Combination of rare right arterial variation with anomalous origins of the vertebral artery, aberrant subclavian artery and persistent trigeminal artery. A case report.

A 32-year-old woman hospitalized for subarachnoid hemorrhage showed rare arterial variation on the right side with anomalous origins of the vertebral artery, aberrant subclavian artery and persistent trigeminal artery. Angiography showed the right vertebral artery to originate from the right common carotid artery, the right subclavian artery to arise separately from the descending aorta, and persistent trigeminal artery on the right side. The possible embryonic mechanism of this previously unreported variant combination is discussed.

Diffusion-weighted MR imaging in carotid angioplasty and stenting with protection by the reversed carotid arterial flow.

BACKGROUND AND PURPOSE: Distal embolism during carotid angioplasty with stent (CAS) can be protected by a flow-reversal device. Diffusion-weighted MR imaging was used to evaluate this protective procedure and perform a comparison with the control. METHODS: Cases of CAS with protection procedures were included in this study. Sixty-five men (68 procedures) and 5 women (5 procedures), with an average age of 68.8 years, having severe carotid stenosis were treated in our department between 2002 and 2004. Eleven cases were treated with the Parodi Anti-Emboli System, with which the internal carotid blood flow is reversed by simultaneous occlusion of the proximal common carotid artery and external carotid artery. Diffusion-weighted MR imaging was performed within 1-3 days after CAS. As controls, data from diffusion-weighted MR imaging in 26 patients who had diagnostic angiography were included. RESULTS: Diffusion-weighted MR imaging in diagnostic angiography showed 11.5% appearance of ischemic spots after procedures. In the Parodi Anti-Emboli System, this value was 18.2%. In the CAS group, ischemic lesions appeared only in the hemisphere ipsilateral to carotid stenosis. There were no ischemic lesions in the opposite carotid or vertebrobasilar territory. The appearance rate of new ischemic spots was not significantly different between the control group and the group of CAS with Parodi Anti-Emboli System (chi2 test, P = .6227, Fisher exact method). CONCLUSIONS: Protection results obtained with the Parodi system were excellent and comparable with conventional angiography.

Digital subtraction and conventional blood flow studies in porcine experimental aneurysms.

SUMMARY: Flow studies are important to understanding pathogenesis and treatment of cerebral aneurysms, but have not been possible in the clinical setting. We used experimental aneurysms established in and then removed from pigs to compare and correlate flow studies by high-speed video photography of introduced particles and by clinically applicable digital subtraction angiography. Venous pouches were used to create aneurysms in incised common carotid arteries. After aneurysms and parent arteries were removed, specimens were rendered translucent with solvents so they could be studied by video photography of introduced plastic particles in addition to digital subtraction angiography with iodinated contrast material. Regions of interest were studied individually. Mean transit time for contrast in the preparation correlated with videographically measured particle flow velocity (r = 0.616). Digital subtraction angiography should be useful in evaluation of flow in the clinical assessment and treatment of cerebral aneurysms, such as in endovascular therapy.

Evaluation of intraaneurysmal blood velocity by time-density curve analysis and digital subtraction angiography.

PURPOSE: Our purpose was to evaluate intraaneurysmal blood velocity by using time-density curve analysis and digital subtraction angiography. METHODS: In 31 aneurysms, aneurysmal blood velocity was examined with digital subtraction angiography to determine mean transit time (MTF), peak density time (time to peak opacification) (PDT), and time to half-peak opacification (T1/2). Thirty frames per second were acquired, and the time-density curve was calculated. Regions of interest were drawn on the proximal parent artery, on the distal parent artery, and on the aneurysm itself. RESULTS: There was no significant difference in MTT of blood velocity in the proximal site on the parent artery, in the distal site on the parent artery, and in the aneurysm. Similarly, there was no significant difference in PDT in the parent artery, in the distal site on the parent artery, and in the aneurysm; nor was there a significant difference in T1/2 in the parent artery, in the distal site on the parent artery, and in the aneurysm; that is, intraaneurysmal blood velocity was similar to that in the parent artery. PDT and T1/2 of small aneurysms were faster than that of large aneurysms; that is, blood velocity of small aneurysms was faster than that of large aneurysms. CONCLUSION: Intraaneurysmal blood velocity in small aneurysms is similar to that in the parent artery; consequently, the central stream probably reaches the aneurysmal wall. Intraaneurysmal blood velocity in large aneurysms appears to be somewhat slower than that in small aneurysms.

Evaluation of Intra-aneurysmal Blood Flow: Investigation of the Flow in Experimental Aneurysms.

SUMMARY: We evaluated the flow in experimental pig aneurysms using a high speed video system with tracer particles and digital subtraction angiography (DSA). We found that flow velocity in experimental aneurysms was fast on the inflow of aneurysms. There was a certain correlation between mean transit time (MTT) and velocity in experimental aneurysms. Therefore, the differences of flow velocity in aneurysms will be detected using DSA. The flow in aneurysms was much changed by platinum coil embolization.

[A case report of the carotid cavernous fistula treated by endovascular embolization using interlocking detachable coil (IDC)].

To treat a carotid cavernous fistula, endovascular embolization using a detachable balloon technique is generally performed to close the fistula. However, the balloon sometimes becomes detached accidentally before reaching the orifice, so it is not an ideal device for closing a fistula from point of view of safety. This time, we performed transarterial endovascular embolization using Interlocking Detachable Coils (IDC) for a symptomatic CCF, and obtained a good result. A 32-year-old male, who was injured in a traffic accident developed symptoms of CCF after four months: edema and pain in the right conjunctiva, bruit at the right orbit. Angiography showed CCF, the orifice of which was located at the transitional portion of C4 and C5. IDC embolization was performed; three IDCs were placed at the cavity of the fistula through the orifice, and complete occlusion of the fistula was confirmed on angiography. Postoperative clinical course was good and symptoms were improved.