A case report: Ruptured aneurysm with a wide neck treated by flow diverter stent and coil embolization

Diagnosis and endovascular treatment for ruptured wide neck aneurysms are challenges in clinics, particularly in developing countries. In the present study, we described a clinical case with a ruptured wide neck aneurysm in Vietnam treated by flow diverter stent and coil embolization. A 77-year-old- female patient had a right droopy eyelid for 2 months. The patient was admitted to hospital on the second day after being presented with a sudden-severe headache. Cerebral computed tomography (CT) and magnetic resonance imaging (MRI) were taken on the second day and fifth day after the onset of the headache. The results showed an aneurysm in the right internal carotid artery but no potential subarachnoid hemorrhage (SAH) was displayed. An uncoagulated blood was found in cerebrospinal fluid indicated by a lumbar puncture test. Digital subtraction angiography provided images with one wide-neck right internal carotid aneurysm. The patient was treated by flow diverter stent and coil embolization and the dual antiplatelet therapy with ticagrelor and aspirin at home. After 45 days, the patient did not face with any complication, no neurological symptoms, and the aneurysm was partially thrombosed indicated by MRI images. These results suggested that a lumbar puncture should be analyzed on the patient with brain aneurysm appeared a sudden severe headache and even no potential SAH on brain MRI or CT was found. The combination of flow diverter stent and coil embolization to treat cases with ruptured wide necked aneurysms should be considered in the future.Key words: Wide neck aneurysm, Flow diverter stent, Ruptured aneurysm, Flow diverter stent and coil embolization     

Treatment of acute intracranial vertebrobasilar dissection with angioplasty and stent placement: report of two cases

Acute vertebrobasilar dissection may cause subarachnoid hemorrhage by rupturing through the adventia or cerebral infarct by progressive occlusion of the true lumen. Recent reports on the endovascular management of this condition have focused on treatment of pseudoaneurysms. We report two cases where angioplasty or stent placement was successfully used to improve compromised blood flow secondary to vertebrobasilar dissection.     

Spontaneous renal artery dissection: treatment with coil embolization

A 47-year-old man presented with nonspecific left flank pain and severe hypertension as a result of a spontaneous dissection of an accessory renal artery. Because of the progressive increase in the size of the dissection flap and uncontrollable hypertension, treatment with segmental embolization of the true and false lumen of the accessory renal artery was performed with successful clinical outcome. This case report will address the salient clinical features of spontaneous renal artery dissections and treatment options.     

Balloon-assisted coil embolization of a posterior cerebral artery aneurysm via a persistent primitive trigeminal artery: technical note

Introduction We present a patient with an acutely ruptured, wide-necked aneurysm of the left posterior cerebral artery (PCA) treated with Guglielmi detachable coils using the remodeling technique.Methods Since the left vertebral artery was compressed due to a tumor in the cerebellopontine angle and the right vertebral artery was hypoplastic, we used a carotid artery approach via a persistent primitive trigeminal artery (PPTA) to selectively catheterize the aneurysm.Results The aneurysm was occluded completely.Conclusion To our knowledge this is the first case of a wide-necked PCA aneurysm treated via a PPTA and using the remodeling technique. In patients with hypoplastic vertebral arteries and a PPTA, this approach may represent an alternative for selective embolization of posterior circulation aneurysms not amenable to the conventional approach.     

Treatment of a spontaneous intracranial dissecting aneurysm with stent-assisted coil embolization

Arterial dissection is now recognized as an important cause of stroke. Most reported dissections involve the extracranial portion of the internal carotid artery (ICA) and vertebral arteries. Spontaneous dissecting aneurysms of the intracranial ICA are uncommon. Endovascular treatment for cerebral aneurysms has become widespread; however, the dissecting aneurysm is still difficult to treat if the parent artery has to be preserved. More recently, stenting has been advocated for use with endosaccular coiling, with the coils held in place by the stent. We herein report a spontaneous intracranial ICA dissecting aneurysm in a 51-year-old woman who was treated using a new technique of combined stent and coils.     

椎动脉颅内段夹层瘤应用覆膜支架成形一例

患者男,56岁.因突发左侧额、面部、牙床剧烈疼痛17年,加重1个月于2007年1月入院.疼痛剧烈,性质无法描述;重体力活动、吃饭时疼痛消失.剧烈疼痛时感颈硬,伴左侧肩痛.白行用手按压左侧耳后乳突处可止痛.10余年前感饮水可诱发疼痛,后逐渐不诱发.曾就诊多所医院,诊断为"左侧三叉神经痛",给予口服卡马西平,可以缓解疼痛,后因查出肝功能受损而停止服药(具体不详).既往体健.体检一般状况良好.颈软,左侧额、顶、面部痛觉减退,温度觉无变化.MRI见左侧椎动脉颅内段异常影像.颅内动脉DSA见左侧椎动脉颅内段小脑后下动脉远端、近基底动脉汇合处异常囊状显影,8 mm×10 mm大小,近端载瘤动脉狭窄.诊断为"椎动脉颅内段夹层动脉瘤".     

Treatment of a ruptured dissecting vertebral artery aneurysm with double stent placement: case report.

A ruptured dissecting right vertebral artery aneurysm was treated by means of double stent placement with two overlapping stents. Control angiography performed 3 d after stent placement revealed beginning aneurysmal thrombosis. Substantial reduction in aneurysmal size was observed after 4 wk, whereas total occlusion was observed after 3 mo. The reduced stent porosity caused by the overlapping stents, which result in significant hemodynamic changes inside the aneurysmal sac, may accelerate intraaneurysmal thrombosis and may be helpful in achieving a more rapid complete occlusion compared with that achieved by single stent placement.     

Coronary-to-bronchial artery communication: Report of two patients successfully treated by embolization

We report two cases of coronary-to-bronchial artery communication responsible for coronary steal. In both cases the anastomosis originated from the proximal circumflex artery and developed because of bronchiectasis. In both cases closure of the anastomosis was achieved successfully by embolization. To date, the patients remained free from symptoms.     

Treatment of intracranial broad-neck aneurysms with a new self-expanding stent and coil embolization

BACKGROUND AND PURPOSE: Endovascular treatment of broad-neck intracranial aneurysms with detachable coils requires special techniques. Placement of a stent over the aneurysm neck and secondary coil embolization prevents coil migration and allows attenuated packing of the coils. However, access for the stent-delivery system can be technically limited in tortuous anatomy. We present six cases of broad-neck aneurysms treated with a new self-expanding stent and coil embolization. METHODS: Three aneurysms of the supraophthalmic internal carotid artery and three aneurysms of the basilar tip with extension to the origin of a posterior cerebral artery were treated. The stent was a new self-expanding stent with a 3F over-the-wire microcatheter delivery system. Coil embolization was performed with electrolytically detachable coils. Time-of-flight MR angiography was performed after treatment in five cases. Three other patients could not be treated with the stent because deployment was not possible after correct positioning of the delivery system. RESULTS: Access with the stent-delivery system was easy, and the aneurysm neck was covered sufficiently. After stent placement, total coil embolization was achieved in four and subtotal coil embolization was achieved in two. Parent arteries remained open, and no secondary coil migration was seen. On follow-up MR imaging, the stent was clearly visible and patency of the parent vessel and emerging branches was assessable. CONCLUSION: This new stent is a safe and efficient tool for the endovascular treatment of intracranial broad-neck aneurysms. Access to smaller vessels was easy, but the mechanism of deployment had to be improved. Follow-up MR imaging was sufficient.     

Hemostatic closure device after carotid puncture for stent and coil placement in an intracranial aneurysm: technical note

A 71-year-old female patient presented with a wide-necked carotid cavernous aneurysm for which stent and coil placement was planned. Arterial tortuosity required direct puncture of the common carotid artery for access. The procedure was performed while the patient was receiving antiplatelet and anticoagulative therapy. To avoid potentially hazardous and prolonged carotid compression, a closure device (Angio-Seal) was used at the end of the procedure. The postoperative period was clinically uneventful. Sonographic and angiographic follow-up of the carotid artery were performed.     

GDC血管内栓塞治疗颅内动脉瘤

目的 探讨电解可脱性弹簧圈（GDC）血管内栓塞治疗颅内动脉瘤的疗效和技术要点。方法 对31例动脉瘤患者应用微导管技术,通过数字减影全脑血管造影,采用GDC作动脉瘤囊内填塞治疗。结果 31例31枚动脉瘤中28枚瘤腔完全闭塞,3枚95％闭塞。术后30例临床痊愈;1例死亡;病死率3．2％。术中并发动脉瘤再破裂出血1例;术后弹簧圈末端逸出1例。术后随访0．5～3年均无再出血。结论 GDC血管内栓塞治疗颅内动脉瘤疗效可靠,早期栓塞及有效的术后处理是提高治愈率的重要方法。     

Unruptured intracranial aneurysms treated by three-dimensional coil embolization: evaluation of the postoperative aneurysm occlusion volume

Our purpose was to evaluate the postoperative aneurysm occlusion volume and clinical results of treating unruptured intracranial aneurysm using three-dimensional (3D) coils. Over a 2-year period 62 aneurysms (39 with a neck 4 mm, 23 with a neck >4 mm) in 62 patients in five participating centres were treated. The procedure consisted, firstly, of framing the aneurysm with one or more spherical 3D coils, and secondly, of filling it with two-dimensional (2D) helical coils. Anatomical and clinical results were evaluated by univariate analysis. Multivariate analysis was used to identify independent predictors of these results. For neck sizes 4 and >4 mm, angiographic occlusion was complete in 31 (79%) and 16 (70%) aneurysms, respectively; the mean percentage of occlusion volume was 31.4% and 29.5%, respectively, and postoperative morbidity was 3% and 4%, respectively, with no significant differences between the two groups. There were no deaths. However, occlusion volume correlated with sac size (P=0.037) and sac-to-neck ratio <1.5 (P=0.073), except when three or more 3D coils per aneurysm were used (P=0.516 and P=0.308, respectively). Occlusion volume correlated with the number of 3D coils per aneurysm (P<0.001) and was an independent predictor of angiographic complete occlusion (P=0.002). The use of the largest number of 3D coils per aneurysm was safe and may improve the postoperative volume and angiographic occlusion of aneurysms with a neck >4 mm, provided the sac-to-neck ratio is 1.5.     

Neuroform颅内支架辅助栓塞宽颈颅内动脉瘤的初步经验

目的　报道我科使用Neuroform支架辅助可脱式弹簧圈栓塞宽颈脑动脉瘤的初步经验。方法　 2 2例 2 4枚宽颈颅内动脉瘤采用Neuroform支架和弹簧圈进行栓塞 ,其中急性破裂动脉瘤 19枚、未破裂动脉瘤 5枚。结果　支架均成功地释放 ,支架置入后的造影未发现有瘤内造影剂滞留的血流动力学改变。 10 0 %闭塞动脉瘤 18枚 ,90 %以上闭塞 5枚 ,1枚伴发的未破裂小型宽颈动脉瘤在支架置入后微导管无法超选 ,载瘤动脉均通畅。有 2枚动脉瘤虽有支架阻挡 ,但仍有部分弹簧圈畔进入载瘤动脉。所有患者没有出现与支架置入有关的症状性缺血性并发症。 17例造影随访中 ,有 1例在 3个月复查时发现再通 ,进行 2次栓塞完全闭塞动脉瘤 ,其余未见复发 ,结论　Neuroform颅内支架使用安全有效 ,适合于宽颈颅内动脉瘤的支架辅助弹簧圈栓塞 ,特别适合于迂曲的脑血管 ;其径向支撑力较差 ,在输送微导管时应防止其移位 ;其支架网眼较大 ,对血流动力学改变不明显 ,致密填塞是重要的 ,在输送弹簧圈时仍应防止弹簧圈畔进入载瘤动脉 ;术前、术后抗血小板药物的应用以及术后严格的系列造影随访是必要的。     

Postoperative bilateral vertebral artery dissection: a case report

With the improvement of medical imaging and surgical techniques, surgery on cervical vertebral is more frequent. Some cases of complications of this type of surgery have been described. We report a case of postoperative bilateral vertebral artery dissection. It concerns a 58 year-old woman who suffered from a left cervico-brachial C6 neuralgia with paresthesiae of the thumb. She underwent discectomy at C5-C6 and C6-C7 followed by setting up intersomatic cages. In subsequent days, an irreversible coma developed. Supra-aortic echographic study revealed bilateral vertebral artery thrombosis. CT scan revealed ischemic lesions of the brain stem and cerebellum. Cerebral death was declared five days after the operation. Autopsy was performed to determine whether death was the consequence of the intervention. The cause of death was determined to be ischemic brain injury of the brain stem and cerebellum resulting from bilateral traumatic occlusion of the vertebral arteries caused by the surgery.     

子宫动脉假性动脉瘤经导管栓塞治疗2例

子宫动脉假性动脉瘤(uterine artery pseudoaneurysm,UAP)是罕见的但危及生命的并发症[1].现报道2例经导管成功栓塞治疗UAP,并作简要讨论.临床资料例1:患者61岁,因“阴道流血15 d,腹痛1d”收入院,33年前曾因“宫外孕”行“右侧输卵管切除术”,绝经年龄55岁.子宫腔内超声提示:“子宫内混合性肿块(大小约130 mm×115 mm×110 mm),考虑肌瘤变性,不除外肿瘤”.盆腔MRI提示:“子宫体积增大,内见一团块状不规则混杂信号影,直径约13.1 cm,T1WI、T2WI呈混杂信号,边界欠清楚,结合带不完整,增强后病灶实性部分明显强化,考虑子宫恶性肉瘤”.     

Comparative study of covered stent with coil embolization in the treatment of cranial internal carotid artery aneurysm: a nonrandomized prospective trial

To evaluate whether Willis covered stent implantation yielded angiographic and clinical results were better than those with coil embolization. Eighty-nine patients with cranial internal carotid artery (CICA) aneurysms were treated nonrandomly with covered stents (n = 43, group A) or coil embolization (n = 46, group B). Data on the technical success, procedure time, initial and final angiographic results, and final clinical outcomes were collected and analyzed at >6 months post-procedure. Covered stent placement and coil embolization were successful in all patients, except for one patient in group A. The initial angiographic results showed complete occlusion in 34 group-A patients (80.9%; 95% CI: 69%, 93%) and 24 group-B patients (52.2%; 95% CI: 37%, 67%) (P = 0.004). The final angiographic results indicated complete occlusion in 39 group A patients (39/41, 95.1%; 95% CI: 88%, 102%) and 22 group B patients (48.9%; 95% CI: 34%, 64%) (P < 0.001). The average procedure time was shorter in group A than that in group B (P < 0.001). CICA aneurysm treatment with covered stents yielded better intermediate-term angiographic outcome than those with the recommended approach of coil embolization. (ClinicalTrials.gov number, NCT01029938)     

Endovascular treatment of a pulmonary artery pseudoaneurysm with a stent graft: report of two cases

Two patients with hemoptysis secondary to pulmonary artery pseudoaneurysm were treated by endovascular placement of stent grafts. Aneurysms were effectively excluded and hemoptysis stopped. Stent grafts were occluded in both patients. However, endovascular treatment of the pulmonary artery pseudoaneurysm with a stent graft is a safe alternative to coil embolization or surgery.     

Duplicate origin of the vertebral artery: report of two cases

Summary We report two cases showing duplicate origin of the vertebral artery; one with fenestaration of the distal portion of the left vertebral artery.     

Overlapping stent-supported coil embolization of wide-neck basilar tip aneurysm: technical case reports

We report two cases in which wide-neck basilar aneurysms were treated with overlapping stent-supported coil embolization. This overlapping technique ensures complete stent interface with the aneurysm neck and likely improves long-term outcomes. We demonstrated the feasibility of this novel technique and suggest its application for other bifurcation aneurysms requiring stent-supported coil embolization.