Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.238
Filtrar
1.
Zhonghua Wai Ke Za Zhi ; 59(3): 210-215, 2021 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-33685055

RESUMO

Objective: To investigate the strategy and the clinical effect of single stage treatment for intracranial or extracranial artery stenosis with intracranial aneurysm. Methods: The clinical data of 15 patients with intracranial aneurysms and extracranial or intracranial artery stenosis treated by one-stage endovascular therapy at Department of Neurosurgery of Peking University First Hospital from April 2013 to September 2018 were analyzed,respectively.There were 6 males and 9 females,aged (63.9±9.1)years (range:43 to 79 years).Fifteen arterial stenosis were found, including 8 in anterior circulatiion and 7 in posterior circulation, and the stenosis rates ranged from 75% to 95%. There were 17 aneurysms, among which 11 in the anterior circulation and 6 in the posterior.The maximal diameter was (5.3±1.2)mm (range:3 to 7 mm).All patients were treated with stenting and embolization at one stage. The operation choices, perioperative and postoperative symptoms,imaging data and complications were recorded. Results: Stents were successfully implanted into arterial stenosis of 15 cases, reducing the stenosis rates to less than 30%.Among the 17 aneurysms,10 cases were treated by coil embolization alone,7 cases by stenting and coil embolization. Eventually all the 17 aneurysms reached complete embolization.One patient had mild symptoms of the cerebral infarction during the perioperative period,and the rest had not shown surgical complications.The follow-up time was (43.8±8.2)months (range:24 to 85 months). All the patients underwent digital subtraction angiography 6 to 12 months after operation.Among them,2 cases had asymptomatic in-stent restenosis,and no recurrence was found in aneurysms.Up to the last follow-up,no patients had showed new symptoms or signs of intracranial hemorrhage or ischemic stroke. Conclusions: For patients suffered from both stenosis and aneurysms,individualized treatment should be made based on the location and severity of the vascular stenosis and aneurysms.With careful preoperative evaluation and surgical planning,the single stage endovascular treatment for intracranial or extracranial artery stenosis combined with intracranial aneurysm is safe,feasible and effective for selected patients.


Assuntos
Constrição Patológica/terapia , Embolização Terapêutica , Aneurisma Intracraniano , Adulto , Idoso , Angiografia Cerebral , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/cirurgia , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/terapia , Constrição Patológica/complicações , Constrição Patológica/diagnóstico por imagem , Procedimentos Endovasculares/métodos , Feminino , Seguimentos , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Masculino , Pessoa de Meia-Idade , Stents , Resultado do Tratamento
2.
BMJ Case Rep ; 14(2)2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526539

RESUMO

Haemodynamic flow-related stress at the vessel curvatures is an important risk factor for intracranial aneurysmal growth and rupture. The rete middle cerebral artery (MCA) is a rare entity causing hyperdynamic blood flow into the ipsilateral anterior cerebral artery (ACA), especially when the contralateral A1-segment is non-dominant. Ruling out the clinicoradiological mimics like vasculitis, moyamoya and chronic occlusive disease with vessel wall imaging and detailed investigations helps manage the clinical entity effectively. We present a successfully managed case of ruptured ACA aneurysm at the acute curvature of the A1-A2 junction associated with ipsilateral rete MCA. Pre-emptive diagnosis of the rete MCA can aid preventive strategies to manage rupture and regrowth of the aneurysm at the points of flow-related stress.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Artéria Cerebral Anterior/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Artéria Cerebral Média/anormalidades , Hemorragia Subaracnóidea/diagnóstico por imagem , Adulto , Aneurisma Roto/etiologia , Aneurisma Roto/terapia , Angiografia Digital , Malformações Vasculares do Sistema Nervoso Central/complicações , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares , Humanos , Aneurisma Intracraniano/etiologia , Aneurisma Intracraniano/terapia , Imagem por Ressonância Magnética , Masculino , Artéria Cerebral Média/diagnóstico por imagem , Hemorragia Subaracnóidea/terapia , Tomografia Computadorizada por Raios X
3.
J Stroke Cerebrovasc Dis ; 30(5): 105643, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33631473

RESUMO

OBJECTIVES: This study sought to assess whether the Population, Hypertension, Age, Size, Earlier Subarachnoid Hemorrhage, Site (PHASES) score can do risk stratification of patients with multiple aneurysms (MIAs). MATERIAL AND METHODS: Patients between January 1, 2016 and January 1, 2019 were recruited retrospectively. The PHASES score was applied to assess the theoretical risk of IA rupture. For patients-level analyses, four modes of the application of the score were used: largest IA PHASES score, highest PHASES score, sum PHASES score, and mean PHASES score. RESULTS: A total of 701 patients with 1673 IAs were included in this study. At aneurysm-level analysis, the average PHASES score was 3.0 ± 3.0 points, with 2.8 ± 3.0 points and 4.1 ± 2.9 points in the unruptured and ruptured groups, respectively (p < 0.001). At the patient-level analysis, for the largest IA PHASES score, the areas under the curves (AUC) was 0.572. The discrimination performance of the largest IA PHASES score decreases as IA number increases, with AUCs were 0.597, 0.518, and 0.450 in the 2 IAs, 3 IAs and, 4 or more IAs subgroups, respectively. For highest PHASES score, sum PHASES score, and mean PHASES score, the AUCs were 0.577, 0.599, and 0.619, respectively. CONCLUSIONS: In this study, PHASES score only serve as a weak tool in decision-making settings for MIAs patients; as such, more accurate models should be developed for MIAs patients and the cumulative effect of MIA may should be considered.


Assuntos
Aneurisma Roto/etiologia , Técnicas de Apoio para a Decisão , Aneurisma Intracraniano/diagnóstico , Idoso , Aneurisma Roto/prevenção & controle , Angiografia Digital , Angiografia Cerebral , Tomada de Decisão Clínica , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/terapia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
4.
Artigo em Chinês | MEDLINE | ID: mdl-33472298

RESUMO

Objective: To explore the diagnosis and clinical features of internal carotid artery aneurysm in the skull base. Methods: The data of 15 patients with internal carotid aneurysms in the skull base diagnosed and treated by digital subtraction angiography (DSA) or CT angiography (CTA) in the Provincial Hospital Affiliated to Shandong First Medical University from 1995 to 2017 were collected and analyzed. Among the 15 patients, 12 were males, and 3 were females, aging from 17 to 67 years old, with a median age of 44 years. Thirteen patients were diagnosed by DSA; the other two patients were diagnosed by CTA. Thirteen patients were diagnosed with pseudoaneurysm with the first symptom of epistaxis, in which eight patients underwent head trauma and 5 underwent radiotherapy of skull base tumor. The other two patients were diagnosed with true aneurysm presented headache and cranial nerve disorder. All patients were followed up for 2 to 12 years after treatment to see whether they were cured and survived. Results: Among the eight patients with a history of trauma, five patients were cured by embolization, two patients without embolization died of massive epistaxis, one patient died of progressive cerebral infarction after embolization. Among the five patients with radiotherapy of skull base tumor, one patient died of cerebral infarction after embolization, two patients died out of the hospital due to the recurrence of the primary tumor and intracranial invasion, one patient recovered well after embolization and surgical operation, one patient gave up treatment and died of massive hemorrhage out of hospital. In the other two patients with symptom of headache, one received embolization treatment outside the hospital after receiving mistake operation, and another one gave up treatment and died due to personal reasons. In total, four patients died in hospital, four died out of the hospital, and seven patients survived. Conclusions: Internal carotid artery aneurysm is a high-risk disease of anterior and middle skull base. For patients with epistaxis with a history of trauma and radiotherapy or patients with headaches and cranial nerve disorders, the possibility of the internal carotid artery aneurysm should be considered, in which DSA or CTA examination is essentially required for ensured diagnosis and disease evaluation.. The correct diagnosis and treatment by the otolaryngologist are crucial to the prognosis of the patient.


Assuntos
Artéria Carótida Interna , Aneurisma Intracraniano , Adolescente , Adulto , Idoso , Artéria Carótida Interna/diagnóstico por imagem , Feminino , Humanos , Aneurisma Intracraniano/terapia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Retrospectivos , Base do Crânio/diagnóstico por imagem , Adulto Jovem
5.
J Stroke Cerebrovasc Dis ; 30(3): 105578, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33401141

RESUMO

Traumatic intracranial aneurysms (TICA) of the distal anterior cerebral artery (dACA) are exceptionally rare and display therapeutic challenges due to their angioanatomical characteristics. The objective of this work was to discuss the mechanisms of TICA formation of the dACA and to elucidate the best treatment and revascularization strategies in these patients based on two illustrative cases. Case 1: 20-year-old patient with a traumatic, partially thrombosed 14 × 10 mm aneurysm of the right pericallosal artery (rPericA), distal to the origin of the right callosomarginal artery (rCMA). Complete trapping of the right dissection A3 aneurysm and flow replacement extra-to-intracranial (EC-IC) bypass (STA - radial artery - A4) was performed. Case 2: 16-year-old patient with a traumatic polylobulated, partially thrombosed 16 × 10 mm aneurysm of the rPericA. Microsurgical excision of the A3- segment harboring the aneurysm and flow replacement intra-to-intracranial (IC-IC) bypass via reimplantation of the right remaining PericA on the contralateral PericA (end-to-side anastomosis) was performed (in situ bypass). TICA of the dACA are exceptionally rare. Mechanical vessel wall injury and aneurysm formation of the dACA in blunt head trauma is very likely due to the proximity of the dACA with the rigid free edge of the falx. Given their nature as dissecting (complex) aneurysm, trapping and revascularization is a very important strategy. The interhemispheric cistern offers multiple revascularization options with its numerous donor vessels. The IC-IC bypass is often the simplest revascularization construct.


Assuntos
Artéria Cerebral Anterior/lesões , Lesões Encefálicas Traumáticas/terapia , Revascularização Cerebral , Aneurisma Intracraniano/terapia , Artéria Radial/transplante , Lesões do Sistema Vascular/terapia , Acidentes de Trânsito , Adolescente , Artéria Cerebral Anterior/diagnóstico por imagem , Artéria Cerebral Anterior/fisiopatologia , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/fisiopatologia , Circulação Cerebrovascular , Hóquei/lesões , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/fisiopatologia , Masculino , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/fisiopatologia , Adulto Jovem
6.
AJNR Am J Neuroradiol ; 42(2): 327-333, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33384292

RESUMO

BACKGROUND: Newer flow diverters are enhanced with antithrombogenic surface modifications like the Pipeline Embolization Device with Shield Technology and the Derivo Embolization Device and are purported to facilitate deployment and reduce ischemic events. PURPOSE: Our aim was to review the safety and efficacy of surface-modified flow diverters in treating patients with cerebral aneurysms. DATA SOURCES: We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review and meta-analysis covering 3 major data bases and gray literature between 2014 and 2019. STUDY SELECTION: Two reviewers independently reviewed human studies of surface-modified flow diverters for eligibility based on predetermined criteria. DATA ANALYSIS: The random effects model and Freeman-Tukey arcsine transformation were used to pool efficacy outcomes (technical success, aneurysm occlusion at 6 and 12 months) and safety outcomes (mortality, morbidity, all ischemia, and serious ischemia). Subgroup analysis was performed to compare outcomes between 2 different flow diverters. DATA SYNTHESIS: Eight single-arm case series involving 911 patients and 1060 aneurysms were included. The median follow-up was 8.24 months. Pooled estimate for technical success was 99.6%, while the aneurysm occlusion at 6 and 12 months were 80.5%, and 85.6%, respectively. Pooled estimates for mortality, morbidity, total ischemia, and serious ischemia rates were 0.7%, 6.0%, 6.7%, and 1.8%, respectively. Most studies were of good quality, and no significant heterogeneity was observed. LIMITATIONS: Limitations include a retrospective, observational design in some studies; heterogeneous and underreported antiplatelet therapy; and potential performance and ecologic bias. CONCLUSIONS: Early-to-midterm safety and efficacy for surface-modified flow diverters appear comparable with older devices, especially for small, unruptured anterior circulation aneurysms. Long-term clinical data are required to further corroborate these results.


Assuntos
Prótese Vascular , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Aneurisma Intracraniano/terapia , Adulto , Idoso , Prótese Vascular/efeitos adversos , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
7.
No Shinkei Geka ; 49(1): 16-23, 2021 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-33494047

RESUMO

Acquiring appropriate preoperative images is an important step in the treatment of cerebral aneurysms. Despite recent advances in contrast-enhanced CT and MRI, catheter angiography remains the standard of care in preoperative imaging tests for both ruptured and unruptured intracranial aneurysms. Three-dimensional rotational angiography can provide a clear view of vascular structure around the aneurysm in an intuitive manner, including the small perforators. For ruptured aneurysms, the treatment modality(i.e., surgical clipping or endovascular embolization)is usually based on emergent contrast CT and catheter angiography findings. For unruptured aneurysms, integrated assessment involving CT, MRI, and angiography is often useful in multimodal treatment decision making.


Assuntos
Aneurisma Roto , Embolização Terapêutica , Aneurisma Intracraniano , Aneurisma Roto/terapia , Angiografia Cerebral , Humanos , Aneurisma Intracraniano/terapia , Resultado do Tratamento
8.
No Shinkei Geka ; 49(1): 93-104, 2021 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-33494055

RESUMO

The goal of coil embolization for cerebral aneurysms is to occlude the cerebral aneurysm to prevent rupture while maintaining the patency of the parent artery. The integrity of cerebral aneurysm occlusion is affected by many factors, including cerebral aneurysm morphology, dome-neck size, dome-neck ratio, and the location of the aneurysm and its parent artery. These factors are then considered pre-operatively and the position of each catheter that allows for the most efficient embolization is assumed. To navigate each catheter to the ideal position, it is necessary to know the characteristics(shape, flexibility, size, etc.)of each catheter. In addition, it is necessary to know the procedure and positioning of balloon catheters or stenting catheters if you use adjunctive techniques. This article will provide guidance for beginners who start coil embolization and provide basic knowledge of how to use catheters, their combinations, and basic methods to help the physician performing optimal coil embolization.


Assuntos
Embolização Terapêutica , Aneurisma Intracraniano , Prótese Vascular , Cateteres , Angiografia Cerebral , Humanos , Aneurisma Intracraniano/terapia , Stents , Resultado do Tratamento
9.
No Shinkei Geka ; 49(1): 105-110, 2021 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-33494056

RESUMO

The first coil should be as thick, long, and large as possible. A retrospective study at the Toranomon Hospital revealed that if the volume of the first coil is 1/3rd or more of the total coil volume, there are less chances of retreatment. Thus, a thick and long first coil contributes to stable long-term anatomical results. The length of the first coil should be approximately 8% of the volume of the aneurysm. After the placement of the first coil, a smaller and shorter coil should be placed sufficiently close to it to complete the procedure. The goal is to achieve prevention of acute re-rupture in ruptured acute aneurysms and life-long prevention of rupture in unruptured asymptomatic aneurysms. If the coil does not detach, check the position of the detachment point, and replace the power supply. In addition, refer to the direction for use of the device for prevention of coil disconnection failure and countermeasures. Although it is not a recommended method, a method of rotating the delivery wire at the detached position to thread the coil and a method of reconstructing the electric circuit with a crocodile clip has been reported.


Assuntos
Aneurisma Roto , Embolização Terapêutica , Aneurisma Intracraniano , Aneurisma Roto/terapia , Humanos , Aneurisma Intracraniano/terapia , Retratamento , Estudos Retrospectivos , Resultado do Tratamento
10.
No Shinkei Geka ; 49(1): 111-118, 2021 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-33494057

RESUMO

We introduce typical use cases and the appropriate use of balloon catheters and neck bridge stents for coil embolization of cerebral aneurysm. There are two types of balloon catheters: single-lumen and double-lumen catheters. They are also classified into compliant and super-compliant balloons by softness. Neck bridge stents are classified into two types: open-cell and closed-cell stents. Balloon- and stent-assisted techniques are both useful for wide-neck aneurysms. The complication rates of these methods are similar but the stent-assisted technique requires long-term administration of antiplatelets after the procedure. Both techniques have the challenge that the microcatheter is fixed during coil embolization. The semi-jailing technique, in which the stent is partially deployed during coil insertion, solves this problem. Open-cell stents seem more suitable for this technique because they fit better to the vessel wall even in the curved part. It is important to understand the characteristics of each device for safe and effective treatments.


Assuntos
Embolização Terapêutica , Aneurisma Intracraniano , Prótese Vascular , Angiografia Cerebral , Humanos , Aneurisma Intracraniano/terapia , Stents , Resultado do Tratamento
11.
No Shinkei Geka ; 49(1): 119-127, 2021 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-33494058

RESUMO

More than 2000 patients with large aneurysms have been treated with PipelineTM Flex since approval in 2015. The indication of PipelineTM Flex has expanded according to the PREMIER trial. Moreover, FREDTM has been approved in 2020 with a wider indication compared to that of PipelineTM. Aneurysms with 5 mm or larger of the maximum diameter in the internal carotid artery(ICA)and vertebral artery(VA)are currently indicated for PipelineTM. Moreover, the indications for FREDTM include the proximal anterior cerebral, proximal middle cerebral artery, and basilar artery in addition to the ICA and VA. The use in the acute stage of subarachnoid hemorrhage remains contraindicated for both. One should note several specific technical tips for these flow diverters. FREDTM can be deployed more easily compared to PipelineTM due to the large caliper filament and the flare ends. However, FREDTM is generally resistant to balloon angioplasty after it is fully deployed, most probably because the anchored flare ends disable foreshortening of FREDTM. Concomitant use of coiling may be recommended for intradural aneurysms to potentially minimize the risk of delayed rupture.


Assuntos
Aneurisma Roto , Embolização Terapêutica , Aneurisma Intracraniano , Aneurisma Roto/terapia , Artéria Carótida Interna , Humanos , Aneurisma Intracraniano/terapia , Resultado do Tratamento
12.
No Shinkei Geka ; 49(1): 128-134, 2021 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-33494059

RESUMO

Intracranial aneurysm rupture is the main fatal complication of coil embolization for an intracranial aneurysm performed in conjunction with systemic heparinization. We answered five clinical questions about anesthesia, systemic heparinization, intraoperative aneurysmal rupture, the balloon-assisted technique, and the next step of initial response in case of aneurysmal rupture. It is crucial to understand when and why intraoperative aneurysmal rupture occurs to reduce its mortality rate. In cases of intraoperative problems, never pull the microcatheter or coil when perforating an aneurysm; lowering blood pressure, administering protamine for the reversal of heparin, and occluding blood flow into an aneurysm by inflating balloon(s) will help in the treatment. It is our pleasure that this chapter will help in your daily care.


Assuntos
Aneurisma Roto , Embolização Terapêutica , Aneurisma Intracraniano , Aneurisma Roto/terapia , Pressão Sanguínea , Prótese Vascular , Humanos , Aneurisma Intracraniano/terapia
13.
No Shinkei Geka ; 49(1): 146-155, 2021 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-33494061

RESUMO

Bifurcation-type aneurysms located at the basilar tip, anterior communicating artery, and middle cerebral artery are difficult to treat by endovascular coil embolization. One reason for this is that it is impossible to completely cover the aneurysm neck with a single stent because of the branching of two large vessels at the location. Moreover, the parent artery blood flows directly into the aneurysm dome and induces recanalization of the placed coils. In 2020, new devices for bifurcation aneurysms, such as PulseRider and W-EB, were approved in Japan. PulseRider has been in use since September, and W-EB is expected to be available by the end of the year. PulseRider has unique leaflets, which easily cover the broad neck of bifurcation aneurysms and prevent the coil from protruding into the parent artery. W-EB is a nitinol self-expandable mesh ball implant that can prevent blood flow into the aneurysm and subsequent induced thrombosis by deployment in the aneurysm sac. Although we do not yet completely know the features and advantages of either, we expect these two new devices to improve endovascular treatment of bifurcation-type aneurysms that thus far have been difficult to treat.


Assuntos
Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Artéria Cerebral Anterior , Humanos , Aneurisma Intracraniano/terapia , Japão , Stents , Resultado do Tratamento
14.
No Shinkei Geka ; 49(1): 156-163, 2021 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-33494062

RESUMO

Currently, two treatment options are available for cerebral aneurysms: clipping and endovascular therapy(EVT). For patients with a ruptured aneurysm, superiority of endovascular coiling was reported by a randomized controlled trial(RCT). Therefore, it is important to know whether the patient has high risk factors for undergoing EVT. In addition, Also, we should know unavailability of adjunctive devices such as stents for ruptured cases. On the other hand, no RCT has reported the efficacy of clipping or EVT or compared treatment options for unruptured aneurysms. Therefore, the indication of treatment for unruptured cases is decided in a case-by-case manner according to the estimated rupture rate of the aneurysm based on data from large registries and institutional treatment complication rates. Introduction of various adjunctive devices such as stents, flow diverters, and bifurcation devices has widened indications of EVT for unruptured aneurysms. However, some patients are still at high risk for undergoing EVT despite the introduction of these devices. Since the superiority of these new devices has not been proven compared to traditional treatments, treatment should be carefully selected by taking aneurysmal and systemic factors into account.


Assuntos
Aneurisma Roto , Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Aneurisma Roto/terapia , Humanos , Aneurisma Intracraniano/terapia , Stents , Resultado do Tratamento
15.
No Shinkei Geka ; 49(1): 164-169, 2021 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-33494063

RESUMO

There has been an increasing role in the low invasive endovascular treatment of intracranial aneurysms. In addition to the detachable coils, the development of intracranial stents that are capable of repairing the parent artery itself has induced a significant treatment paradigm shift from open surgical to endovascular intervention. Recent evidence suggests that chronic inflammation plays a critical role in the process of intracranial aneurysm formation and rupture. It is, therefore, a natural evolution to seek drug treatments for intracranial aneurysms for growth or rupture prevention rather than any mechanical intervention. The authors review the current preclinical efforts on aneurysm drug treatments and prospective. Also covered is an emerging technology such as robotic endovascular treatment. The robotic system is capable of performing a subset of endovascular procedures such as stent-assisted aneurysm coiling. Although a lot of work needs to be done, remote health care is no longer science fiction.


Assuntos
Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Humanos , Aneurisma Intracraniano/terapia , Estudos Prospectivos , Stents , Resultado do Tratamento
16.
Medicine (Baltimore) ; 100(1): e24239, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429826

RESUMO

RATIONALE: Subarachnoid hemorrhages (SAHs) from ruptured intracranial aneurysms are very rare during pregnancy. Management of ruptured intracranial aneurysms with SAH in pregnancy is often challenging because of the risks to the fetus and the mother. We present the first successful awake endovascular coiling of a dissected intracranial aneurysm in a third trimester twin pregnancy. PATIENT CONCERNS: A 28 years' old pregnant woman was admitted at the obstetric department of our hospital on account of very severe headaches associated with nausea and vomiting. DIAGNOSIS: Emergency obstetric ultrasound scan done confirmed 32 weeks' twin gestation, whereas magnetic resonance imaging established hemorrhage in the suprasellar cistern and the subarachnoid space. Magnetic resonance angiography revealed a dissected aneurysm in the ophthalmic segment of the left internal carotid artery. INTERVENTIONS: Awake cerebral angiography as well as embolization of the aneurysm with coils was done via the transarterial route and the twins were delivered via caesarean section at 37 weeks' gestation. OUTCOMES: Two years' follow-up indicated no complications and children as well as their mother are healthy. LESIONS: Awake endovascular coiling was very beneficial in our case because we avoided general anesthesia and the use of osmotic diuretics which are potentially hazardous during pregnancy.


Assuntos
Aneurisma Intracraniano/diagnóstico , Complicações Cardiovasculares na Gravidez/diagnóstico , Gravidez de Gêmeos , Hemorragia Subaracnóidea/diagnóstico , Ultrassonografia Pré-Natal , Adulto , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Embolização Terapêutica , Procedimentos Endovasculares , Feminino , Cefaleia/etiologia , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Angiografia por Ressonância Magnética , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/terapia , Terceiro Trimestre da Gravidez , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/terapia
17.
Stroke ; 52(1): 213-222, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33349014

RESUMO

BACKGROUND AND PURPOSE: Aneurysmal wall enhancement (AWE) on vessel wall magnetic resonance imaging (VW-MRI) has been described as a new imaging biomarker of unstable unruptured intracranial aneurysms (UIAs). Previous studies of symptomatic UIAs are limited due to small sample sizes and lack of AWE quantification. Our study aims to investigate whether qualitative and quantitative assessment of AWE can differentiate symptomatic and asymptomatic UIAs. METHODS: Consecutive patients with UIAs were prospectively recruited for vessel wall magnetic resonance imaging at 3T from October 2014 to October 2019. UIAs were categorized as symptomatic if presenting with sentinel headache or oculomotor nerve palsy directly related to the aneurysm. Evaluation of wall enhancement included enhancement pattern (0=none, 1=focal, and 2=circumferential) and quantitative wall enhancement index (WEI). Univariate and multivariate analyses were used to identify the parameters associated with symptoms. RESULTS: Two hundred sixty-seven patients with 341 UIAs (93 symptomatic and 248 asymptomatic) were included in this study. Symptomatic UIAs more frequently showed circumferential AWE than asymptomatic UIAs (66.7% versus 17.3%, P<0.001), as well as higher WEI (median [interquartile range], 1.3 [1.0-1.9] versus 0.3 [0.1-0.9], P<0.001). In multivariate analysis, both AWE pattern and WEI were independent factors associated with symptoms (odds ratio=2.03 across AWE patterns [95% CI, 1.21-3.39], P=0.01; odds ratio=3.32 for WEI [95% CI, 1.51-7.26], P=0.003). The combination of AWE pattern and WEI had an area under the curve of 0.91 to identify symptomatic UIAs, with a sensitivity of 95.7% and a specificity of 73.4%. CONCLUSIONS: In a large cohort of UIAs with vessel wall magnetic resonance imaging, both AWE pattern and WEI were independently associated with aneurysm-related symptoms. The qualitative and quantitative features of AWE can potentially be used to identify unstable intracranial aneurysms.


Assuntos
Vasos Sanguíneos/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Adulto , Idoso , Aneurisma Roto/diagnóstico por imagem , Angiografia Digital , Área Sob a Curva , Angiografia Cerebral , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Aneurisma Intracraniano/terapia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Sensibilidade e Especificidade
18.
Neurosurgery ; 88(2): E179-E189, 2021 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-33319900

RESUMO

BACKGROUND: The optimal magnetic resonance angiography (MRA) sequence for assessing the aneurysm occlusion state or in-stent flow after endovascular coiling is not well established. OBJECTIVE: To evaluate the diagnostic performance of pointwise encoding time reduction with radial acquisition (PETRA)-MRA in patients who underwent endovascular coiling relative to that of time-of-flight (TOF)-MRA and contrast-enhanced (CE)-MRA. METHODS: We evaluated the aneurysm occlusion state using digital subtraction angiography (DSA) and MRA. In patients who underwent stent-assisted coiling, we estimated the visibility of in-stent flow. RESULTS: We enrolled 189 patients with assessable TOF, PETRA, and CE-MRAs after coiling. In patients who underwent simple coiling (128 patients), PETRA showed a higher sensitivity in the detection of residual flow than TOF and CE (PETRA, 100%; CE, 83%; TOF, 80%). There were no significant differences in the height of residual flow between DSA (0.68 ± 1.45 mm) and PETRA (0.70 ± 1.50 mm; P = 1.000). In patients who underwent stent-assisted coiling (61 patients), PETRA showed the highest sensitivity (88%) in detecting residual flow (CE, 56%; TOF, 31%). Regarding in-stent flow, PETRA, CE, and TOF showed visual scores of ≥3 with frequencies of 96.7%, 85.2%, and 37.7%, respectively. Relative signal-to-noise ratio of PETRA (0.62 ± 0.18) was significantly higher than that of CE (0.56 ± 0.12) and TOF (0.39 ± 0.12; P < .001 for both). CONCLUSION: PETRA-MRA showed excellent diagnostic performance in terms of residual flow detection and in-stent flow assessment. PETRA could be a versatile alternative sequence for following up patients with coiled aneurysm.


Assuntos
Angiografia Digital/métodos , Angiografia Cerebral/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Angiografia por Ressonância Magnética/métodos , Adulto , Idoso , Procedimentos Endovasculares/métodos , Feminino , Seguimentos , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do Tratamento
19.
Brain Nerve ; 73(1): 89-93, 2021 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-33361516

RESUMO

Lenticulostriate artery (LSA) aneurysm is relatively rare, and the need for surgical intervention is controversial. Here, we report a case of ruptured LSA aneurysm which was accompanied by familial Mediterranean fever (FMF). A 45-year-old woman with a history of FMF presented with sudden onset of headache and vertigo. Computed tomography revealed hemorrhage in the right caudate nucleus and lateral ventricles. Digital subtraction angiography revealed a fusiform aneurysm (3mm) at the distal site of medial LSA. Observation was selected, and the aneurysm gradually decreased and eventually disappeared on the 105th day from the onset. This was the first report describing an LSA aneurysm associated with FMF. It suggests that such aneurysms could be treated conservatively with close radiological follow-up.


Assuntos
Aneurisma Roto , Doença Cerebrovascular dos Gânglios da Base , Febre Familiar do Mediterrâneo , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Angiografia Cerebral , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Hemorragias Intracranianas , Pessoa de Meia-Idade
20.
Yonsei Med J ; 62(1): 91-94, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33381939

RESUMO

We report the 3-year follow-up result of Wingspan intracranial stenting for symptomatic severe in-stent stenosis after stent-assisted coiling (SAC) for a ruptured left distal internal carotid artery (ICA) aneurysm. A middle-aged male patient visited our hospital for in-stent stenosis of a stent that was placed to treat a ruptured ICA aneurysm. Routine follow-up cerebral angiography, 1 year after SAC, showed in-stent stenosis around the distal markers of the inserted stent at the left M1 proximal segment. Six months later, he developed right dysesthesia. We performed intracranial stenting with Wingspan stent for the in-stent stenosis. Follow-up digital subtraction angiography performed 1 year after the Wingspan stenting showed good patency of the ICA and middle cerebral artery flow without evidence of restenosis. At 3-year follow-up, magnetic resonance angiography showed sufficient middle cerebral artery flow although the stenting segment could not be visualized clearly. Wingspan stenting might be a feasible option in patients with iatrogenic intracranial stenosis resulting from in-stent stenosis who experience the progression of intracranial stenosis with manifestation of neurological symptoms despite dual anti-platelet therapy.


Assuntos
Aneurisma Roto/terapia , Aneurisma Intracraniano/terapia , Stents , Idoso , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Angiografia Digital , Angiografia Cerebral , Constrição Patológica/complicações , Estudos de Viabilidade , Feminino , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...