Coil treatment of a fusiform upper basilar trunk aneurysm with a combination of “kissing” neuroform stents,TriSpan-, 3D- and fibered coils,and permanent implantation of the microguidewires

Endovascular coil occlusion of fusiform intracranial aneurysms without sacrifice of the parent artery can be technically challenging. Bridging of wide aneurysm necks with stents is common practice for side-wall aneurysms but is less frequently used for bifurcation aneurysms. We describe the technical aspects of the successful coil occlusion of a fusiform aneurysm of the upper basilar trunk, with preservation of the parent vessel. The procedure comprised the following steps: (a) stenting of the left V1- and proximal V2 segments; (b) simultaneous deployment of two Neuroform stents from both P1 segments down to the basilar artery (kissing stents) (c) using a TriSpan device to hold (d) three-dimensional electrolytically detachable coils in place and (e) filling the aneurysmal lumen mainly with fibered electrolytically detachable coils; and finally (f) cutting the extracorporeal part of both microguidewires below the skin level in both groins, leaving the microguidewires as they were used for the deployment of the stents in place, thus reaching from both P2 segments down to the basilar artery and further proximally.     

Superselective Embolization in Posttraumatic Priapism with Glubran 2 Acrylic Glue

Two patients with posttraumatic priapism underwent transcatheter embolization using microcoils, resulting in temporary penile detumescence and an apparent resolution of the artero-venous fistula. In both cases, priapism recurred 24 hours after the procedure and was successfully treated through selective transcatheter embolization of the nidus using acrylic glue (Glubran 2). The patients showed complete recovery of sexual activity within 30 days from the procedure and persistent exclusion of the artero-venous fistula after a 12-month follow-up.     

Magnetic stimulation of axons in a nerve bundle: Effects of current redistribution in the bundle

Recently, we developed a model of magnetic stimulation of a concentric axon in an anisotropic nerve bundle. In that earlier paper, we considered a single axon surrounded by a nerve bundle represented as a homogeneous anisotropic monodomain medium. In this paper we extend our previous calculations to examine excitation of axons within a nerve bundle without neglecting the presence of other axons in the nerve bundle. A three-dimensional axial symmetry volume conductor model is used to determine the transmembrane potential response along an axon due to induced electric fields produced by a toroidal coil. Our principal objective is to examine the effect of current redistribution to other axons in the bundle on excitation characteristics. We derive the transmembrane potential along an axon for two currently available models of current redistribution: the biodomain model and the spatial-frequency monodomain model. Results indicate that a reduction in the transmembrane potential along an axon due to the presence of other nerve fibers in the bundle is observed. Axons located at the periphery of a nerve bundle have lower thresholds and different excitation sites compared with axons located near the center of a nerve bundle.     

支架辅助弹簧圈栓塞治疗颅内动脉瘤相关并发症分析

目的探讨架辅助弹簧圈栓塞治疗颅内动脉瘤的并发症及处理措施。方法2012年1月至12月我科共收治颅内动脉瘤584例,血管内治疗244例（253枚动脉瘤）,其中应用支架辅助弹簧圈栓塞137例（144枚动脉瘤）,采用BALT的LEO支架27枚、Codman的Enterprise支架103枚、EV3的Sditaire支架19枚、LVIS支架1枚。结果13例出现并发症,发生率为9．5％（13／137）。包括术中动脉瘤破裂5例,其中3例死亡,支架诱发血栓栓塞2例（均为LEO支架）,支架移位4例,血管痉挛2例,经积极处理后,10例患者预后均良好。结论支架辅助弹簧圈栓塞治疗颅内动脉瘤是一项成熟的技术,但也存在一定的并发症,因而需要手术者具有良好的手术技能和丰富的经验,同时也需要加强围手术期管理,以减低并发症发生率和改善患者的预后。     

双支架错位重叠技术辅助弹簧圈栓塞治疗颈内动脉床突上段血泡样动脉瘤

目的 探讨双支架错位重叠技术辅助弹簧圈栓塞治疗颈内动脉床突上段血泡样动脉瘤（BBAs）的可行性、有效性及预后。方法 回顾性分析2014年7月至2018年6月采用双支架技术辅助弹簧圈栓塞治疗的9例BBAs的临床资料。结果 9例均成功实施双支架错位重叠技术辅助弹簧圈栓塞治疗,术中即刻影像Raymond分级Ⅰ级5例,Ⅱ级1例,Ⅲ级3例。出院时改良Rankin量表（mRS）评分0分4例,3分2例,4分1例,死亡2例;术后90 d mRS评分0分5例,1分1例,3分1例。7例存活病人影像学随访1周~24个月,动脉瘤均完全闭塞,载流动脉无狭窄。结论 双支架错位重叠技术辅助弹簧圈栓塞治疗颈内动脉床突上段BBAs是一种可行、有效的方法,可降低动脉瘤术后复发率,改善病人预后。     

Endovascular management of massive hemoptysis due to covid-19 related pulmonary artery pseudoaneurysm: A rare entity

Pulmonary artery pseudoaneurysms are rare causes of massive hemoptysis, even less common in setting of COVID-19 pneumonia. We describe and discuss an index case of cavitating COVID-19 pneumonia complicated by a pulmonary artery pseudoaneurysm without concomitant pulmonary thromboembolism. The patient presented with severe hemoptysis and was managed by endovascular coil embolization. Good technical and clinical success was achieved with complete resolution of hemoptysis.