RESUMO
PURPOSE: The quick establishment of adequate vascular access is essential for the technical success of mechanical thrombectomy (MT). Focusing on shifts in aortic arch geometry and aging-related changes, we propose an imaging parameter for predicting access difficulty using chest CT. METHODS: Patients with acute anterior circulation large-vessel occlusion who underwent MT from April 2020 to September 2021 were included in this retrospective multicenter observational study. The distance from the sternum to the ascending aorta (S-AAD) was defined as the surrogate marker of access difficulty. Access was defined as difficult when the time from femoral sheath placement to guiding catheter induction (guiding time: GT) ≥ 30â¯minutes, and the patients were dichotomized into groups with short GT (sGT: GT < 30â¯min) and long GT (lGT: GT ≥ 30â¯min). RESULTS: One hundred fifteen patients were included. There were 12 patients (10.4â¯%) in lGT group. The median (IQR) S-AAD was 11.9â¯mm (6.3, 18.3â¯mm) in sGT group and 6.6â¯mm (4.0, 10.3â¯mm) in lGT group, and a significant difference in S-AAD was observed (P = 0.026). In multivariate analyses, dyslipidemia and S-AAD < 5â¯mm were significantly associated with difficult access (OR, 5.938 [95â¯% CI, 1.468, 24.022], P = 0.012 for dyslipidemia; OR, 5.147 [95â¯% CI, 1.267, 20.917], P = 0.022 for S-AAD < 5â¯mm). CONCLUSION: S-AAD is a simple and reliable imaging parameter to predict access difficulty. This parameter may be helpful in selecting the appropriate devices and access routes in preinterventional practice.
Assuntos
Trombectomia , Tomografia Computadorizada por Raios X , Humanos , Masculino , Feminino , Idoso , Estudos Retrospectivos , Trombectomia/métodos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Idoso de 80 Anos ou mais , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgiaRESUMO
Subarachnoid hemorrhage due to the A1 segment of an anterior cerebral artery dissecting aneurysm is rare. Therefore, a standard treatment has not been established. Though several case reports of direct surgery exist, there are few reports on endovascular treatment. This is the first study to describe five patients who underwent endovascular treatment for ruptured A1 dissecting aneurysms. Between January 2001 and December 2022 in our affiliated centers, five cases of SAH-onset A1 dissecting aneurysms were treated with endovascular treatment. We describe in detail two representative cases, briefly summarize the other three, and analyze their complications and outcomes. In the five cases, four were female. Four were in their 50s, and one was in her 80s. The WFNS grades were as follows: three were 2, one was 4, and one was 5. No re-ruptures or symptomatic complications were observed. The modified Rankin Scale scores at the time of discharge were as follows; one was 0, one was 1, two were 2, and one was 5. One in five patients needed retreatment after endovascular trapping because of recanalization. Endovascular treatment may be an effective and viable treatment option for ruptured A1 dissecting aneurysms. Further studies are needed to collect detailed data on complications and outcomes.
Assuntos
Aneurisma Roto , Artéria Cerebral Anterior , Dissecção Aórtica , Procedimentos Endovasculares , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Humanos , Feminino , Procedimentos Endovasculares/métodos , Pessoa de Meia-Idade , Aneurisma Roto/cirurgia , Aneurisma Roto/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Dissecção Aórtica/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Aneurisma Intracraniano/diagnóstico por imagem , Masculino , Resultado do Tratamento , Hemorragia Subaracnóidea/cirurgia , Hemorragia Subaracnóidea/diagnóstico por imagem , Artéria Cerebral Anterior/cirurgia , Artéria Cerebral Anterior/diagnóstico por imagem , Idoso de 80 Anos ou mais , IdosoRESUMO
OBJECTIVE: Effective thrombectomies in the posterior circulation remain controversial. Previous reports have demonstrated the superiority of contact aspiration in anterior circulation. Aspiration catheters and stent retrievers are often used alone on a global scale, while combined techniques are commonly used in Japan. This study evaluated the effect of first-line contact aspiration with other strategies for the treatment of basilar artery occlusion. METHODS: The primary outcome was the frequency of the first-pass effect, and the secondary outcome was the time from puncture to the first-pass effect. A multicenter observational registry including 16 Japanese stroke centers was used. Between December 2013 and February 2021, enrolled patients underwent endovascular thrombectomy for basilar artery occlusion. The efficacy of contact aspiration compared to other methods (including stent retrievers and combined techniques) was evaluated. RESULTS: Eighty-four patients were included, all of whom had achieved effective recanalization. Twenty-six patients were treated with contact aspiration, 13 with combined technique, and 45 with stent retrievers. The two groups: contact aspiration and non-contact aspiration, had different backgrounds. Both had similar frequencies of effective recanalization and first-pass effects. The contact aspiration group experienced better functional outcomes without statistical significance, while this strategy was significantly associated with a shorter puncture-to-recanalization time (38 vs. 55â¯minutes, P=0.036). In particular, in the 55 patients with the first-pass effect, multivariate Cox proportional hazard analysis showed that contact aspiration was significantly associated with a shorter time from puncture to first-pass effect, independent of age and etiology of large-artery atherosclerosis (hazard ratio 2.02, 95% confidence intervals 1.10-3.69, P=0.023). CONCLUSION: This study suggested that contact aspiration for basilar artery occlusion may shorten the puncture-to-first-pass effect, compared to stent retrievers and combined techniques.
Assuntos
Procedimentos Endovasculares , Trombectomia , Humanos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Trombectomia/métodos , Procedimentos Endovasculares/métodos , Insuficiência Vertebrobasilar/cirurgia , Resultado do Tratamento , Punções/métodos , Idoso de 80 Anos ou mais , Sistema de Registros , Tempo para o Tratamento , Artéria Basilar/cirurgia , Stents , Sucção/métodosRESUMO
AIM: To report our experience and the technique of two-step effective Onyx embolization from occipital artery (OA) for the obliteration of dural arteriovenous fistulas (DAVFs) with OA feeders. MATERIAL AND METHODS: The medical records of patients with intracranial DAVFs treated with trans-arterial embolization (TAE) using Onyx from the OA were retrospectively reviewed. RESULTS: Seven patients were included. The methods of Onyx injection from the OA were categorized as simple Onyx injection into the shunt, and two-step embolization. Two-step embolization involved the Onyx or coil embolization of the OA distal to the branching site of the feeders in the first step, and Onyx was injected toward the target shunt in the second step. Simple Onyx injection was performed in two cases; in both cases, the residual shunt remained. By contrast, the two-step embolization technique was performed in five cases, and in all those cases, sufficient embolization of the DAVFs was achieved. CONCLUSION: Prior embolization using Onyx or coil of the distal OA helped prevent Onyx from unexpected embolization through the subcutaneous branches that were not associated with the shunt, thereby leading to effective embolization. This new two-step embolization technique from the OA may improve the obliteration rate of DAVFs with OA feeders using TAE with Onyx.
Assuntos
Malformações Vasculares do Sistema Nervoso Central , Dimetil Sulfóxido , Embolização Terapêutica , Polivinil , Humanos , Embolização Terapêutica/métodos , Malformações Vasculares do Sistema Nervoso Central/terapia , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Masculino , Feminino , Pessoa de Meia-Idade , Polivinil/administração & dosagem , Estudos Retrospectivos , Idoso , Resultado do Tratamento , Dimetil Sulfóxido/administração & dosagem , Adulto , Angiografia CerebralRESUMO
Flow diverter (FD) placement is increasingly used to treat large supraclinoid aneurysms. Here, we report a case of hydrocephalus following FD placement. One patient in her 60 s underwent FD placement combined with coil embolization. Within 1 month, the patient started to show visual field defects and symptoms of hydrocephalus, which worsened within another month. We report that hydrocephalus developed acutely, without high protein levels in the cerebrospinal fluid, and as a complication using a Surpass Streamline. Although the precise mechanisms are unclear, our report suggests a different mechanism for the development of hydrocephalus after FD placement combined with coil embolization.
Assuntos
Embolização Terapêutica , Procedimentos Endovasculares , Hidrocefalia , Aneurisma Intracraniano , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Campos Visuais , Procedimentos Endovasculares/efeitos adversos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Embolização Terapêutica/efeitos adversosRESUMO
AIM: Assessing the indication for elective neuro-endovascular treatment (EVT) in older patients requires consideration of the impact of systemic comorbidities on their overall reduced life expectancy. The objective of this study was to determine the long-term outcomes of elective neuro-EVT in patients aged ≥80 years, and to investigate the impact of pre-existing cancer on their long-term outcomes. METHODS: Of the patients enrolled in multicenter observational registry, those aged ≥80 years undergoing elective neuro-EVT between 2011 and 2020 were enrolled. A history of cancer was defined as a pre-existing solid or hematologic malignancy at the time of EVT. The primary outcome was time to death from elective neuro-EVT. RESULTS: Of the 6183 neuro-EVT cases implemented at 10 stroke centers, a total of 289 patients (median age, 82 years [interquartile range 81-84 years]) were analyzed. A total of 58 (20.1%) patients had a history of cancer. A total of 78 patients (27.0%) died during follow up. The 5-year survival rate of enrolled patients was 64.6%. Compared with patients without a history of cancer, those with a history of cancer showed significantly worse survival (log-rank test, P = 0.001). Multivariate Cox proportional hazards analysis showed history of cancer was an independent predictor of time to death from elective neuro-EVT (HR 1.74, 95% CI 1.01-3.00, P = 0.047). Cancer was the leading cause of death, accounting for 25.6% of all deaths. CONCLUSIONS: The present study showed that history of cancer has a significant impact on time to death from elective neuro-EVT in patients aged ≥80 years. Geriatr Gerontol Int 2024; 24: 211-217.
Assuntos
Isquemia Encefálica , Procedimentos Endovasculares , Neoplasias , Acidente Vascular Cerebral , Humanos , Idoso , Idoso de 80 Anos ou mais , Resultado do Tratamento , Acidente Vascular Cerebral/etiologia , Estudos Retrospectivos , Isquemia Encefálica/etiologiaRESUMO
Objective: Cerebral venous sinus thrombosis (CVST) is one of the rare and severe complications of coronavirus disease 2019 (COVID-19) vaccines. CVST has also been reported to develop into dural arteriovenous fistula; however, there were no reports of dural arteriovenous fistula associated with COVID-19 vaccine-induced cerebral venous sinus thrombosis. Here, we describe a rare case of a transverse-sigmoid sinus dural arteriovenous fistula followed by CVST due to COVID-19 vaccination. Case Presentation: A 70-year-old patient presented with headache five days after receiving a second dose of COVID-19 vaccine. MRI showed a CVST in the superior sagittal sinus, left transverse sinus, and left sigmoid sinus. His headache improved after the administration of anticoagulant therapy. Six months later, a similar headache recurred, and cerebral angiography demonstrated a dural arteriovenous fistula in the left transverse sigmoid sinus and convexity dural arteriovenous fistulas in the left parietal cortex. The patient was treated twice with two sessions of transarterial embolization, and the shunts were completely occluded. His symptoms improved, and he was discharged with a modified Rankin Scale score of 0. Conclusion: Dural arteriovenous fistula can develop after CVST in association with COVID-19 vaccination.