Significance of atherosclerotic plaque location in recanalizing non-acute long-segment occlusion of the internal carotid artery.

To investigate the significance of atherosclerotic plaque location in hybrid surgery comprising both endovascular recanalization approaches and carotid endarterectomy for symptomatic atherosclerotic non-acute long-segment occlusion of the internal carotid artery (ICA), 162 patients were enrolled, including 120 (74.1%) patients in the proximal plaque group and 42 (25.9%) in the distal plaque group. Surgical recanalization was performed in all patients, with successful recanalization in 119 (99.2%) patients in the proximal and 39 (92.9%) in the distal plaque group. The total successful recanalization rate was 97.5% (158/162) with a failure rate of 2.5% (4/162). Periprocedural complications occurred in 5 (4.2% or 5/120) patients in the proximal plaque group, including neck infection in two (1.7%), recurrent nerve injury in 1 (0.8%), and laryngeal edema in 2 (1.7%), and 2 (4.8%) in the distal plaque group, including femoral puncture infection in 2 (4.8%). No severe complications occurred in either group. Univariate analysis showed plaque location was a significant (P = 0.018) risk factor for successful recanalization, and multivariate analysis indicated that the plaque location remained a significant independent risk factor for recanalization success (P = 0.017). In follow-up 6-48 months after the recanalization surgery, reocclusion occurred in two (2.8%) patients in the proximal plaque group and 4 (13.3%) in the distal plaque group. In conclusion, although hybrid surgery achieves similar outcomes in patients with ICA occlusion caused by either proximal or distal atherosclerotic plaques, plaque location may be a significant risk factor for successful recanalization of symptomatic non-acute long-segment ICA occlusion.

Transradial intra-aortic catheter looping in the angioplasty of severe intracranial symptomatic arteriosclerotic diseases.

Purpose: This study aims to investigate the effect and feasibility of intra-aortic catheter looping via transradial access in angioplasty for symptomatic intracranial severe (>70%) atherosclerotic stenosis or occlusion of large arteries (SISOLAs). Materials and methods: Patients with SISOLAs who underwent transradial endovascular angioplasty using the catheter looping technique in the ascending aorta were retrospectively enrolled. The clinical data and treatment outcomes were analyzed. Results: Fifteen patients aged 48-71 years were enrolled in this study. Left vertebrobasilar artery occlusion was present in 1 (6.7%) patient, severe left middle cerebral artery stenosis in 7 (46.7%) patients, severe left internal carotid artery (ICA) stenosis of the ophthalmic segment in 4 (26.7%) patients, severe left ICA stenosis of the cavernous segment in 2 (13.3%) patients, and severe right middle cerebral artery stenosis in 2 (13.3%) patients. The arterial stenosis ranged from 70 to 92% (mean 86%) before stenting. The looping of a guiding catheter in the ascending aorta via transradial access for angioplasty was successful in all patients (100%). The vertebral artery intracranial segment occlusion was successfully recanalized, while severe stenosis in the remaining 14 patients was successfully eliminated. After endovascular recanalization, the residual stenosis was reduced by 12-26% (median 18%). No puncture-related complications or surgical-related neurological complications occurred in these patients. In the follow-up angiography conducted on 10 (66.7%) patients after 6-25 months, no in-stent restenosis was detected. Conclusion: Intra-aortic guiding catheter looping via transradial access for endovascular angioplasty of SISOLAs is technically safe, feasible, and effective, especially when the transfemoral artery approach is difficult or impossible to undertake.

Transradial access with intra-aortic catheter looping for the treatment of intracranial aneurysms.

Purpose: The study aimed to investigate the feasibility and effect of transradial access with intra-aortic catheter looping for the treatment of intracranial aneurysms. Materials and methods: This retrospective one-center study was performed on patients with intracranial aneurysms which were embolized through transradial access with intra-aortic catheter looping because of the difficulty of transfemoral access or transradial access without intra-aortic catheter looping. The imaging and clinical data were analyzed. Results: A total of 11 patients were enrolled, including seven (63.6%) male patients. Most patients were associated with one or two risk factors of atherosclerosis. There were nine aneurysms in the left internal carotid artery system and two aneurysms in the right internal carotid artery system. All 11 patients had complications with different anatomic variations or vascular diseases, which made endovascular operation via the transfemoral artery difficult or a failure. The right transradial artery approach was adopted in all patients, and the success rate of intra-aortic catheter looping was 100%. Embolization of intracranial aneurysms was successfully completed in all patients. No instability of the guide catheter was encountered. No puncture site complications or surgical-related neurological complications occurred. Conclusion: Transradial access with intra-aortic catheter looping for embolization of intracranial aneurysms is technically feasible, safe, and efficient as an important supplementary approach to the routine transfemoral access or transradial access without intra-aortic catheter looping.

Endovascular treatment of intracranial vertebral artery unruptured dissecting aneurysms: Comparison of flow diversion and stent-assisted coiling or stenting alone.

Purpose: To investigate the effect and safety of flow diverters in the treatment of unruptured dissecting intracranial aneurysms of the vertebral artery in comparison with stent-assisted coiling or stenting alone. Materials and methods: Patients with unruptured dissecting intracranial aneurysms of the vertebral artery treated with the flow diverter, stent-assisted coiling, or stenting alone were retrospectively enrolled. The clinical data were analyzed and compared. Results: Twenty-five patients were enrolled in the flow diversion group and 42 patients in the stenting group. Twenty-six flow diverters were deployed in the flow diversion group. Immediate angiography revealed contrast agent retention within the aneurysm cavity in all patients. In the stenting group, 48 stents were deployed, and immediate angiographic outcome showed O'Kelly-Marotta (OKM) grade D in 18 (42.9%) aneurysms, grade C in 16 (38.1%), and grade B in 8 (19.0%). Periprocedural ischemic complications of thrombosis occurred in two (4.8%) patients and were treated with thrombolysis. In the flow diversion group, 19 (76%) patients underwent angiographic follow-up 3-46 (median 24) months after the procedure, with the OKM grade D in 11 (57.9%) patients, C in two (10.5%), and B in six (31.6%). The aneurysm recurrence rate was zero, and all diverters remained patent. Asymptomatic instent stenosis occurred in two (10.5%) patients. In seven of the ten patients with mild or moderate parent artery stenosis before the procedure who experienced angiographic follow-up, the stenosis was improved in five (71.4%) patients. In the stenting group, angiographic follow-up was carried out in 33 (78.6%) patients 6-58 months (median 34) after the procedure, with OKM grade D in 22 (66.7%) patients, grade C in five (15.2%), grade B in three (9.1%), and aneurysm recurrence (grade B, with increased contrast agent into the aneurysm cavity) in three (9.1%). Five (16.7%) patients experienced asymptomatic instent stenosis, and six of the 12 patients (50%) with parent artery stenosis were improved. Conclusion: Flow diverters with or without selective adjunctive coiling for the treatment of unruptured dissecting intracranial aneurysms of the vertebral artery may be safe and effective with good occlusion effects not inferior to those of stent-assisted coiling and stenting alone even though the long-term effect still warrants confirmation.

Tiny Cerebral Aneurysms Can Be Treated Safely and Effectively with Low-Profile Visualized Intraluminal Support Stent-Assisted Coiling or Coiling Alone.

BACKGROUND: The effectiveness and safety of LVIS stent-coiling is currently not known for treating tiny intracranial aneurysms. OBJECTIVE: To investigate the effectiveness and safety of Low-profile visualized intraluminal support (LVIS) stent-assisted coiling and coiling alone in treating patients with mostly ruptured tiny aneurysms. METHODS: Seventy-five patients with tiny intracranial aneurysms, including 63 ruptured ones, were treated endovascularly and analyzed. RESULTS: In the coiling group, complete occlusion was achieved in 35 patients (83.6%)-nearly complete in 4 patients (9.5%) and noncomplete in 3 patients (7.1%). Intraprocedural rerupture occurred in 2 patients (4.8%), and coil protrusion occurred in 1 patient, with a complication rate of 7.1%. Clinical follow-up at 6-12 months revealed a modified Rankin Scale (mRS) score of 0-1 in 41 patients and 3 in 1 patient. In the stent-assisted group, occlusion was complete in 12 patients (36.4%), nearly complete in 15 patients (45.5%), and noncomplete in 6 patients (18.1%). Six stents (18.2%) did not have good adherence to the wall, with thrombus formation in 3 stents (9.1%). Follow-up angiography in 27 patients at 3-6 months showed no dislocation of the stents, complete occlusion in 24 patients (88.9%), and nearly complete occlusion in the other 3 patients. At 6 months, the mRS score was 0 in 30 patients and 2 in 3 patients. No significant (P > 0.05) differences existed between the 2 groups. CONCLUSION: Tiny cerebral aneurysms can be safely and effectively treated with appropriate endovascular approaches based on aneurysm specific morphology, especially neck size and neck-to-dome ratio.

Characteristics and Endovascular Management of the Posterior Cerebral Artery Anterior Temporal Branch Aneurysms.

PURPOSE: To investigate characteristics of the posterior cerebral artery anterior temporal branch aneurysm and the safety and efficacy of endovascular management. MATERIALS AND METHODS: A total of 6 patients with anterior temporal branch aneurysms were enrolled. All 6 patients had concurrent occlusion of the ipsilateral anterior circulating arteries. The aneurysms ranged from 2.5 to 5.0 mm. All patients were treated and followed up. RESULTS: Four unruptured aneurysms were treated with coil embolization of the aneurysm sac only, with the parent artery maintained in 2 patients, slow flow in the parent artery in one and thrombosis at the aneurysm neck leading to parent artery occlusion in the last one. One patient with subarachnoid hemorrhage was treated with coil embolization of both the aneurysm and the parent artery, and the last patient with subarachnoid hemorrhage was treated with the Glubran 2 glue to embolize both the aneurysm and the parent artery. One patient with subarachnoid hemorrhage died of lung complication after embolization. Followed up for 3 months to 1 year, the 4 patients with unruptured aneurysms had no symptoms, including 1 patient with slow flow in the anterior temporal artery and 1 patient with thrombosis and parent artery occlusion. The remaining patient with parent artery occlusion had a good recovery. CONCLUSIONS: The anterior temporal artery aneurysm is a special subtype of aneurysm and can be readily misdiagnosed as on the posterior cerebral artery trunk or the superior cerebellar artery. Endovascular management has a greater success rate, good effect, and fewer complications but with greater difficulties.

Transradial Stenting for Carotid Stenosis in Patients with Bovine Type and Type III Aortic Arch: Experience in 28 Patients.

BACKGROUND: The effects and safety of transradial access for stenting of carotid artery stenosis in patients with bovine-type and type III aortic arch are currently unknown and are the purpose of this study. METHODS: Patients who were treated with stenting via transradial (n = 28) compared with transfemoral (n = 30) access of carotid artery stenosis complicated with bovine-type and type III aortic arch were enrolled. The clinical data were studied for comparison. RESULTS: The success rate of transradial access for carotid artery stenting was 100%. During the transradial access procedure, 3 patients experienced a temporary blood pressure drop and bradycardia that was resolved with atropine injection. No radial artery occlusion or severe cardiac or cerebral events occurred. The success rate of transfemoral access for carotid artery stenting was 90% with failure in 3 patients. No complications occurred during or after the stenting procedure. The irradiation duration was significantly (P = 0.001) smaller in transradial than in transfemoral access stenting (8.6 ± 0.87 vs. 11.4 ± 1.25 minutes). The arterial stenosis ranged 71.25%-96.50% (mean, 86.50% ± 10.15%) for transradial and 78%-97.75% (85.1% ± 10.42%) for transfemoral access groups before treatment, and the residual stenosis following treatment was significantly smaller in either the transradial (2.4%-17.75%; mean, 11.2% ± 6.03%) or transfemoral (4%-18.6%; mean, 12.4% ± 6.3%) groups compared with before treatment, respectively. CONCLUSIONS: The transradial access for stenting of patients with type III aortic arch plus left carotid artery stenosis or in the bovine-type aortic arch combined with right carotid artery stenosis can decrease the stenting difficulty, risks of embolization, and radiation time and increase the success rate.