESUMO
PURPOSE: This study aimed to investigate the efficacy and safety of an intraprocedural image fusion technique using flat-panel detector computed tomography-based rotational angiography (FDCT-RA) and image fusion (IF) for the transvenous approach in treating intracranial dural arteriovenous fistulas (dAVFs). METHODS: A retrospective review was conducted on patients who underwent transvenous embolization for dural AVFs. The patients were classified into two groups according to the treatment technique used: the FDCT-RA and IF technique group and the conventional technique group. The primary outcomes assessed were the angiographic and clinical outcomes, complications, fluoroscopy time, and radiation exposure. Univariate analyses were performed to compare the two treatment modalities. RESULTS: Eighty-six patients with intracranial dAVFs were treated with transvenous embolization (TVE), of which 37 patients underwent transvenous approach with flat-panel detector computed tomography-based rotational angiography (FDCT-RA) and image fusion (IF) technique used. The FDCT-RA and IF group showed difference in the location of dAVFs, occlusion state of the sinus, and access routes in comparison to the conventional treatment group. The FDCT-RA and IF technique was predominantly used for dAVFs involving the anterior condylar confluence and cavernous sinus with ipsilateral inferior petrosal sinus (IPS) occlusion. Patients treated with this technique demonstrated a higher rate of complete occlusion (91.9%, n = 34) compared to those treated with the conventional technique (79.6%, n = 39), but this difference was not statistically significant (p = 0.136). Although the implementation of this technique during the treatment procedure showed a tendency to decrease both fluoroscopy duration and radiation dose, the observed results did not reach statistical significance (p = 0.315, p = 0.130). CONCLUSION: The intraprocedural image fusion technique using FDCT-RA for transvenous treatment of intracranial dAVFs could provide help in treatment of dAVFs of certain locations or access routes. It might provide aid in microcatheter navigation, without increasing the radiation exposure and fluoroscopy time.
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Seio Cavernoso , Malformações Vasculares do Sistema Nervoso Central , Embolização Terapêutica , Humanos , Resultado do Tratamento , Embolização Terapêutica/métodos , Cavidades Cranianas , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Estudos RetrospectivosRESUMO
Precise evaluation of the feeders, fistulous points, and draining veins plays a key role for successful embolization of intracranial dural arteriovenous fistulas (DAVF). Digital subtraction angiography (DSA) is a gold standard diagnostic tool to assess the exact angioarchitecture of DAVFs. With the advent of new image postprocessing techniques, we lately have been able to apply image fusion techniques with two different image sets obtained with flat panel detector rotational angiography. This new technique can provide additional and better pretherapeutic information of DAVFs over the conventional 2D and 3D angiographies. In addition, it can be used during the endovascular treatment to help the accurate and precise navigation of the microcatheter and microguidwire inside the vessels and identify the proper location of microcatheter in the targeted shunting pouch. In this study, we briefly review the process of an image fusion technique and introduce our clinical application for treating DAVFs, especially focused on the transvenous embolization.
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OBJECTIVE: We aimed to compare the clinical and radiological outcomes of vertebral artery dissecting aneurysms (VADAs) stratified using different endovascular treatment methods. METHODS: We retrospectively reviewed 116 patients with VADAs treated at a single tertiary institute between September 2008 and December 2020. We analyzed and compared the clinical and radiological parameters according to different treatment methods. RESULTS: In total, 127 endovascular procedures were performed in 116 patients. We initially treated 46 patients with parent artery occlusion, 9 with coil embolization without stent, 43 with single stent with or without coil, 16 with multiple stents with or without coils, and 13 with flow-diverting stent. At the last follow-up (mean 37.8 ± 30.9 months), the complete occlusion rate (85.7%) was higher in the multiple-stent group than in the groups that received other reconstructive treatment methods. Moreover, the recurrence (0%) and retreatment (0%) rates were significantly lower in the multiple stent group (P < 0.001). The coil embolization-only group showed the highest recurrence (n = 5, 62.5%) and incomplete occlusion (n = 1, 12.5%) rates. The single-stent group showed higher recurrence (n = 9, 22.5%) and retreatment (n = 3, 7%) rates. Multivariate logistic regression analyses showed that coil embolization without stent placement (odds ratio = 172.76, 95% confidence interval = 6.83-4366.85; P = 0.002) was significantly associated with recurrence. At the last follow-up (mean, 42.1 ± 37.7 months), we achieved favorable clinical outcomes (modified Rankin Scale ≤2) in 106 of 127 patients. CONCLUSION: When treating VADAs, multiple stent placements may play a key role in achieving favorable long-term radiological outcomes.
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Dissecção Aórtica , Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Dissecação da Artéria Vertebral , Humanos , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Embolização Terapêutica/métodos , Dissecação da Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/cirurgia , Stents , Procedimentos Endovasculares/métodos , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Angiografia CerebralRESUMO
OBJECTIVES: Endovascular treatment (EVT) has become a popular option for the treatment of basilar artery (BA) trunk aneurysms because microsurgery of these lesions is difficult due to narrow surgical fields and perforating arteries or cranial nerves in the brainstem. The purpose of this study is to report our experiences using EVT for ruptured BA trunk aneurysms in the acute period and to evaluate the risk factors for periprocedural complications. METHODS: From October 2004 to December 2020, a total of 27 consecutive patients with ruptured BA trunk aneurysms were treated with EVT. All patients met the following criteria: presence of ruptured BA trunk aneurysms and treatment with EVT for those aneurysms within 72 hours of rupture. The incidence of and risk factors for periprocedural complications were evaluated retrospectively. RESULTS: Among the 27 patients, periprocedural complications occurred in 4 patients (14.8%); mass effect inducing cranial neuropathy due to brainstem compression in 1 (3.7%) and brainstem infarction in 3 (11.1%). Hemorrhagic complications did not occur within 30 days. Subacute or delayed thromboembolic complications were not observed during the follow-up period. Large/giant aneurysm (odds ratio [OR], 6.417; 95% confidence interval [CI], 1.732-18.031; P = 0.045) and stent-assisted coiling (OR, 4.145; 95% CI, 1.018-14.212; P = 0.031) remained independent risk factors for periprocedural complications based on multiple logistic regression analysis. CONCLUSIONS: When performing stent-assisted coiling for ruptured large/giant BA trunk aneurysms, awareness of and caution regarding periprocedural complications, such as brainstem infarction caused by thromboembolism or brainstem compression due to mass effect, are necessary.
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Aneurisma Roto , Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Tromboembolia , Humanos , Resultado do Tratamento , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/cirurgia , Estudos Retrospectivos , Aneurisma Roto/complicações , Aneurisma Intracraniano/complicações , Stents , Tromboembolia/complicações , Fatores de Risco , Procedimentos Endovasculares/efeitos adversosRESUMO
BACKGROUND: Eosinophilic meningitis is a rare known complication after brain surgery associated with duraplasty using artificial bovine graft. However, eosinophilic meningitis after craniotomy without bovine dural graft has not been reported. OBSERVATIONS: A 48-year-old female presented with lateral medullary infarction caused by a vertebral artery dissecting aneurysm incorporating the posterior inferior cerebellar artery (PICA). The authors performed occipital artery-PICA anastomosis and repaired the dura by primary suture without bovine graft. Thereafter, endovascular internal trapping using coils was conducted. Severe headache developed at postoperative day 17, and the patient was diagnosed with eosinophilic meningitis. After administration of a high-dose corticosteroid for 2 weeks, her symptoms and laboratory findings were improved. LESSONS: Postoperative eosinophilic meningitis is rarely related to craniotomy without using bovine graft. Neurosurgeons should consider the possibility of eosinophilic meningitis after craniotomy without a xenogeneic dural material.
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OBJECTIVE: To assess clinical outcomes of ruptured vertebral artery dissecting aneurysms, focusing on comparing parent artery occlusion (PAO) with stent-assisted treatments, and to identify risk factors for unfavorable outcomes and postprocedural complications. METHODS: This retrospective review included 36 ruptured vertebral artery dissecting aneurysms treated between February 2009 and April 2020. Treatment modalities included PAO without stent and stent-assisted treatments. Stent-assisted treatments included PAO with posterior inferior cerebellar artery (PICA) stenting and stent-assisted coiling. Univariate and multivariate analyses were conducted to evaluate risk factors for unfavorable outcomes and postprocedural complications. RESULTS: Patients were treated with PAO only (24, 66.7%), PAO with PICA stenting (4, 11.1%), and PAO with stent-assisted coiling (8, 22.2%). There were only fusiform aneurysms with PICA involvement in the PAO with PICA stenting group. In the stent-assisted coiling group, 4 aneurysms incorporated PICA, and 4 aneurysms involved dominant vertebral artery. Old age (odds ratio [OR] = 1.25, 95% confidence interval [CI] = 1.01-1.56, P = 0.044) and poor Hunt-Hess grade (OR = 537.99, 95% CI = 6.73-42994.1, P = 0.005) were significantly associated with unfavorable clinical outcomes after a mean follow-up of 37.5 ± 32.8 months. Fusiform dilatation shape (OR = 15.97, 95% CI = 1.52-167.38, P = 0.021) and PICA involvement (OR = 13.71, 95% CI = 1.29-145.89, P = 0.030) were independent risk factors for ischemic complications. CONCLUSIONS: Unfavorable clinical outcomes were significantly related to old age and poor Hunt-Hess grade. There were no significant differences between treatment groups in clinical outcomes or ischemic complications. Stent-assisted treatments might be effective and safe methods for ruptured vertebral artery dissecting aneurysms.
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Aneurisma Roto , Dissecção Aórtica , Traumatismos Craniocerebrais , Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Dissecação da Artéria Vertebral , Humanos , Lactente , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/cirurgia , Resultado do Tratamento , Dissecação da Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/cirurgia , Stents , Embolização Terapêutica/métodos , Estudos Retrospectivos , Procedimentos Endovasculares/métodos , Traumatismos Craniocerebrais/terapia , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Aneurisma Intracraniano/terapiaRESUMO
OBJECTIVE: Stent-assisted coil embolization (SAC) has been increasingly used to treat various types of intracranial aneurysms. Delayed thromboembolic complications are major concerns regarding this procedure, so dual antiplatelet therapy with aspirin and clopidogrel is needed. However, clinicians vary the duration of dual antiplatelet therapy after SAC, and no randomized study has been performed. This study aims to compare the safety and efficacy of long-term (12 months) dual antiplatelet therapy and shortterm dual antiplatelet therapy (6 months) after SAC for patients with unruptured intracranial aneurysms (UIAs). METHODS: This is a prospective, randomized and multicenter trial to investigate the optimal duration of dual antiplatelet therapy after SAC in patients with UIAs. Subjects will receive dual antiplatelet therapy for 6 months (short-term group) or 12 months (longterm group) after SAC. The primary endpoint is the assessment of thromboembolic complications between 1 and 18 months after SAC. We will enroll 528 subjects (264 subjects in each group) and perform 1 : 1 randomization. This study will involve 14 topperforming, high-volume Korean institutions specializing in coil embolization. RESULTS: The trial will begin enrollment in 2022, and clinical data will be available after enrollment and follow-up. CONCLUSION: This article describes that the aim of this prospective randomized multicenter trial is to compare the effect of short-term (6 months) and long-term (12 months) dual antiplatelet therapy on UIAs in patients undergoing SAC, and to find the optimal duration.
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BACKGROUND: We aimed to compare clinical outcomes of acute ischemic stroke (AIS) due to internal carotid artery (ICA) occlusion following mechanical thrombectomy (MT), focusing on occlusion types. METHODS: We retrospectively reviewed 67 AIS patients who had an ICA occlusion on computed tomography angiography and underwent MT in a single tertiary center. ICA occlusion types were categorized as (1) true cervical ICA (cICA) occlusion (true occlusion), (2) pseudo-occlusion of the cICA (pseudo-occlusion), and (3) distal ICA (dICA) occlusion. We compared the clinical characteristics and their outcomes according to the ICA occlusion type. RESULTS: Fourteen patients were diagnosed with true occlusion, 32 with pseudo-occlusion, and 21 with dICA occlusion. The main etiologies were atherothrombotic in true occlusion (64.3%) and cardioembolic in pseudo-occlusion (81.3%) and dICA occlusion (71.4%) (P < 0.001). Pseudo-occlusion showed lower rates of successful reperfusion (37.5%, P = 0.009, 78.6% in true occlusion and 71.4% in dICA occlusion) and poor functional outcome at 3 months (18.8%, P = 0.037, 50% in true occlusion and 47.6% in dICA occlusion) with statistical significance. The infarction volume (169.4 ± 154.4 mL, P = 0.004, 29.2 ± 52.7 mL in true occlusion and 105.8 ± 13.4 mL in dICA occlusion) was significantly higher in pseudo-occlusion. On multivariate logistic analysis, pseudo-occlusion (odds ratio [OR]: 4.84, 95% confidence interval [CI] 1.02-22.87, P = 0.023) was an independent risk factor for poor reperfusion, which was significantly associated with a poor functional prognosis (OR: 22.04, 95% CI 1.99-243.83, P = 0.012). CONCLUSIONS: Patients with pseudo-occlusion showed poorer clinical outcomes compared with other ICA occlusion types, possibly due to a poor reperfusion rate after MT.
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Doenças das Artérias Carótidas , Estenose das Carótidas , AVC Isquêmico , Acidente Vascular Cerebral , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/cirurgia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/cirurgia , Humanos , Prognóstico , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Resultado do TratamentoRESUMO
PURPOSE: The aim of this study is to investigate the clinical and radiological features related to the symptomatic ischemic complications of vertebral artery dissecting aneurysm (VADA) following endovascular treatment (EVT). METHODS: The clinical and radiological features of 127 VADAs, which were treated in a single tertiary institute between September 2008 and December 2020, were retrospectively reviewed. We defined a thrombosed aneurysm as being one which the thrombus was in the aneurysm in magnetic resonance imaging (MRI). Symptomatic ischemic complication was defined as a case in which acute infarction was confirmed on diffusion weighted image after EVT with associated clinical symptoms. Univariate and multivariate analyses were executed to demonstrate the associations between symptomatic ischemic complication and characteristics of VADA. RESULTS: The rate of symptomatic ischemic complication was 13.4% (17 of 127). The thrombosed aneurysms were observed in 24.4% (31 of 127) and posterior inferior cerebellar artery (PICA) involvement was shown in 38.6% (49 of 127). Multivariate logistic regression analysis demonstrated that thrombosed aneurysms (odds ratio [OR] = 8.54, 95% confidence interval [CI] 1.98-36.87, p = 0.004) and PICA involvement (OR = 4.26, 95% CI 1.03-17.68, p = 0.046) were significantly associated with symptomatic ischemic complications following EVT. CONCLUSION: This study showed that the VADAs with intra-aneurysmal thrombose and PICA involvement may be independent risk factors for symptomatic ischemic complications following EVT. Therefore, when the thrombosed VADAs with PICA involvement are observed, practitioners may consider close postoperative monitoring for early detection of ischemic complications.
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Aneurisma , Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Dissecação da Artéria Vertebral , Aneurisma/complicações , Embolização Terapêutica/métodos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Humanos , Aneurisma Intracraniano/complicações , Estudos Retrospectivos , Resultado do Tratamento , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/cirurgia , Dissecação da Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/cirurgiaRESUMO
PURPOSE: The purpose of this study was to report the author's experiences in treating large (10-25 mm) and giant (>25 mm) intracranial aneurysms (IAs) using a single Flow Re-direction Endoluminal Device (FRED) without assistant coiling, with a focus on procedure-related complications. MATERIALS AND METHODS: A total of 33 patients who were treated with FRED between January 2018 and July 2020 were retrospectively reviewed. The timing of procedure-related complications was chronologically categorized as acute (within 7 days), subacute (8 to 21 days), and delayed (after 21 days) periods. Follow-up angiography was performed at 2 to 27 months (mean 9.7 months), and clinical follow-up was performed at 1 to 31 months (mean 14.1 months) in all patients. RESULTS: Six (18.2%) patients experienced procedure-related complications, including 2 (6.1%) in acute period, 1 (3.0%) in subacute period, and 3 (9.1%) in delayed period. Thromboembolic complications occurred in 5 (15.2%) patients and hemorrhagic complications in 1 (3.0%). Permanent morbidity and mortality rates were 3.0% each. Non-internal carotid artery (ICA) location of IAs (odds ratio 6.532; 95% confidence interval, 1.335-17.816; p=0.034) was the only independent risk factor for procedure-related complications on multivariate logistic regression analysis. CONCLUSION: The procedure-related complication rate was 18.2% in this study. Procedure-related complications might increase when treating large and giant IAs located on a non-ICA, especially on the middle cerebral artery. Therefore, it may be suggested that neurointerventionists and endovascular neurosurgeons should pay attention to the location of IAs when treating large and giant IAs with a single FRED.
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Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Embolização Terapêutica/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Morbidade , Estudos RetrospectivosRESUMO
OBJECTIVE: This study aimed to evaluate the image quality and dose reduction of low-dose three-dimensional (3D) rotational angiography (RA) for evaluating intracranial aneurysms. MATERIALS AND METHODS: We retrospectively evaluated the clinical data and 3D RA datasets obtained from 146 prospectively registered patients (male:female, 46:100; median age, 58 years; range, 19-81 years). The subjective image quality of 79 examinations obtained from a conventional method and 67 examinations obtained from a low-dose (5-seconds and 0.10-µGy/frame) method was assessed by two neurointerventionists using a 3-point scale for four evaluation criteria. The total image quality score was then obtained as the average of the four scores. The image quality scores were compared between the two methods using a noninferiority statistical testing, with a margin of -0.2 (i.e., score of low-dose group - score of conventional group). For the evaluation of dose reduction, dose-area product (DAP) and air kerma (AK) were analyzed and compared between the two groups. RESULTS: The mean total image quality score ± standard deviation of the 3D RA was 2.97 ± 0.17 by reader 1 and 2.95 ± 0.20 by reader 2 for conventional group and 2.92 ± 0.30 and 2.95 ± 0.22, respectively, for low-dose group. The image quality of the 3D RA in the low-dose group was not inferior to that of the conventional group according to the total image quality score as well as individual scores for the four criteria in both readers. The mean DAP and AK per rotation were 5.87 Gy-cm² and 0.56 Gy, respectively, in the conventional group, and 1.32 Gy-cm² (p < 0.001) and 0.17 Gy (p < 0.001), respectively, in the low-dose group. CONCLUSION: Low-dose 3D RA was not inferior in image quality and reduced the radiation dose by 70%-77% compared to the conventional 3D RA in evaluating intracranial aneurysms.
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Aneurisma Intracraniano , Angiografia Digital/métodos , Feminino , Humanos , Imageamento Tridimensional/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Estudos RetrospectivosRESUMO
PURPOSE: The treatment of choice for chronic subdural hematoma (CSDH) has been established as burr-hole trephination with drain insertion; however, controversy remains over the best place for the drainage catheter. In this study, we compare the safety and efficacy of a subperiosteal drain (SPD) with that of a subdural drain (SDD) after one burr-hole trephination for CSDH. METHODS: This retrospective and comparative study includes all CSDH patients treated with burr-hole trephination at our institution between January 2015 and December 2019. 59 patients were treated with SPD insertion (SPD group), and 203 patients were treated with SDD insertion (SDD group). RESULTS: The median hematoma thickness of the SPD group within 24 h after surgery was significantly thicker than that of the SDD group (9.5 mm vs. 7.5 mm, p = 0.003), but the midline shifting of the SPD group did not differ from that of the SDD group (3.8 mm vs. 3.5 mm, p = 0.280). The recurrence rate in the SPD group did not differ significantly from that in the SDD group (13.2% vs. 8.5%, p = 0.351). The frequency of bleeding events after surgery also did not differ significantly (5.1% vs. 3.5% p-value = 0.636). In contrast to surgery-related morbidities, medical morbidities such as pneumonia were significantly higher in the SDD group (4.4% vs. 0.0%, p = 0.044). The all-cause mortality rates during the perioperative period did not differ between the two groups (5.1% vs. 3.4%, p = 0.848). CONCLUSION: Our findings may suggest that burr-hole trephination with SPD insertion had better surgical feasibility and fewer perioperative complications than SDD insertion. The type of anesthesia seems to be related with fewer medical complications at perioperative period. Larger, randomized clinical trials focusing not only the drain type but anesthesia type, are needed to validate our findings.
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Drenagem/efeitos adversos , Hematoma Subdural Crônico/cirurgia , Trepanação/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Drenagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Periósteo/cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Espaço Subdural/cirurgia , Trepanação/métodos , Adulto JovemRESUMO
BACKGROUND: Basilar artery (BA) trunk aneurysms are rare, and the clinical characteristics and outcomes of endovascular treatment (EVT) remain unclear. The purpose of this study was to report clinical and angiographic outcomes of BA trunk aneurysm treated with EVT and to analyze risk factors for unfavorable outcomes. METHODS: From October 2004 to December 2020, a total of 40 patients with BA trunk aneurysms underwent EVT. Clinical characteristics and outcomes were evaluated retrospectively from a prospectively collected database. Of the 40 enrolled patients, nine were treated by coiling without stents, 17 were treated by stent-assisted coiling, six by stent only, five by flow diverters, and three by vertebral artery occlusion. RESULTS: In total, 27 (67.5%) patients had subarachnoid hemorrhage as an initial presentation, and 20 (50.0%) had large/giant aneurysms. Procedure-related complications occurred in five patients (12.5%); favorable clinical outcome was achieved in 27 patients (67.5%); and six patients (15.0%) died. Favorable angiographic outcome was achieved in 26 (83.9%) of 31 patients who underwent follow-up angiography. Poor initial Hunt-and-Hess grade (OR 7.67, 95% CI 1.55 to 37.80; p=0.018) was the only independent risk factor for unfavorable clinical outcome. Large/giant aneurysm (OR 8.14, 95% CI 1.88 to 27.46; p=0.047) and long lesion (OR 14.25, 95% CI 1.48 to 69.80; p=0.013) were independent risk factors for unfavorable angiographic outcomes during follow-up. CONCLUSIONS: EVT might be a feasible option for this rare disease entity. Unfavorable angiographic outcome might be expected in a large/giant aneurysm or a long lesion. It can be difficult to treat BA trunk aneurysms by EVT, needing multiple procedures or various techniques due to diverse clinical and angiographic features.
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Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Artéria Basilar/diagnóstico por imagem , Artéria Basilar/patologia , Angiografia Cerebral/métodos , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Seguimentos , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Estudos Retrospectivos , Stents , Resultado do TratamentoRESUMO
OBJECTIVE: The aim of this study was to investigate the clinical and radiological factors associated with the rupture of a vertebral artery dissecting aneurysm (VADA) and to evaluate whether the stagnation sign is a significant risk factor for rupture of VADA. METHODS: Clinical and radiological variables of 117 VADAs treated in a tertiary hospital from September 2008 to December 2020 were retrospectively reviewed. The stagnation sign is defined as the finding of contrast agent remaining in the lesion until the venous phase of angiography. Univariate and multivariate analyses were executed to reveal the associations between rupture status and VADA characteristics. RESULTS: The rate of ruptured VADAs was 29.1% (34 of 117) and the stagnation sign was observed in 39.3% (46 of 117). Fusiform shape (OR 5.105, 95% CI 1.591-16.383, p = 0.006), irregular surface (OR 4.200, 95% CI 1.412-12.495, p = 0.010), posterior inferior cerebellar artery (PICA) involvement (OR 3.788, 95% CI 1.288-11.136, p = 0.016), and the stagnation sign (OR = 3.317, 95% CI 1.131-9.732, p = 0.029) were significantly related to rupture of VADA in multivariate logistic regression analysis. CONCLUSIONS: This study showed that fusiform shape, irregular surface, PICA involvement, and the stagnation sign may be independent risk factors for the rupture of VADA. Therefore, when the potential risk factors are observed in unruptured VADA, more aggressive treatment rather than follow-up or medical therapy may be considered.
RESUMO
BACKGROUND: This study aimed to identify the association between the number of anterior choroidal arteries (AchoAs) and procedure-related ischemic complications in microsurgical clipping of unruptured AchoA aneurysms. METHODS: We retrospectively reviewed the clinical, radiological, and intraoperative findings of 153 patients with unruptured AchoA aneurysms treated with microsurgical clipping between January 2012 and November 2020 in a single tertiary institution. Intraoperative video clips were reviewed, and the AchoA type was categorized into two according to the number of AchoAs: (1) single-type group with single origin and single branch and (2) multiple-type group with duplicated origin or divided multiple branches. Uni- and multivariate analyses were performed to assess the relationship between clinical and radiological factors and perioperative ischemic complications. RESULTS: Of the 153 patients, 52 (34%) were categorized as multiple-type group. The frequency of perioperative ischemic complications, including decreased intraoperative motor evoked potential (MEP), silent infarction, and postoperative ischemic symptoms, was significantly higher in the multiple-type group than in the single-type group (13 [25%] vs 6 [5.9%], p = 0.001). Multivariate logistic regression analysis showed that multiple-type group (odds ratio [OR], 3.725; 95% confidence interval [CI], 1.171-11.845, p = 0.026) and multilobulated shape (OR, 9.512; 95% CI, 2.093-43.224; p = 0.004) were significantly associated with perioperative ischemic complications. Among 9 patients with decreased MEP, postoperative ischemic symptoms developed in 2 patients after clip adjustment. CONCLUSIONS: Multiple-type AchoA aneurysms and multilobulated shape are significantly correlated with perioperative ischemic complications. Postoperative ischemic complications can be minimized by recognizing these variations and using multimodal approach with MEP monitoring.
Assuntos
Aneurisma Intracraniano , Artéria Carótida Interna , Humanos , Aneurisma Intracraniano/cirurgia , Microcirurgia , Procedimentos Neurocirúrgicos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos RetrospectivosRESUMO
OBJECTIVES: The purpose of this study was to investigate the risk factors associated with recurrence of posterior communicating artery aneurysms after treatment and to evaluate the significance of fetal-type posterior cerebral artery as an independent risk factor for recurrence of posterior communicating artery aneurysms. MATERIALS AND METHODS: The clinical and radiological findings of 220 posterior communicating artery aneurysms treated between January 2009 and December 2016 in a single tertiary institute were retrospectively reviewed. Univariate and multivariate analyses were performed to evaluate the association between clinical and radiological variables and recurrence. RESULTS: Of 220 posterior communicating artery aneurysms, 148 aneurysms were unruptured and 82 aneurysms were treated with surgery. Forty-six out of 220 aneurysms (20.9%) were associated with fetal-type posterior cerebral artery. Overall recurrence rate was 19% (42 out of 220 aneurysms) during mean 54.6 ± 29.8 months follow-up. Multivariate logistic regression analysis showed that size (OR=1.238; 95% CI, 1.087-1.409, p = 0.001), ruptured status (OR=2.699; 95% CI, 1.179-6.117, p = 0.019), endovascular treatment (OR=3.803; 95% CI, 1.330-10.875, p = 0.013), incomplete occlusion (OR=4.699; 95% CI, 1.999-11.048, p = <0.001) and fetal-type posterior cerebral artery (OR=3.533; 95% CI, 1.373-9.089, p = 0.009) were significantly associated with recurrence after treatment. CONCLUSIONS: The results demonstrated that fetal-type posterior cerebral artery may be an independent risk factor for the recurrence of posterior communicating artery aneurysms. Therefore, fetal-type posterior cerebral artery can be considered as an important risk factor for the recurrence of posterior communicating artery aneurysms, along with other known risk factors such as size, ruptured status, endovascular treatment, and incomplete occlusion.
Assuntos
Procedimentos Endovasculares/efeitos adversos , Aneurisma Intracraniano/cirurgia , Microcirurgia/efeitos adversos , Artéria Cerebral Posterior/anormalidades , Artéria Cerebral Posterior/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Posterior/diagnóstico por imagem , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do TratamentoRESUMO
Long-term hormone replacement therapy due to panhypopituitarism can lead to serious complications and thus, pituitary transplantation is considered a more desirable. We investigated functional restoration after allotransplatation of the pituitary gland. We transplanted extracted pituitary gland into the omentum of an hypophysectomized rat. Two experiments were performed: (1) to confirm the hypophysectomy was successful and (2) to assess functional restoration after pituitary transplantation. Pituitary hormone level and weight change were consecutively assessed. Electron microscopic (EM) examinations were performed to identify morphological changes at 3 days after transplantation. We confirmed that pituitary gland was properly extracted from 6 rats after sacrifice. The findings showed (1) a weight loss of more than 3% or (2) a weight change of less than 2% along with a decreased growth hormone (GH) level by more than 80% at 2 weeks post-hypophysectomy. A further four rats underwent pituitary transplantation after hypophysectomy and were compared with the previously hypophysectomized rats. All showed rapid weight gain during the two weeks after transplantation. The thyroid-stimulating hormone, prolactin, and GH levels were restored at one week post-transplantation and maintained for 10 weeks. Hypophyseal tissue architecture was maintained at 3 days after transplantation, as indicated by EM. These data suggest that a transplanted pituitary gland can survive in the omentum with concomitant partial restoration of anterior pituitary hormones.