Endovascular Treatment of Wide-Neck Bifurcation Aneurysm: Recent Trends in Coil Embolization with Adjunctive Technique.

Wide-neck bifurcation aneurysms (WNBAs) are sometimes challenging to treat. During endovascular treatment, it is important to prevent coil deviation and preserve normal vessels. Adjunctive balloon- and stent-assisted techniques have been developed. A meta-analysis of endovascular treatments of WNBAs revealed that only 40% of patients had complete occlusion. Recently, novel devices have been developed to expand the range of treatment options. Flow-diverter stents and intra-aneurysmal flow disruption devices do not require coils; however, coil embolization remains the standard procedure used by many neurointerventionists. This review describes the recent trends in adjunctive techniques for supporting coil embolization for WNBAs. We referred to literature on balloon-assisted techniques, stent-assisted techniques, Y-stenting, PulseRider, Barrel stents, Comaneci temporary stents, pCONUS, and eCLIPs. These reports showed that adequate embolization rates were generally greater than 80%, and the complete occlusion rate was as high as 94.6%. All devices had a relatively high occlusion rate; however, it may be inaccurate to simply compare each device because of the heterogeneity of the studies. It is important to select the best treatment for each individual case by considering not only literature-based efficacy and safety but also patient background, aneurysm characteristics, and operator experience.

Ureteral obstruction following transurethral resection of bladder cancer within the Hutch's diverticulum.

Here, we report a rare case of bladder cancer within the left congenital periureteral diverticulum, termed the Hutch's diverticulum. Following transurethral resection of the bladder tumor, repeated pyelonephritis was caused by stricture of the diverticulum orifice and ureter. We attempted transurethral dilation and ureteral stenting, but the obstruction did not improve. The patient's renal dysfunction showed gradual progression due to recurrent left pyelonephritis as well as the ureteral obstruction. Therefore, we finally performed a partial cystectomy, involving stricture and ureteral reimplantation. No tumor recurrence was observed over 39 months, and renal dysfunction did not progress following partial cystectomy.

Detailed Anatomy of Bridging Veins Around the Foramen Magnum: a Multicenter Study Using Three-dimensional Angiography.

BACKGROUND AND PURPOSE: There has been limited literature regarding the bridging veins (BVs) of the medulla oblongata around the foramen magnum (FM). The present study aims to analyze the normal angioarchitecture of the BVs around the FM using slab MIP images of three-dimensional (3D) angiography. METHODS: We collected 3D angiography data of posterior fossa veins and analyzed the BVs around the FM using slab MIP images. We analyzed the course, outlet, and number of BVs around the FM. We also examined the detection rate and mean diameter of each BV. RESULTS: Of 57 patients, 55 patients (96%) had any BV. The median number of BVs was two (range: 0-5). The BVs originate from the perimedullary veins and run anterolaterally to join the anterior condylar vein (ACV), inferior petrosal sinus, sigmoid sinus, or jugular bulb, inferolaterally to join the suboccipital cavernous sinus (SCS), laterally or posterolaterally to join the marginal sinus (MS), and posteriorly to join the MS or occipital sinus. We classified BVs into five subtypes according to the draining location: ACV, jugular foramen (JF), MS, SCS, and cerebellomedullary cistern (CMC). ACV, JF, MS, SCS, and CMC BVs were detected in 11 (19%), 18 (32%), 32 (56%), 20 (35%), and 16 (28%) patients, respectively. The mean diameter of the BVs other than CMC was 0.6 mm, and that of CMC BV was 0.8 mm. CONCLUSION: Using venous data from 3D angiography, we detected FM BVs in most cases, and the BVs were connected in various directions.

Paradoxical worsening of ocular symptoms after transvenous embolization of cavernous sinus dural arteriovenous fistula due to coil-induced perifocal inflammation: A case report.

Ocular symptoms usually completely resolve after successful transvenous embolization of cavernous sinus dural arteriovenous fistulas (CS-dAVFs). Herein, we report a case of CS-dAVF in which sinus packing of the superior ophthalmic vein (SOV) caused coil-induced inflammation in orbital tissue, leading to deteriorating ocular symptoms. A 73-year-old woman presented with right-eye exophthalmos and chemosis. Cerebral angiography demonstrated right CS-dAVF, which retrogradely drained into the right SOV. We conducted sinus packing with coils via the right inferior petrosal sinus, resulting in obliteration of the shunts. One day after sinus packing, right exophthalmos and chemosis progressed, suggesting dAVF recurrence. However, no residual angiographic shunts were observed. Orbital magnetic resonance imaging (MRI) revealed edema in intraorbital tissue and gadolinium contrast enhancement of SOV wall. We presumed that the coils in SOV induced perifocal inflammation at the venous wall and surrounding orbital tissue, leading to aggravation of ocular symptoms. Following steroid therapy for 2 months, ocular symptoms and contrast enhancement on orbital MRI significantly improved without anticoagulant treatment. Posttreatment paradoxical worsening of ocular symptoms could be caused by coil-induced inflammation of the SOV wall near the orbital tissue. Steroid therapy could be effective in reducing orbital inflammatory reactions.

Six-month Outcomes after PulseRider- and Conventional Single Stent-assisted Embolization for Bifurcation Aneurysms: A Propensity-adjusted Comparison.

Endovascular treatment of wide-necked bifurcation aneurysms (WNBAs) remains challenging despite using a stent. PulseRider is a novel device specifically designed to treat WNBAs, protecting both daughter branches, but the outcomes have not been compared with conventional single stent-assisted embolization. This study aimed to compare the six-month outcomes of PulseRider and single stent-assisted embolization for intracranial unruptured WNBAs using propensity score adjustment. Between February 2012 and October 2021, 46 unruptured WNBAs (34 basilar and 12 middle cerebral arteries) smaller than 10 mm in diameter were treated with PulseRider-assisted embolization (n = 17) or single stent-assisted embolization (n = 29). The immediate and six-month outcomes were compared using inverse probability of treatment weighting analysis. The immediate adequate occlusion rates for the PulseRider- and single stent-assisted embolization were similar (47.1% vs. 62.1%). At six months, adequate occlusion rates for the two groups were also similar (94.1% vs. 86.2%). However, the complete obliteration rate was significantly high after PulseRider-assisted embolization (88.2% vs. 41.4%, adjusted OR 10.54, 95% CI 1.93-57.63). The angiographical improvement rate was also significantly high after PulseRider-assisted embolization (70.6% vs. 37.9%, adjusted OR 6.06, 95% CI 1.54-23.76). The neurologic thromboembolic complication rate was 0% after PulseRider-assisted embolization and 3.4% after single stent-assisted embolization. PulseRider-assisted embolization of WNBAs smaller than 10 mm in diameter was associated with complete obliteration and angiographical improvement at six months. The unique shape of the PulseRider might contribute to the improved midterm aneurysm occlusion.

Peritoneal and pulmonary tuberculosis following intravesical administration of Bacillus Calmette-Guérin for bladder cancer.

We report a rare case of peritoneal and pulmonary tuberculosis after intravesical instillation of Bacillus Calmette-Guérin (BCG). A 76-year-old man diagnosed as high-grade urothelial carcinoma (UC) with carcinoma in situ (CIS) was treated with intravesical BCG instillation and transurethral resection of bladder tumor (TUR-BT). Three months later, TUR-BT for recurrent tumors and multiple site biopsy of bladder mucosa were performed. During TUR-BT, near perforation in the posterior wall was observed, and was disappeared after observation with urethral catheterization for 1 week. Two weeks later, he was admitted with a complaint of abdominal distention, and a computed tomography (CT) showed ascites. One week later, CT showed pleural effusion and worsening of ascites. Drainage of pleural effusion and ascites puncture was performed, and elevated adenosine deaminase (ADA) and lymphocytes count were subsequently found. In laparoscopic examination, numerous white nodules were observed in the peritoneum and omentum, and Langhans giant cells were pathologically identified in biopsy specimens. Mycobacterium culture confirmed Mycobacterium tuberculosis complex. The patient was then diagnosed with pulmonary and peritoneal tuberculosis. Anti-tuberculous agents consisting of isoniazid (INH), rifampicin (RFP), and ethambutol (EB) were administered. Six months later, a CT scan showed no evidence of pleural effusion or ascites. There has been no recurrence of either urothelial cancer or tuberculosis during follow-up for 2 years.

Flow diverter therapy for immunosuppressant-resistant vertebral artery fusiform aneurysm due to eosinophilic granulomatosis with polyangiitis: illustrative case.

BACKGROUND: Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic small-vessel vasculitis characterized by the presence of asthma and eosinophilia. Because cerebral aneurysm formation induced by EGPA is a rare occurrence, there is no established treatment strategy for this condition. OBSERVATIONS: A 67-year-old female who was diagnosed with idiopathic eosinophilia 3 months ago developed de novo fusiform aneurysms in the left vertebral, left internal carotid, and bilateral superficial temporal arteries, as noted during a regular follow-up examination of a convexity meningioma. Pathological examination of the resected superficial temporal artery revealed eosinophilic granulomas, which led to the diagnosis of EGPA, as well as EGPA-induced aneurysm formation. As the partially thrombosed vertebral artery fusiform aneurysm enlarged, the compression of the medulla oblongata occurred despite intensive immunosuppressive therapy for 1 year. The patient underwent flow diversion therapy administered using the pipeline embolization device, resulting in complete disappearance of the aneurysm. LESSONS: Considering that the entire circumference of the aneurysmal wall is affected by necrotizing vasculitis, flow diverter therapy would be a reasonable and efficient approach for the treatment of EGPA-related aneurysms in cases in which the patient is nonresponsive to immunosuppressants.

Rupture of an adjacent cerebral aneurysm following the deployment of a Pipeline embolization device: illustrative case.

BACKGROUND: Although the Pipeline embolization device (PED) is effective for intracranial aneurysm treatment, its impact on the surrounding vascular structure is unknown. OBSERVATIONS: A 71-year-old woman was incidentally found to have a simultaneous large posterior communicating artery aneurysm and an ipsilateral small anterior choroidal artery aneurysm. She underwent flow diversion therapy for both aneurysms with a PED, but the distal shortening of the PED after deployment led to the exposure of the anterior choroidal artery aneurysm. Follow-up angiography revealed complete obliteration of the posterior communicating artery aneurysm, but the anterior choroidal artery aneurysm remained. Three years after the endovascular surgery, the patient experienced a subarachnoid hemorrhage due to the rupture of the anterior choroidal artery aneurysm. Retrospective analysis of angiographic images revealed a change in the vascular geometry surrounding the ruptured aneurysm after PED deployment; this was further accompanied by an increase in the flow velocity inside the aneurysm. LESSONS: Because PED use might induce the adverse effects on the adjacent uncovered aneurysm by changing the vascular geometry and hemodynamic stress, a cautious therapeutic strategy, such as proper placement of the stent and using a longer and appropriate-sized PED, should be chosen when deploying the PED.

Plasma tRNA derivatives concentrations for detecting early brain damage in patients with acute large vessel occlusion and predicting clinical outcomes after endovascular thrombectomy.

OBJECTIVE: Transfer RNA (tRNA) is involved in the acute stress response, which results in conformational changes and subsequent fragmentation. Using an antibody against tRNA-specific modified nucleoside 1-methyladenosine, we can selectively detect blood tRNA derivatives from damaged tissues, including neuronal tissue, which serves as a potential marker of early tissue damage. This preliminary study aimed to investigate the correlation between tRNA derivatives and clinical outcomes in patients with acute anterior large vessel occlusion, especially those who underwent endovascular thrombectomy (EVT). METHODS: Patients with acute ischemic stroke due to anterior circulation large vessel occlusion were prospectively enrolled in this study. Plasma tRNA derivatives were measured using an enzyme-linked immunosorbent assay with an anti-modified nucleoside 1-methyladenosine antibody. RESULTS: Seventeen patients were included. The plasma tRNA derivatives concentrations on admission increased significantly, corresponding to the infarction size (r = 0.492, p = 0.038), and were associated with clinical outcomes (p = 0.00309). A good clinical outcome (90-day modified Rankin scale score: 0-2) was achieved in seven patients (41.2%), and all had undergone EVT. Among these patients, tRNA derivatives concentrations were the only preoperative predictor, which was associated with good outcomes (modified Rankin scale score: 0-2) and was significantly lower than those with poor outcomes (modified Rankin scale score: 3-6) (p = 0.0333). Receiver operating characteristic analysis revealed that a tRNA derivative value of ≤ 142.0 mg/mL was associated with good clinical outcomes, with a sensitivity of 85.7% and a specificity of 100% (area under the curve, 0.952; 95% confidence interval: 0.82-1). CONCLUSION: tRNA derivatives concentration may be a sensitive marker of early brain damage in patients with acute large vessel occlusion. Patients with low levels of tRNA derivatives on arrival are likely to benefit from thrombectomy and have the potential to achieve good clinical outcomes.

Direct carotid puncture for endovascular surgery of intracranial aneurysms: Technical note for avoiding complications.

BACKGROUND: While the most intracranial aneurysms are approachable by femoral or brachial artery puncture during endovascular surgery, in some cases, the lesion is difficult to reach due to complications such as the presence of winding pathways. Direct carotid puncture (DCP) is an alternative access approach, despite the potential risk of fatal neck hematoma. Herein, we describe the DCP technique in a series of five patients with intracranial aneurysms, together with its technical considerations. METHODS: Patients with intracranial aneurysms who underwent endovascular surgery using DCP were reviewed retrospectively. We selected the 3F to 6F systems for DCP depending on the necessity of adjunctive techniques. To prevent DCP-associated complications, we (1) conducted a micropuncture before introducing the short sheaths,(2) selected the smallest possible size for the system, (3) reversed heparin postoperatively, and (4) performed perioperative intubation/sedation management. RESULTS: Five out of 535 patients underwent DCP in our hospital between 2015 and 2019; successful vascular access was achieved in all cases. Although a minor neck hematoma occurred in one case, the patient did not require additional treatment. According to a literature review, severe neck hematoma requiring rescue therapy occurs in 5 out of 95 cases (5.3%). CONCLUSION: Although the potential risk of neck hematoma is not negligible, the DCP technique appears to be a safe and effective approach in treating intracranial aneurysms with challenging access routes in cases where perioperative counter measurements are appropriately performed.

Potential hemorrhagic risk of endovascular revascularization therapy due to recanalization of the dissected perforator in intracranial internal carotid artery dissection: A case report.

BACKGROUND: Intracranial internal carotid artery (ICA) dissection manifesting as ischemic stroke is rare. Although endovascular revascularization therapy is effective in preventing the progression of stroke, little is known about the potential risk of this therapeutic approach. CASE DESCRIPTION: We report a case of a 38-year-old woman who presented with acute ischemic infarcts in the territory of the left anterior choroidal artery (AChA) due to intracranial ICA dissection. She underwent balloon angioplasty, resulting in the complete resolution of the stenosis. The AChA, which was nearly occluded preoperatively, was unexpectedly recanalized after the procedure. Four hours later, she developed a parenchymal hemorrhage in the left basal ganglia without subarachnoid hemorrhage. The AChA, suspected as the hemorrhagic source during surgical hematoma removal, was revealed to have a disrupted internal elastic lamina on pathological examination, suggesting that the dissection of the ICA extended to the AChA. CONCLUSION: To the best of our knowledge, this is the first case report demonstrating that the intracranial ICA dissection extends to the associated perforator. Considering the potential risk of subsequent hemorrhagic complications by recanalization of the dissected perforator, prudent postoperative management, including strict blood pressure control, is advisable following endovascular revascularization therapy against intracranial artery dissection involving perforators.

Rescue of distally placed stents in the setting of internal carotid artery dissection: A report of 2 cases with mechanistic insights.

Potential procedural complications of endovascular therapy for carotid artery dissection have not been clarified. Herein, we present the cases of a 46-year-old woman and a 59-year-old man who underwent carotid artery stenting for left cervical internal carotid artery dissection. During the procedure, intramural hematoma was squeezed out by stent placement, causing further extension of the pseudolumen and a prominent stenosis proximal to the stent. Additional stent deployment was subsequently performed to fully cover the newly arising stenosis, resulting in good recanalization. In cases with a long-affected lesion, we should consider the potential risk of dissection advancement following stent deployment. Using longer stents or additional rescue stenting would be efficient in counteracting this rare complication.

Stent-Assisted Embolization for Acutely Ruptured Aneurysm.

Objective: The purpose of this study was to report the results of stent-assisted embolization performed at our hospital for acutely ruptured aneurysms. Methods: This study consisted of 19 patients (4 men and 15 women) with acutely ruptured wide neck aneurysm who underwent stent-assisted coil embolization in acute stage between December 2016 and October 2020. Stent-assisted embolization in the acute stage was performed for very wide neck ruptured aneurysm only when balloon-assisted embolization was failed or was thought to be impossible. Factors related to poor clinical outcome were examined. Results: There were nine internal carotid artery (ICA) aneurysms, four anterior communicating artery (AcomA) aneurysms, three basilar artery (BA) aneurysms, two vertebral artery (VA) aneurysms and one anterior cerebral artery (ACA) aneurysm. The stents used were one Neuroform EZ and 18 Neuroform Atlas (Stryker). The contrast of the bleb disappeared in all cases with obvious bleb. Complete obliteration was achieved in two cases, neck remnant was in ten, and body filling was in seven. Both of the complete obliteration cases developed thrombotic complications. Modified Rankin score of 0-2 was observed in eight patients (good clinical outcome), whereas that of 4-6 was observed in 11 patients (poor clinical outcome). Several factors possibly affected to poor clinical outcome were examined and only age over 80 years was statically different. Complications related to procedure occurred in five patients; two cases of in-stent thrombosis, one case each of MCA perforation, stent occlusion, and coil fracture. Conclusion: Stent-assisted coil embolization using Neuroform EZ and Neuroform Atlas could be considered as an emergency treatment for acutely ruptured cerebral aneurysms with very wide neck. It is rarely indicated in patients with age over 80 years.

Carotid artery stenting in a patient with an incidentally found double aortic arch: A case report.

Double aortic arch is a type of congenital vascular ring, which rarely presents in adults. Herein, we report a case of carotid artery stenting (CAS) accompanied by an incidentally found double aortic arch. A 77-year-old man presented with bilateral severe carotid artery stenosis. The patient underwent truncal 3D-computed tomography angiography (CTA) to evaluate the access route before CAS, which lead to the diagnosis of an asymptomatic double aortic arch. Referring to the 3D-CTA images, a guiding catheter was successfully navigated to the targeted common carotid artery via the transfemoral approach despite the challenging, complex anatomy of the aortic arch. CAS was performed in both carotid arteries under distal balloon protection, without any neurological deficits. Considering the possible presence of anatomical variants such as double aortic arch, preoperative evaluation of the access route would be efficient for prospective CAS patients.

Bow hunter's syndrome due to an embolic mechanism: illustrative case.

BACKGROUND: Bow hunter's syndrome (BHS) is an uncommon cause of vertebrobasilar ischemic stroke, which results from occlusion or injury to the vertebral artery (VA) during neck rotation. Although hemodynamic insufficiency is the predominant underlying mechanism of this entity, BHS due to embolic mechanisms is rare. The authors report a case of BHS characterized by repeated posterior circulation embolism and present some considerations of BHS with an embolic mechanism. OBSERVATIONS: A 57-year-old man suffered from repeated embolic stroke in the posterior circulation. Digital subtraction angiography revealed caliber irregularity of the V3 segment of the left nondominant-side VA, which occluded when the neck rotated to the right side. The patient was diagnosed with BHS with an embolic mechanism due to endothelial damage caused by osteophytes at the C1 foramen transversarium. After C1-C2 fusion surgery, the patient never experienced the recurrence of stroke. According to a literature review, BHS due to embolic mechanisms tends to occur in young male adults, manifesting as recurrent stroke in the posterior circulation. Involvement of the nondominant-side VA can cause BHS with an underlying embolic mechanism. LESSONS: BHS due to an embolic mechanism should be considered as a differential diagnosis if patients have repeated embolic strokes in the posterior circulation.

Carotid Artery Stenting Using Balloon-Expandable Coronary Stent: Intentional Use for Staged Angioplasty.

Objective: We report carotid artery stenting (CAS) using balloon-expandable coronary (BECo) stent. The materials in this study consist of 15 cases of high-grade stenosis in internal carotid artery (ICA) in which self-expanding carotid (SECa) stent was not utilized. There were two groups why BECo stent was used instead of SECa stent: alternative group and intentional group. The alternative group was subdivided into two groups: access difficulty of guiding catheter and access difficulty of SECa stent. Case Presentation: The alternative group included 11 cases (access difficulty of guiding catheter in 10 and access difficulty of SECa stent in 1), and the intentional group included 4 cases. There were four cases using transbrachial approach. All the intentional group cases were the first stage of staged angioplasty (SAP). The second stage of SAP was PTA in two and SECa stent over the BECo stent in two. There was no complication related to CAS. Conclusion: CAS using BECo stent is one of the choices for the first stage of SAP, if stent placement instead of PTA is required at the first stage. It is also the useful alternative for the patient having difficulty of SECa stent.

Intraaneurysmal Neck Plasty: Efficacy of a Super Compliant Double-Lumen Balloon Microcatheter.

Objective: While wide-neck aneurysms can be treated with several methods, we report the specific technique of intraaneurysmal neck plasty (IANP) with a super compliant double-lumen balloon microcatheter (Super-Masamune). Methods: The Super-Masamune was inflated inside 18 aneurysms. Cases in which the tip of the Super-Masamune was located in the aneurysm were included. Embolization methods were the same as those used in the application of other balloons/stents. The use of the Super-Masamune for the performance of IANP followed two patterns: (1) the Super-Masamune was used not only as a balloon but also for coil insertion (simple IANP); (2) the Super-Masamune was used only as a balloon, and a microcatheter for coil insertion was separately introduced coaxially (coaxial IANP). Results: The aneurysms were located in the anterior communicating artery (n = 6), middle cerebral artery (MCA; n = 4), anterior cerebral artery (n = 1), internal carotid artery (n = 5), basilar artery (n = 1), and vertebral artery (n = 1). Eight of the aneurysms were ruptured, while 10 were unruptured. Simple and coaxial IANP were both performed in seven cases. Embolization was not performed after inflating the Super-Masamune inside the aneurysm in four cases. Embolization grades following the procedure included eight neck remnants (NRs) and six body fillings (BFs). There was one complication of intraoperative rerupture; however, there was no rupture/rerupture in the follow-up period. Retreatment of the target aneurysm was performed in two cases. The embolization grade assessed in the follow-up period reached complete occlusion for one patient, NR for five, and BF for two patients. Conclusion: IANP using the Super-Masamune is useful for the treatment of wide-neck aneurysms in which the introduction of a guidewire and/or microcatheter into the branching artery is difficult.

Preservation of Branching Vessel Using Super Compliant Double-Lumen Balloon Microcatheter: Bulging Neck Plasty Technique and Other Options.

Objective: There are several methods to treat wide-neck aneurysms. We survey the cases that were treated using a super-compliant double-lumen balloon microcatheter (Super-Masamune) for preservation of the branching vessel originating proximal to the aneurysm, especially in the bulging neck plasty (BNP) technique. Methods: We assessed 10 cases in which branching vessel preservation was performed using Super-Masamune. The cases were categorized into three groups: (1) ordinary neck plasty (ONP): balloon microcatheter was navigated to the branch that should be preserved; (2) BNP: another branch was preserved by inflating balloon bulging without cannulation; (3) protection during parent artery occlusion (PPO): the balloon microcatheter was navigated to the vessel to be occluded. The balloon preserves a branch originating near the aneurysm without cannulating to the branch. Results: The aneurysm locations were as follows: internal carotid artery (ICA), three cases; anterior communicating artery (AcomA), one case; basilar artery (BA), three cases; and vertebral artery (VA), three cases. Four cases were ruptured aneurysms, while six cases were unruptured or ruptured in chronic stage. The ONP, BNP, and PPO groups contained two, five, and three cases, respectively. Embolization resulted in complete obliteration in six cases, neck remnant in two cases and body filling in two cases. No rupture/rerupture was noted in this series. One case showed an intraoperative rupture. Conclusion: Super-Masamune is useful for neck plasty, especially BNP, in wide-neck aneurysms. Super-Masamune is also useful for parent artery occlusion when an important branch originates proximal to the aneurysm.

Intentional Stent Herniation Technique Using Neuroform Atlas Stent System for Embolization of a Wide-Necked Basilar Tip Aneurysm.

Objective: Endovascular treatment for complex wide-necked basilar tip aneurysms is challenging. Multiple stenting may be an option to deal with such aneurysms; however, the risk of ischemic complications is reported to be relatively high. Here, we report a case of unruptured basilar tip aneurysm treated using the intentional stent herniation technique to preserve the aneurysmal neck branches. Case Presentation: A 65-year-old woman presented with a growing unruptured basilar tip aneurysm associated with bilateral posterior cerebral arteries (PCAs) arising from the aneurysmal dome. We intentionally selected a large-sized Neuroform Atlas stent (Stryker, Kalamazoo, MI, USA) compared to the parent artery and deployed it along the right PCA to the basilar artery. The stent was herniated into the aneurysmal dome near the origin of the left PCA, resulting in the preservation of the left PCA. Successful coil embolization was achieved with acceptable obliteration. Conclusion: The intentional stent herniation technique may be an effective approach to treat complex wide-necked basilar tip aneurysms.

Anterior-posterior ground reaction forces across a range of running speeds in unilateral transfemoral amputees.

As a fundamental motor pattern, the ability to run at a range of constant speeds is a prerequisite for participating in competitive games and recreational sports. However, it remains unclear how unilateral transfemoral amputees modulate anterior and posterior ground reaction force impulses (GRFIs) in order to maintain constant running speeds. The purpose of this study was to investigate anterior and posterior GRFIs across a wide range of constant running speeds in unilateral transfemoral amputees wearing a running-specific prosthesis. Eleven runners with unilateral transfemoral amputation ran on an instrumented treadmill at 5 different speeds (30%, 40%, 50%, 60%, and 70% of the average velocity of their 100-m personal records). Anterior-posterior ground reaction forces (GRFs) were measured at 1000 Hz over 14 consecutive steps. Impulse, magnitude, and duration of anterior and posterior GRFs were compared between the affected and unaffected limbs at each speed. The net anterior-posterior GRFI, reflecting the changes in horizontal running velocity, was consistently positive (propulsion) in the affected limb and negative (braking) in the unaffected limb at all speeds. Regardless of running speed, unilateral transfemoral amputees maintain constant running speeds not over each step, but over 2 consecutive steps (i.e., one stride).