Endovascular treatment of a cervical paraspinal arteriovenous malformation via arterial and venous approaches.

We describe a cervical congenital paraspinal arteriovenous malformation (AVM) drained by paraspinal and epidural ectatic veins, which caused massive erosion of the C6 and C7 vertebral bodies, threatening the cervical stability and necessitating treatment. During the first session, six arterial embolizations were performed to reduce the size and the flow of the AVM. Two months later, a venous approach was used to occlude the remnant venous exit of the AVM and achieve a complete cure. All embolizations were performed using N-butylcyanoacrylate.

Pulsating mass after accidental artery trauma: diagnosis with duplex ultrasound and the role of angiography.

BACKGROUND: Pulsating mass located close to peripheral arteries is usually considered as a result of arterial wall injury. Clinically important is to distinct pseudoaneurysm from haematoma and also to evaluate proximal and distal arterial bed for the assessment of the injury extent. A few previous reports claim good results of duplex Doppler US diagnosis of iatrogenic (post-catheterization) femoral artery injuries. This paper presents diagnostic findings of arterial injuries caused by accidental trauma. PATIENTS AND METHODS: A retrospective analysis of 49 patients with post-traumatic pulsating mass close to peripheral artery was performed. The diagnostic results of both sonography and angiography were reviewed. All the patients underwent B-mode and duplex Doppler US examination using PW-, color- and power Doppler imaging techniques. RESULTS: 34 pseudoaneurysms were diagnosed correctly with typical B-mode, color/power Doppler images and PW-Doppler spectral waveforms. The lack of flow signal and distinctive B-mode images enabled proper diagnosis of 13 haematomas. In 2 patients duplex Doppler US misdiagnosis occurred, because of secondary pseudoaneurysm formation, primary diagnosed as haematoma. The 47 correct US findings gave 96% efficacy in distinguishing pseudoaneurysm from haematoma, which compares well with the other studies. In 20 patients suffering from peripheral ischemia, US examination, in spite of proper distinction between pseudoaneurysm and haematoma was unable for precise estimation of proximal and distal arterial damage. Thus, it was successfully supported with angiography before surgical decision making. Angiography was also necessary in 8 patients with severe injuries of carotid, subclavian and palmar arch arteries, hardly accessible for ultrasound penetration. CONCLUSIONS: We conclude that duplex Doppler US is essential for noninvasive, unequivocal distinction between pseudoaneurysm and haematoma but it could not completely replace contrast angiography in the evaluation of post-traumatic pulsating mass caused by severe, extensive trauma, frequently complicated with peripheral ischemia or located in regions with poor access for ultrasound penetration.

[Endovascular treatment of internal carotid artery giant aneurysm by embolization of the parent artery using a detachable balloon]. / Przeznaczyniowe leczenie gigantyccznego tetniaka tetnicy szyjnej wewnetrznej na drodze calkowitej embolizacji tetnicy macierzystej przy uzyciu balonu odczepialnego.

A giant, unclippable right ICA aneurysm located partially intracavernously is reported with neck deriving at C3 level. The aneurysm caused optic chiasm compression, progressive left eye vision loss and exophthalmus as well as persistent headache. The presence of the aneurysm was first found in CT and confirmed by angiography. After having performed the temporary occlusion test of right ICA the ICA was permanently occluded with a detachable balloon. Control angiography showed complete occlusion of right ICA and no opacification of the aneurysm sac from vertebral and left carotid arteries.

[Secondary glaucoma in the course of arterio-cavernous fistula: a case report]. / Jaskra wtórna w przebiegu przetoki tetniczo-jamistej--opis przypadku.

PURPOSE: To present a case of 59-year-old woman with the symptoms of redness, proptosis of her left eye and temporary bruit in her head. METHODS: Basic ophthalmological examination, measurement of proptosis, tonometry, visual field examination (Humphrey 30-2 threshold) CT, MRI and carotid angiography were performed. CLINICAL SIGNS: Proptosis of the left eye, dilatation of the episcleral vessels, fundus examination--optic disc normal, enlarged and engorged venous vessels, intraretinal haemorrhages in posterior pole. Tonometry--13 mm Hg--right eye, 24 mm Hg--left eye. Perimetry--general reduction of sensitivity. CT scan--abnormal structure (0.9 x 0.4 cm) in the medial part of the left orbit, without enhancement after applying contrast. MRI examination--enlargement of extraocular muscles of the left eye. Carotid artery angiography revealed indirect carotid--cavernous fistula. CONCLUSION: Special investigations like CT and MRI showed different picture, final diagnosis could be based upon the clinical picture and confirmed by angiography.

Spontaneous Thrombosis of the Pseudoaneurysm of Right SCA after an Attempt at Embolisation. A Case Report.

SUMMARY: Spontaneous thrombosis of intracranial aneurysms rare, mostly affecting giant aneurysms with narrow necks. We present the case of 34 y/o man with pseudoaneurysm that developed in the course of SAH. The initial CT scan showed an isolated, well-defined hematoma within the right cerebellar hemisphere, digital subtraction angiogram (DSA) performed in a regional hospital showed an irregular shaped aneurysm of the distal segment of the right SCA. The patient was sent to our department, where diagnostic DSA, performed before embolisation revealed an entirely different morphology of the aneurysm. It became larger, round and no other functional branches distal to it were found (picture of "a balloon on a string"). During supraselective catheterization, when microcatheter and microguidewire were already in the right SCA a technical problem of our angio-machine occurred, so the intervention had to be postponed. A week later, a second attempt at embolisation was made. This time an initial DSA showed a lack of filling of the aneurysm sac and thrombosis of the main trunk of the right SCA. The patient remained clinically stable. He was discharged from our hospital five days later.

Two Distally Located Right SCA Aneurysms: Endovascular Treatment by Parent Artery Occlusion with GDC Coils and N-BCA Injection. Case Report and Review of the Literature.

SUMMARY: Peripheral aneurysms of the superior cerebellar artery are considered difficult to treat surgically and endovascularly because of their inaccessibility. Parent artery occlusion is therefore frequently the preferred method. Embolic materials previously reported in this situation are either GDC coils or a polymerizing agent (n- BCA). We report a patient with two distally located, wide-neck aneurysms of the right superior cerebellar artery who presented with hemorrhage and was treated by endovascular embolization of the parent artery using a combination of GDC coils and n-BCA.

Power Doppler imaging in the evaluation of extracranial vertebral artery compression in patients with vertebrobasilar insufficiency.

OBJECTIVE: The recent introduction of Power Doppler Imaging (PDI) made a promise for better visualization of blood vessels lying in regions anatomically difficult for ultrasound imaging, i.e. vertebral arteries. The purpose of our study was to assess usefulness of PDI technique in visualization of vertebral artery course and to assess its utility in the detecting spondylotic vertebral artery compression in patients with vertebrobasilar insufficiency (VBI). METHODS: A total of 428 patients with VBI symptoms was evaluated. A total of 282 (66%) patients related their symptoms to a specific head position. Thus, all Doppler examinations were performed in four head positions: hyperextension, flexion and right/left rotation and also in a position reported by a patient to produce symptoms. PDI technique was employed as vertebral artery mapping for precise PW-Doppler range gate placing. RESULTS: Vertebral artery compression was found in 73 (17%) patients: 65 unilateral and eight bilateral. The diagnosis was based on flow decrease or its absence shown on PW-Doppler scans, after a specific head turning. CONCLUSION: Vertebral artery compression, related to a specific head position is relatively frequent in patients with VBI symptoms, especially in an older population commonly suffering from cervical spondylosis. PDI facilitates noninvasive Doppler US diagnosis by showing the real course of vertebral artery, particularly its intertransverse portion.

Endovascular treatment of giant p1/p2 aneurysm by direct puncture of the vertebral artery. Case report.

SUMMARY: Vascular access is usually achieved through a femoral arterial puncture using a modified Seldinger technique. However, selective catheterization of the great cerebral vessels by femoral approach fails completely when the vessel is tortuous or atheromatous. In case of posterior vascular circulation aneurysms, transbrachial approach or direct puncture of the vertebral artery (VA) is an alternative. The aneurysms of the posterior cerebral artery (PCA) are reported to be rare. Due to unfavorable anatomic location, the PCA aneurysms are difficult to reach during surgical procedure. Endovascular embolization is at present considered to be more effective and safer treatment of the PCA aneurysms arising from different segments, offering a viable alternative to the surgical approach. We report the case of the giant left PCA aneurysm, located at the junction of P1/P2 segments, successfully treated by parent artery occlusion achieved after the direct puncture of the right VA which was used because both VAs were tortuous, irregular and their ostia were not accessible by femoral approach. According to different authors, parent artery occlusion appears to be safe in the treatment of P2 segment aneurysms, whatever the location of the occlusion. In our case we decided to perform this kind of treatment believing it was the only possible one.